By Stephen Kafeero
But lack of facilities at the Special Care Unit imposes tough choices on them
When you arrive at the entrance to the Special Care Unit (SCU) of Mulago National Referral Hospital in Kampala, the personnel politely ask you to take off your shoes. It is a good thing. “It keeps hygiene at the unit,” says Jolly Nankunda, a Senior Paediatrics Consultant at the unit, “these children can easily be infected.”
Apart from the hygienic consideration, taking off one’s shoes has a ritual-like feel to it and the SCU is full of rituals designed to save the lives of newborn babies with medical complications. Soon you get immersed into the activity of the unit; nurses scurrying around the rows of little bodies, some of them no bigger than an adult man’s foot, in little cages that look like glass ovens.
Everything is mainly quiet as the harried medical workers and scared mothers speak mainly in whispers. Occasionally, one of the tiny bodies, who are mostly born prematurely, sets off a yelp, that startles the mother and gets the nurse on her feet again.
In all, there are 18 baby cages. Each designed to hold one baby and ensure that it does not die by maintaining a desired temperature as numerous fluids sustain it with medicine and nutrients. But there is a problem. Only one of the baby cages actually works. The rest are dead and, if they are out of luck, one of the babies in them will die as you look on.
Ideally, an incubator is a micro computerised system that measures and sets the required temperature of the infants, protects them from infection, provides specialised feeding avenues, and ventilation for them to breath until their lungs are strong enough. The incubator has large bright displays for easy monitoring that can be viewed from distance, a heater, fan, water container, and oxygen valve. Unfortunately, except for one incubator, all those systems are dead in the Mulago SCU.
Yet demand for incubators in the SCU is so high that infants in need of care have spilled over to the room that was designed for staff caring for the infants.
The SCU which was designed in the 1960s for about 20 infants now handles an average 60 infants daily. As a result, the most desperate babies are sometimes crammed, three instead of one, into the only fully functioning incubator. This is dangerous because it raises the chances of infection among the babies. But these infants are possibly better off than the other infants who are merely wrapped up in warm clothes and put in the incubators who systems have broken down. Deaths occur.
Uganda infant mortality remains high at 62 deaths per every 1000 live births but has declined slightly over the years. It was 67 deaths per 1000 live births in 2007. The Mulago SCU accounts for some of those dreadful statistics.
In February, news broke that 30 children had died in one night when power supply to the SCU went off. The hospital administrators concede that a number of infants died but actual numbers vary. Initially, the Hospital Public Relations Officer, Dan Kimosho, said two infants died but the executive director at the time, Dr Edward Dumba, denied any infant died. He was subsequently removed from his job.
But that did not improve conditions at the SCU where the 14 staffs work under the most difficult conditions. Jamiir Mugalu, a Senior Neonatologist and Head of the SCU, says the unit needs about 40 incubators.
“The space is too small, the staffroom has long been turned into a ward and the staffs sit in the middle of beds and incubators; we cannot chase the patients because our work is to protect lives,” he says.
The doctors cry out aloud for the lack of automated syringes which have a timer and can be used easily to administer fluids to the babies. They now feed the babies manually which is risky. Each syringe, which functions like ordinary drips, currently costs about Shs 5 million.
“Automated syringes should be purchased to feed the babies through Total Parenteral Nutrition (TPN),” says Mugalu.
Dr Nyombi, whose local name is surprising because she is a white lady, says the ratio of the staff to the patient should be at least 1/4 in the SCU because the babies need to be watched all the time but theirs is 1/60.
“This is very high,” says the unit matron, in a tone of one stating a fact and not complaining.
Nurses and doctors who work overnight sometimes continue in the morning because of an acute shortage of staff. It requires a lot of dedication and all personnel we spoke to or observed appeared determined to save the lives.
The unit was designed to operate at four levels; level one for feeding and monitoring growth, level two for feeding via veins, level three for ventilating and level four for administering blood to infants awaiting surgery.
“The unit has to operate at four levels but we do not even have the capacity for level one,” says Mugalu.
Supplies to the unit often run out and patients have to buy them. Unfortunately, patients who attend Mulago are usually the poor ones who cannot afford private care. Many desperate parents abandon their infants at the hospital because they cannot afford the care and fear for the worst.
The room reserved for mothers whose children are in the SCU was constructed to accommodate about five people, but is today home to over 30 women. Many more spill over into the hallways of the hospital. The room lacks beds and the women sleep on the floor.
Nankunda says if the unit is to be rejuvenated, it must have all the requirements of level one, functional incubators should be provided and be properly maintained, and the number of staff should be increased for strict monitoring.
Wakiso District Woman MP Rosemary Sseninde, who is the former chairperson for the Parliamentary Committee on Social Services says that the time they visited the SCU they were shocked by the general environment, poor sanitation, and overcrowding and wrote a report to the government to increase funding to the unit. Nothing has changed.
Recently, newly sworn-in independent members of parliament who toured the hospital were equally shocked by the pathetic condition of the SCU. One of them, Tororo Municipality MP Sanjay Tana immediately challenged the the government to increase funding to Mulago hospital if lives are to be saved. A few days later, on July 4, the newly appointed Minister of Health, Dr Christine Androa, also visited the SCU and promised government support. The SCU is waiting and a baby might have died as you were reading this.