Dear Tingasiga;
When Dr Joseph Buwembo, an Associate Professor of Neurosurgery at the University of Saskatchewan, Canada, visited Uganda in 2012, his mission was not only to see his relatives and enjoy his homeland, but also to give back to his people. He offered free neurosurgery on a baby that had a very complex brain problem. This would help that baby and teach skills to younger colleagues.
When Dr Joseph Buwembo, an Associate Professor of Neurosurgery at the University of Saskatchewan, Canada, visited Uganda in 2012, his mission was not only to see his relatives and enjoy his homeland, but also to give back to his people. He offered free neurosurgery on a baby that had a very complex brain problem. This would help that baby and teach skills to younger colleagues.
With
this offer, Mulago and Makerere Medical School were getting the best of
the best, for Dr Buwembo is one of the most highly educated
neurosurgeons around. A graduate of Makerere Medical School, Kampala, Dr
Buwembo qualified as a neurosurgeon in South Africa before relocating
to Canada in 1996. He underwent another four years of training in
neurosurgery and became a Fellow of the Royal College of Surgeons of
Canada in 2000. He is an Associate Professor of Surgery at the
University of Saskatchewan, Canada.
Prior to arriving
in Kampala in 2012, Dr Buwembo had made arrangements to commence the
operation on the baby at 7.30 am on the appointed date. However, when he
and his Canadian team of nurses arrived at Mulago National Referral and
Teaching Hospital, they found that there was no anaesthetist to put the
baby to sleep and manage her heart and breathing during the extremely
delicate procedure. There was no explanation given and there was no
other anaesthetist to do the job. The baby, her family, Dr Buwembo and
his team simply waited, in the dark so-to-speak.
When
the anaesthetist showed up at 10am, he appeared unperturbed by the delay
and simply informed the team that he had been busy attending to his
parent who was unwell. Dr Buwembo and his team proceeded with the
surgery, which lasted three and half hours. The team then spent another
hour speaking with the parents and accompanying the baby to the
post-operative unit. Needless to say, the team’s other engagements were
disrupted. The compensation was that the baby did well, at least in the
short-term.
When Dr Buwembo shared his experience with
me six years ago, I was as concerned as he was, but I felt optimistic
that Mulago had learned a lesson from it and had identified
opportunities for improvement. However, an experience last week by Dr
William Manyilirah, a consultant cardiothoracic surgeon at the Uganda
Heart Institute, suggests that, if anything, the situation at Mulago
needs radical intervention.
Dr Manyilirah, a Makerere
Medical School graduate who trained as a general surgeon at Mulago and
as a cardiothoracic surgeon at the University of the Free State, South
Africa, returned home in 2015 to serve Uganda and his alma mater. He
wrote an anguished letter last week that invites urgent and close
attention by all who care about our once famous hospital. A full copy of
his letter, which he posted to a WhatsApp group on Friday, October 26,
is available on my website www.mulerasfireplace.com.
The
letter describes the last-minute cancellation of planned operations on
two patients with very serious chest diseases. The reasons for the
cancellation? First, there was no oxygen. When Dr Manyilirah borrowed an
oxygen cylinder from the thoracic surgery ward, he was told that there
was no anaesthetist.
The senior anaesthetist on duty was reportedly “indisposed” and there was no back-up plan because all the senior house officers (SHO) were busy attending a research conference. The other anaesthetists were attending to patients in other theatres. It is enough to make one give up.
The senior anaesthetist on duty was reportedly “indisposed” and there was no back-up plan because all the senior house officers (SHO) were busy attending a research conference. The other anaesthetists were attending to patients in other theatres. It is enough to make one give up.
So why does Dr Manyilirah
continue to offer his skills to Mulago Hospital? “I go to operate at
Mulago to share my thoracic surgery skills and knowledge with the SHOs
and other surgeons,” he wrote.
