CORONAVIRUS, UGANDA'S 55 ICU BEDS, 80 CABINET MINISTERS AND WHY IT IS EASY TO GET 7,900 ICU BEDS IN LESS THAN A YEAR WITH OUR OWN MONEY

With about 42 million souls, if one includes the 1.2m or so refugees, Uganda is amongst Africa’s top 10 populous countries.

As of today, we have 55 functional ICU beds in the wake of the COVID-19/Corona Virus pandemic. Now, from as far back as 2012, the need for expansion of our ICU bed capacity has been at the forefront. In fact, the 1,500 bed Mulago Super Specialised Hospital, should have at least 150 high dependency beds.

After its renovation, Mulago, was to add at least 50 ICU beds.

The first ICUs were established in the late 1990s by Dr. Catherine Omaswa. Little has changed, despite provision of funds to the Ministry of Health for Mulago Hospital Renovation which, having started in 2014, with a timeline of 2 years, is now in its 6th year, with no definite finish line.

Had it been completed in 2016, as envisaged, we would be having at least 105 ICU beds.

Now, of course, our 80 member cabinet is, unfortunately, in the demographic most susceptible to fatalities as a result of COVID-19. No country is going to allow any sick geriatric whatever his clout, in its airspace, to come occupy its citizens’ ICU beds. This is why COVID-19 may be a crisis that should not be wasted.

Starting 2012, dedicated Ugandan medics have sought ways of increasing our ICU beds but, because they are such a small, albeit ignorable constituency, their efforts seem to go to waste in a country with rulers that prefer to go abroad for any and all ailments.

Our 80 Cabinet members, for lack of a better reference point, all drive (in various forms) vehicles that cost at least $150,000.

There are 3 levels of ICUs

• Level One
• Level Two
• Level Three

Let us examine the cost for each 12 bed ICU unit, and its accessories.

A 12 bed Level One ICU unit, which is the most basic or entry-level ICU, will have:

• 12 basic ICU beds
• 12 patient ventilators with limited options
• 24 syringe pumps
• 12 patient monitors with no invasive monitoring options
• 1 crash cart with a defibrillator and airway accessories & a blood gas point of care analyser.

Cost of each ICU bed at this level?

$50,000 or UGX 185 million. A basic Land Cruiser TX 2019 minus the taxes.

So, for a 12-bed unit, we need $600,000 or UGX 2.22 billion. Pocket change for those buying property in Munyonyo or Kololo. And only about 6 ministers not having vehicles, anyway.

Next, is Level 2. Here, we are becoming more advanced in providing tertiary care.

A 12 bed Level 2 ICU will have;

• 12 intermediate ICU beds
• 12 patient ventilators with full options
• 48 syringe pumps
• 12 patient monitors with 2 invasive monitoring options
• 1 crash cart with a defibrillator and airway accessories
• 2 Dialysis machines

Cost of all these per bed?

Only $100,000 per bed with all those accessories. That is the approximate cost of a Land Cruiser TX 2019 Model without any frills. Only $1.2million. About UGX 4.44 billion. About all the vehicles allegedly given to Kenzo, Bebe Cool, Full Figure, Kusasira and an additional 8 ministers, who can afford their own, anyway.

Next, is Level 3. A country with a sizeable number of old officials would want to have a significant number of its ICU units being Level 3. What is required here?

A 12 bed Level 3 ICU will have

• 12 advanced ICU beds
• 12 patient ventilators with full options
• 48 syringe pumps
• 12 feeding pumps
• 12 patient monitors with 2 invasive monitoring options and cardiac output monitoring
• 1 crash cart with a defibrillator and airway accessories
• Bronchoscope machine
• 3 CRRT Dialysis machines to do both kidney, and liver dialysis
• Extra Corporeal Membranous Oxygenation
• Brain dialysis, etc

This is where we expect the most severe cases to go.

Cost? $150,000 per bed. UGX 555 million. A normal house in Najjeera.

Total cost of a 12 bed Level 3 is $1.8m. About UGX 6.7billion.

Lubowa Hospital will cost $397m. It will probably add a few dozen ICU beds.

If that money was to establish Level 3 ICUs in Uganda, we would have 220 Level 3 ICU units (note that a unit is 12 beds, as you may have realized if you have read this far, which you should if you are interested in your well-being) or 2,640 Level 3 ICU beds.

Uganda has about 48,900 hospital beds in its 6,900+ health centres, clinics and hospitals. 10% of these should be ICU beds of whatever level. That should be about 4,800 ICU beds. If Lubowa’s money was given to Ministry of Health for the purpose of establishing Level 3 ICU units, we would have 2,640 Level 3 ICU BEDS. COVID-19 wouldn’t seem so dreadful if we had such capacity.

With $397m, we would have 397 Level 2 ICU units. That would be 4,764 ICU beds! Almost close to the recommended 4,800 we should have by now as our 10% of the 48,900 we have! In case you have forgotten, we have only about 55 FUNCTIONAL ICU beds.

At Level One, $397m would ensure 661 units or 7,932 ICU beds. In all, we would be a better-off country without the tragicomedy of the furniture makers, Finasi, getting our money.

It is ironic that this COVID-19 may just be the poor man’s best lobbyist for improved health. It is also indeed an almost Robin Hood kind of justice, that the demographic over which they lord it, may after all not need the ICU beds when it strikes, but the Lords, themselves. That it nullified the option of flying out to whatever fancy hospital to get “world-class” treatment, when the money and means and human capital to get that is here, is something only God or the gods can conjure.