When is Our Change For The Better Coming?

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Professor Harriet Mayanja

WHY DO PATIENTS SEEK MEDICAL ATTENTION LATE IN UGANDA?

As I was going to church last Sunday, rushing, since it was already 7:40 a.m. for a service starting at 7:30 a.m., a boda-boda (motorcycle taxi) stopped next to me. On it was the driver, a church member, with his 10-year-old son holding a 9-month-old baby, and another church member running after them! They had been looking for me, and had tried to call me on what later turned out to be the wrong number.

The man jumped off the boda-boda on the side of the road and held the baby up to me. The baby had a pimple on its swollen and tender thigh. He had been ill for a week, and his parents had sought care at the local private clinic where they were given oral ampiclox, which the child had taken for 4 days. The medication is often over-diluted and under dosed, assuming it is a good quality brand. The parents had tried to squeeze pus out of the small wound opening. The baby had had a very restless, painful night.  His father was relieved to see me, and asked for a prescription for a better drug as the one they had been given had made no difference.

On examination I noted that the baby had a fairly deep abscess on its thigh, and I advised his parents to bring him to a “big hospital.” His father was hesitant, recounting to me that his experience with “big hospitals” was not very good, and preferred smaller private clinics. He was concerned about the long queues and poor attention often seen at the “big hospitals.” I counseled him on a possible need for an incision and drainage procedure, and probably an X-ray to make sure the bone was not involved. I also reminded him that there are often fewer patients at “big hospitals” on Sundays. On my advice, he went to the “big hospital” rather reluctantly.

I called to check on them at 2 p.m. The baby had been seen and had had an X-ray. The bone  was okay. His father was advised to buy gauze, cotton, gloves, a surgical blade, disinfectant  and other requirements on a fairly long shopping list for the incision and drainage procedure.

Today, three days later, I called to check on the baby, and was told he is much better and had gone back to hospital with the mother for review. Being a weekday, chances are that they could spend the whole day at the hospital, but hopefully they will be seen.

If they fail to get medical attention today, I will advise them to go to the local doctors, the equivalent of clinical officers or physician’s assistant, at private clinic down the road.

ACROSS THE OCEANS

Across the oceans and seas, my limited experience of observing health units in the USA, Canada and Europe was overwhelming. The hospitals do not look like hospitals at all.

Some, actually many, look like 5-star hotels complete with sofa chairs, carpets, flowers, magazines, water dispensers,  and no askaris (guards) to chase people out of the hospital. The clinic waiting rooms may have between zero and six patients at any one time, reading magazines or just sitting out the fairly short waiting period.

It all looked so surreal. What I love most at these hospitals is the artwork. These places are like art museums, often with changing themes. One had feet, another old faces, sometimes children, or flowers, or houses. The corridors may be dotted with art pieces, or huge potted plants, but nearly always with restaurants and book/card /flower shops.

It is only when one gets to the wards that one sees sick patients. Some very sick patients. One child was riding a tricycle on the ward with the mother in tow just one day after a liver transplant! Another child in isolation who had had a bone marrow transplant for a congenital inborn error was doing class work with a teacher.

During my first visit to Yale New Haven Pediatric Hospital, the pediatric ward had three children: a 17-year-old sickler about to go home, a child with leukemia, and a baby with a congenital anomaly. There, babies do not often get sick with febrile illness, or straightforward infections. Most are only seen at the “well child” clinics.

SO…

This perspective resounded the question: how and when did the USA, Canada and Europe reach where they are now? What did they do right, and what do we do wrong?

In one hospital in Canada, a large painting of a Canadian street in the early 1900’s looked like Wandegeya, our local peri-urban slum dwelling, with small local shops. When was the turning point?

It seems after the World Wars and the Steel Age, Europe and the Americas changed for the better. But we have had many wars in Africa – when is our Change For The Better coming?

When will we be able to be at par with South Africa’s healthcare system? What is that magic bullet? Will a national health insurance scheme help?

Someone out there, please advise. We need help.

 

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