What we should know about our public medical facilities and their professionals as we face a pandemic
THE LAST WORD | Andrew M Mwenda | The corona virus is finally with us. For a large and loud section of Ugandan elites, our country should have the facilities like Intensive Care Units (ICUs) and High Dependency Units (HDUs), Organ Transplant Units (OTU) in numbers and standards we find in German, France and Italy. The gulf between these expectations and the financial, institutional and human-capital capacity of our poor nations is something that never ceases to amaze me.
For instance, on March 13, I went with singer Bebe Cool to the newly rehabilitated and refurbished Mulago Hospital. During the tour under the guidance of its indefatigable administrator, David Nuwamanya, we were shown 27 state of the art ICU beds for adults, 15 for children, two for the OTU and four for the Heart Institute bringing the total to 48 beds. The new specialised maternal and neonatal hospital at Mulago has 25 fully equipped ICU beds for adults and 47 for neonatal, giving a total of 120 ICU beds at Mulago alone.
Each ICU bed has the fittings that make an IC bed: a mechanical ventilator, a volumetric pump, a defibrillator, a feeding pump, infusion pump, a patient warmer and a patient monitor. More interestingly, in the main wards, all the beds have a supply of oxygen, vacuum and medical air. This means each ward can act as a High Dependency Unit (HDU) to support a patient on high dependency. We visited its radiography department and saw the advanced X-rays they have installed, the MRI and CT Scans and were impressed.
For a poor country like Uganda with a per capita income of $830 dollars (or $2,500 in Purchasing Power Parity), this was encouraging. Indeed, to break this down, Uganda has revenue per person of $120, public spending per person of $190 and health spending per person of $16. This level of poverty does not predict the quality of our facilities and caliber of our doctors. We are punching far above our wallet. Yet many people think our medical services have fallen apart. In fact I had taken Bebe Cool to use his celebrity status to bring awareness to the public about the medical facilities our country has and the efforts of government and many people to make Uganda a better country in serving her citizens.
Over the last two years, I have visited many of our medical facilities and I have been impressed. At the Cancer Institute at Mulago, I was impressed by the investments government has done in infrastructure, equipment, drugs and training of the staff (all of which are overwhelmed) under the great leadership of Dr. Jackson Orem. At the Heart Institute at Mulago, led by the able Dr. John Omagino, I was inspired by the facilities and skills our country has accumulated and heard great stories of those whose lives have been saved.
Foreign Affairs Minister Sam Kutesa (middle) being shown the new equipment donated by India at the cancer institute recently
One of the enduring stories of Mulago, which made me pick a deep interest in the hospital, was my visit there on September 7, 2018. I met a brain surgeon called Dr. Michael Muhumuza who had conducted ten brain surgeries the previous two days; some of them when patients were awake. Staff told me of the story of a man whose skull had been crushed in a motor accident and the brains were oozing out of his head. Muhumuza reconstructed the man’s skull, put the brains back and the man fully recovered even though some functions of his brain, like aspects of his memory, could not recover because some brain parts remained on the road.
It sounded like a science fiction movie and I looked for the patient and interviewed him. This was a major turning point for me. I had no idea our country had such specialists at Mulago and the ability to perform highly complex surgeries. I cannot name all the great doctors I have met at Mulago but Emmy Okello, Elias Sebatta, Cephas Mijumbi and Peter Lwabi at the Heart Institute; Abraham Omoding and his colleagues at the Cancer Institute truly inspired me. I can even volunteer to work at Mulago, even as a cleaner, to be in the company of these great men and women.
These doctors and nurses work under cases of poor pay and scarcity of equipment and drugs, yet remain motivated and hardworking. They tend to the sick, the dying and the dead. I asked them what it is that motivates them to get out of bed everyday and go do such great and heroic things, even when our government and chattering elites on social media do not recognise their efforts. The answer is everywhere similar: we get satisfaction from saving lives; the people we treat appreciate our work.
For many years I behaved like many other Ugandan elites, assuming that the problems in our medical services are because government does not care. The more I began dealing with officials of government who make decisions and implement policy, studied our budget and compared with the budgets of the countries we reference ourselves with, the more I realised that I was living in dreamland. The fundamental problem of Uganda is poverty, not the selfishness, greed, corruption and malevolence of our public officials as Western (and African) scholarship and journalism claim.
There is no doubt that the rich and powerful abuse office, and critics are right to point this out. There are many and clear cases of poor deployment of public resources often because some corrupt person is pursuing a selfish ambition over our collective good. Yet this is not the dominant aspect of public service in Uganda. I am also aware that we cannot end such abuses. The aim of criticism is to moderate it. There is no country where such abuse is absent; the differences being in degree on detail but not in substance.
In any case, it is natural that the rich and powerful will always get a pass. If the privileges of the president and those of the homeless were similar, few would seek the presidency. People do not seek powerful and influential positions in government to be like everyone else. The rich will have better access to decision making than the poor. I take it for granted that the powerful will always live better. My appreciation of the good things about Uganda is not blindness to its weaknesses but acknowledgment of reality. As we fight the corona virus, let us also celebrate our medical professionals, recognising that they are our heroes.
(This week’s THE INDEPENDENT #CoronaVirus special edition is online-only and available to all our readers. . Read the other articles in the magazine here –click)