I have railed against the terrible medical provision in Uganda two times already. This time I am going to try to delve into some of the reasons for the rot.
The state of Uganda’s hospitals is so dire that the president, his ministers and most of their relatives now routinely travel out of the country, at taxpayers’ expense, to have their medical check-ups and procedures done by doctors who still have adequate training.
Only recently, it was disclosed that top government officials have been running up bills of Uganda Shillings 380 billion ($150m) per year for years on their own personal medical expenses abroad. That money is about the same amount (Shs397.31 billion) provided by donors to plug the gap in the country’s annual Shs985.5 billion health budget which is intended to cater for more than 33 million people.
Given that level of selfishness among Uganda’s top government honchos, it is little wonder that hardly anyone else cares about the patients. Once you are admitted to hospital, public or fee-paying, you find a stark picture of little to no care, arrogant practices and even downright criminal actions perpetrated by nurses and doctors.
How have things gotten so bad?
In Uganda they stopped teaching medicine to nurses in the 1970s. It’s not unusual to hear of ones who graduate to go and tend to patients when they don’t even know the ABC of resuscitation. The nurses’ tender, loving, care (TLC) stopped showing up with them on the wards in the 1980s and now they rudely demand payment for medical services they have no idea how to dispense before they check whether the patient has any pulse.
It is, terrifyingly, quite true that Uganda’s hospitals today are manned by a lot of heartless Rosa Klebbs who study to be nurses because they have failed at everything else, including basic maths and science; who only bother to show up on the hospital ward in order to fleece the sick and dying of their last pieces of silver and dignity. It’s amazing that most Ugandan nurses don’t carry whips given their disinterest in their profession and total disregard for patients. The ones who care are soon overwhelmed by the workload and stop trying or they leave the profession all together.
The doctors are no better. First of all, you don’t want to be touched by any doctor younger than 40 in Uganda unless they have received additional training in a reputable medical facility abroad. The reason for this is that the doctors who have been churned out from Uganda’s medical schools over the last 25 years studied at a time when students routinely stole exams, forged transcripts, bribed examiners, paid mercenaries to sit exams for them. The rest were taught in moribund facilities, using outdated practices, by distracted lecturers.
It is, for instance, not unheard of for a high school student to completely fail his Advanced Level (equivalent of 12th grade in the US and Year 12 in the UK) exams and then end up reading medicine at university with his results certificate showing that he passed high school with flying colors. Students forge pass slips, bribe teachers, who in turn collude with examiners, who in turn connive with ministry officials to do all sorts of unscrupulous things to manipulate results in favor of the payer. Most disturbingly, you will find a lot of Ugandans who show admiration for the student’s “creativity” when such ethical transgressions are uncovered. The amorality is as astonishing as it is disturbing.
I have had friends get emergency mastectomy operations in South Africa two weeks after being given an all clear and being told to return in a year’s time by Ugandan doctors. Others have received an all clear in London two weeks after being told they needed to start chemotherapy by their Ugandan doctor. Chemotherapy is dispensed as liberally as antibiotics and “drips.” If the doctor (without consultation) diagnoses cancer, the treatment must be chemotherapy. Any pains and aches you are prescribed antibiotics. For everything else, including fatigue, malnutrition, diarrhoea, malaria, a high temperature, don’t be surprised if you are put on a drip at whatever stage in your illness when you visit the medical center.
I know of a friend’s father who continued bleeding over 12 hours following an operation at Uganda’s foremost referral hospital. The duty nurse told the relatives that she couldn’t do anything until the ‘specialist’ doctor returned. The junior doctor on duty also insisted that it would be treading on another doctor’s territory to intervene. “Just change the bed sheets if he is bleeding too much” the nurse dismissively told them. The man died in the morning before his ‘specialist’ had returned to tend to him.
Another friend told me about a gall stone operation she had in a private hospital only for her stomach to continue swelling and the pain to get totally out of hand following the procedure. “Post operative trauma” the doctor who had worked on her kept on saying.”It will subside,” he insisted, handing her yet more pain killers. When she hadn’t improved after three weeks, her relatives pooled together and flew her to South Africa. There they discovered that she still had the gall stones and removed them, plus a bucket-load of fluid which was what had distended her tummy so. She was well enough to walk around the same afternoon.
The [very, very expensive] private hospitals might look swanky and welcoming but the medical personnel who work in them suffer from the same poor training, flippancy about human life, disinterest, negligence, arrogance and languidness that you find in government institutions. In any case, the same doctors assigned to public hospitals are the same ones moonlighting in private, fee-paying, ones. So, you also have issues with doctors being overworked, tired and incapable of keeping their focus because they work in too many places in order to make ends meet. Those are the doctors who have not deserted the country for better pay and working conditions elsewhere in the world.
As a professional recruiter, some years ago, I interviewed nurses for theater nurse positions whose CVs showed that they had been in the profession for 11 years but who couldn’t tell you, even when they were prompted, the basic procedures to go through before wheeling a patient into the operating room.
“Nodding disease is not an issue for State House. That falls under Ministry of Health and disaster preparedness. Those MPs who are complaining about President’s expenditure should stop advancing peasantry arguments. State House has not grabbed any money for health and they should stop inciting the public,” he said yesterday. “They should drop that peasantry mentality and think like legislators. They need to be helped to think in a modern way.” Tamale Mirundi, the president’s spokesman, defending the president’s demand for 92bn/= in supplementary spending while the victims of nodding disease in Northern Uganda got nothing.
My adopted son was operated for a hernia in a renowned Muslim hospital in Kampala in December 2008, and then collapsed again two months later due to the same problem. That is when we discovered that the first time he had been cut up and sewn back again by a ‘doctor’ who didn’t know what he was doing. The operation had to be redone on a Sunday evening else the boy wouldn’t have seen the light of the next day. I have also experienced the negligence and incompetence first hand. The horror stories are too many and too consistent for anyone but the most obtuse to draw any other conclusion.
Uganda’s medical professionalism, the quality of patient care and adherence to best practice don’t meet the basic, minimum, standards you might expect for a dog in Western Europe or the Americas.
Medical doctors in Uganda don’t consult with each other, likely because they are too egotistic to seek a second opinion. So, even experienced doctors let patients down because they rely on their singular conclusions even in the most serious of cases. The incidences of doctors admitting to distraught relatives that they don’t know how or why a patient died in their care are too many to enumerate. In Uganda, doctors still make such damning admissions because they know there are no consequences for doing so.
Yet the public trust in the doctors remains high – how could it not be when the study of medicine is still seen as a domain only for the most intelligent people on earth, and doctors routinely lecture patients and their relatives about how they are the professionals? If you dare ask a doctor why he/she is recommending whatever treatment, you will likely get the response “because I am the doctor,” that is if you get any response at all. The nurses will ignore you if you are difficult and I have even heard of shocking tales of malice, such as deliberately administering overdoses or the wrong medication, if a patient asks ‘impertinent’ questions.
It was with the reality of their mother being mistreated in mind that the relatives of a friend of mine, who had flown in following her mother’s stroke and started asking questions of the nurses, implored her to leave well alone despite being a nurse herself. “We are the ones who are going to remain with the trouble once you get on the plane and return to the US” they beseeched her. In order to keep the peace with her relatives, she had to suppress every instinct in her body that was screaming at her that the medical provision her mother was receiving was medieval. She got back on the plane resigned in the knowledge that she would never see her beloved mother alive again. Surely enough, her mother never recovered from the stroke she’d suffered.