On Mulago -what your politicians do not tell Ugandans and why the seek their healthcare overseas.

Posted on June 5, 2011

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authored by Ddembe on 3. January 2010 at 04:35
 
A pharmacists role has never been to prescribe but to dispense of a prescription by a doctor. Given the lack of personnel in both, and calculating the cost-benefit ratio, some drugs have been given OTC, others are still restricted. But walking into any pharmacy one may even get narcotic drugs without prescription, as the only consideration of these drug shops cum pharmacies is commercial.
 
Am not sure why you got the impression I may not know the role of a pharmacist. Without really going into details, I actually have a very intimate detail of the role of a pharmacist as well as the training and work conditions of doctors in Makerere. And if you were a privately sponsored medical student, you have me to thank for that. Once upon a time it was possible for a Kenyan or Indian to have that priviledge but not for a Ugandan! Again I will not go into details. I have discussed medical training in Mulago with an external examiner and have been to the units myself and spoken to clinical and academic staff.
 
I will not go into details of training at Mulago except to note that some of the units you mention are very uni dimensional i.e HIV with plenty of duplication! I do not see the role of multiple research organisations that all do the same job -ie research HIV but that is a debate for another day! I see a lot of redundancy and duplication in having Baylor, John Hopkins, Case western, UCLA, IDU all struggling for a piece of the same hill doing the same thing!
 
It is common for people to say as you do that there is nothing wrong with medical training at Makerere without qualifying their statement! I say there is and will qualify mine even withoyt touching the big elephant of ethics. I would also like to see the benefits of those facilities percolating directly to the medical units in Mulago. The issue of subspecialty training is one that again would require a different discussion and probably a different forum. The reality is that specialty training is stunted at the specialty level with little development of subspecialty training except infectious diseases with an emphasis on HIV. Here am talking of nephrology including dialysis both haemodialysis and peritoneal, transplant (matched related, matched unrelated and cadaveric) and , neurology including interventional, stroke, EEG/EMG, cardiology including desk, echo, interventional and percutaneous technics for valvuloplasty, angiography and angioplasty, transplant, critical and coronary care), radiology including neuroradiology, interventional, diagnostic (CT, plain, MRI and ultrasound), gastroenterology including endoscopy, endoscopic ultrasound, hepatology, transplant, endocrinology including sexual and reproductive, diabetes, osteoporosis and bone densitometry, endocrine physiology, oncology including medical oncology, radiation oncology, haemato oncology, specialised diagnostic and interventional radiology in oncology, and surgical oncology including specialised breast, gynaecology, colorectal and liver, paediatric neurosurgery and solid tumour/sarcoma surgeons, endocrine surgeons, nuclear medicine including radioisotope diagnostic imaging and PET scan, rheumatology including competence in new biological agents, respiratory including desk, bronchoscopy and biopsy, bronchoscopic ultrasound and laser treatment, CF, transplant, critical care including ICU, neuro HDU, surgical HDU, immunology, respiratory HDU, medical HDU, geriatric medicine including rehabilitation for stroke, orthogeriatrics, and general as well as ambulant clinics for memory, continence, general geriatric, internal medicine including acute and sub acute care, laboratory including specialised and subspecialised pathology services haematology, immunology etc. we could go on forever but am sure you get the point.
 
The only research organisations in Mulago are single issue HIV/AIDS research based units set up by donors mainly for donors because mulago is a place they can accumulate patients most rapidly in comparison to their own units. The management given to out patients in these units while good is not in general integrated into Mulago the hospital leading to duplication. Show me your respiratory, cardiology, Diabetes, nephrology, Cancer, Malaria and other “neglected diseases” research institutes at mulago!
 
The range of subspecialties offered in Mulago for a tertiary national referral and research facility with the pedigree of being the second oldest medical school in Africa stopped in 1972 while the rest of the world including Nairobi and Dar medical schools that were started by Makerere graduates have moved on! The clinical training facilites and available supervision remains limited too. There is no formal subspecialty training beyond general specialisation in general and surgical including gynae and paeds as well as radiology! Subspecialists were available are underutilised and many subspecialties are run by general physicains with little formal or even informal training in those specialties!
 
While Mulago does not have to have the full range of available specialties and subspecialties, as a national referral and teaching hospital, one would expect it to at least be on par with the rest of the region! Rwanda is now the destination for our specialists while we continue to refer patients to Nairobi, South Africa and India for things we could do 30 years ago but have lost the skills or been left behind!
 
Show me the specialists in these fields and put that in context of a population of over 30 million! Show me the training programs other than M.Med and the Infectious diseases fellowships from Baylor and IDU. Show me the subspecialty departments in our “centre of excellence” and national training facility. Show me the scholarships for clinical training NOT public health which almost every second doctor has done! There are more PH qualified doctors than clinicians -all lost to the clinical ranks and you believe there is no problem? More managers than clinicians but continuing chaos! More workshops and white papers are produced by the MOH but no follow up!
 
Part of the problem is funding but some of these things are not funding but organisation! Between inept politicians who are little better than goat herds in suits and public health managers and administrators like yourself (please do not take this personally) who left the clinical ranks at a junior internship stage, the myth continues to be propagated that Mulago is fine -until some hot shot politician like Mayombo dies from a very treatable problem then instead of fixing the problems, the same politicians clamour for the right to be airlifted at taxpayer expense to South Africa where THEY have developed these skills!! Coupled with a lack of exposure because our students are not encouraged or funded to do electives overseas or even in neighbouring countries, we continue to produce an inbred population of health managers whose own range of exposure is limited advising the paesants in suits that “everything is fine and there is nothing wrong with our range of clinical skills”!
 
In the meantime frustrated clinicians with ambition vote with their feet to the benefit of Rwanda, Kenya, Tanzania, South Africa, Europe, the middle east, America and Australia where they get not only better pay but MORE satisfying working and training conditions as well as the chance to develop their subspecialty skills.
 
To me what galls me the most is the fact that we lose clinicians to Rwanda!!! Three friends of mine all dedicated specialists have moved to Rwanda in the last few months! What has Rwanda got that Ugandan cannot afford its own doctors! Someone in Uganda’s health administration really has their head up their own backside!!!
 
Disclaimer: Please note that none of this is personal and that I have nothing but the utmost respect for clinicians who continue to work in Mulago!

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