By Muniini K. Mulera
Dear Tingasiga: Pray that your next serious illness finds you in a major city like Kampala or Nairobi where you have a choice of upscale private hospitals from which to seek medical attention. Should your appendix riot or, as is more likely, should you and your friend, the MP for our area, become the latest victims of Uganda’s treacherous upcountry roads, you will be taken to a regional referral hospital for emergency treatment before you are evacuated to India or South Africa for your VIP care.
Given your status as big men in Uganda, you will not wait too long before a doctor is summoned to take a look at the ghastly wounds that threaten your lives. The young doctor that will stand between you and death will be a medical intern, that most underappreciated professional that sits at the bottom of the medical hierarchy.
Do not be surprised if the intern looks a little exhausted and in no mood to recite your titles. He may have spent the previous 18 hours hard at work – delivering babies, resuscitating a desperately sick infant, attending to all manner of injuries, including draining blood from the head of a nameless citizen, reviving a comatose fellow whose blood sugar went south under the effects of alcohol.
More than likely, the Intern will have no recent memory of a decent meal, not only because he has had no time to attend to himself but also because he can hardly afford it. The poor fellow has not been paid his salary in three months, yet he is expected to smile and fulfil the Hippocratic Oath, one of the most misquoted and misunderstood vows.
The Hippocratic Oath, in its various iterations, is not a commitment to economic or physical suicide by doctors. There is nothing in the Hippocratic Oath that mandates doctors to provide free services to patients, or to accept dangerously substandard facilities and resources with which to treat their patients. The Oath does not include a promise to work without rest and without a fair wage. The fundamental commitments in the Classic Hippocratic Oath are respect and support for one’s teachers and colleagues; scrupulously ethical practice; and adherence to the principle of primum non nocere (first, do no harm.)
In concluding the Hippocratic Oath, the new doctor swears: “If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.”
The young doctor therefore expects to enjoy life (including healthy remuneration) and art (including appropriate resources with which to work.) Some have used the Hippocratic Oath to blackmail doctors into accepting abuse and the most unfair treatment by their governments which consider them slaves with high-sounding titles. In fact doctors who refuse to work in dangerously under-re sourced circumstances do so in compliance with the Hippocratic Oath. “I will keep (the sick) from harm and injustice,” the doctor swears the day he graduates from medical school.
The Kenyan doctors who are demanding that their government allocates at least 15 per cent of the national budget to the health sector are attempting to keep their patients from harm and from the injustice of substandard medical care.
An African government which hopes to retain its medical manpower has no choice but to pay doctors salaries that take into account their many years of education; the critical nature of their work; the very long hours they must put in; the risks they face and the indispensability of their services.
To view a doctor’s expertise as a commodity that must be subjected to the basic laws of the market is not inconsistent with the Hippocratic Oath. The rules of the market dictate that a high price needs to be paid for doctors’ essential services which are in short supply. At a minimum, therefore, medical Interns deserve salaries that are comparable to those of senior managers in departments such as the Central Bank of the land.
The specialists/consultants in various fields of medicine and surgery should be paid salaries that are at par with those that are currently lavished on MPs and Cabinet ministers.
To afford this, sub-Saharan African governments should rethink their priorities. Does country X need six air force jets worth $740 million or does it need 740 doctors? At $50,000 per doctor per year, the cost of the jets would pay 740 doctors for 20 years. Does country Y need 350 MPs and 100 presidential advisers or does it need modern equipment and other resources with which to help reduce maternal, neonatal and infant mortality? It is a matter of priorities.
One resource that awaits the attention of sub-Saharan African governments is the huge number of doctors currently working in countries like Australia, Canada, UK and USA.
Repatriating them to work in their homelands should be a priority engagement for any government that is interested in serving its citizens. But it will not come cheap.
Dr Mulera is a consultant pediatrician and neonatologist