By Flavia Nassaka
Ask questions and demand answers from your doctor
Robinah Kaitiritimba, the Executive Director of Uganda National Health Consumers’ Organisation (UNHCO) is helping those whose rights have allegedly been violated seek justice but she is faced with a tough situation – gathering proof. Earlier in the year, the 36-year old woman whose identity is protected for ethical reasons approached UNHCO with a touching story. Her uterus had been removed during an operation without her knowledge.
While in the ward, she overheard two health workers saying that her uterus had been removed. She got concerned and asked. That’s when they told her that the organ had been badly affected by fibroids and doctors had decided to remove it,” Kaitiritimba tells The Independent.
Kaitiritimba says they are faced with a challenge of proving that the hospital carried out the operation without the patient’s knowledge because she signed a consent form. Kaitiritimba says this case is not unusual.
“People don’t know their rights,” she says, “that’s why they think that clinic or hospital is doing them a favour. That’s why they stand mistreatment. They don’t ask for the record of their healthcare, not even asking about the medicine prescribed for them.” Kaitiritimba said most of the violations are caused by lack of supervision in addition to lack of understanding of patients’ rights and responsibilities by health workers.
Dr. Zeridah Muyinda, a radiologist at Mulago National Referral Hospital in Kampala says when a doctorprescribes medicine without explaining what it does and what side effect to expect or how this medicine will help; they are violating a patient’s right to information and making an informed consent.
Muyinda who encourages patients to ask about the expertise of a medical expert before undergoing a particular test says this helps the patient to gauge what to expect out of a procedure.
“I know this is not in our culture but it gives one confidence that someone doing the test is good at it or he’s just a starter. A patient has a right to ask. This is why hospitals should pin up names of their doctors and their expertise on a chart or board for everyone to see,” she says.
Currently, most hospitals and clinics do not even give patients medical forms indicating the diagnosis and treatment offered. Patients too almost never ask for their medical forms after receiving treatment.
Some hospitals or clinics claim to make and keep file of patient records and others outrightly say it is their policy not to give medical forms to patients. This is against the 2009 Ministry of Health Patients’ Charter which gives a patient a right to their medical information. The information may be withheld only when there is a strong case that by giving this information, it is likely to cause severe harm to the patient’s mental or physical health.
The charter which is currently the only document that outlines patients rights and responsibilities also gives a patient a right to participation in decision making about the medicine or procedure they are undergoing, a right to a healthy and safe environment, confidentiality and privacy, and a right to refuse treatment.
Kaitiritimba who is one of the participants in the formation of the charter said that while patient rights and healthcare are important, the Constitution or the Bill of Rights do not mention them specifically but only mentions a right to life in Article 22.
She said this Article needs to be revised to include a clause stipulating the right to health so that one is able to enforce this right to the extent that they can sue government if the services provided are lacking because they committed to providing a minimum healthcare package where everyone has access to treatment.
Primah Kwagala, an advocate says patients suffering from mental disabilities are particularly mistreated.
“What usually happens is that when a patient is admitted in Butabika Mental Hospital, they are secluded from other patients. On some occasions, mental health survivors claim they are stripped naked, showered with cold water, kept in chains among other painful behaviors,” she says.
Kwagala who says her organization and a one Kabale Benon are challenging in court the manner in which patients with mental problems are treated when admitted in Butabika Hospital told The Independent that this treatment is inhuman and degrading. She says it violates Article 2 of the charter which spells out that no health facility or health provider shall discriminate between patients on ground of disease, religion, disability, race or social status.
Unfortunately, this charter is not permissible in courts of law.
A new law has been proposed. It is argued that if the Patients’ Rights and Responsibilities Bill 2015 is passed then the provisions of the charter would be legally binding. Introduced on the floor of parliament by MP Milton Muwuma (Kigulu South constituency), the Bill seeks to protect patients from unethical medical conduct.
The new law will empower patients to give feedback on how they are handled in health facilities both in terms of how they are helped in making treatment choices and facilities at the various health centers and hospitals.
Dr. Jacinto Amandua, the Commissioner for Clinical Services at the Ministry of Health told The Independent that the Bill will also empower health workers to provide better services since those who violate the provisions will be penalised.
But Kwagala says even though the proposed law is a good step forward, it would be better to include other health issues that are being fronted by several stakeholders. It should be an omnibus law that covers a broad perspective of the right to health in its entirety.
That soft-hearted goal, however, runs into the hardheaded reality that state-of-the-art health care is increasingly becoming expensive and public facilities, which would hopefully offer affordable services, are mismanaged and inadequately funded.