Over the past few weeks, the GROW team has visited several hospitals and health centers in order to understand the different levels of healthcare that our beneficiaries have access to. What follows is an account of the six sites we visited. The centers ranged from hospitals with over 500 staff members to small regional health centers with only two full time staff. Through these visits, we learned a great deal about healthcare both in Northern Uganda and in our project’s target districts. We also saw firsthand both how impressive some health centers were as well as how dramatic the disparities in access to healthcare could be. These first three accounts are of the smaller health centers that we visited.
Aywee Health Center
Perhaps one of the smallest health centers we visited was Aywee Health Center. This government funded center focuses on maternal health and conducts mainly outpatient services. According to the assistant who gave us a brief tour, the center has 14 staff (with 2 midwives) and sees around 100 patients per day. As impressive as this sounded, we were a bit confused by the statistic since the health center appeared almost deserted when we arrived. Nevertheless, the location of the health center was such that mothers living in rural villages far from any of the regional hospitals could at least go to the center to give birth and get Antenatal Care (ANC).
An important fact about health centers is that they rarely have actual physicians working on their staff. At this health center, there is one chief clinical officer who oversees operations, and the rest of the staff is midwives, nurses, or volunteer health workers. While severely sick patients can be admitted to the health center for up to 24 hours, they eventually must be transferred to Gulu Regional Referral Hospital. This can sometimes prove difficult as Aywee does not have a functioning ambulance. Another issue with this particular health center is that, according to our guide, there is often a shortage of medication. This is particularly problematic for HIV positive mothers who rely on the center for ARVs, both for themselves and, sometimes, their children. Overall, though the center seemed well staffed and had adequate facilities, supplies and transportation appeared to be lacking.
Marie Stopes Health Center
The Marie Stopes Health Center is close to the outskirts of Gulu Town, and only a few kilometers away from both Gulu hospitals. Funded by different NGOs including USAID, Johns Hopkins, and UKAID, this family planning and maternal health center is one of over 30 across the country. Marie Stopes’ services are two-fold; they run a small clinic where they receive patients needing maternal health services, family planning procedures, and HIV testing. They also conduct community outreaches, reaching over 700 patients with free family planning and testing services. Though the services at the clinic are not free, the charges are relatively minimal and the center conducts free referrals and counseling services. They have two full time doctors on staff; one remains at the clinic while the other helps conduct outreaches. The center gets between 30 and 50 patients per day. While the center used to also conduct GBV sensitizations, these services were suspended due to lack of funding. In addition, the center appeared to be very well stocked, and apparently almost never has a shortage of medication. We were impressed with how clean and organized the center was, and how well utilized their resources were.
Joint Clinical Research Center
JCRC was founded by a consortium of different partners including the Ugandan Ministry of Health, the Department of Defense, and Mbarara University, in 1999. While the main branch is in Kampala, the district branch serves patients in the Acholi sub-region, which includes Gulu District. Though not a “hospital” in the traditional sense, the JCRC does have clinical and outreach departments that serve patients in the surrounding community. However, the main purpose of this center is to conduct large scale clinical research trials, with patients being recruited from countries such as Zambia, Zimbabwe, Malawi, Kenya, and Uganda. As of now, they have three ongoing clinical trials, serving around 1,200 patients. Areas of interest include pediatric HIV/AIDS studies and HIV/AIDS medication and testing procedure studies.
All the equipment at the JCRC is state-of-the-art, though the lab technician who gave us a tour admitted that maintenance of their machines was sometimes time-consuming and costly. Though JCRC does not serve as a public hospital, they do allow their partners to utilize their equipment. GWED-G has procured large amounts of HIV testing kits from them several times in the past, and health centers and hospitals in the region often use their labs and x-rays when their own are in disrepair. Despite not having a large volume of non-clinical trial patients, we were glad to see that the JCRC does share at least some of the resources that they have.
After visiting the smaller health centers we came to the large regional hospitals, which serve a population of around two million people in the seven districts of the Acholi sub-region. We visited three of the hospitals in the region, and were once again struck by the disparities in healthcare and the dedication of certain individuals in the face of such challenges.
Gulu Regional Referral Hospital
Gulu Regional Referral Hospital is the region’s designated government health center, located right on the outskirts of Gulu Town. As the district’s regional hospital, this is both the center to which all cases are referred, and the final stop for emergencies and injuries of any kind. In theory, the hospital should have enough staff, funds, equipment, and resources to serve the general community and maintain an acceptable standard of public health.
