The Uganda Medical Association (UMA) Secretary General, Dr. Mukuzi Muhereza, is at the heart of an impending industrial action by the medical fraternity in Uganda who are demanding better pay for medical interns and nurses.
On the UMA website, Dr. Mukunzi is described is an enterprising doctor living and working among the hard to reach people of central Uganda. His passion is in equitable, affordable and quality healthcare to all that deserve it. He is also passionate about fellow practitioners to work in a safe, caring and resource limitless environment. Having qualified with an MD from Univėsitė National du Rwanda in 2001 he worked in HIV care and treatment for over 10 years till he set up Inspire Health after his MBA from Makerere University Business School in 2015. He lives and works in Ngoma Nakaseke district.
Dr. Mukunzi is a self-confessed maverick but maintains it is what gets the job done. He says the issue of intern doctors needs an innovative and a responsive multi sectoral approach. In this exclusive interview with Dr. Muhereza comes weeks to an impending industrial action by members of UMA, citing a number of issues challenging the sector. Although the government of Uganda has promised to improve their pay, Dr. Mukunzi gives reasons why they deserve attention. Dr. Mukuzi tells MediaScape News that intern doctors work so hard and a mere Shs. 750, 000 is not good a pay for them, factoring in rent, transport and meals among others.
“….I may lose a salary, an appointment sijuyi pension, not this intern. Let us face it. Shs 750, 000 in Kampala is nothing. Most don’t have housing and will definitely not all have rentable places where you can walk to Mulago. Factor in transport. Most hospitals don’t have meals. Surely what is Shs 750, 000?….” continues to the excepts
Qn: Tell us about you. Who is Dr Mukunzi in 100 words?
Ans: I was born on Aug 16th 1975 as a second born among two, me and my elder sister to Mr. Gideon Bwajoojo and Vasta Galiyo. My dad was a pastoralist moving with his cows wherever the best pasture was found. My mother, having migrated from Rujumbura in current Nyakagyeme Rukungiri district, was a teacher for lower classes. Though not a trained teacher, she had gone to school unlike my dad.
I attended multiple primary schools, that time called church schools and ended my primary with aggregate 12 and was admitted to Kako SS. Unfortunately, my mum died that very year. I couldn’t start secondary school because there was no money and she had been the one pushing my schooling. I repeated P7 and was the best in the whole examination centre. So I went to Ibanda SSS for O’level where I finished four years being the best in class. Then I went to Ntare School for my A’level.
Qn: What happened after that?
Ans: In 1995, as the war and genocide was ending in Rwanda, I crossed over there primarily to get a vacation job. As the new government wanted to reopen activities, doing university from there was one of the ideas I liked. We did entrance exams and after scoring very highly, I remember it was 97% average of the two papers, I was allocated to study Medicine. Medicine was fun but also challenging. New stuff, Latin names and later in the clinical years behavior would determine your marks also. Being a maverick and always cheeky earned me some negative marks. Despite the fun, this was the first time I faced challenges being a foreigner. Kisangani wars (1 and 2) found me in Rwanda and you can imagine the tensions, the choosing of a side.
Qn: What next after this phase?
Ans: Immediately after completion I came and registered with UMDPC and started working in Uganda, with my first ever job at St Karooli Lwanga Nyakibaare Hospital, Rukungiri District. From there, I joined the NGO world with TASO taking me to open its centre in Gulu at the height of the Kony war in 2002-03 and later to Masindi. After 10 years, I was not seeing a lot of raise in my salary and I resigned. Most people including my immediate family thought I had run mad.
Qn: Why did you choose this path?
Ans: I had planned to do purely private practice but I found I had a lot of time on my hands and later joined the government here in Nakaseke district.
Qn: How then do you catch this activism disease?
Ans: Around 2015, there was a lot of arrests of doctors and I remember teaming up with some fellow Doctors like Dr Ekwaro Obuku and going to Kiryandongo then Masindi district to bail out Dr Gerald Mwesigye. Then Mityana and Fort Portal. That is how my passion for fighting for others started. While in the Kigezi region, I had done a Diploma in Health Services from Kabale University and later a Master in Business Administration from MUBS. This is how I got into the side of the world, away from medicine.
Qn: Why are you in Nakaseke and not in the high end location of Kampala? What pushed you to Nakaseke?
Ans: Nakaseke came naturally, being near Masindi where I had resigned from and having a population that could sustain private practice, I decided to practice from here. My ethos in life was to touch and make a relationship with my patients. Yes, it can be possible in big towns and cities but easier and effortless in such a close knit community who I know their cultures and belong completely. Let’s face it: having been an orphan early in life, opening a clinic in Kampala would be a tough decision after all one must continue to earn.
Qn: What is a day like in the life of any doctor anywhere in Uganda?
Ans: At the public facility, you never know what is in store for you on an average day. In other words, there is never an average day. Some days are calm, some you spend all day on your feet. I wake up and usually do a ward round in the allocated ward. Now I am on a female ward, then scroll over all the other wards with the typical phrase: ‘any emergency?’ These might be cases that have been wheeled in or not yet reviewed by a Doctor. They could also be those with surgical emergencies to be wheeled to theatre right away.
