Stupefying medical bills and death as COVID-19 bites

I (names withheld) will share what my family has learnt through stupefying medical bills and death with a request and very humble advice: please don’t share this quoting my name.

Secondly, it is highly imprudent, in fact highly risky to use this information to go on a politicized GOU/ MoH bashing spree because the doctors at Mulago Hospital generally try their best under very very difficult circumstances. If you attack their work, you might need them to save your life or that of a dear one before Xmas.

Therefore, keep your goodwill options open. Instead, if you know senior cabinet ministers or people close to Finance Minister/ PS or the presidency, just use this information to plead for more emergency funding for the Ministry of Health.

It is extremely difficult to get that bed if the patient requires ICU admission. The ICU beds at Mulago Hospital are almost always fully used up. COVID-19 has exceeded Uganda hospital capacity.

One can try Entebbe Regional Referral Hospital but a doctor there told me their ICU is not fully operational because they don’t yet have an oxygen plant (been seeing very disappointing social media explanations about this). Entebbe therefore depends on oxygen from portable cylinders and the day I checked (very recently), they had only 4 cylinders left and were doomed to run out the following day if MoH did not resupply them.

My patient was terribly sick and required 25 litres of oxygen per minute to stay alive. We were dumbfounded by this quantity. She was in the HDU of Mulago’s COVID-19 isolation ward and needed emergency upgrade to ICU which was full. The doctors deemed her more likely to die than those whom they hoped could emerge alive from ICU so ICU admission at Mulago Hospital was not an option for her. Hence my desperate inquiries at Entebbe. These decisions require doctors to pray to God and I have heard of cases of doctors going into depression.

Desperate pleading with the Ministry to send oxygen was underway at Entebbe Regional and I got the impression that the government cash crunch and the recent decision to prioritize only Defense, State House and the EC plus salaries is wreaking havoc in Ministry of Health procurement.

At Mulago Hospitals there is/ was a severe shortage of PPE and medics are contracting COVID from patients. Nurses reduce their physical contact with patients below the minimum necessary to support a bedridden patient with personal hygiene and bathroom alternatives. As I learnt all this I had 2 bedridden immediate family members in the HDU (High Dependency Unit). Both were hooked to wall oxygen supply from the hospital plant but one of them kept sending us desperate text messages (with increasing spelling incapacity) pleading that she was not receiving oxygen.

When I later read Daniel Kalinaki’s Daily Monitor lead story detailing the faulty piping network of the newly installed Mulago Hospital oxygen plant, I wondered to what extent my patient was just unable to inhale due to the severity of her lung  tissue damage versus the possibility of faulty oxygen piping to her mask.

The medics working with PPE shortages under these circumstances are no longer getting their allowances due to the government cash crunch. Some are un-salaried non-permanent staff who depend only on those allowances.

Mulago Hospital has a shortage of 120 intensive care/ HDU nurses and a doctor there showed me the job advertisement. Government is always increasing the size of parliament but is only now only now accepting to reduce the manpower deficit of the MoH, 7 months after lockdown. At Mbarara Regional Referral Hospital, about 40 medics tested positive for COVID-19 as I was learning all this (early to mid November).

The 25 litres/ minute oxygen requirement of my patient would deplete Entebbe’s diminished stock in less than a day and Entebbe was instead doomed to emergency discharge all oxygen dependent HDU patients if the Ministry did not send oxygen cylinders within 24 hours or less.

My overall experience was scary. If you have no private medical insurance capable of paying dozens of millions for ICU admission in a private hospital, you might be doomed to die a preventable death.

Sam is talking about a deposit of shs3 million for admission. Most private hospitals require a shs5 million deposit. After that, if your patient is in ICU, your daily bill will be in the region of shs6.5 million+ per day. My patient was on the verge of same day death and had to leave Mulago Hospital to find an ICU bed. The bill now exceeds sh90 million and she is still on life support. Death is in the backyard.

Yet before you hit this wall, only a few private hospitals have a COVID-19 isolation ICU ward. My family has had good prior experience with Nakasero’s ICU but that hospital will discharge you the day you test positive for COVID-19. To my knowledge, private hospitals with a second ICU for COVID-19 patients include Case, Norvik and Victoria. I’m not currently aware of any other. None is materially cheaper than the other.

At a practical level, let me give some tough-learnt advice to TUWW. If you or someone close to you suspects that emerging symptoms might indicate COVID-19, test immediately and commence treatment without delay if you test positive. Otherwise, death is likely to occur.

The worst mistake is to delay taking any medical action for days, due to doubts, false hopes, resorting to prayer as sole solution (no offense intended) or doing an ostrich approach to avoid death. I’ am learning from multiple cases that some ladies (possibly more than men; again, no offense intended) are very prone to self diagnosis and self medication (perhaps a traditional responsibility to care-give to children while over relying on doctors?) as well as disproportionate reliance on pastors and prayers.

If you delay the commencement of medical interventions, the virus may descend from the back of your throat to your lungs. This is when asymptomatic or mildly affected patients become moderate to severely affected patients. Don’t waste a day if you have suspicious symptoms. Start the home therapy even as you wait for medical test results.

Finally, if your symptoms are consistent with COVID-19, take no solace in a negative test result. Request a chest x-ray and a lung scan. The rapid test has a minimum % of false negatives and false positives. My patient twice tested negative for the virus in 2 separate hospitals while all symptoms confirmed COVID-19. As she worsened, a third test was done using lung samples extracted via diagnostic needle and COVID-19 was immediately confirmed in her lungs though there was none in her nose and throat.

Overall, medical requirement; avoidance is definitely better than cure.