Extortion syndicates not the bane of a tumbled-down healthcare system

Matthew Nsimamukama Kanyeihamba

Recently, NTV’s Panorama exposed what they dubbed an extortion syndicate that has hijacked a major regional referral hospital in Uganda, and subsequently doctors as usually is, plunged into shame. 

As a public health care personnel who has been at the center of health care dispensation, it is not strange to appreciate the dilapidated nature of the majority if not all public health care systems, notwithstanding the gallant resuscitation forms to sustain it. Albeit the outstanding criticism, it is also honest to say that there are a number of desperate citizens who greatly benefit from it.

Regarding the extortion syndicate referred to by NTV panorama, I don’t condone it either, however, I find it part of a natural fitting to offset the preexisting obvious health care gaps. As a matter of fact, I would like to infer that the interplay of public and private health care should not be entirely likened to a word or context like extortion. It is only prudent to remind the public and the ministry that in a worrying resource limited healthcare system like the form in which we operate, the word extortion must not equal evil but of course well applied in any obvious dubious business as executed by form of medical malpractice.

The plight of our healthcare system roots deep down to an obvious menace and regarding such means as outsourcing services to complement the system as extortion might be paradoxical in reality.

I would like to relay a scenario; A patient admitted at Emergency Unit-ER with signs of intestinal obstruction and full blown peritonitis, (This means the intestines are blocked and stool and gas are stagnant, if emergency intervention is delayed, some patients will die in less than 30 minutes). 

At ER this is treated as an emergency and the patient is expected to be done the necessary preparations prerequisite to surgery; CBC turn-around time is 1 hour, grouping and booking blood is 30minutes-1 hour, electrolytes 1hour, RFTS,LFTS turn-around time is 3 hours. This patient is in imminent organ failure if obstruction is not corrected in the shortest time possible. In such a scenario it takes over 1 hour to mobilize the surgeon, theatre assistants, anesthetist, the necessary requirements and investigations, the patient will die. 

In unfortunate circumstances, all these resources aren’t ready or available at all. In a well-researched Ugandan healthcare environment, emergency health care systems are not developed and often completely absent. It is often horrific that basic components like an intravenous cannula, urinary catheter, a syringe or even a requisition form for blood transfusion are not uncommonly in dire lack. In a medical emergency, a delay of any length or compromise of any measure can cause death.

Under these circumstances, private outsourcing or incentivising health personnel is not only a necessary evil but also a readily consensual alternative to save a life.

Amidst these crises, the doctor is not idle, neither absent from duty at leisure. They are busy resuscitating two near dying patients at the same time or suffering a protracted botched surgery on table. The most he’s negligent, is the interlude for a quick snack or at least saving another life at a well-paying private clinic. 

In all entirety, the doctor is saving lives…but also at any point, it is true, there are isolated elements who may want to disadvantage the desperate patients by exerting unnecessary sanctions prerequisite to their health, and these errant officers should be dealt with by appropriate measures.

The bottom line, therefore, is to project the public anger and frustration away from the syndicates of extortion to the larger picture; the government is greatly indebted especially to regional referral centres. For example, the government should establish a fully-fledged and world standard emergency unit at each regional referral, and even if that dream is elusive, let there be at least a minimal standard different from the appalling status quo. By doing so, I believe extortion syndicates will be well enough justifiably irrelevant.

Matthew Nsimamukama Kanyeihamba MBChB is a creative non fiction writer and poet. 


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