By Frank Kisakye & Carolyne Nakazibwe, KAMPALA Uganda
Praised
by the World Health Organisation (WHO) as a model country in the fight against
the spread of the novel coronavirus, Uganda is now seemingly headed into the
same trajectory as other badly-hit countries, if events of the last few weeks
are any indicator.
Interviews with Covid-19 patients, their
relatives and medical experts, help explain how the country’s rather good fight
got off its rails. From March 18, when President Yoweri Museveni announced a
total lockdown, all appeared to be going well. Cases were few, recoveries
impressively high and the country began to open up.
Compliance with standard operating
procedures (SOPs) especially washing hands and social distancing was
religiously adhered to. The fear of contracting the disease stood between 70 and
80 per cent between March and May, according to survey results from the
ministry of Health.
In June, that figure dropped to between
30 and 40 per cent and could be lower today. At the end of July, WHO regional
director for Africa Dr Matshidiso Moeti praised Uganda, Seychelles and
Mauritius for effectively managing to control the spread of the pandemic on the
continent.
Ministry of Health permanent secretary
Dr Diana Atwine even chastised Tanzania’s seeming laxity in fighting Covid-19,
adding that the entire world was looking up to Uganda’s exemplary and success
story.
On June 25, when the country had 848
cumulative cases, 780 recoveries and no deaths, the president of the Society of
Uganda Private Medical Practitioners Dr Lulume Bayiga told a press conference
that it was going to be an uphill task to convince Ugandans that the health
impact of Covid-19 was as big as projected.
Lulume urged Uganda to emulate Tanzania
and Burundi that had not locked down their countries but had kept their
economies running amidst the pandemic, in hope for herd immunity (a form of
indirect protection from an infectious disease that occurs when a sufficient
percentage of the population has become immune either through vaccination or
previous infections).
In response, Atwine told Uganda Radio
Network (URN) that the perceived normality in Tanzania and Burundi was
farfetched because their people were dying, according to intelligence shared
between health experts in the region.
“What is there to learn [from Tanzania
and Burundi]? Do you know thousands of people who have died just because they
don’t share with you? Do you know how many thousands, thousands, we’re not
talking about hundreds but thousands of people who have died?” she challenged.
“Look at those countries that relaxed, they bought even extra land for graves.
Is that what we want?”
But going by the recent trajectory,
Uganda is headed for difficult times; hospital beds in Kampala are filling
fast, with just 2,600 confirmed cases. SOPs have generally been dropped, and
one only has to venture into downtown Kampala’s Kikuubo Lane or Luwum Street,
to understand why Kampala Metropolitan is the latest hotspot for the virus.
While taxis were ordered by the
president to ferry only eight passengers for social distancing purposes,
passengers report that the case is different once the matatus get to the
crowded suburbs.
“The taxi conductors are very strict on
masks, but when I asked to use the sanitizer at the door, one conductor
quipped: ‘eno ya ba traffic! Kozesa eyiyo (this one is kept for traffic checks;
use your own)’,” one regular passenger told The Observer.
No wonder the city is seeing an
explosion in cases. A patient hospitalized in Mulago with Covid-19 symptoms
said on condition of anonymity, that four floors of the newly-refurbished New
Mulago complex are operating at full bed capacity.
Cubicles meant for six beds are now
reportedly accommodating between eight and 12 patients. Another patient in
Entebbe Grade B hospital said some patients are starting to occupy space in
corridors. Also, the recovery rate has dwindled, as symptomatic community cases
start reporting to health facilities, unlike the asymptomatic truck drivers who
previously recorded themselves dancing in wards.
The Uganda Medical Association proposed
that the ministry stops admitting every patient who tests positive, to
decongest hospitals, and admit only those with severe symptoms. But Health
Minister Jane Ruth Aceng said with the complacency exhibited by Ugandans, it is
unlikely that Covid-19 positive Ugandans with mild symptoms can self-isolate
for 14 days without interacting with other members of the public.