By 1100hrs I go to the theatre where I wait for emergencies. Here I also order for breakfast. We call our breakfast ‘concrete’ for its composition. Being a village, we do some fried cassava, some banana pancakes, some bread, usually some roasted soya or ground nuts washed down with black tea. I am a coffee person but it’s rare to get it here, it’s expensive and shops won’t stock it for only me. Then we delve into both emergency and elective cases. It’s normal to work till it is 1700hrs or even 1800hrs without breaking or even knowing it’s that late.
Qn: What does it feel to practice medicine in a poor country like Uganda?
Ans: You adjust and pretty quickly. Some little things that set us apart are the people you are dealing with. Someone comes from the garden to come and deliver her baby. Telling her to take a shower seems rude but very necessary especially for the good of the passage of the coming baby.
When you don’t have what to use, which is the routine, asking a patient to buy drugs and sundries is a tag of war. Things that sound so small like even Shs 500 elicits emotions. I used to chip in like most health workers but you realise that you can’t finish these needs. You develop a thick skin. Bad, but it happens. I used to ask: You had 9 months to prepare for this baby, these days I do what I can do and leave the rest to the gods. On the flip side, you see genuine appreciation and love of the service rendered.
Qn: The Hippocratic Oath engenders you guys to stick to saving lives? Why do you strike for pay? Why don’t you sacrifice?
Ans: This oath is probably the most misquoted or misunderstood. I challenge you to read it especially towards its end. In part I quote: ‘If I fulfill this path 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.’
As you can see, the oath allows us to enjoy the sweat of our labor. Hypothetically, imagine a doctor that works without pay for a month in and month out? What motivation does he have to work for the next one? So unless you pay him and pay him well, don’t expect that smile, that passion next time. Simple and straightforward. An average Ugandan Doctor is already sacrificing. The conditions he works in. The long hours. So let us pay him better, and I mean minimum. Remember we know what is happening in the neighborhood. We know what is being paid in Kenya, South Sudan etc. Same skill set, same qualifications so why not pay this one the same or at least near that.
Qn: Tells us about the situation of interns in Uganda. We were used to doctors striking. But these days it is always interns. What exactly is wrong?
Ans: I will handle the intern’s issue with the candidness I can muster.
First, this is a group that works really hard, for we (the seniors) feel one year is even short to sharpen these university graduates to make them the required Doctor thus the demands.
Second, they are young and would lose nothing if they go on strike, I may lose a salary an appointment sijuyi pension not this intern.
Three, let us face it. Shs 750, 000 in Kampala is nothing. Most don’t have housing and will definitely not all have rentable places where you can walk to Mulago, so you factor in transport. Most hospitals don’t have meals. Surely what is 750, 000?
Four, then there is this gospel that has been going on for some time and it is being manifested among young people. Tubalemese, etc.. the militancy that has been being preached to us by politicians and you see it raising its head now and again.
Five, the training is changing. We were trained almost like priests. Now it’s human rights and liberation.
But the mother of all evils (or good) depending on what lenses you use is the issue of numbers. Ten or twenty years ago the only university producing doctors was Makerere University and later Mbarara. Combined they would struggle to reach 150. Then the floodgates of privatisation were opened and numbers have jumped to more than 500 for Doctors alone. Add nurses, pharmacists and others, it comes to 1200. This raise didn’t raise the resources to keep a smooth internship. This by the way is all spheres: supervisors, internship centres that have facilities, etc.
So to respond to this needs a whole range of innovations and a responsive multi sectoral approach.
Qn: What can make a doctor comfortable in a country like Uganda?
Ans: What I get from most members is practicing their trade to the best of their abilities. This business of “out-of-stock” kills us most. Uganda is changing but lack of facilities has been a challenge. Good schools, good amenities and of course all these come at a cost. The expectation in society of a doctor is so high and this can even be depressing if you don’t meet it. So yes, the pay must be commensurate with these needs and expectations.
Qn: Seeing how doctors have been treated in Uganda, do you think children should study medicine or politics?
Ans: Medicine continues to be prestigious. But deep down especially when it is close home, these children are observing, comparing and analysing.
They see judges, accountants coming home early, no interruptions of their time with them and the earnings are way off the roof compared to the doctors. They see the risks especially from infectious diseases and needle stick injuries without care or compensation. All these are hindrances.
Qn: What is your assessment of the health sector in Uganda? Is the government doing its best or window dressing?
Ans: My assessment is prone to go towards curative. Hospitals are not as great as we/I would love them to. The human resources are demotivated yet they are so skilled, the equipment is hard to come by. Can you imagine when you cross the Nile you can’t get a CT scan at all in public facilities?
We have as a country made some strides in preventive health and most of our indices are either great or improving greatly. Talk of maternal or child mortality, immunizations, etc. All in all we must agree that all this is in a poor country. The mushrooming medical schools must be regulated and quality assured.
Qn: How do we stop medical personnel strikes in Uganda?
Ans: Wish I can have a panacea to this or a magic wand to do so. The biggest cause of these strikes to me is the priorities we give to the health sector. The powers that be tell everyone to tighten our belts then bingo you see a Presidential Advisor the quality of Kusasira or Butcherman being given a fuel guzzler. The other issue that continues to pop us is the lack of protective equipment. One of the hardest tasks was to douse a strike that had been passed in the middle of COVID 19 second wave. One side was advocating for responding to the second wave, another was telling us how we were dying sue to lack of PPE. So sad you don’t know where or which side to listen to. Let there be equitable distribution of resources. Let leadership especially at the Ministry of Health listen but also talk to the Doctors.