Seeking medical treatment abroad

By Flavia Nassaka

Doctors advise on what you should do before travelling

The death of renowned singer Juliana Kanyomozi’s son, Keron Kabugo, on July 20 affected many people in a very personal and emotional way. Her son passed on at the Aga Khan University Hospital in Nairobi, capital of neighbouring Kenya. He was referred there for more specialized treatment by doctors at one of Uganda’s top private health facilities; the Nakasero Hospital in Kampala.

A few days later Nobert Mao, the Democratic Party President, was also rushed out of the country to The Nairobi Hospital, also in Kenya. Many other prominent patients; famous ones being the late Brig. Noble Mayombo and the late former Prime Minister Eriya Kategeya have been flown out of Uganda to seek `better medical care’. The question is why?

According to Enock Kusasira, the spokesperson of Uganda’s top medical facility, the Mulago National Referral Hospital in Kampala, some of this travel is unwarranted.

“There are many Ugandans who request treatment abroad, not out of strict necessity, but from preference especially the celebrities,” he told The Independent.

But Frank Gashumba, a well-known businessman in Kampala who has sought treatment abroad before, disagrees. He says Ugandans who can either afford it or can get the government to foot their bills prefer treatment abroad because local medics are incompetent.  Gashumba says he cannot trust Uganda’s medics to treat him “even for flu”.  Gashumba’s loss of trust started when he developed abdominal pain that medics in most top hospitals in Uganda failed to diagnose to the extent that it was dubbed a “mystery illness”.

It is not until he went to Nairobi Hospital that the pain he had endured for weeks was diagnosed as a small cyst on the intestines and he was treated within a few hours. He says to him, the relief was almost magical considering the pain he had gone through.

Even when the diagnosis is right, it appears sometimes the treatment is ineffective. In the latest incidents, although details of medical conditions are usually confidential, it appears that Norbert Mao was correctly diagnosed with malaria and pneumonia at one of the top medical facilities in northern Uganda, St. Mary’s Hospital Lacor in Gulu, but the treatment given was not effective. It appears to have been the same in Keron Kabugo’s case.

Medical treatment is as much about confidence, as about the objective facts, and sadly many people do not have confidence in the Ugandan healthcare system.

As Dr David Basangwa who heads the Butabika National Referral and Teaching Mental Hospital in Kampala explains, although the health sector is improving greatly, no efforts have been made to change people’s perceptions.

“Many individuals will continue to pay for their own treatment abroad, but if we strengthen our own capacity in Ugandan healthcare, perceptions will gradually change and patients will opt to stay at home, since if one is seriously ill, it is immensely more comfortable to be surrounded by family and friends than to be alone in a foreign land,” he explains.

The lack of trust is not helped when, as happened recently in the World Bank Service Delivery Indicators report, some of the bad news appears to be confirmed. That World Bank report noted that “doctors in Uganda performed at about the same level as Kenyan nurses on both diagnostic accuracy and the capability to provide full treatment.”

Later, the Uganda Medical and Dental Practitioners Council moved aggressively to refute the report findings but many doctors that The Independent spoke to seemed to suggest that seeking medical treatment abroad cannot be entirely stopped because there will always be the necessity for patients to travel for specialised procedures.

Dr Shaban Wani of the Kampala International University Teaching hospital in Ishaka, western Uganda, says patients are sometimes justified to seek treatment abroad.

“Medical personnel in Uganda are always striking; if it’s not over salary, it’s over poor accommodation, or lack of utilities. How can you really trust a depressed person with your life? I believe those who travel put all this into account because no one can just decide to go and spend yet they can get the same services in Uganda,” he says.  Dr Wani says the nurses’ tender, loving care is lost as they sink in thought of how they are to settle their enormous household bills, and end up working just for the sake of it, dispensing negligently, and giving patients wrong dosages.   “The ones who care are soon overwhelmed by the workload and stop trying; they seek greener pastures abroad, or they leave the profession altogether,” he adds.  He adds that Uganda has not invested in institutions with sophisticated facilities, where staff can access training at the highest international standards.

“Therefore, health professionals are quick to go abroad for training, many of whom then fail to return due to lack of opportunities to practice their specialty at home,” he says.

Dr Ian Clarke who founded one of Uganda’s top medical facilities; the International Hospital Kampala, and is the chairman and CEO of the International Medical Group sees nothing wrong with people seeking treatment abroad – if it’s necessary.  He cites Rwanda where the government clears the bills for even ordinary citizens who seek treatment abroad.

He says although Uganda has thousands of health facilities, most of them do not have medicine, have poor sanitation and insufficient staff that are over worked, underpaid, and are sometimes defrauded.

But he suggests that part of the billions of shillings that the government spends per year to settle high profile people’s medical expenses abroad could be used to plug the gaps within the health budget that caters for millions of Ugandans.

In the 2014/15 national budget, Shs1.3 trillion was allocated to implementing crucial government programmes in the health sector; including procuring treatment of top government officials abroad.

Dr Clarke says some of this money could be used in building confidence through enhancing the capacity of the health sector.

“The solution is not in the government paying for more sophisticated equipment only, but also investing heavily in training,” he says.  Some of the doctors also advise that those who travel should insist on a strong liaison with the Ugandan referring physician so that preliminary tests and follow up treatment can be handled within Uganda.   “One finds patients having lengthy stays in India, because the hospital there is repeating all the work which was carried out in Uganda since the Indians have little contact with the Ugandan physician. Links with international doctors are very necessary if we are to develop our health system,” advices Dr Clarke.