Perhaps it has something to do with the lack of, and ineffectiveness of, regulatory bodies. Perhaps the training at many Universities is below par. Perhaps it is due to the everyday Ugandan’s powerlessness and incapability of demanding and knowing their rights. Or perhaps it is the simple truth that money-motivated-medicine around the world always seems to behave badly. I’m not sure why it is the way it is – I will not presume to give an opinion on a complex issue I know almost nothing about.
What am I talking about?
Poor quality medical services – in this case the private system – in Uganda.*
The public system in many developing countries has a lot to be desired, and a thousand reasons why this is so. But the private system? The system with money and drugs and equipment and trained staff on good salaries?
I wanted to share a simple story of something that happened the other day that left me bewildered. Before I share my experience, let me first say that there are many intelligent, professional, trustworthy doctors in Uganda who practice very good medicine. Unfortunately, they are not by any stretch of the imagination the majority.
Michael and I stayed with our family in Kampala for a few days last week. One night, our brother Pete (who’s a year older than me) staggered through the door complaining of a severe headache that he’d had most of the day. It had come on suddenly. After a heap of questions, Michael was convinced it was a migraine and all the symptoms pointed to this – whatever the case, we decided to take him to the Gensi’s family doctor, a private middle-class clinic a block from our place where he could get some fluids and painkillers. We (Michael, me, and Margaret, our mum) loaded Pete into our car to take him. It was peak hour, and so we sat impatiently waiting in traffic even though the clinic was literally around the corner, as Pete moaned and threatened to vomit in the car. Eventually, Margaret had had enough. She instructed Michael to put on his hazard lights, ordered him to drive on the wrong side of the road, abruptly jumped out of the car and starting stubbornly walking into the oncoming traffic (have I mentioned before that you don’t mess with Bakiga women?) as Michael eased his way past the jam on the wrong side of the road ignoring the glares from passing vehicles. Her display of motherly love was quite astounding, but I didn’t know whether to laugh at the situation or hide from angry faces in the vehicles that Margaret had forced to the side of the road.
Arriving at the clinic, a small building with a consulting room, a lab and a few rooms with beds, we found the doctor reading his newspaper. After getting his attention, he took a very short history from Pete – like 2 questions. Pete was convinced it was a migraine and not malaria; after all he had had malaria dozens of times in his life and knew what it felt like. Clearly though the doctor felt he had gathered the info he needed and had had enough of interacting with his patient, because at that point he wrote some things on a piece of paper, ordered a blood test, and told us to wait. There was no explanation given. Pete, in the meantime, was struggling to stay on his chair due to the pain.
After a few requests from Michael, they led him to a room with a bed in it, and shortly after a nurse came in. They apparently had the results of the blood tests back, although no staff mentioned this. She came loaded with several injections and ordered Pete to remain still as she jabbed him several times. He had no idea what the diagnosis was. No conversation with the doctor. No idea what treatment he was getting. No permission was sought to administer the drugs.
Pete was still dehydrated so Michael requested they get a drip into him. Reluctantly, they agreed. The headache had lasted a long time, so Michael also checked for signs of bleeding on the brain. Something they had also not bothered to do.
In the meantime, we were all curious to know what was happening, and what the diagnosis was. (These patients and their demands, how annoying…) Margaret went to find the doctor, who informed her that Pete had a bacterial infection. No further explanation.
Eventually, we found out what they treated him with. The list is as follows:
- 1 shot of malaria treatment
- 1 shot of anti-nausea
- 2 shots of extremely heavy duty antibiotics
- 1 shot of an anti-inflammatory (this one was actually for the migraine and very helpful)
- 1 drip of glucose (used in patients with malaria), not helpful for rehydration
By this stage Michael was a little confused. He was convinced that all Pete had was a migraine, and he needed fluids and rest. So he asked the nurse to show him the lab results.
It turned out that Pete tested negative for malaria and negative for any bacterial infection. His white blood cell count was within the normal range.
After several hours, when he had slept and was feeling better, they discharged him and he came home. However, not without being told he would need to come back for the next three days, to have more anti-malarial and antibiotic injections. Up to this point, they had not mentioned money, but Pete was dreading the cost. From past experience, Pete estimated it would be around 300,000UGX (A$150) or possibly more. That is big money in Uganda.
Now, I’m not a doctor. I have not been through medical school. But being married to a GP – wait – even visiting a GP on many occasions in Australia would have made me more equipped to deal with this situation than the doctor who saw Pete. Here’s ‘Kim’s General Practice Medicine 1-0-1’.
Lesson 1: Talk to your patient, gather a comprehensive history, think of all possible causes (not just malaria because it’s an easy diagnosis).
Lesson 2: Once you have a diagnosis, communicate this to your patient.
Lesson 3: Make sure your diagnosis is based on facts/lab tests/at least some semblance of science and NOT based on the fact that you can charge more money for medication if its malaria or infection (or both?!), which it clearly was not. If in doubt, run the tests again.
Lesson 4: If you are going to administer drugs, explain the diagnosis and medications to the patient and SEEK his permission to administer them. Again, communication is key! In Australia we call administering drugs without permission ‘assault.’
Lesson 5: Do not treat your patient for diseases he doesn’t have, so that you continue the spiral of malarial and antibiotic resistance that are out of control in places like Uganda where drugs are not regulated well.
Lesson 6: Don’t be a money-hungry incompetent idiot.
Thus endeth my rant for today.
*By the way, I don’t deliberately mean to exclude some of the terrible displays of medicine practiced in Australia – by a wide range of doctors. Statistics show that the average private surgeon in Australia will operate many more times than necessary if there is a bit of money to be made and some fun to be had – often to the detriment of the patient.