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In Uganda, disputes over bills mark chaotic COVID-19 care

In Uganda, disputes over bills mark chaotic COVID-19 care

Holding out for nearly $9,000 in unpaid medical bills, one hospital in Uganda allegedly refused to hand over the dead body of a patient who had received oxygen therapy for several daysBy RODNEY MUHUMUZA Associated PressJuly 7, 2021, 10:01 AM• 4 min readShare to FacebookShare to TwitterEmail this articleKAMPALA, Uganda — Holding out for nearly $9,000 in unpaid medical bills, one hospital in Uganda allegedly refused to hand over the dead body of a patient who had received oxygen therapy for several days.Tofa Tamale said he tried to reason with hospital managers, hoping for an arrangement that would preserve his mother’s dignity. After a lawsuit was threatened, the body was released to the family but with no post-mortem report.“The hospital didn’t give us a single piece of documentation,” said Tamale, who believes his mother had COVID-19 before she suffered a stroke.The case, one of two publicly known as this East African country sees a surge in COVID-19 infections, has shocked many in a socially conservative society where bereavement customs are strictly observed.“You can’t say you’re holding onto a dead body in order for you to get your fee. That’s repugnant,” said Joseph Luzige, an attorney who represented Tamale.The case also highlights the sense of chaos in COVID-19 care as Ugandans grapple with the high cost of treatment. Some hospitals are accused of demanding cash deposits upfront before admission. Others are said to demand security items such as title deeds in lieu of cash, drawing the attention of an anti-corruption investigator who says her office has received over 200 complaints.Uganda has confirmed a total of 84,554 COVID-19 cases, including 1,995 deaths as of Wednesday. Authorities are reporting dozens of deaths a day.As in many other African countries, the actual number of infections and deaths are believed to be much higher because testing is not widely available. And now “the speed and scale of Africa’s third wave is like nothing we’ve seen before,” the World Health Organization’s Africa director, Matshidiso Moeti, said last week.The highly infectious delta variant is fueling Africa’s new surge in cases, a worrying situation on a continent where just over 1% of the continent’s 1.3 billion people are fully vaccinated.In Uganda, where less than 1% of the country’s 44 million people have received even one shot of the AstraZeneca vaccine, hundreds of new cases daily are overwhelming public health centers and creating more business for private facilities, which traditionally accept cash.Some hospitals with COVID-19 wards have charged nearly $1,500 in daily treatment fees, a prohibitive sum for most Ugandans. Many are now self-medicating within their homes, experimenting with everything from traditional medicine to new herbal remedies.“There are many Ugandans who are dying in their homes simply because they fear to face high-deposit hospital fees,” Col. Edith Nakalema, leader of an anti-corruption unit under the presidency, said in a series of Twitter posts. “If you have not yet suffered this personally remember that you might suffer it soon.”Grace Kiwanuka, executive director of an association of private health groups, said hospitals are caught “between a rock and a hard place” as they balance their obligations to patients and business concerns in an unprecedented pandemic. “The market is dictating certain prices we have to pay,” she said, citing complicated COVID-19 cases of patients with kidney failure who stay in intensive care units for several days.Some die, leaving hefty bills that hospital directors have to account for, she said: “I feel for these people. I really do. But the fact is, this is medicine.”The fear of detaining patients — dead or alive — over medical bills is a source of frustration, said Sarah Mirembe, who recently accused a hospital director of not honoring his word to waive certain fees.Although her grandmother recovered from COVID-19, Mirembe said, the experience left her upset after the family had to sanitize the “filthy” room she was given. After threatening to take her grandmother elsewhere, she was able to negotiate the daily rate down to $170 from $714.The total bill was $4,000, she said.“What if I didn’t have this money?” she asked.

As virus surges in Uganda, hospitals accused of profiteering

As virus surges in Uganda, hospitals accused of profiteering

KAMPALA, Uganda — As he struggled to breathe earlier this month, Dr. Nathan Tumubone was tormented by thoughts of hospitalization as a COVID-19 patient. Thinking of the costs involved, he knew he wanted to stay home.He and his wife “steamed” up to five times a day, inhaling what they felt was the relieving vapor rising from a boiling concoction of herbs.”The truth is I didn’t want to go to hospital,” said the general practitioner. “We’ve seen the costs are really high, and one wouldn’t want to get in there.”As virus cases surge in Uganda, making scarce hospital beds even more expensive, concern is growing over the alleged exploitation of patients by private hospitals accused of demanding payment up front and hiking fees.Uganda is among African countries seeing a dramatic rise in the number of infections amid a severe vaccine shortage. The pandemic is resurging in 12 of Africa’s 54 countries, the World Health Organization reported Thursday, saying the current wave is “picking up speed, spreading faster, hitting harder.”Africa’s top public health official, John Nkengasong of the Africa Centers for Disease Control and Prevention, said Thursday that Africa’s third wave is “very devastating” as the delta variant drives infections in many countries.Just 1% of people across Africa have been fully vaccinated, and Uganda has vaccinated under 1% of its 44 million people. It has confirmed 75,537 infections, including 781 deaths. The actual totals are believed to be much higher because only a few thousand samples are tested daily.Hospitals in cities including the capital, Kampala, report difficulties in finding bottled oxygen, and some are running out of space for COVID-19 patients. Intensive care units are in high demand.Although the practice of requiring deposits from patients has long been seen as acceptable in this East African country where few have health insurance, it is raising anger among some who cite attempts to profiteer from the pandemic.Without a national health insurance scheme, COVID-19 has highlighted that health care in Uganda is “commoditized, available to the highest bidder,” said Daniel Kalinaki, a columnist with the Daily Monitor newspaper.“The lingering question is how did we go from a place where you paid what you could and made sure to clear your dues on your next visit, to one where patients will not be touched until the whiny-voiced bean counter in the accounts office confirms that their deposit has cleared?”Many Ugandans don’t trust government hospitals, citing the decay they find there as well as the occasional lack of basic supplies. Top government officials routinely seek treatment abroad. Most people attend private facilities that have mushroomed across the country in the years since the health sector was opened up to private investors.Some hospital bills shared by families of COVID-19 patients emerging from intensive care show sums of up to $15,000, a small fortune in a country where annual per capita income is less than $1,000.Private hospital directors who spoke to the local press defended their fees policy, saying looking after COVID-19 patients is risky and not cheap.Health authorities have said they are investigating allegations of exploitation.Cissy Kagaba, a prominent anti-corruption activist who recently lost both parents to COVID-19, told The Associated Press she was shocked when the family received a bill of nearly $6,000 when her father was let out of an intensive care unit. “Risk allowances” and other items on the receipt looked suspicious, she said.“When we saw the bill, we couldn’t believe how much it was,” she said, adding that alleged exploitation of patients mirrors rampant official corruption. “You cannot expect any different from them. If you have a government that exploits its own people, what do you expect from the private sector?”Tumubone, the doctor who is recovering from COVID-19, said he panicked when it seemed he would need to go to a hospital. He and his wife experimented with home care, inhaling steam from the boiling leaves of guava, mango and eucalyptus trees.Lockdown measures were tightened in Uganda last week. All schools have been ordered shut, a nighttime curfew remains in place, and only vehicles carrying cargo and those transporting the sick or essential workers are permitted to operate on the roads.