OutToLunch: Lasting wealth is through hard work not placing bets

By Denis Jjuuko You probably know somebody who after trying many healthcare facilities, they were told there was nothing wrong with them and they should go back home. The symptoms persisted though and the more facilities they visited, the more they were told the same. Sometimes they were given painkillers to psychologically manage them. Desperate, they visited a traditional healer whose Thursday clinic deep in the village is thronged by many people who share similar experiences. The healer is basking in glory. He saved so and so; his marketing team disguising themselves as waiting clients assure them. After a few months of some relief, the pain comes back and this time more excruciating. But since they tried everything and failed, they give up and wait to die. And indeed, they die. At their funeral, we claim that it was God’s plan! Well, if you don’t know anyone who has gone through that, at least you heard of King Oyo’s story. The now deceased Tooro Kingdom leader visited some high-end hospitals in Kampala after feeling persistent backpain. X-rays, MRI scans later, they told him they saw nothing. Being a person of means, he flew to a hospital in Nairobi where he was diagnosed with cancer. A year later he was dead. What did the people in Nairobi saw that the Kampala ones couldn’t? Well, Nairobi has a PET Scan or a few. Kampala and the whole of Uganda don’t. A PET Scan costs about US$3m or approximately 17 Landcruisers. If there was a meeting of government officials, you would run out of space to park them. That is how many we have in Uganda but a PET Scan is not something we have been able to buy and install yet. But it isn’t just the lack of technology that is a problem. You can have a PET Scan and still fail to diagnose a patient properly. Patients aren’t sent for a PET Scan on their first visit to a clinic as it is rarely used as a diagnostic test rather one that determines an extent of the disease. Other tests have to be done. And still a diagnosis can be missed depending on who has done the scan or X-ray and the reading of the results. If for example a child has a bone tumor, a pediatric radiologist would probably pick up the first signs that an adult radiologist may easily miss. Even then, the doctors who ordered the tests and other specialists can sit as a group and discuss what they are seeing. They may even disagree. After that, they could order for a biopsy and eventually a PET Scan if it is needed. You see, that means that you need to have a team of specialists with not only adequate training but also experience that exposed them to a diverse spectrum of patient diseases and how to diagnose them. If you only train in Uganda and practice in Uganda for a year or two, it is most likely you won’t be able to diagnose many diseases even with advanced technologies at your disposal. Doctors in Europe struggle to diagnose and even treat malaria, which is many times chicken feed to Ugandan doctors. When did your doctor last consult anyone before prescribing drugs? Most likely he or she listened to you, sent you to the lab, looked at the results and sent you to the pharmacy or told you to go back home. Isn’t that likely to lead to a wrong diagnosis? I am not saying that a team needs to look at each and every case but you get the drift. To have good doctors in Uganda, there is a need for a robust apprenticeship program so that the graduate doctors can learn from as many experts as possible. When we spend years discussing intern doctors’ wages, it means we are delaying their learning. They aren’t getting the right exposure from the seniors. And if they aren’t properly apprenticed, they will not become good doctors. There is no two ways about it. We also need to have a critical number of health workers sent elsewhere for exposure. They should learn how medicine is practiced elsewhere while getting exposed to different diseases and treatment methods. Government should be talking for example to American hospitals for medical residency. We could send some to Aga Khan in Nairobi as well. Those who are sent by government, they should be contracted and incentivized to come back to work here. The right technology and generally good working conditions should be in place. Upon return, they should train others through apprenticeships. They should spend a certain number of hours a week for a few years in public hospitals with the list of young doctors they have mentored as part of their deliverables. Ensure that those trained doctors remain in hospital wards too. This is actually cheaper than sending politically connected patients abroad for treatment because Uganda can only send so many. The writer is a communication and visibility consultant. djjuuko@gmail.com