Riots in Kampala: healthcare ironies/tragedies

Uganda is one of the poorest countries in the world with annual income 1/50th that of the US, healthcare expenditure per capita of ~$135 (vs ~$6000 in the US) and thus it is not surprising that Uganda has a life-expectancy (52yrs vs 80 yrs in the US) and other health outcome indicators that reflect this.

Also true is the fact that Uganda receives billions of dollars in aid with thousands of registered NGOs and many more medical tourists coming through annually.

In this environment there is no shortage of healthcare tragedies.

The failure of aid in environments like this has been highlighted in Kampala and elsewhere before, but was once again apparent while spending time at the Mulago emergency room during the riots this trip.

Mulago is the national referral hospital: 1500 beds, most subspecialty practices one can think of (neurosurgery, oncology, hematology, infectious disease, ENT, ophtho, etc). There is a new neuro ICU, expensive operating micorsopes, two heart-lung bypass machines, a state-of-the-art ICU with equipment as good as anywhere in the developed world, thousands of visiting healthcare professionals (annually) with millions of dollars of equipment and manpower donated.

But that is only one side of it – unfortunately many of these resources are not readily available to the general public.

During the first night of riots earlier this week, about 75 wounded were brought into the emergency room – mostly by police and lay-first responders. Side note – The riots were initially sparked by conflict between the government and local tribal politics… but the buzz around Kampala was that the unrest was more a reflection of building discontent with current ruling political party.

The riots highlighted for me once again the tragic irony apparent at Mulago: despite the donated equipment and wealth of health care resources pouring into Uganda (some of which I referred to above) – - there were only two working vitals monitors in the emergency department… There were not nearly enough stretchers or wheelchairs to move patients… No flashlights (which would have been useful for the basic evaluation of one young girl who was shot in the eye on her way home from school)… Only one bed with oxygen… I could go on with this list.

There was one patient in shock who needed to be transferred to the ICU emergently. As a public patient – he was not eligible for the private ICU (where the nicest equipment resides). He was not triaged to the one bed with oxygen and there were not ventilators around- which made ventilating him once intubated suboptimal.

Perhaps these cases and shortages would not be so frustrating to had I not known from prior visits what exists around Mulago and Kampala for that matter. For example, in the hospital storage facility are 10,000 brand new flashlights, 100s of new wheelchairs, numerous mechanical ventilators and much more donated to the hospital years ago but remaining unused for a variety of reasons I can’t begin to go into in this post – suffice it to say that the blame is shared by the donors as much as it is shared by the recipients.

If you happen to be a patient at Mulago on the right day, with the fortuitous alignment of local and visiting resources, one can be successfully treated for even the most complicated heart or neurosurgical conditions. However, if you happen to be an ordinary patient on an ordinary day you may struggle to get your blood pressure checked, receive life-saving oxygen or receive what anywhere else would be considered “ordinary” care.