Doctors: Without interns we are overworked, drained

In the 2023/2014 financial year budget, the government allocated Shs 22.9 billion to cater for the allowances of medical interns and senior house officers.

However, upon releasing the funds on June 22, 2023, Minister of Health Dr Jane Ruth Aceng clarified that the released amount was not intended for the deployment of the 1,901 pre-medical interns. Instead, it was allocated to pay arrears owed to the 935 interns who had completed their internship in April of the same year.

Dr. Aceng explained that to deploy the remaining 1901 interns, an additional budget of Shs 80.4 billion was required. Out of this amount, the ministry of Finance had pro- vided Shs 8 billion for interns and Shs 2 billion for senior house officers.

However, due to the shortfall in funds, the deployment of interns had been put on hold until the necessary budget allocation could be secured. In response to this situation, Dr. Diana Atwine, the permanent secretary of the ministry of Health, advised pre-medical interns who could afford it to apply at various health centers of their choice.

If the ministry of Finance later availed the required funds, the interns would be reimbursed accordingly. On July 4, 2023, The Observer conducted a spot check at Mulago national referral hospital to assess the impact of the delayed deployment of medical interns and doctors on service delivery.

The observation revealed many patients and caregivers crowding the hospital’s various departments in search of healthcare services. Throughout the hospital, including the Makerere Assessment Center, Laboratory, Emergency ward, Immunization center, Uganda Cancer Institute, UCI-Fred Hutch Cancer Center, Surgical clinic, pharmacy, and sundry, overcrowding was evident.

Patients were seen waiting on verandas, steps, and other areas, often accompanied by their belongings. Un-admitted patients sat next to their mattresses, suitcases, and other items. The slow pace of healthcare delivery was noted during the visit. Doctors at the various clinics were overwhelmed by the sheer number of patients seeking medical attention.

The Emergency ward witnessed a continuous influx of patients, with three ambulances and a police patrol regularly transport- ing accident victims to the hospital. Stains of blood were visible from the entrance of the ward, which raised concerns about cleanliness and hygiene.

The limited number of beds, spaces, and mattresses in the Emergency ward led to at least seven patients having to sleep on the concrete floor while waiting to be attended to. Our reporters observed three health workers attending to over 40 patients, with others arriving continuously.

It was later discovered that doctors and health workers were working in shifts to cope with the workload. On two occasions, our reporter witnessed a distressing incident where an accident victim died in a pool of blood. Shockingly, the body was swiftly removed from the bed and immediately replaced with another patient without proper cleaning.

This disregard for cleanliness, according to doctors, poses a risk of HIV/Aids transmission, especially when patients are forced to sleep on the floor. Additionally, sleeping on the floor increases the likelihood of contracting staph infections, which can cause skin and bloodstream infections, as well as pneumonia resistant to common antibiotics.

The hospital management responded to these challenges by deploying private security guards at the entrances of the wards. These guards now question suspicious visitors and strangers to enhance security within the hospital premises. Despite these measures, the situation remains critical, with a significant gap created by the delayed deployment of interns who would have assisted in tasks such as bed cleaning.

The delayed deployment of medical interns and doctors has had a severe impact on service delivery at Mulago national referral hospital. Overcrowding, compromised hygiene, and an overwhelming workload for doctors have become common issues. Urgent measures are required to address this situation and ensure the provision of quality healthcare services to the patients in need.

HEAVY WORKLOAD

During interviews conducted for this story, doctors expressed their concerns regarding the need for medical interns and the impact of their delayed deployment. One doctor emphasized the importance of medical interns, stating that they are crucial in reducing the workload at healthcare facilities. The doctors train interns in various tasks while they gain practical experience.

“They [interns] are so critical only that the ministry is shielding the issue of medical interns. We receive a huge number of patients every day. Look at the line outside. Those are all patients, and I must examine all of them,” one doctor said.

The doctor acknowledged the significant number of patients seen daily and emphasized the need for the ministry of Health to prioritize the issue of medical interns and doctors. He suggested that the ministry should allocate a supplementary budget to address this matter, as healthcare facilities are currently overwhelmed. He mentioned that not only Mulago hospital but also Kawempe hospital faces similar challenges and sometimes must refer patients to the women’s hospital.

Another doctor, who had been an intern three months prior, shared his experience of unfulfilled promises. He claimed that interns were promised Shs 1.8m per month but only received Shs 1.3m. Furthermore, he expressed frustration about having to pay taxes on their allowances, which are not supposed to be taxed.

A senior house officer at the national referral hospital highlighted the overwhelming number of patients seen daily. He emphasized the disparity between the workload and the compensation received, describing it as earning “peanuts” compared to the volume of work undertaken by doctors. He believed that deploying medical interns would help alleviate the workload, as they can perform simple examinations not only at Mulago hospital but also in other health facilities across the country.

EARNING PEANUTS

“When you check at the emergency ward, cancer institute and other areas, you will realize that doctors are overwhelmed by the patients. When you compare the number of patients we attend to and the amount of money we get, you will see that we earn peanuts,” he said.

Dr Rosemary Byanyima, the deputy executive director of Mulago hospital, referred to medical interns as students who have completed their first degree and require hands-on training. She requested to discuss the matter further after concluding a meeting.

Dr Herbert Luswata, secretary general of the Uganda Medical Association, addressed the shortage of human resources in public health facilities due to the delayed deployment of interns and senior house officers. He explained that the coverage of human resources in these facilities ranges from 40% to 45%.

The absence of interns exacerbates the long queues observed at health facilities and increases the mortality rate.

“Our colleagues at these hospitals ask us how far we have reached with the deployment of medical interns. The numbers of patients are so high, and the mortality rate increases when we don’t have interns on the grounds,” he said.

Luswata expressed concern about the overworked and drained state of his colleagues. Due to the lack of interns, doctors find themselves doing the work that should be covered by multiple individuals. The strain of overwork in the medical field leads to a decline in the quality of services provided, resulting in potential misdiagnoses or underdiagnoses.

The quality of surgical services is also compromised, as fatigued doctors continue to perform procedures, increasing the chances of errors and subsequent loss of life.