The real issues with healthcare in Uganda

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“Student dies during tooth extraction in Iganga. Electric shock used as anaesthesia!” – read a status on one of my associate friends off a social web page.  My initial take was to laugh at the black humour of the statement but just as I laughed I also started to get quite angry at myself.  This was manslaughter down to medical negligence and a parent(s), sibling(s) was mourning the life lost…

Not long earlier on in the day I had read yet another status comment on the deplorable situation of patients in another hospital in another part of Uganda’s hospitals – Mengo.  This was talking about the suffering of TB patients amongst all else…The comments which followed on to that statement left me sick to my stomach at how low human life is graded and to question how persons have come to loose empathy for others to such an extent where they make such callous remarks in the face of real suffering.  Such comments are not restricted to persons in cyber space who most often use pseudo-names to hide their identities in order not to be held accountable for what they type.

Such comments I’ve often heard healthcare workers on ground speak openly on my walkabouts whilst in Uganda.   For instance it is not unusual for a labouring woman in the throes of giving birth to have one hand holding on to a packet of cash (in what should be a free hospital) that will ensure the midwives around give her the attention she requires.  Without this, the woman better pray she has no complications that would hinder her giving birth naturally without much assistance from the so-called professional medical staff present.  On occasion, I’ve witnessed trauma victims arrive at the national hospital (Mulago) and if lacking in private funds, not get seen by a medical officer until almost a day following their admission- at which point, they are critical or dead.  It would appear to be an accepted fact amongst a great deal of the public that if one is taken to Mulago – it is like signing their death warrant.  And as the comments reflected on the posting made by someone passing through a TB ward found out, the general take is “…so what if they die – would they be the first to go? Or such as “…they die –make way for others to live, after all, there’s too many of us around anyway!” are often common retorts.  Empathy is definitely not something some health professionals keep in their brief.  It is little wonder that one 45yr old cancer suffer (Joshua Kato) decided to end his life at Mulago after being frustrated by all he saw around him in late September of this year!

Returning back to my opening and for those not familiar, Iganga is a rural town in eastern Uganda.   Of recent this sub-county has also made headlines far reaching internationally albeit not for good news, but for the re-emergence of an infestation of jiggers .  The irony of this is that when the story first broke out nationally, as has been the norm, plenty of well-to-do or seemingly educated individuals tried to hush it up as they saw it as an embarrassment whilst others blamed the sufferers for what they saw as deserved results of their (sufferers) ignorance or stupidity.  However, by bringing such an issue to the foe and perhaps also because of the current presidential elections that are taking afoot and are at a fever pitch, government officials were forced to act.  Whatever their motives, I for one I’m glad that at long last such health issues as these which affect the everyday person on ground more than what the cabinet ministers demand for four wheel drives etc… for whatever else their priority in being elected to office is.

Now the student that died whilst having dental treatment brings yet another long-term problem within the healthcare system in Uganda observed on many of my trips over there.  Malpractice, albeit now starting to be addressed, ( 5 medics arrested over illegal practice) has been prevalent in most government run institutions across the board.  However this is not to say private-run clinics too are safe havens!  I once had to deal with a nephew of mine who had the tip of his finger cut off by a bogus nurse at a privately operated clinic simply because she thought it would cure the abscess that had developed.  She realised what she’d done and made a run for it before any investigations or charges could be made.  Sadly – my guess is that this nurse went to set up shop in another area where her past was not known…This kind of thing happens most of the time because there are no regulatory laws in place for healthcare workers to be monitored or even held on registration and accountability. Hence you get someone who may have been a porter in hospital for a brief spell setting up a clinic and claiming to be a doctor or a nurse prescribing and treating persons or should I say, murdering them.

Also if regulations were to be set up, chances are pretty high, corruption would eat in to the system, however this is not to say regulations wouldn’t be welcomed as a starting point of a legal framework at least.  It starts from the very top of governance where the big cats siphon off large shares of what is allocated, and it spreads out like a virus to the small cats.  The practice of corruption of this nature has been ignored for decades by a succession of governance – only to be touched upon in political rhetoric during electioneering by the incumbent government officials who no sooner than the vote is cast go back to business as usual. There are many challenges still to overcome on a lot of levels.

Corruption and poor governance are both a cause of poverty and a barrier to overcoming it. Poor governance undermines poverty alleviation efforts and increases the risk that funds intended for social spending are lost, misused, or misallocated. Where transparency and accountability mechanisms are weak or lacking, the needs of the poor are marginalised and development outcomes in basic service sectors such as education, health, and water suffer. Systems of checks and balances, including civil society monitoring, need to be strengthened to reduce such abuses of power and diversion of funds for private interest.

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