Prevention, cures, therapy going to overwhelm country after-Covid-19

Thursday April 02 2020

First, the national health infrastructure is sitting on a false bottom. From time immemorial, Mulago and Entebbe share certain functions at the apex of the healthcare system. Entebbe has two hospitals (although one that seems to have been transferred to the Ministry of Defence) is ideal for isolation and it sits in an eco-system that has institutions like the Uganda Virus Research Institute. Interestingly, animal genetics are also developed in Entebbe and for years, the Ministry of Health was headquartered in Entebbe. Proximity to the only international airport, regional and international agencies make it attractive for travel.

Mulago hosts the national referral hospital. Mulago’s size hosts Makerere Medical School, its Institute of Public Health, several specialist centres, Cancer Institute, Heart Institute, Infectious Diseases Institute and a number of centres set up like the ones in Entebbe. The eco-system around Mulago is very detailed; it promotes knowledge and equipment sharing. Many students are taught by both Makerere faculty and Mulago faculty with what are still outstanding results.

Once you are done with these two, the infrastructure simply drops to emergency care, management and treatment if diagnosis is made. Even if there is a will, the specialist manpower at regional hospitals like Mbarara, Jinja, Soroti, Gulu and Arua does not exist. It is the opposite - overwhelmed primary healthcare workers, inadequate drugs and a seminar culture as most health workers need to attend these activities to support their official income from government. For a start, it is not the end of the world. During the Covid-19 outbreak, we have found out that there are a number of specialist and middle ranks that pay Shs3.5m for a senior medical officer, Shs4.5m for a specialist medical officer and Shs7m for super specialist medical officer.

The situation was dire, the advertisement note had a number of typos, but the point had been made, why haven’t these been advertised before or regularly yet Makerere is no longer the only medical school graduating students?
The medical profession has bodies like the Medical Council, which registers and writes letters of finding and reprimand to doctors who fall short in their practice. Between 2016 and 2018, they disposed of a number of cases involving negligent conduct by doctors. This was a ray of hope.

Desperate citizens at the outposts have exposed bribe takers, but basically most upcountry healthcare centres are in bare bones shape. In many districts, the Director of Medical Services, is the Director of the hospital, a situation that makes him neither. During the current outbreak, the Ministry of Health sent out a letter to Members of Parliament to add their “ambulances” to a central pool. This was a peculiar request because when Pope Francis visited Uganda in 2015, new ambulances were procured for public safety and these were supposed to go to the districts after the visit. Probably, the documents got lost.

Right now, there is a critical gap in information on how the virus is spreading. There is a significant difference between physical contact through droplets of saliva on clothes and surfaces where the virus can reside for an unexplained prolonged period and transmission through the air, which is potentially even more lethal. National medical experts in infectious diseases have yet had a chance to explain on the platform of national communications media to educate the population.

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There was a lady, a director at Makerere Institute of Public Health, trying to say something but she couldn’t come through. There was another lady at Makerere, an expert in immunology, who hadn’t received a call from the authorities to lend a hand yet ostensibly, they are both on government payroll. Ugandans after years of conflict became very territorial. “My job etc.” Sharing is in a very limited context for targeted audiences like donors. This is just one small piece from the public healthcare sector.

Mr Ssemogerere is an Attorney-at-Law and an Advocate. kssemoge@gmail.com

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