Tuesday May 15 2018

Importing Cuban doctors is an excellent measure



Muniini K Mulera

Muniini K Mulera 

By Muniini K Mulera

Dear Tingasiga;
It is good that the government is planning to import Cuban doctors to serve Ugandan patients. Partisan politics and reasonable demands by Ugandan physicians for better pay should not cloud the wisdom of sourcing doctors from any country that is willing to help ease Uganda’s critical shortage of these professionals.

Whereas the World Health Organisation recommends a doctor to population ratio of 1:1,000, Uganda’s ratio is 1:24,725. Expressed differently, Uganda has 0.1 doctors for every 1,000 people. Most African countries, including South Africa, fall below the WHO standard.
On the other hand, Cuba has one of the highest ratios. Its ratio of 6.72 to 1,000 is only exceeded by Monaco with 7.17 to 1,000 and Qatar, which has 7.7 to 1,000. To put Cuba’s relative abundance of doctors in perspective, Canada’s ratio is only 2.7 to 1,000 and the USA has 2.5 to 1,000. One notes in passing that India, the choice destination for sick well-off or well-connected Africans, has only 0.8 doctors per 1,000 people.

Cuba’s physician supply is not only numerically impressive, but by all accounts, offers high quality service in a relatively under-resourced environment. They are probably more likely to adapt easily to the Ugandan medical practice environment than their counterparts from say, Canada, UK, USA or even China.
The government’s effort to address Uganda’s severe doctor shortage by bringing in Cubans is, therefore, welcome and should be encouraged by anyone who wishes our people well.

To support this measure is not a repudiation of the struggles of Ugandan doctors, who truly deserve, at a minimum, the same remuneration that is proposed for their Cuban colleagues. The confrontational approach that the Ugandan President and his ministers have adopted towards Ugandan doctors is unhelpful, counterproductive and awfully short-sighted.
The central drivers of Uganda’s healthcare service should be the Ugandan-trained physicians, not the imports. The notion that foreign-trained doctors are somehow better than the home-made variety is false.

Indeed, even graduates of Ugandan medical schools, who have spent long stretches of their careers in developed countries, need to be guided and re-educated by their colleagues who have had recent experience in Uganda.
I know one example of a Makerere Medical School graduate, who would definitely need a long period of re-education and re-orientation, before gaining the confidence to practice his specialty in Uganda.
I have spent 37 years learning, teaching and practicing paediatric medicine in Canada. My knowledge and skills are tuned to childhood medical problems in a very advanced society, one with an abundance of technological devices that we heavily depend on for diagnosis and/or treatment of serious illnesses.

I would sweat rivers if I was shipped off to Bundibugyo or even Mulago Hospital without a period of clinical orientation under the supervision of locally-based paediatricians. Indeed, if I applied to practice paediatric medicine in Uganda, it would be wise to subject me to a probationary period, followed by a rigorous examination before according me a certificate of independent practice. These are measures we insist upon here in Canada, regardless of one’s professional origin and credentials. It should be the same expectation in Uganda.
Needless to say, the Uganda Medical and Dental Practitioners Council must satisfy itself that foreign doctors are what they claim to be and have certificates of good standing from the medical regulatory bodies in their home countries. Not every doctor is a doctor. Competence in one’s profession must always be accompanied by ethical conduct.

But who will supervise and certify the clinical and ethical competence of foreign-trained and long-term expatriate Ugandan doctors? Clearly it is the much maligned and underappreciated Uganda-based colleagues, who must stand between the foreign doctors and the unsuspecting citizens.
But let us consider a scenario where a struggling and underpaid Ugandan doctor is required to supervise and examine the competence of a better-paid Cuban doctor, for example. Would we be surprised if the Ugandan doctor was not as cordial and fair to his Cuban colleague as we would hope?

I fully appreciate President Museveni’s frustration with Ugandan doctors’ demands and industrial action. It is a natural reaction of political rulers and leaders towards doctors. Short of donning a stethoscope and working in the trenches with doctors for long hours, politicians rarely seem to appreciate the toll that medical and surgical practice take on practitioners.

Over the years, I have heard similar remarks by some Canadian politicians whenever doctors have demanded better pay and resources. The difference here, of course, is that politicians, aware of the power of the doctors’ unions and patients’ support for their physicians, almost always choose to negotiate until they reach a mutually agreeable compromise.
President Museveni would be well advised to appreciate and value Ugandan doctors and resist the temptation to insult or intimidate them. He should try respectful dialogue and make it his government’s priority to empower them to be the very best that they can be.

The President has already demonstrated a great understanding of the great impact of good salaries and working conditions on the output of key sector employees. The Uganda Revenue Authority and Bank of Uganda are just two examples of public organisations whose well-paid employees treasure their jobs and, I am told, have produced good results.
Even as the President so rightly welcomes help from our Cuban colleagues, he should remember that Ugandan doctors who endure the enormous challenges and financial struggles of practicing medicine in our country are great patriots. Most will still be on duty long after the Cubans have returned to their Caribbean Island.
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