Greetings. The Ugandan medical professionals went on strike last week, a practice they have done countless number of times. The health sector, just like education, is a cornerstone of human capital development that will deliver the government's desired middle-income status. You can't be productive when your health is found wanting, and it's partly through skilled medical personnel (as well as their availability) that our longevity can be secured. With a country whose life expectancy is at 63, the government is so casual about the guardians of our health system going on strike.
The current crop
of medical doctors at the age of 30 years have been practicing for
approximately 4 years. Revisiting their HSC class set up a decade ago can help
understand their demands for an increment in remuneration.
PCB/Maths
Back in 2011,
there were four medical schools in the country, with government scholarships only
available at Makerere University, Gulu University and Mbarara University of Science and Technology (students at Kampala
International University, a privately-owned institution, are not eligible for
government scholarships). The essential subjects for an admission to a medicine
program are Chemistry and Biology. Therefore, for students preparing for the
Higher School Certificate with an eye on a career in the medical field, their subject combination must include these two. The most common combination at the time was Physics, Chemistry,
Biology and Mathematics, colloquially known as kalamba (full set).
It is in the
Mathematics classes that PCB/M brigade rubbed shoulders with students
whose career paths are targeted outside the life sciences of Medicine, Pharmacy
and Dentistry. Students interested in Engineering could opt for PCM/Economics
or PEM (while stroking Fine Art or Technical Drawing), whereas for those
interested in Quantitative Economics and Statistics anything with Mathematics
was good enough.
For students who
didn't pursue the path of sciences, the options in Humanities included History,
Christian Religious Education (Divinity), Islamic Religious Education, and
Geography. Subjects like Economics, Fine Art and the languages (French, German,
Luganda) were open to both science and humanities specialists. The kalamba for
humanities was HEG/D. University courses for humanities students included the
law, social sciences, history, mass communication, business administration, and
languages. Whereas Medicine was only available at three universities,
Architecture at only Makerere and Engineering restricted to Makerere, Kyambogo
and Ndejje, humanities courses were available at all 31 universities in the
country at the time. With limited university vacancies available, the race to become a doctor was more competitive than the other career paths.
Upon reaching the university, Medicine - which comprised of two undergraduate degrees (Bachelor of Medicine and Bachelor of Surgery) - has a duration of five years. Architecture is the only other undergraduate course that requires five years of study. Of the Humanities courses, the longest duration is reserved for the Bachelor of Laws (4 years), with the rest of the courses having a three year duration.
Therefore, as the medical student commences his/her fourth year of study, majority of his/her HSC classmates that opted for a path in the Humanities are commencing their job hunt. It is during the second semester of this year (sometimes the year before) that the big four audit firms reach out to university students that are likely interested in a career in accounting/auditing. These firms have an inclination to hire people with a background in Engineering, Economics, Mathematics and Statistics, believing that the quantitative background in these courses gives them a leg up when completing the chartered courses in accounting.
For a student fresh out of campus, the audit firm presents a very enticing career starter. The net salary ranges between UGX 700,000 and UGX 1,000,000/=, along with health insurance and a scholarship to study the chartered accounting course. For the class that joined university in 2011, by the time the doctors signed their first professional contract their counterparts in the auditing career path already had two years of experience and were on track to complete their professional courses.
As the years progress, the gap between the doctor and the rest only grows wider. Considering that the individuals in the audit path can opt for careers in financial management as well, the humanities career paths advancement is often not that quick. One has to obtain a postgraduate education to become more competitive in the job market and this comes with its costs as well. However, for those that don't choose that path the option of a side hustle can bring their monthly earnings to a respectable level. The time available for people in this line of work is not accorded to the doctors. A doctor has to establish their reputation and specialisation in their formative years before they can branch out and establish their own practice, which is often a very expensive venture.
The Medicine Man and the King
The government's treatment of the medical professionals, and the health system for that matter, leaves a lot to be desired. The 2018 decision to hire doctors from Cuba rather than raise the Ugandan doctors remuneration, was a major slap in the face to the medical profession. Along with the police's aggressive efforts to quell the doctors' demonstrations, these events are reminiscent of the ancient arrangement between the witch doctor and the king. The excerpt below from Matthias S.M. Kiwanuka's book sheds light on the relationship between the medicine man and the king:
"The relationship between the king and the medicine men depended very much on the character and personality of the former. If vexed, a man of a violent nature treated them violently. King Tebandeke, for instance, executed very many of them, burned down all their temples, and looted their estates with impunity. During the eighteenth-century King Kyabaggu treated them in the same fashion."
The medicine men doubled as diviners and physicians. Like their modern successors, they spent their apprenticeships at the temple learning the skills necessary from the old guard. However, in contrast to their modern successors, the ancient medicine man determined what he charged for his services. One had the liberty of charging ten bulls for treating the king's boil whereas charging the peasant a domestic fowl for treating a more serious ailment.
Perhaps our doctors that have chosen to pursue a career abroad can charge the President's acolytes - considering they get their treatment outside these borders - exorbitantly when they seek treatment. But our president is easily vexed. And the equivalent of an academic temple (read Makerere's Ivory Tower) already burnt down a few years ago. The looting of the doctors' meagre earnings will long continue.
Ceteris. Paribus.
MILESTONE: This is the 40th article posted on this blog. In commemoration, we should all remember to wish the medical professionals a happy festive season because majority of them will be on call.
References
Abet, T., (22nd December 2021). "Medical interns, doctors call off strike," The Daily Monitor.
Aboneka, J., (15th May 2018). "Cubans won't fix our healthcare," The Daily Monitor.
Kiwanuka, M. S. (1972). A History of Buganda from the Foundation of the Kingdom to 1900. Holmes & Meier Pub. pp 178.
Rigby, P. (1975). Prophets, Diviners, and Prophetism: The Recent History of Kiganda Religion. Journal of Anthropological Research, 31(2), 116-148.




