Our Side of the Story - Ugandan health workers speak up - VSO

Our Side of the Story: Ugandan health workers speak up
Equipment and medical supplies
Health workers praised facilities with good diagnostic equipment, such as X-ray
and ultrasound, and a commitment to a well-equipped establishment: “It’s a good
place, that’s why I have stayed so long.” Elsewhere, working with inadequate
equipment was a huge challenge, damaging workers’ professional fulfilment,
the quality of services and community relationships. The difficulties were acute
in the government sector, but present too in parts of the not-for-profit sector.
The impact on health workers
Government sector medical doctors and nurses told of
interruptions in supplies of oxygen and blood; missing canulas,
needles, giving sets and sutures; minimal availability of urinetesting
kits and family planning supplies; insufficient dressing
packs; and absent or faulty diagnostic equipment. Rural
midwives in the government sector told how they struggled
to provide a service with no delivery kit, cord clamp, sucker,
gauze or cotton wool and just one pair of scissors. Working
without protective wear – gloves, aprons, gumboots, shoes,
masks – was a huge risk, especially for midwives working in
the dark: “You are bathed in blood.” Lacking gloves, midwives
even used their own clothes and plastic bags to grasp the
baby during delivery. Workers in some rural facilities in the
government sector provided their own work clothes as, it was
said, the Ministry of Health no longer supplied uniforms.
In the government sector there was widespread frustration at
not being able to work effectively: “What really hinders my
work is lack of some equipment” and “The equipment does
not allow you to do what you are supposed to do.”
Nurses spoke about thwarted professional fulfilment. Willing to
work to the best of their ability, they felt “handicapped” and
“disappointed”. As a result, work was neither enjoyable nor
happy: “If I am provided with what I am supposed to use, I can
enjoy the work” or “You can’t really be happy in such conditions,
but would be happier with equipment to do your best.”
Frontline medical doctors spoke of “struggling with the minimum”
and of feeling “deflated” by poorly maintained equipment such
as X-ray machines with blown bulbs or no chemical to print the
film: “You wake up and have the same problem, you go home,
you come back and it has not changed.”
Doctors wanting the satisfaction of doing their best for their
patients spoke of frustrations such as a lack of diagnostic
equipment or facility for blood counts. Managers recognised
that medical doctors “eventually lose morale” when they are
unable to operate on a patient because oxygen or sutures
are missing, and that being unable to apply knowledge was
“very demotivating”.
Failing their patients greatly distressed nurses and doctors.
Patients died because of the lack of essential supplies: “We
would have saved that life if we had oxygen. It stresses you.”
A lack of diagnostic equipment cost lives too: “The patient
probably would have survived if you were able to investigate.”
Government sector workers faced a dilemma when the facility
ran out of supplies. User charges were abolished in 2001 in all
government facilities except private wings in hospitals, and
health workers told of prohibitions on asking patients to go and
buy missing items: “It is very annoying, you go home dissatisfied.”
The medical doctor has a duty towards the patient’s health:
“What do you do Ask the patient to buy or see them get worse”
The other option was “to be kind” and refer the patient to
a higher-level facility. Participants spoke against the policy:
“I don’t feel it wrong to ask a patient to buy needles in order
to help them,” and it was clear that patients in some facilities
were being asked to buy supplies. It was hard to ask a patient
to buy items that should have been provided free of charge:
“I don’t want to be the one to say go and look for a canula.”
Participants in facilities with relatively good supplies welcomed
relief from the stresses of telling patients to buy their own. They
also expressed pride in a facility that did not force patients to
spend what money they had on intravenous fluids, canulas,
gloves, dressings and the like. There was praise for imaginative
management that solved temporary supply problems by
borrowing from other facilities.
The impact on attitudes,
behaviour and practices
Participants working in the private and not-for-profit sectors
spoke frankly about the effects of shortages they had seen
during their time in government facilities. They told of nurses
forgetting what they had been taught in training schools and
some not working as a result, thus projecting a bad image to
the community which in turn made nurses feel not respected
and prompted them to leave. Participants in the government
sector did not identify these effects. However, there was a
suggestion that nurses were reluctant to come to work and
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