KAMPALA — It would be expected that any hospital administrator would panic on receiving a phone call informing them that they were receiving 70 patients that had tested positive for Covid-19.
However that was not the case for Dr Moses Muwanga, the director at Entebbe Regional Referral Hospital. In fact at the time of receiving the 70 patients, the hospital was already treating 70 other patients.
Dr Muwanga tells of how the hospital, which has for so many years been handling outbreaks in the country due to its portal location near the airport, was shocked by the first case but has since built capacity to handle any number that they receive. According to Dr Muwanga, the capacity building involved writing a protocol of drugs to treat patients suffering from the disease that has no known cure as well as building a team.
“For Uganda as a country, everything about Covid was new. From how to build the facility, how do we organise it and how do we treat the patients. On top of which was the welfare of the patients and the staff. We had to settle our staff here since they were not allowed to return home for fear of spreading the virus.
Since Covid-19 was new in the country, we had not built a protocol of medication to administer to patients. We had to think on our own and compare that to medication that has been written about as being administered elsewhere in the world.
We started by observing how these people were exposed. Some people came in with cough, others with red eyes, headaches, fevers etc. So we built a combination of drugs to manage the symptoms that the patients exhibited.
We had been told about chloroquine and other drugs that have been talked about. We especially gave a big dose of vitamin C. So from the very good response we saw towards the treatment from the first few cases, we wrote and have contributed a lot to the protocol of treatment that is being used all over the country.
We are happy that out of more than 30 patients we got from abroad, only two progressed to real disease. The others did so well, responded to our treatment and we discharged them in a very short time.
The only challenge we got was from the expectant mother who picked the virus from her husband. We admitted her and had to help her deliver while at the same time treating her of Covid. We had to set up a protocol of reproductive service for an expectant Covid-19 positive patient. With this mother we had to rehearse for hours. That was the first phase of preparing and building capacity to handle a new virus.
The second phase involved truck drivers. At one point in time we had over 130 cases and I got a phone call from the Director General of Health Services informing me that they were sending 70 truck drivers that had tested positive. I did not panic at the mention of the 70, the way I panicked when we got the first case because here I Knew what to do, it was just a matter of expanding capacity to handle more people than we had handled at first. But the index case is an experience I will never forget.
We relied a lot on support from the Ministry of Health, the Covid-19 National Taskforce and other support pillars that helped us build this capacity. As a hospital we decided to look at ourselves as a whole system where every player was vital. We decided to build a team and hold two meetings every week to review our challenges and what has gone right.
We have built our team from 20 core staff to more than 120 staff.
Our goal as the team was to stay safe and alive in order to save lives of others. We realised that if even just one of us got infected, then there was no way we could save others. So we preached to our health workers to stay safe.
The other thing we did was to set roles for our teams. We set up four sections, the information section, the surveillance team which went out looking for infected persons, the suspect ward and the confirmed cases ward. We were once bombarded here by people returning from abroad. We were so overwhelmed that we nearly sent them away. However when we sat back we decided to set up an information area to handle these people who came in anxious. So we would reassure them, take their contacts and follow them up.
We then set up a suspect ward where we kept those that had some in contact with infected people. If after testing anyone in the suspect area turned out positive, we would move them to the confirmed cases ward. We started with one ward which had 21 beds, it got full and we created another with 26 beds. At one time all these were full so we created a third one with 130 beds. These were also at one time all full.
We also had clinical teams, hygienists as well as security personnel. At one time we were overwhelmed. We had employed private security guards but we co-opted the Uganda Police, later the army and when the situation called for it we brought on the Military Police personnel. This was prompted by the arrival of truck drivers who were rowdy. At one time they almost rioted. These were people from different countries with different cultures. Some were rowdy, other were drug addicts. To manage these people in a hospital needed tough security deployment. To-date we still have Military Police personnel deployed.
Our other objective has been to ensure that every patient that is discharged has fully recovered. We have a challenge that the some people in community still believe to this day that Covid-19 is a hoax. This is rather absurd.