Karoli Ssemogerere
8 July 2009
opinion
There are many categories of persons in need of medical care. Public health is an important aspect of any healthcare system; it plays a big role in curbing the spread of communicable diseases; known in old lingua as the "killer diseases"-cholera, tuberculosis, polio, diphtheria, tetanus, yellow fever, measles. Communicable adds new diseases- malaria transmitted by mosquito bites, and the venerable HIV.
The other diseases are significant mostly because of the individual toll on the sufferer compared to the outbreak proportions associated with communicable diseases. Chronic illnesses- diabetes, cancer, asthma, hypertension, other diseases of internal organs and body systems are no less severe. Most of these are managed by hospital care. Dr Kihumuro Apuuli, public servant of many years who has occupied the big three appointments in Uganda's health service (director Mulago Hospital, director general medical services and now director general at the Uganda Aids Commission) was recently quoted in the media arguing that a shift from preventive to clinical approaches was responsible for higher HIV Aids prevalence.
This mindset in recent approaches to improving patient care and clinical medicine explains why most donors have poured money into preventive medicine ignoring the efficacy of clinical care. Resources in public hospitals are spent on diagnostic rather than curative medicine.
The State Minister for Labour, Dr Emmanuel Otaala, received bad press for physically assaulting a nurse on duty at Mulago Hospital for dereliction of duty. Dr Otaala seemed to grasp one small aspect of the problem-insolent personnel frustrated by the low quality of care they are able to provide patients. It is very common for Police patrol to pay a kitu kidogo to Mulago sentry-men to locate these nurses in medical emergencies. In Butabika Psychiatric Hospital, patients are routinely raped and exposed to HIV.
Otaala, now safely shuffled into ministerial obscurity, lost an opportunity to explain why he lost his temper; the detail why hospitals were now being feared and avoided by doctors. Sam Lyomoki, the maverick Workers MP, occasionally conducts some theatrics on behalf of underpaid medical workers but has not been able to accomplish more from Parliament as a representative of the Medical Workers Union.
On a different visit to Kalangala last month, I had to encounter an odd medical emergency. A dear friend of mine, on a long hike in the woods decided to follow me in a jump over a log, spraining her foot. The three of us on this Saturday morning expedition did not take it seriously until it became obvious that two miles on foot had only worsened the sprain and she required medical attention.
Kalangala has one of those clinics I must admit I don't take seriously. In Kampala, some of them have been glorified to the level of hospitals without even the basics required for safe hospital medical care. My middle class friends patronise them for values remotely linked to safe medicine, like privacy.
On a visit to Kololo Hospital, a celebrity--one of the musicians in town-- had been in a car accident. Access to this hospital is a narrow lane moving off a busy thoroughfare-Acacia Avenue. In the precious minutes following the celebrity's arrival to a converted grand colonial mansion, activity halted to a stop. In a medical emergency at Kololo Hospital-- nothing superior to write home about from the aging facilities in Mulago, Mengo, Nsambya etc-- there was no safe room for egress. Neither did the ward or room numbering convince me that patients could easily be located if a distress call came from one of the rooms.
Kampala's well-to-do often request to be moved to private hospitals as their medical condition deteriorates in this pursuit of privacy even though these lateral moves as in the case of high profile deaths like Brigadier Mayombo, Winnie Makumbi do not necessarily result in better outcomes.
The exit of trained professionals from medicine has heralded the healthcare of the Colonel Ramathan Kyamuleesire type, one among many high profile Ugandans- both President Museveni and Vice President Gilbert Bukenya admit to past acquiescence to some of these practices. Maybe the appointment of hardscrabble James Kakooza to the Health docket should carry widening his job docket to primary, alternative and traditional healthcare. This on its own would not be an issue if the second and third portions have not been linked to useless human sacrifice, bondage, robbery, organ and limb mutations.
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