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



2 Comments so far. Leave a comment below.
  1. 3TOC,

    The reason why the doctors in the States will consult a book, or leave the room is mostly down to litigation.It more they are covering their backs.

    I do agree that Uganda has well trained medical staff. However I can see why doctors/nurses/health care professionals would put off investing in continued profession development – no-one invests in them.Their pay is dire, the doctors village at Mulago is a village, they are paid late.Yes, we take the Hippocratic oath but people’s families do not eat the Hippocratic oath. That is why many of these health care professions either hurry up and leave the country in search of both a better continued-education or a better pay for less work.

    It is a tough call because the medical team owe it to the patients to have the patients best interest at heart but it is kind of hard to sleep in a house with a broken window when the money for malaria tablets bought family holidays!

    Tough call but I do agree Uganda’s medical staff can be brilliant.

  2. Florence,

    Doctors in Uganda are very well trained, that is why they can leave Uganda and work in any country of the world, and they are valued over there for their technical expertise. The challenge is remuneration, all service providers, doctors, nurses, teachers, police, and even the army are not paid a living wage. That is why doctors and nurses rush the civil service job to go work in private clinics, that is why they remain in the bigger towns, that is where the private money is. A doctor setting up a private clinic in a rural area would still not be able to make ends meet. That is also why there is internal brain drain, from the general clinical care services, to the HIV AIDS projects, where the money is.
    Uganda’s health care service is already decentralised, we are already training Village Health Teams to provide services at the village level, we have levels of care above from Health Center I to Health Center IV and then Hospitals, with increasing complexity of care provided. The challenge is the support to the referral system, ambulances are driving the Med sups up and down on private business since remuneration is so poor he/she cannot afford the personal car and fuel. I believe the Ministry of Health is making a real effort to get services to the people, the challenge is underfunding of health, look at the health budget, how much comes in from GoU sources and how much is donor funds? And donor funds often are for the AIDS projects, so they do support or strengthen systems.
    We have three medical schools, Mbarara, Makerere and Gulu and graduates from all three schools are excellent. We are already training graduate nurses, we also train Comprehensive nurses, who are able to prescribe, we still have all kinds of specialisations in the Clinical Officer cadres, such as psychiatric, opthalmic, general, orthopedic, etc.
    My feeling is that at policy level, the Ministry of Health has the best intention, but it is impossible to implement without the financing.

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