This interns' mess and its implications for policy makers

By Mpaata Owagage

For any hospital intern, the word “mess” always evokes positive sentiments. It was the place where one had their meals, where one went to relax after a long shift and where one went to share with colleagues on complicated cases. Yet it is not in this cheerful sense that I employ it today.

I would know. In 2008, I was an intern at Mulago National Referral Hospital. Fresh out of Pharmacy School, I knew my vocation to be a calling. My ambition was restricted to the idealistic notion of ensuring, by all means, that whoever crossed my path ailing would leave our meeting revived.

A pastor would probably articulate this better but lest we miss the point, I intended to use the pill to change lives.

Often times, said pill was out of stock and I would be confined to the humbling work of using words to effect healing. Whereas many scientists despise verbose methods for lack of evidence and scientific logic, many health professionals have attempted to use lexicon to affect physiological processes in the face of material scarcity.

It was not quite like counseling but a rather delicate and often undignifying hybrid that involved explaining to patient after patient that they could not get their prescription filled and that, perhaps, they could try the option of buying the medicines from the myriad of drug shops cum pharmacies that littered the hospital’s immediate surroundings.

A blank stare would confirm my worst fears. These patients could not afford to buy and to date, I still wonder how their fates were sealed.

My experience is by no means the standard, but I know many whose internships followed a similar trajectory. One had to learn political skills first, such that one could then look a patient in the eye and give them the assurance that their life would get better sans therapy.

Yet this was not the most challenging aspect of my internship. For four months, our allowances were not remitted. Quickly, many of us realized that even the most noble of callings could only be heeded if one were alive and thriving.

There is nothing as intellectually acrobatic as trying to comfort the sick from a position of discomfort, worry and anxiety over the source of one’s next meal.

Having exhausted all means of diplomatic engagement with the Ministry of Health (MoH), we contemplated a sit-down strike but quickly dismissed the idea. Our patients’ lives were too precious to be sacrificed at the altar of bureaucratic apathy. 

It might be that circumstances have changed since 2008. Recent media reports certainly suggest so. In the space of two months, I have read with delight that The National Medical Stores was stuck, first with mama kits, and more recently, with antiretroviral drugs. I use ‘delight’ not as a schadenfreude but as an acknowledgement that an excess of supply should be good for the Ugandan patient. Never mind that maternal mortality remains high and many patients in need of antiretroviral therapy are unable to access it.

What remains clearly unchanged is the value that the MoH places on the intern health worker. Intern health workers’ plight has dominated national news for some time. For six months, their allowances have not been remitted and many have narrated how, even soap, a basic hygiene requirement, is impossible to afford. I could delve into the public health implications of this revelation alone but there will be another forum, another time and one more qualified.

It is the inconsistencies revealed by these circumstances that I wish to point out. On one hand, the government is investing heavily in more medical schools and churning out health workers by the numbers. The President has been on record encouraging a focus on science education. Whether I agree with his position or not is beyond the scope of this missive. Yet on the other, the MoH seems to be out of step. One is nowadays considered lucky to get an internship placement site. When they do get one, their luck must stretch to whether or not they get facilitated.

It must be remembered that a hospital internship is the health workers’ first exposure to the Uganda health care system, especially its human resource aspects. Many of us make the decision of whether or not to stay in the government employ at this level of our careers. If I may employ an ill-fitting analogy, poor management of interns’ emoluments with the expectation that they will be well paid once they transition into government service is akin to refusing to spend on a prospective spouse with the anticipation that once married, one will then open the resource taps. Anyone that depends on such flawed logic is likely to remain single for a long time. Any prospect will most certainly flee.

Consequently, to get to the bottom of the brain drain question, one does not need to commission a scientific study with complicated hypotheses; one only needs to look at how interns are managed. Many will steer clear of anything government the very moment the mandatory internship is over. And this need not be the case. It thus becomes a strange case of duplicity for MoH and policy makers to bemoan the insufficient numbers of health workers on one hand yet fail to inspire those with the most zest to serve on the other.

It might surprise many to learn that the MoH has a Planning Department. According to the MoH website, the department is complete with, among others, a Human Resource Development division as well as a Budget and Finance section. Their mandates may, of course, be deduced from their respective nomenclature. I wouldn’t be so crass as to suggest that the technocrats staffing these divisions have failed to deliver but I dare say that the evidence leaves one no alternative.

With a degree of confidence, I can state that it is in the MoH’s interests and well within the interests of the Ugandan people if interns, nay health workers in general, are paid on time. As far as I am aware, they are not asking for a pay rise; just that the little that goes into making their service easier is dispatched in orderly fashion.

The writer is a practicing pharmacist who specialises in health and medical law.