Uganda sued in landmark medical ‘brain drain’ case
RAYMOND Mwesiga’s “darling kid sister” had much to live for, but when she needed medical help after a car crash, Uganda’s overstretched health system fatally failed her.
Distracted by her toddler while driving her new car, 22-year-old Sandra Mbabazi had a “minor” accident and didn’t seem to be badly hurt. A passerby took her to a private health facility in Buwama, some 65 kilometres (40 miles) from Uganda’s capital, Kampala.
“She had internal bleeding and needed quick attention,” Mwesiga, 34, told AFP.
“But there were not enough skilled doctors to look at her. She had already lost a lot of time and they were still procrastinating about this and that, so she passed away,” he said.
“She should still be alive.”
In Uganda, such stories of people dying because of medical neglect are all too common. But with the country plagued by a shortage of health workers, anger is mounting over government plans to “export” at least 241 medical workers to Trinidad and Tobago.
The medics, according to a 2014 advertisement by Uganda’s foreign ministry, were requested by the Caribbean nation to “strengthen its health service sector”.
But Ugandan activists claim the east African nation can ill afford to lose skilled staff and argue that more people will die needlessly if the plan goes ahead. They point out that Trinidad and Tobago already has a doctor to patient ratio that is 12 times better than Uganda’s.
The Institute of Public Policy and Research (IPPR), a Ugandan think-tank, is suing the government in what it says is one of the first ever public interest litigation cases concerning a medical “brain drain”.
In a petition filed in the High Court in December, the IPPR argues that government recruitment of public health workers for another government violates the constitutional rights of Ugandans to access basic medical services.
The group is seeking an interim injunction to halt the “imminent” export of the workers, with a hearing set for this week.
“Thousands of people will die, thousands die already,” IPPR director Justinian Kateera told AFP, pointing out that already 16 women die each day through complications related to childbirth – and that an exodus of midwives would be a disaster.
The IPPR says the shortlist of health workers set to leave includes scores of nurses and midwives, as well as anaesthetists, psychiatrists, ophthalmologists, radiographers, gynaecologists, paediatricians, pathologists and surgeons. One of Uganda’s three neurosurgeons had also been shortlisted, Kateera added.
“Our health systems are weak because of our inability to retain medics,” he said, asserting that the case will “settle jurisprudence on an issue that has afflicted Africa for ages, as revealed by the recent Ebola outbreak.”
Ghana, Malawi, Zimbabwe, Zambia and South Africa were also “badly affected” by medical brain drains, he added.
In Uganda, 42 per cent of vacancies remain unfilled, and according to a 2012 British Medical Journal study the country has fewer than 5,000 doctors for 35 million people, with 50 specialists having left in search of better pay overseas in the past decade, while the bulk of new graduates prefer to look for jobs abroad too.
Many shortlisted under the latest scheme, such as 47-year-old trauma nurse, Santina Obin, say they would prefer to remain in Uganda. But Obin added that conditions were tough and that her net monthly salary of 700,000 shillings ($245 dollars) was too little and often not paid on time.
Such salaries are comparable to those of other civil servants in Uganda, which has a GDP per capita of $572. Members of parliament, on the other hand, enjoy wages of over $6,000 a month.
“We are underpaid, we have a lot of patients and few personnel,” Obin told AFP.
While details of what she could earn abroad have not been given, it is expected to be several times more and to include a raft of benefits such as free housing. Hence the scheme drew at least 400 applicants, the majority from public hospitals and health centres.
Uganda’s attorney general has argued that it is the constitutional right of all professionals to seek gainful employment anywhere, while the Ministry of Health says it had not been involved in the recruiting process.
The planned export has been criticised by the United States, which gives $400 million in aid to Uganda’s health sector every year.
Mwesiga, whose wife gave birth to a stillborn baby, as well as losing his sister in the road accident, is due to give evidence in the case.
“I want to be sure that I’m going to get adequate and good medical care,” Mwesiga said.