Ethics, morality, and humanity could improve health workers' attitudes

Jul 20, 2016

Many health workers have given all their lives to the service of their communities.

By Mayora Chrispus

For long, there has been public debate on whether most health workers in Uganda undertake their duties with diligence, professionalism, and positive attitude. It is important to note that a sizeable number of health workers do perform their duties diligently with utmost good will, ethic, and professionalism.

Many health workers have given all their life to the service of their communities. In Uganda, health workers are among the less paid, less remunerated, and less recognised professionals. Yet, most go beyond what is ordinarily expected of them to serve. We must applaud and encourage them. To many, these are the unsung heroes!

Alongside the group of unsung heroes however, is another lot, around which the public has constructed a narrative and perception - a negative one - about health workers generally in Uganda. Building upon this narrative, many commentators partly attribute the noticeable deterioration in health service quality in Uganda to unprofessional conduct and poor attitudes of health workers towards work.

They cite reports of patient neglect in health facilities, absenteeism, corruption, and other forms of unprofessionalism. At maternal care departments, one will hear of rude midwives and nurses and that this partly forces mothers to deliver at home or with the help of traditional birth attendants who are perceived to be good at customer care.   

While every health worker swears an oath to serve in the best interest of the patient (client) irrespective of circumstances, for some health workers, individual interests including finances have sometimes taken precedence over ethics and patient life. We have seen press stories where pregnant mothers are left to bleed to death, because they could not meet the financial bargain with the health worker. Until I encountered an experience, I had not thought these were in some cases real!

Last month, I drove to Kasese, my home area from Kampala. On my way, I parked at a road-side trading centre to buy food. While here, a gentleman came at the taxi stage to wait for public transport to his destination. I seemed to know him and so I offered to give him a ride because we were going in the same direction. While in the car, this gentleman made a phone call to a colleague, who we learnt he had left at work. In the phone call, he was directing the colleague to find theatre supplies in some place where they often kept them, and in case they needed more, they could proceed to the store. After the phone call, we learnt that he was a health worker in theatre in one of the biggest hospitals in Kasese district. He told us, he had just run out of theatre because he had worked his ‘day'.

But towards the end of his ‘day', emergency cases were being brought in - courtesy of accident that had just occurred on the road. While we wondered where the accident had happened because we did not find the accident scene on our way, he confirmed the first batch of casualties had been delivered, all destined for theatre.

According to him, he had to immediately wind out whatever he was doing and ensure he is out, because the new arrivals were going to keep him there! He also made a number of phone calls to colleagues asking if they had been caught in this emergence situation while still at work, and telling them how lucky he was able to run away and if they were planning to casually go back to the workplace for leisure, to avoid doing so, lest they are recalled to participate in handling the crisis.

This individual went ahead to tell us of cases where doctors are put "on call" but decide to switch off their phones to avoid being reached in case they are needed.  Haa! His ride of about 20 minutes came to an end, disembarked, looked for pocket change to pay for the ride, at this point we told him we had just offered him a lift.

This story could be a reflection  of what happens daily in many health facilities, when patients especially in emergency situations find it hard to access emergence care, because either those supposed to attend to them look on, or are simply not available. Three things emerge from the story: From a professional ethical perspective, one would expect that no matter what situation, health workers would ordinarily work towards saving a life. It is also morally right that in such an emergency situation, any individual would offer to help. If these two may coincidentally be absent, the humanity in you would prevail.

I am certain that combining these three concepts would go a long way in improving health worker attitudes towards work. But beyond this, we must also recognize that health workers are humans who must work within their reasonable human capacities and capabilities and time allowable by the existing labor laws. With an ever increase demand for emergency services - accidents and other circumstances - the broader policy discussion must also focus on creating a framework for provision of emergency services across the country. The new health sector development plan (2015) recognizes provision of emergency medical Services / ambulance services as key in improving health service delivery.

The plan proposes a number of strategies to improve emergency care, including establishment of general hospitals at highways with accident and emergency units, and creation of the Uganda National Ambulance and Emergency Service to help coordinate and respond to emergencies.  

While these are important starting points, it is critical to recognise that unless special provisions are made for health workers, not much may be achieved.

The writer is a Health Economist - SPEED Project - Makerere University School of Public Health

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