the vast majority of Ugandan lawyers are incompetent to prosecute a medicolegal case. The system and infrastructure within which they work virtually makes it impossible to win a case without being unfair to the individual doctors who most times. The ethics and level of knowledge of the lawyers themselves mean that the husband would spend more than that 50 million on litigation and still lose or have the case drag on for years while the evidence gets lost! While the training of doctors in Uganda is important, sueing individuals will not really improve practice standards. It will in this current environment only increase risk minimisation and increase patient hardship and worsen supply while increasing price and waitlists in public hospitals. The key here is to look at a systemwide approach to the problem. Western style litigation in an incompetent system just simply is not going to work but may increase victimisation of even the good ones available which will drive them out of practice or increase the premium on quality services. Quite frankly if am competent enough to work in a competent system why would I wish to work in an incompetent system for peanuts while being vilified, maligned, blackmailed and set up to fail? A Ugandan brain surgeon in north America visited Uganda. He arranged to operate in Mulago voluntarily. Lists were prepared for him. When he turned up to theatre at 7 am, there was no one. theatre nurses wandered in at 11 and pissed off at 1 pm. Anaesthetist/anaesthesiologists were difficult to work with and to quote him unethical. The list was contaminated by cases sneaked in under the radar. the genuine patients on the ward didnt get operated upon. ICU support which is important was not availed. ICU was private He decided after that he would only do rounds and finish off looking after the ones he had operated upon and enjoy his holiday with his family. What people do not understand is that a surgeon like this is not insured to work when he is on holiday in Uganda and could lose his livelihood if he had a mishap or picked up an infectious disease. It is a risk that one has to wonder whether its worth taking. He went back home and did not repeat the experiment again! Like many cases in Uganda, this case is probably edited to the point of being useless. Any comments or conclusions based on it are effectively not very useful, plus it presents a single story ... that of only one side. It also says nothing about the infrastructure in which these surgical services were offered. it mentions a high quality hospital but quite frankly am not sure what that means. A hospital is not a hotel were they give injections. Many Ugandans have a very unsophisticated view of medical services including those who are educated. Even policy makers can be very vacuous as to what constitutes quality! That said I will contradict myself and make a few comments. -the reference to 10 million shillings is extraneous and really means nothing. it is designed to sway your opinion. -this operation was elective presumably for an ovarian cyst. -the operation got complicated and took longer than expected. it was more extensive than planned with surgery being extended to the uterus. -the recovery was complicated by hypothermia (low temperature) probably related to the duration of the surgery. There may have been problems with the monitoring but nevertheless she survived. the figures on the oxygen levels are designed to sway your opinion too. They may suggest poor monitoring or just the fact that she was unwell. -the post operative phase was complicated by fevers which were managed presumably peripherally as typhoid! **Now this is where the contamination happens. Typhoid is a quack diagnosis and usually reflects the incompetence of the person diagnosing it! -Her laypersons interpretation of ureteric obstruction, a potential complication of the kind of surgery she presumably had was that the ureter was cut. this is not necessarily correct. -Am not quite sure what is wrong with a doctor playing golf! She turned up, without an appointment. Granted it was a very important issue for her but could at that point in time wait till after his golf game or whatever. A hurried diagnosis is as bad as no diagnosis. The same surgeon thenext day opined that she needed a urologist and actually communicated back and made a referral. -she had by this time lost confidence in the system and sought a second opinion elsewhere which differed from the first. obviously she has the money so she self referred to india where she not only had corrective procedures but also managed to stay for 3 months ... a very expensive process which hopefully was not at taxpayer expense! -while there she met 3 other Ugandans. which begs the question, how did they end up there? Who referred them. Was it really appropriate? By this time she of course is angry and wants someone to pay her. One has to deal with issues of consent. Did she consent to a hysterectomy? What exactly was the nature of the övarian cyst? Was it a cyst or more? If she self referred to a quack who misdiagnosed and treated a post operative pelvic infection that could have caused scarring and stenosis, then in part she transfers the blame to herself. As you can see she is going to have a monumental problem trying to apportion blame. She will also have to fault or find someone to offer expert testimony questioning her surgeons competence and judgement. Is she a typical Ugandan ... ie overweight? In which case overweight people present special problems to surgeons and anaesthetists!
Posted on: Wed, 26 Mar 2014 13:23:26 +0000
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