This interview was first published by Sunday Vision in 2013 following the appointment of Dr. Margaret Mungherera (now deceased) as head of the World Medical Association.
AS she takes on the reins at the World Medical Association, Dr. Margaret Mungherera hopes to, among other things advocate better representation for poor nations like Uganda on the world medical stage. It is her contention though that countries such as Uganda badly need to observe proper medical ethics and professionalism in order to be taken seriously. In this interview with Stephen Ssenkaaba, she reflects on the ethical issues affecting the medical profession in Uganda and why they need to be urgently addressed.
What is the mandate of the World Medical Association concerning medical ethics and professionalism?
The mandate of the World Medical Association is to address professional and ethical issues in medical practice. This is done through the international code of medical ethics. Several medical associations in different parts of the world that are members of the WMA derive their ethical codes from this code. It is the same case in Uganda. Various medical practices have medical councils, each of which has a code of ethics. In essence these medical codes ensure first that health workers are qualified to do their job, and that they are registered to practice; that their registration gets renewed and lastly, that they continue to upgrade their skills through continuous education and training.
What are the most serious ethical issues affecting medical practice in Uganda today?
Quite a big number of health workers are not registered, meaning that they are operating illegally. Recently, it emerged that out of about 6000 doctors and dentists, just over 3000 had renewed their licenses. This therefore means that about half of all doctors and dentists are operating illegally. We also did a spot check in Kampala in which we found that 75% of private health workers are operating illegally.
Health workers violate many ethical practices today. For instance, they do not respect patients’ rights to privacy. They prescribe drugs for diseases they are not qualified to treat when they should be referring patients to specialists, or when they should be seeking a second opinion.
Health workers never explain the treatment they give out to patients, including the dosage and the possible side effects it will have on the patient’s health. Instead they just scribble confusing prescriptions that often confuse patients. There is also a lot of corruption among health workers. Some health workers operate under the influence of alcohol.
We have health workers that sexually abuse their patients and many that renounce their responsibility to their fellow doctors. It is a rule that we offer free medical treatment to sick fellow doctors, but many doctors today do not observer that rule.
What reasons underlie such unethical behavior?
Firstly, we seem to be admitting the wrong people into medical school. When admitting students to medical courses, we focus mainly on their academic performance; we do not test for character and other non-academic attributes which are very crucial to this profession.
As a result we admit people whose main reason for joining the profession is to make money and gain prestige. Medical practice is a calling that thrives one’s ability to have compassion, competence and autonomy. We need to screen candidates for these values.
Secondly, training focuses on theoretical aspects of ethics and neglects the practical part of it. This is worsened by the absence of role models who our junior health workers can look up to and emulate.
Thirdly, the environment in which we operate does not encourage ethical behavior. Health centers do not have sufficient rooms where doctors can safely examine patients to ensure confidentiality. They also lack proper record keeping facilities where patients’ information can be safely kept.
Medical regulatory bodies are not adequately financed to ensure quality. Many of them do not have inspectorate units. Instead they rely on district administration units which are often too busy. The medical councils too do not operate well because the government does not support them. They are weak.
Ordinary people are not knowledgeable about their rights. They are not aware about their right to privacy, to informed consent and to a second opinion from another doctor; they don’t know that they have a right to an explanation of the treatment being given to them and its possible effects on them; they are not aware that it is their right to refuse a drug if they so wish. Medical workers often take advantage of this to do all sorts of unethical practices.
Surely as Uganda Medical Association you should be able to do something about all this.
We try our best. We use the media to promote awareness about these issues- in the newspapers, radio and on television through programme such Health Zone on WBS television. We also try to discipline errant health workers, but since membership to our association is voluntary, we do not have the power to crack down on the many health workers that are not our members. Government should help us to pass a law that makes it mandatory for all recognized medical workers to belong to an association. This will then give us jurisdiction over them and allow us to enforce proper ethics and professionalism. We have asked the ministry of health to help us prepare a bill to parliament that will make it mandatory for all registered medical workers to belong to an association.
What do you propose as the way forward to the ethical dilemmas that medical practice faces in Uganda today?
We need to improve the way we teach medical ethics, to make it more practical. We also need to improve pay for medical doctors, especially the senior staff so that they may stay at home and inspire the junior health workers. Government needs to improve the regulatory councils to ensure that each of them has an inspectorate to monitor and ensure standards. Employers of medical workers should ensure that their staff members are registered and have their licenses renewed and that they pursue continuing education to keep up to date with new developments and information in the medical field. Senior medical workers should behave as role models so that junior staff can learn from them. Government should improve the quality of health services to ensure that patients’ rights are observed. Government should strengthen medical associations by passing laws that make it a requirement for all qualified health professionals to belong to an association. Government should ensure the public know their rights to quality healthcare.
What are your concluding remarks?
Medical professionals should be conscious and should try their best to observe medical ethics and behave responsibly.