Uganda medics baulk at Ebola hospital work

When Ebola broke out in Uganda in September, 10 doctors immediately stepped forward to work in an isolation unit at Fort Portal Regional Referral Hospital, but two months later only three of them are left.

Staff are reluctant to work in the unit for fear of catching the deadly haemorrhagic fever, and also because of exhaustion and postponed wages, said one of the remaining doctors, who asked not to be identified as they had not been authorised to talk to the media.

Two health workers at the hospital in western Uganda have died from Ebola in this outbreak. Across the nation, 15 health workers have tested positive and six have died.

The virus circulating in Uganda is the Sudan strain of Ebola, for which there is no proven vaccine. Total recorded cases have reached 141 people, of whom 55 have died.

“At the beginning the number of health workers willing to work in that unit was good but now we have low coverage. If we get five cases the work we do is overwhelming,” said the doctor, who avoids discussing their work for fear of being stigmatised.

“But if we all run away all of us will get sick,” the doctor said, adding that the hospital sometimes lacks the fluids essential for treatment.

The East African country has one of the world’s lowest doctor-to-patient ratios, with one for every 25,000 people, versus the 1-to-1,000 ratio recommended by the World Health Organization (WHO).

The WHO and aid groups are providing Uganda with assistance to cope with the Ebola outbreak, and the US says it has channelled $22m through local partners.

Yet Uganda still faces significant funding shortfalls — a WHO official said an initial $20m earmarked by the government was burnt through in the first month as cases soared.

Ugandan health ministry incident commander, Dr Henry Kyobe Bosa, denied there are staff or resource shortages. Intensive care staff work maximum eight-hour shifts and personnel from Ebola-free regions are rotated in, he said.

But staff coverage was 40% before the outbreak, and Ebola is now “crippling the system indirectly”, according to Dr Alone Nahabwe, the Uganda Medical Association’s head of worker welfare.

Staff lack personal protective equipment such as face shields, gowns, gloves and gum boots, Nahabwe added.

“There are facilities where doctors and health workers are still touching patients without gloves because [gloves] are not there,” he said.

COPE

Government officials say after a chaotic start the situation is improving. Case numbers are still low compared with an Ebola outbreak from 2013 to 2016 in West Africa that killed at least 11,300 people.

“The fact is we don’t have huge case numbers so we can cope,” said Bosa. “The only major fear we have is that cases come to Kampala.”

So far 20 cases have been confirmed in the capital, home to about 2-million people.

At the isolation unit in Mubende district, the outbreak’s epicentre, one doctor said personal protective equipment and staffing crunches eased as case numbers fell: in his unit, 12 of 60 beds were occupied last week, down from a peak of 48.

But experts worry about cases spreading. On Sunday the first case was reported in the country’s east.

“The staff numbers that you need under IPC [infection, prevention and control], surveillance, contact tracing, the numbers are big,” said Dr Miriam Nanyunja, a WHO adviser for emergency risk management currently in Uganda.

“While the numbers of cases are not many, the geographic spread is going up,” she said. “If it goes on much longer you will need a lot more resource mobilisation.”