COMMENT: The role of the Uganda Cancer Institute at Mulago needs to be reviewed

Uganda  Cancer Institute-Mulago a death trap?

COMMENT | Samson Tinka | On 19^th Sept 2022 my sister checked in at Uganda cancer institute Mulago. Previously, we were admitted for over a week at Nsambya Hospital. The diagnosis was multiple myeloma, which many confirmed to us that it is treatable cancer depending on the level it is by the time it’s diagnosed. I had another relative who was diagnosed with the same disease a few years ago, he was rushed to India, and he was treated and has since declared cancer free. I will not derail much on the kind of service we got from previous hospitals but will only stick to what I saw, observed, witnessed and felt about a government self-autonomy institute- Uganda Cancer Institute-Mulago.

4^th Oct 2022 night.

When I called my nephew to update me on how my sister was doing on the night of October 4, the reply I got forced me to head to hospital. The  answer in an usual tone was, I quote “ Ija oyerebere” meaning come and see by yourself.

When I arrived, no medical personnel was on sight. Fortunately, among the visitors with us was a medical doctor. He rushed to the patient and started to assist especially with breathing issues like positioning the patient, placing masks etc. on this ward, there was only one nurse, and on the whole block there was no doctor. At least I checked on level 2, 3, 4, 5 and no doctor was on sight. Even the two nurses we spoke to confirmed that there was no Doctor.

The nurse on our level was overwhelmed and looked exhausted, tired, disgusted and lacked clarity on everything. Everyone was calling her, those that require extra fluids, those that needed her to stop drips, those that required injections etc.

Fast forward, our patient’s oxygen run out. We rushed to level five and begged a nurse to assist us with a mobile unit which I think provides oxygen. This unit was supporting a patient who looked relatively better compared to ours, the nurse disconnected it from the other patient and gave it to us. Our Visitor Doctor was happy to see us with the mobile oxygen machine. Soon he connected it and our patient was back to life but struggling, but its time was limited.

We mobilized for an ambulance from city ambulance and headed to Kampala hospital.  Patient was received at emergency point, straight for chest scan, later to ICU. All this in a blink of an eye. Doctors were there, nurses present, you would see activity after another.

Despite this, on 5^th Oct 2022 early morning, I lost my sister. Death is a given and certainly at one point all of us will die, the only drawn question is always how did he/she die?

Doctors’ absence from duty

I did not know that in this age and era a facility like Mulago Cancer Institute can be without a doctor within the vicinity for duty not even an intern.  After 50 years of existence, the facility has at several points in the day no doctor present with over hundred in-patients. What’s the justification?  How can a whole facility be without oxygen when the new 5^th oxygen plant was commissioned recently to produce 70 cubic meters of oxygen which translates into 70,000 litres per hour?

Worse, the place stinks, some of the equipment in use are rusty, and the whole arrangement is messy. It is not the cancer institute known and desired. At night especially on level three, people (caregivers) sleep at reception and the whole area becomes smelly. Washrooms in place are not enough; the cleaners clean only at night. In fact, one risk getting infection from this place. A cancer patient is always fragile, immunity down; they deserve a well neat and clean environment. Sanitation is so bad. On scale of 1-10, I would give CIU a core of 2. If CIU is struggling with sanitation, how will they give required medical services?

Specialist doctors vending services.

DR O K M ( being his initials)  is a DR  UCI-Mulago. The same Dr was allocated to us while still at Nsambya. When we transferred ourselves to Kampala hospital, the same Doctor was called at night and he came in the morning only to find my sister dead. I wondered why a fully employed government medial officer well paid would vend his services to more than 5 medical facilities?

From what I have observed over time a few doctors especially the so-called specialist provide their services for 8 hours a day. Productivity doctor by doctor should be measured. URA should interest itself on many specialized doctors.

The Health Service Commission Act

I picked a few lines in this Act

32. Responsibility to health unit or place of work

A health worker shall abide by rules and regulations governing the place of work and shall conform with the expectations of the health unit and strive to fulfil the mission of the institution.

30 (9) A health worker shall not abandon a patient under his or her care.

30. (2) A health workershall ensure that no action or omission on his or her part, or within his or her sphere of responsibility, is detrimental to the interest, condition or safety of a patient.

Way forward

I think the Ministry of Health should install electronic monitoring tools, which will ensure Doctors and nurses, adhere to roasters. In security, there is a tool called guard patrol monitoring tool, where a guard on duty touches a guard point every after one hour. A report is auto generated on the guards performance during that shift. ED and your team fold your selves and come on ground at different times especially weekend and night times to see if the staff are on duty. Leadership calls commanding from front not rare.

Robin S . Sharma once said: Leadership is not about executive position or title. It is about connection and influence. At its highest, leadership is all about adding value to the world and blessing lives through the work you do. Is this what you doing the CIU top leadership?

As I end this article, we will demand satisfactory explanation including route cause analysis and way forward so this incident will never happen again to any other patient.

Dear sister, rest in peace. You are dearly missed and forever loved.