Basic medical diagnosis entails a doctor being certain of a patient’s ailment before prescribing medication, but this has recently not been the case at Kamuzu Central Hospital (KCH) in Lilongwe where most doctors are reportedly diagnosing patients using guess work due to lack of essential equipment, Nation on Sunday can reveal.
Four medical doctors at the hospital confirmed the development in separate interviews this week that most patients at the referral hospital are being treated without investigating their ailments because the hospital’s laboratory equipment is most times not functional.
According to the doctors—who opted not to be mentioned for fear of reprisals—key diagnosis machines such as the computerised tomography (CT) scan and full blood count (FBC) machine, have not been working consistently, forcing doctors to guess patient’s ailments or ask them to seek diagnosis from other hospitals.
A CT scan detects, among others, tumors, calcifications, haemorrhage and bone trauma while the FBC is a common blood test that screens for some diseases. It confirms a diagnosis of some medical conditions, monitors a medical condition or body changes caused by medical treatment, among others.
KCH director Dr. Jonathan Ngoma admitted the hospital CT scan equipment does not function continuously and that the full blood count machine is not working.
“There is a time when they [CT scans] have to undergo preventive maintenance. During this time, they are not used. As a result, hospitals enter into service level agreements with other facilities whether government or private. There is nothing wrong with that,” he said.
Ngoma said the hospital has not been doing full blood counts because its machine has “a calibration problem”.
“The calibrators and controls are not readily available in the country. They have to be ordered specially. At the mean time, we are doing full blood counts at Baylor College within the hospital premises.
“The technicians for the FBC machine have arrived and will work on the machine and it will be up and running [soon],” he said, but did not elaborate on who pays for the use of the Baylor College facilities.
One doctor said the lack of facilities at the hospital sometimes delays assessment of patients’ ailments, adding that most doctors choose to treat people without waiting for pathology evidence.
“Most of the times doctors are just making diagnosis based on the patient’s information because the process of referring every case to other facilities is sometimes tedious,” said the doctor.
Malawi Health Equity Network executive director Martha Kwataine said it is unfortunate that KCH “has become a death trap.”
Said Kwataine: “People die while waiting for results. KCH needs a complete overhaul. We need to equip our district hospitals to have everything and then save lives. Guessing is not right; people can overdose or be given wrong treatment. Why did management have to wait until the situation reached [this level]?”
Another doctor said the regular break down of the hospital medical laboratory equipment was due to poor purchasing of material, which is usually done at the headquarters without proper consultations with the technicians that use the machines.
“The frequent breaking down of machines at the hospital is because of the willy-nilly procurement of the laboratory equipment. There is no accompanying service contract and there is lack of involvement of the people that use the equipment,” said the doctor.
On average, according to the doctor, the CT scan services 750 patients a month.
Another source at the hospital said government bought two CT scans at $2 million two years ago but only one was mounted at KCH while the other one is idle at the Ministry of Health’s Kanengo warehouse in Lilongwe. The idle machine was to be installed at Queen Elizabeth Central Hospital in Blantyre.
The ministry’s spokesperson, Henry Chimbali, said the CT scan in the warehouse is awaiting completion of a building that will house it at QECH.
Chimbali defended the ministry’s procurement process, describing it as a rigorous exercise that assesses hospital needs before procurement is done.
“Many times we consult but perhaps there could be some omissions that are observed after we have procured the equipment and we are always ready to work with the experts, and as far as we are concerned, that has worked so well on most machines,” he said, adding that the ministry is working towards ensuring that its big machines are on service contracts.