The reality of the situation is almost unbelievable, especially given the intended purpose of the hospital. According to the hardworking pediatrician who spoke to us on our tour, the staffing norm for a hospital of that size is around 20 specialists and 40 general practitioners. Gulu Regional Referral Hospital has 5 specialists, 3 hospital-paid doctors, and 3 doctors funded by external NGOs, for a total of 11 staff. These 11 doctors serve a daily patient flow of over 450 people, which is almost twice the hospital’s capacity of 250 patients. There is no OB/GYN specialist, no radiologist, no anesthesiologist, and no staff recruitment for the past three years due to lack of funds. Supplies are scarce, equipment is broken or outdated, and the hospital budget allocated by the state is one-tenth (~$400,000 USD) of the nearby Catholic Church-funded Lacor Hospital, where Gulu Regional Referral Hospital sends the patients it is unable to serve.
Needless to say, the state of the hospital was disheartening for the GROW team. We began to truly understand our beneficiaries’ complaints of unavailability of medication, poor treatment, and general lack of healthcare. However, despite the abysmal state of this hospital, we could not help but be impressed by the dedication of the staff, especially the pediatrician that we spoke to. Despite being the only doctor serving his entire ward, he works tirelessly to ensure that as many patients as possible can be helped. He and his fellow physicians are acutely aware of the structural problems facing the hospital, yet despite the seemingly insurmountable challenges they continue to struggle, continue to treat more patients than seems humanly possible for a single person to handle. Even though the team was shocked by the utter lack of resources, we had to admire the dedication of Gulu Regional Referral Hospital’s physicians in the face of their challenges.
Gulu Independent Hospital
Our expectations for Gulu Independent Hospital were very low due to the revealing blog post published by last year’s GROW team. We were consequently unsurprised to find Gulu Independent an impressive, clean, well staffed, well supplied, and totally deserted hospital. Most wards in the hospital were either completely empty or half full (though saying “half full” in a ward with twelve beds does not really mean much). Pamela told us about some of the items that the hospital charges for, in addition to admission fees: a simple doctor’s consultation, with no prescriptions or admittance, is 50,000 shillings, or around 40 dollars. In addition, patients must pay for everything used in the procedures, which includes charges for each glove (5,000 sh per glove), piece of gauze (3,000 sh per piece), and even the water used.
As the last GROW team pointed out, because of these exorbitant charges the hospital does not see many patients. Pamela said that many of the doctors simply stay in the lounge for the majority of their day, relaxing and eating and seeing maybe one or two patients per day. Most of these doctors make much more than the physicians at Gulu Regional Referral Hospital do, especially since Gulu Independent is privately funded. Though the patients who are there do receive a high level of care, and the facilities are very impressive, the most striking feature of Gulu Independent is how much these resources are wasted in the face of exorbitant expenses.
I personally loved Lacor Hospital as soon as I walked in, if only because everything was so warm and picturesque. The more I learned about the hospital, the more I appreciated its presence in the community. Lacor was founded by Drs. Lucille and Piero Corti, an Italian surgeon and pediatrician who arrived in Uganda in 1961. Their pictures are shown on the monument below. Lucille died in 2000 after contracting HIV while performing surgery. Piero died a few years later in 2006.
The other man in the picture is Dr. Matthew Lukwiya, a Ugandan physician who helped run the hospital. Franny told us about how loved he was in the community – so much so that hospital felt lonely after he died. Dr. Lukwiya died in 2000 during the Ebola outbreak in Gulu, wherein he and 100 other hospital staff risked their lives caring for patients, helping to bury those who had died from the disease, and going into town to treat and admit suspicious cases. Franny told us that Dr. Lukwiya refused to leave the hospital for safety during the outbreak, and he said that though he knew he would most likely get the disease, he would be the last to die before the outbreak was over. As it turned out, it was only after 12 other staff had died from the disease and the last patient was leaving the hospital that Dr. Lukwiya contracted Ebola. He refused treatment, not wanting to risk the lives of other doctors and nurses, and died at the end of 2000.
Lacor Hospital is an impressive testament to the work of these individuals. It now has 555 staff, and has a capacity of over 2,000 patients. Because the hospital is funded by the Catholic Church, the services are offered at either no or minimal costs, and the majority of severe cases from villages in the area get referred there. The facilities are expansive, and we managed to get a look at the maternity ward before leaving. Though it was a bit crowded, the patients seemed comfortable, and one of the patients we visited appeared to be getting the proper treatment, having successfully delivered a baby two days earlier. Hospitals such as Lacor give hope to those in great suffering, even though transportation and access for people in remote villages remains a pressing issue.
Visiting these hospitals and health centers helped us learn about healthcare in Uganda and gave us insight into the challenges facing our beneficiaries. We were able to understand which resources they are lacking and where they could potentially go to access said resources. We also heard several inspiring stories of physicians who showed true dedication to their work, even in the face of death. These amazing individuals give us hope that access to healthcare may increase in the future, though that future may be far away.
GROW team out.
– Menaka Dhingra