Day 3: What I’ve Learned About Mulago Hospital

New Mulago Hospital
New Mulago Hospital

Ask any Ugandan on the streets of Kampala how to get to Mulago Hospital, and you will get an enthusiastic response to your inquiry. Faces lighten up with curiosity, “Are you a nurse? A doctor? Ahh, good.” The place and name is as important a part of the city as its churches, mosques, markets, and historic landmarks. At one time or another, it has served all of those buildings’ purposes, too.

Old Mulago
A network of walkways connects the many buildings of Old Mulago. Getting a photo without anyone in the background took me a whole week!

Mulago Hospital is a sprawling establishment in northern Kampala, bearing witness to almost 100 years of history and symbolizing the evolution of Ugandan health. Known quickly as “Mulago,” the Mulago National Referral Hospital was founded in 1917 by Albert Ruskin Cook, a British mission doctor and revered as the “founder of modern Ugandan medicine” [1]. In 1962, the original Mulago site was replaced with a collection of smaller buildings now called Old Mulago. As of the summer of 2015, Mulago’s activity is split between the Old Mulago buildings from its 1962 construction and half of the massive complex under construction as of 2012, the New Mulago. With a 1790 bed capacity, Old and New Mulago are housing 3000+ inpatients and between 6000 to 7000 outpatients daily [2]. It’s next to impossible to wrap your head around such massive patient volumes until you see the wards in person. Most beds are full, or waiting to be taken. Patients and their family members bring mats for the floor, while the outside corridors, courtyards, and benches are occupied day and night.

Directions in Old MulagoIt is the oldest, and largest, of Uganda’s three referral hospitals (the others being Butabika and Mbarara). Today, it offers services under a wide variety of specialists and affiliated institutes: surgery, internal medicine, cardiology, infectious disease, pediatrics, obstetrics and gynecology, oncology, radiology, neurology, endocrinology, rheumatology, ICU, renal dialysis, dentistry and oral surgery, orthopedics, otolaryngology, dermatology, sexual health, urology, accident and emergency medicine, physiotherapy, and pharmacologic services. These are the ones I have been able to record during my rounds, but I’m sure there are more.

Makerere University Physiology Department
Student centre and physiology department offices at Makerere University College of Health Sciences at Mulago Hospital

Affiliated with the Makerere University College of Health Sciences, which also has its campus on Mulago premises, the hospital is quickly becoming the Ugandan (and African) centre for clinical and research innovation. Any Google search can provide publications and international collaborations based from and at Mulago. Government and foreign investments maintain Mulago as a public hospital, available through referrals from clinics and hospitals throughout Uganda or direct access for those most in need of its services (more to come on the Ugandan healthcare system next week, when I’ll attempt to describe it as accurately as possible). Despite seemingly constant shortages in staff (many Ugandan doctors left in the 1970s during Idi Amin’s rule) and supplies (patients are expected to bring many resources, from gloves to surgical blades), Mulago remains a testament to the ingenuity and loyalty of its people.

New Mulago Renovation Concept Art
New Mulago renovation concept art, to be completed in 2016 [2].
The New Mulago building is expected to be complete in 2016, after an estimated $49mil USD of investment [3]. Staff at Mulago are clearly anticipating New Mulago’s opening with cautious optimism. Any improvement is all well and wanted, especially considering the new building will centralize all specialties of care under one roof. But some are skeptical that Mulago is ready for its increased demands on the horizon of its renovation. Currently operating on an annual budget of 33.2bil Ugandan shillings (around $10mil USD), 20bil shillings are for staff salaries and 8.2bil shillings for recurrent non-wage expenditures (e.g., food, power and water bills). That leaves only 5bil shillings for resource development, like buying much-needed medical equipment and repairing existing hospital infrastructure [2]. Some estimate that, for Mulago to efficiently service all of its patients, it needs to triple its budget. How, and if, such enormous gaps will be filled is a mystery to me.

Weighing the struggles Mulago faces daily to keep its doors open, it truly is an inspiring institution. Positive collaborations with influential international collaborators and the enthusiasm of the Ugandan medical and academic community will likely sustain Mulago and contribute to its growing strength. Staring down the courtyard at the hundreds of Ugandans awaiting their brief but highly anticipated interaction with the healthcare system, I cannot help but feel small. My presence here is so insignificant, unhelpful to any of these people waiting so patiently and desperately for care. The knowledge of these physicians, nurses, midwives, and all other staff could fill thousands of libraries, yet the resources they need to carry out their patient management plans couldn’t even fill their hospital. How they carry on will be my most important, and humbling, medical lesson yet.

Ambulances at Mulago Hospital Entrance
Ambulances at New Mulago Hospital entrance

Resources:
[1] Mulago.or.ug. Mulago | Uganda National Referral Hospital [Internet]. 2015 [cited 25 July 2015]. Available from: http://mulago.or.ug/
[2] Ayebazibwe A. Mulago hospital renovation starts [Internet]. The Saturday Monitor. 2014 [cited 25 July 2015]. Available from: http://www.monitor.co.ug/News/National/Mulago-hospital-renovation-starts/-/688334/2481588/-/item/1/-/13ye8mb/-/index.html.
[3] Obore C. Time bomb: The inside story of Mulago hospital’s troubles [Internet]. The Saturday Monitor. 2013 [cited 25 July 2015]. Available from: http://www.monitor.co.ug/News/National/Time-bomb–The-inside-story-of-Mulago-hospital-s-troubles/-/688334/1669688/-/13xumh5/-/index.html.

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