Kisoro Hospital: From pandemonium to stronger health systems
“Probably nobody was better placed than our hospital to take on the outbreak."
When Kisoro District Hospital identified its first patient of the COVID-19 pandemic, pandemonium broke loose and patients who could, fled from the wards, followed even by some of the health workers.
The hospital’s medical superintendent, Dr Michael Baganizi weighed the situation, and it was double jeopardy; not only was the hospital expected to continue delivering treatment for all the existing health problems, but it was also expected to be the centre of handling the deadly new disease in the district of 350,000 people plus many more patients who come from neighbouring Democratic Republic of Congo (DRC) and Rwanda. All these had to be served relying on the reduced staff.
Looking back today, Dr Baganizi is glad that his team chose to make lemonade from the bitter lemon that fate handed them.
“We quickly drew our response plan even as government was still developing the national one, and our first action was to set up a 14-bed isolation ward,”
He further explains: “Probably nobody was better placed than our hospital to take on the outbreak, considering our previous experience in containing the not-so-infrequent Ebola outbreaks from DRC.”
Because of its transit role as a district at the confluence of three countries, Kisoro always has refugees from the troubled neighbourhood whom it processes for onward transportation to other districts where there are refugee settlements. The ‘processing’ involves health screening and strict enforcement of measures for minimizing disease transmission as well as restricting the newly arriving refugees from mixing with the locals.
These measures which were immediately instituted at the hospital became permanent and remain in forces even now though no single person has tested positive for Coronavirus Disease since January this year. On checking the records, we found that the last case was in December 2021, of a mother who had just delivered by caesarian section.
Another positive outcome of the pandemic response was proper tracking of stocks and processes. At the start, everything needed to contain the outbreak was in short supply, or no supply at all. Everything from medicines (and later vaccines) to Personal Protective Equipment and worst of all Oxygen, was scarce across the country. Kisoro Hospital had only four oxygen cylinders which could only be refilled at Kabale Regional Referral Hospital, during which process one or two had to remain behind for those patients that were on oxygen to continue breathing. At the time, the hospital didn’t even have an oxygen concentrator.
So besides adopting strict tracking which has now become its culture, management also had to learn resource mobilization, and very fast because it was literally a matter of life and death. With the whole world scrambling for resources from the same donors to fight the pandemic, Kisoro Hospital prioritized the local donors while approaching the external ones as well. The locals’ contributions yielded over 40 cylinders.
In the end, the district’s health teams have emerged victorious, the total death toll not exceeding three persons since the pandemic broke out two years ago. But the sheer will and commitment of Dr Baganizi’s team would not have achieved as much had it not been for the adequate supply of medicines and logistics that were made possible by UNICEF with funding from the Luxembourg National Committee for UNICEF that was extended to select districts and the Ministry of Health.
Another important resource the hospital discovered locally were medical students who were home because of the lockdown and putting out a call for them, they turned up in sufficient numbers to fill the gap of the staff who had panicked and stayed away.
But the staff category Dr. Baganizi has most praise for are the midwives, whose maternity ward remained fully operational even as other departments like Pediatrics were closed completely. Soon all departments were merged into one, operating alongside the COVID-19 isolation ward that was set up immediately the first patient was diagnosed. The exception was the maternity section, whose staff not only did their work as maternal labour cannot be postponed once it comes, but they also had to work in the isolation ward where mothers found to have the coronavirus were admitted.
Sister Antoni Nyiramugisha, the Deputy Nursing Officer in-charge of the Maternity ward explained a simple, effective strategy they adopted at the start of the pandemic. Knowing that any number of the 20 midwives would either be diagnosed with the Coronavirus or become contacts of affected persons, they decided to have half of the number be at home for a week as the remaining half redoubled their efforts manning all the shifts that week. This ensured that whenever any staff had to go in isolation and on treatment for say, three weeks, fresh members were available for immediate recall to take their place.