Interviewed by the New Vision recently,
Dr Monica Musenero, the senior presidential advisor on epidemics, said Uganda
is fast moving to the stage of uncontrolled transmission, especially in
Kampala.
“The bed capacity, especially in
Kampala, has been outstripped and that is why we have close to 150 people, who
tested positive, being treated at home,” she said.
However, even Aceng’s current admit-all,
treat-all method is not foolproof. Two weeks ago, Bettina (name changed on
request) took her husband to Lancet Laboratories for a Covid-19 test at Shs
345,000, because he had presented with all the symptoms – including chest pain,
fever, loss of sense of smell/taste, headache and difficulty in breathing – for
at least five days.
Five days during which the couple went
to different hospitals in Kampala and could not secure a test or help.
According to Bettina, the couple contacted KCCA for help and were referred to
Mengo hospital only to be turned away because there were neither testing kits
nor doctors designated for Covid-19, despite the hospital being identified as a
testing centre at the time.
As her husband’s health deteriorated,
they opted for the expensive private test.
“When he received a positive result the
following day, through connections we secured an ambulance to transfer him to
Mulago as our car was impounded for fumigation,” Bettina said.
“As soon as the technician gave us the
results, he told us to go home and wait for a call from the ministry. Had we
not used our connections to deliver my husband to Mulago, the ministry would
probably never have called, because he has never received the said call since
his positive test.”
“After his admission, I was told to
self-isolate for 14 days, and also find my way to Kiswa health centre in
Bugolobi for a test, because the Mulago sample collection centre had been closed
and reserved for VIPs.”
“Meanwhile, they told me not to use
public means to go to Kiswa, but there was no vehicle or ambulance to take me.
How was I supposed to get there and go back home?” Bettina said.
That was August 20. By Monday August 31
when The Observer compiled
this, Bettina was yet to receive her test results, despite repeated calls to
Kiswa.
“One health worker told me on phone they
were undergoing health training and there was no one to update me on the
results,” she recounted.
Also, no contact tracer has been to
Bettina’s neighbours/community, neither has she received a follow-up phone call
from health workers as a primary contact to a Covid-19 patient. At Mulago too,
her husband reports that no one has asked for his list of contacts!
She is ‘self-isolating’, but ironically
has to deliver food and fruits to her husband, after the Mulago patients
reportedly protested against the bad food and the administration allowed
caretakers to drop off food daily between 10am and 1pm.
The hospital executive director, Dr
Byarugaba Baterana told the Public Accounts Committee of Parliament on August
25, the hospital had budgetary shortfalls and needed funding from government to
handle Covid-19, instead of dipping into the usual allocated budget.
He disclosed that the hospital was
struggling to feed Covid-19 patients, whose appetites are not necessarily
affected by Coronavirus. Many on the wards are asymptomatic. The hospital
currently has close to 300 Covid-19 admissions and has registered at least four
deaths.
Delays in release of the test results is
one of the big setbacks in the Covid-19 fight. While Kiswa told Bettina she
would get her results within four days, it had been 10 days and counting,
when The Observer last
checked; the facility had stopped taking her calls.
Other patients have reported similar
delays, and with no strict quarantine measures for community cases, the spread
is inevitable. The delay in releasing results could also be responsible for the
hospital congestion, since a patient is not discharged until they have a
negative result.
Minister Aceng has previously said each
test takes about five hours to complete. But surprisingly in places like Ghana,
the wait time for a Covid-19 PCR (polymerase chain reaction) test result is 30
minutes.
The ministry has religiously updated
Ugandans on ‘new’ cases, recoveries and deaths daily, but unknown to most, the
results announced daily are from past tests done over several days, announced
as and when the laboratories eventually turn them in.
For community cases, Ugandans are
trusted to stay in self-isolation until their results come in.
“This entire Covid thing is a mess. I
was tested 10 days ago and it is only today that they called to bring me to
Mulago. Do they know how many people I have infected? I believe I have actually
healed between then and now if indeed I was positive,” a patient who had just
been dropped at Mulago from Busia, said.
