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Day March 10, 2009

Mulago and Nurses should be facilitated enough

Kampala International hospital, the best private hospital in Kampala

Dialysis is not a rocket scientist’s procedure.Extreme caution and great knowledge are essetial in carrying it out  though. There is nothing medical that Mulago will not do if the right personnel is trainned for the appropriate equipment/procedure. Mulago is doing well on removal of prostates, using one of the  most non invasive surgical methods(forget those bloody laporatomies for prostatectomies) I have known in modern medicine. Dr. Kagwa, who trainned in the US is a real shinning star on this one. He will do dialysis in a heart beat if the equipment is in place. Remember so much has been done with olden equipment and obsolete medications( for the west).Prioritising in health investments should not be embattled at all as health is the pivot of our lives.

On the issue of man power,according to the original plan, Mbarara University was to start and  help the  already trained allied health professionals to upgrade into medicine mostly, Medical Assistants now called Clinical officers like their compatriots in Kenya and TZ. But the plans changed when Museveni came onto the political scene. The unfinished university buildings were suddenly occupied by fresh students whom Makerere medical school could not take due to different reasons, space, level of passing etc. In a heartbeat, Cuban doctors were brought in to teach the fresh medical students. This has in the long run become a good thing, but at the same time, there has been a tremendous loss of manpower to be tapped into by not facilitating further education for people who are already in the system.

Nursing is still looked upon in Uganda and yet revered in the US. Bottom line is that the practice of medicine in general is simply based on patient care which is done by a team (forget the hard academic hassles). Many times doctors will do work that one would consider fit for a nurse and a nurse will act as a doctor in times of emergency. A case in point is airway management, say in case of an accident and someone sustains a head injury, is unconscious, bleeding from the nose and mouth  and probably through the ears(bad stuff here). Do you think a nurse at site will stand with arms akimbo saying, OK, this is a doctor’s case, may be a neurologist to see so I will not secure the  airway?

NO, unless she is in the US where legalities and red tape are the order of the day. Remember the first caesarean section was done by a midwife. She managed to save the baby but the mother died. This mentality of overlooking nursing should stop and the nurses be allowed to study more and become nurse practitioners as they do here in the US so that quality care to patients could extend to remote areas of the country as the nurse practitioners would be allowed to open up private clinics just like their colleagues in the US. I am sure they would be able to determine the types of cases and emergencies they would handle and be able to refer the rest in time.

I just remembered the Lines of patients on Rubaga Road that used to zigzag into Dr.Mumpi’s clinic. This was real madness, as one doctor or medical assistant could not accurately investigate, diagnose and treat diseases of all those many people that flocked into his clinic every day. Something has to be done by the government of Uganda to improve the quality of health care as well as improving the training standards of the medical personnel. Buying new text books, introducing high tech equipment and supplying ample sundries for practical work for the students will greatly improve our people’s health. But how will this be possible if the financial resources are wasted on non priorities like buying new presidential jets or when our people have been told not to pay graduated taxes, so that they keep in a happy state(euphoria) , happy enough not to disagree with a selfish Museveni who hates  and fears democracy?

One is tempted to  bet that the books some people used at the Albert cook Library in the 70s, the Cunninghams, the Gray’s Anatomy, Nzarubara’s book  on surgery  are still the same  volumes that  fill that beautiful library annexed to a perennially blocked private place, while the modern world is writing new books with new information almost every day! This is our Uganda and its president of 23 years.

Jenifer Biri

Ugandan resident in New York/UAH member

Uganda has got enough doctors,nurses and public healthists

On the issue of manpower, when one talks about the healthcare system doctors are on top of the pyramid and we usually think that everyone has to be seen by a doctor. Uganda has a large group of Medical assistants who are the equivalent of physician assistants in America. These medical assistants work like horses and they never get rewarded as they should. Ugandans must have heard of people who used to swear on Doctor Mumpi on Rubaga road. He had patients lining out his clinic yet he was just a medical assistant. If this group of workers is given more support and training emphasis on continuing medical  education plus being shadowed by a physician you will have your local community health center fully covered. We can train these easily and within a short period.

We also have a big supply of nurses. Unlike the past the nurses most of the nurses we have these days have finished high school, they are very bright and very hard working. I don’t see why the government of Uganda can’t come up with a nursing practitioner program. At this level if you bring back the pride of being a nurse in Uganda we can even get college graduates to join the nursing profession. You can then shift to doctors. Previously we had only Makerere hospital graduates, but now we also have Mbarara University. My guess is that we might be graduating up to 120 doctors every year. If you arrange your patient flow and change the referral system you can down the road have a large number of primary care doctors. The beauty is that you then start pushing these docs into further training and we will surely get there. We can have enough medical personnel to take care of our population.

Doctors in Mulago are very well trained, the issue though is that you can only be as good as your teacher or can only use what’s before you. Medicine is a continuous learning process that’s why a very strong continuing education unit in the ministry of health is very important. You can’t know it all, you have to study all the time, you need to be exposed to those that are better than you all the time, you must be challenged and rise to the challenge. In well developed countries you don’t only have to maintain your status but the patients will challenge you and the fear of making a mistake will cloud you all the time. We need this in Uganda.

By the way, has anyone ever figured out how efficient doctors in Uganda are? They can see patients at an imaginable rate; they diagnose in a flash and come up with treatment plans like lightening. Consultation between each other is causal, and they so often can go days without reading a medical book or magazine. Next time you visit your doctor in the states just ask him why he leaves you in the room and takes long before coming back to see you? Is he calling some one?  Checking with a colleague? Reading in a book or searching on the internet? Why are they quick to refer you to the specialist? Why can’t they read there x-rays for goodness seek? Let me know what their answers will be.

Ugandan doctors are very good doctors but in the rush to make as much money as they can, they tend to put continuing medical education on the side. We also need more specialists who have trained outside Uganda to teach our medical students.

Lastly, we have a very strong public health sector; those in public health have trained widely and have the knowledge we need on this front. Having said that, I personally think public health’s success is one of our problems. Some of the best students in my class, I mean the best have turned to public health and abandoned the practice of medicine. Public health pays. Public health has also messed up the foundation of our health system.

Eddie. MD

Ugandan Doctor based in USA

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