Should medical fatalities affect new hospital construction?

The world over is grappling with the rise in chronic non-infectious diseases. The so-called lifestyle diseases that account for the biggest number of deaths. The list is long - heart disease, respiratory illnesses, including asthma, lung disease, diabetes and Alzheimer’s and dementia. Tuberculosis appears on this list because it is associated with HIV-related infection. Last on the list is liver disease, including disease caused by hepatitis infection, which present in many HIV patients.
There is another category of disease, eye disease with varying environmental causes. Diabetes may be misplaced here because it is both hereditary disease associated with certain blood types and genes.
In Uganda, historically, all the big 10 were the preserve of the national healthcare system, Mulago at the apex and specialists posted to regional hospitals. Physical treatment and management of conditions like cancer was never a business for private clinics. Treatment of HIV-related complications also had a national approach, but chronic forms were directed into the national system. The Cancer Institute and Heart Institute both housed in Mulago are relevant elevations of treatment of the biggest killers on the list. More people die of heart disease than cancer, and the two account for half of the conditions on the list.
Most chronic diseases, if not treated early or if they present in weaker patients with higher risk factors, inevitably result in death. Some of the new killers in Uganda like dementia have the ability to strike younger patients and last a long time without any known cure. Conditions like TB are treatable while liver cirrhosis rarely has good outcomes.
In our healthcare system, due to a breakdown in centralised health management, members of the public first confront the system when their loved ones fall sick. We fail to confront these basic facts upfront that a system growing in a vegetative state, in terms of inputs, personnel cannot handle our beloved patient. Each of these killer diseases carry great treatment cost.
Very often doctors treat “symptoms” using a combination of “guess medication” handling side effects like inflammation, for example, with steroids which may have worse side effects. Anyone who has lost someone to cancer knows the inevitable slide as the disease progresses with chemotherapy and radiation depriving the body of strength, exhausting the cells. Medical advances can pinpoint how far the disease has progressed as it goes through clear and distinct stages.
What have we learnt from all of this? It is a sad fact that folks faced with such conditions are the most vulnerable because they are desperate. The way we have treated the doctors armed with all this diagnostic and palliative information has put the cost of being attended to by the best humiliating them with low pay has driven the best talent out of the profession. But it has also led to the rise to another category of practice that takes financial advantage of patients with terminal diseases.
Very few Ugandans have a regular primary care doctor, whom they see regularly. Most of the healthy ones are afraid of hospitals where they shudder at the risk of getting unnecessary infections. Yes a few non-essential procedures have a high fatality rate. But some decisions have to be made. Primary care detects some of these conditions early and must be made mandatory. Government already spends billions of shillings shipping essential drugs all over the country without requiring mandatory attendance.
There is also a need to regulate private medical care that deals with the big 10. Very few doctors are invested with the resources to acquire the equipment and resources to treat these, which should be in an organised national health network. Just like clinics should not be entrusted with lethal drugs, which can be abused like vaccines to great effect. The story of Ugandans dying in big “living rooms” called private hospitals needs to be addressed, urgently.

Mr Ssemogerere is an Attorney-at-Law and an Advocate. [email protected]