As the number of samples and occasional
shortage of reagents overwhelm laboratories, Covid-19 is spreading from the
crowded downtown Kampala to upmarket air-conditioned ministry offices (Ministry
of Finance, Planning and Economic Development registered 21 cases), banking
halls (Dfcu Lugogo branch), newsrooms (so far, New Vision, NTV, NBS, UBC and
Radio Pacis), hospitals, supermarkets, among others.
“I feel Coronavirus results are only
important if they are released within 24 hours or 48 hours. That is when they
are important. Apart from that, you’re going to create a trail of contacts that
you can’t handle. Maybe the government is enjoying having enough numbers of
Covid-19 patients,” said a laboratory technician from one of the Covid-19
contracted labs, in a voice note sent to The Observer on July 29.
Recently the ministry of Health
spokesperson Emmanuel Ainebyoona told The
Observer that it takes only 48 hours to know one’s results.
The facts on the ground state differently. Even Ministry of Finance, Planning
and Economic Development staff who were tested between August 19 and 21,
received results on August 24. And that was considered fast.
“Sometimes when the results delay, it is
due to the running out of reagents or sometimes traffic jam affects movements
of medical officers from sample collection centers to testing laboratories,”
Ainebyoona told The
Observer.
He also said there is a planned rapid
assessment that will occur in greater Kampala Metropolitan, Wakiso and Mukono
districts like what happened in other high-risk districts.
“We shall be selecting a number of
people scattered across in these districts and test them. We shall also do risk
basic testing; for example, if premise X has a case, then we test all the
occupants and their contacts there,” he says.
Meanwhile, a patient at Mulago said in a
phone interview that patients are neither sensitised about proper hygiene, nor
supplied with sanitizers. They, however, get one surgical mask per day.
“Patients are also cleaning the
washrooms, because most of the cleaners who were doing the job reportedly
contracted the disease. Unfortunately, there is no liquid soap or other
detergents to help. If patients don’t volunteer to clean the washrooms, they
remain dirty all day,” he said.
Perhaps the ministry of Health’s major
battle now is against public complacency and skepticism over the seriousness of
the pandemic. After reported misuse and theft of Covid-19 funds in some African
countries including Kenya, a section of Ugandans still believe there is no
pandemic and government is only using the term to collect donations.
Not even public figures such as AIGP
Asan Kasingye, businessman Isaac Rucibigango (he was discharged on August 27
after a negative result), Makerere University lecturer Amanda Ngabirano and
others, talking about their personal struggles with Covid-19 made much impact.
One Twitter user even responded to
Kasingye’s Covid-19 infection announcement that he (the tweep) would not
believe Covid-19 exists unless the Police Chief Political Commissar succumbs to
the disease, to Kasingye’s chagrin!
The ministry of Health’s fight was dealt
further blows when Aceng was captured in an unfortunate video mingling with
masses in Lira, without a mask. Several other ministers and politicians have
also flouted the SOPs as the election season kicks into high gear, further
disenfranchising the doubting Thomases.
It did not help matters when on July 19
the ministry released its daily update that showed more Covid-19 recoveries
(1,071) than confirmed cases (1,069). In their explanation on social media that
was missed by many, the ministry said the recoveries included Ugandans,
non-Ugandans, as well as refugees.
However, foreign confirmed cases had
earlier been expunged from the country’s totals on the orders of President
Museveni, a development that even led to mini friction with WHO, who said it
was against international pandemic practices.
In addition, when the country started
recording Covid-19 deaths, affected families took to social media to dispute
the ministry’s findings that their people had died of the disease. This only
fueled social media allegations of ‘scaremongering’.
Even The Observer, which has consistently been
making daily updates on our online platforms on the status of Coronavirus in
the country, was falsely accused of colluding with the ministry to steal Covid
money.
As cases spike and the country continues
to open up with SOPs, the ministry remains faced with the challenge of
upholding an image it boasted of earlier this year, which even made Aceng,
Atwine, Dr Monica Musenero and other taskforce members adored celebrities. For
a short while. - The Observer