“I do so to help operate on needy Ugandans with more complex thoracic disease who would otherwise not afford the cost of the same surgery in private hospitals, and to prevent attrition of my hard-earned thoracic surgery skills and knowledge.” He adds: “Other than the above reasons, I have no obligation to work on the Mulago Thoracic Surgery Ward!”
Dr Manyilirah says “the setup of the Mulago theatre calls for a high degree of sacrifice by right-thinking surgeons and other staff.”
“I do so to help operate on needy Ugandans with more complex thoracic disease who would otherwise not afford the cost of the same surgery in private hospitals, and to prevent attrition of my hard-earned thoracic surgery skills and knowledge.” He adds: “Other than the above reasons, I have no obligation to work on the Mulago Thoracic Surgery Ward!”
Dr Manyilirah says “the setup of the Mulago theatre calls for a high degree of sacrifice by right-thinking surgeons and other staff.”
To him, the situation goes
against most standard operating protocols and common sense. He sometimes
feels that “it takes some degree of insanity to accept to perform
specialised surgeries in that operating theatre.”
“On some days, if it is not lack of essential supplies, a surgeon has got to literally beg and cajole the anaesthetist or theatre staff to have a case operated on at Mulago”, he continues. “Sometimes it appears as though the surgeon owns or has a special interest in the patient!”
“On some days, if it is not lack of essential supplies, a surgeon has got to literally beg and cajole the anaesthetist or theatre staff to have a case operated on at Mulago”, he continues. “Sometimes it appears as though the surgeon owns or has a special interest in the patient!”
Dr
Manyilirah observes that nurses and doctors at Mulago Hospital often
turn a blind eye to problems in their units because they fear admonition
by the hospital administration and even loss of employment.
“This is very disturbing and is a source of despondency among the staff - a recipe for poor service delivery,” he writes.
After offering excellent suggestions for remedying the situation, Dr Manyilirah urges his colleagues to boldly voice their concerns about the poor working environment. “We should not directly or indirectly perpetuate it,” he implores them. He advises the hospital administration to find a way of encouraging the staff to come forward and discuss “the issues openly without fear of being unfairly reprimanded.”
“This is very disturbing and is a source of despondency among the staff - a recipe for poor service delivery,” he writes.
After offering excellent suggestions for remedying the situation, Dr Manyilirah urges his colleagues to boldly voice their concerns about the poor working environment. “We should not directly or indirectly perpetuate it,” he implores them. He advises the hospital administration to find a way of encouraging the staff to come forward and discuss “the issues openly without fear of being unfairly reprimanded.”
Reacting
to Dr Manyilirah’s letter, a senior consultant surgeon who knows him,
said: “I was in charge of theatres at Mulago for over five years. What
Dr Manyilirah, my former student, is talking about is just the tip of
the iceberg. Unfortunately, whenever and however one complains makes no
difference. One creates more enemies. You just simply keep quiet or give
up just as I did.”
Dr Manyilirah’s choice to go public suggests deep frustration with the absence or failure of internal mechanisms for resolving these problems.
Dr Manyilirah’s choice to go public suggests deep frustration with the absence or failure of internal mechanisms for resolving these problems.
His letter is a patriotic
act by one who could have chosen to stay in South Africa or sought
opportunities in many other countries. Instead of the Mulago Hospital
administration going on the defensive or taking punitive measures
against him, they should engage with him and other stakeholders to find a
sustainable solution that provides the best care to patients.
Beyond celebrating the newly renovated hospital building, the executive and legislative branches of the Uganda government have an urgent duty to act on Dr Manyilirah’s concerns. The place to start is a thorough and independent external review of Mulago Hospital, with a view to making necessary radical changes.
muniini@mulerasfireplace.com
Beyond celebrating the newly renovated hospital building, the executive and legislative branches of the Uganda government have an urgent duty to act on Dr Manyilirah’s concerns. The place to start is a thorough and independent external review of Mulago Hospital, with a view to making necessary radical changes.
muniini@mulerasfireplace.com
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