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Tackling the medical internship challenge

Medical Interns demonstrate. Interns have on several occasions went on strike over poor working conditions and delay in getting stipends. INDEPENDENT JIMMY/ SIYA
Medical Interns demonstrate. Interns have on several occasions went on strike over poor working conditions and delay in getting stipends. INDEPENDENT JIMMY/ SIYA

Questions as Health ministry proposes stringent guidelines on enrollment

The mood at Nakasero Primary School in Kampala on Oct.01 was similar to a movie shooting scene gone wrong – bitter exchanges and mean stares were flying about. The unpleasant body language of medical interns to-be as Dr. Jacinto Amandua, the commissioner Clinical Services in the Ministry of Health addressed them screamed of rage.  It was the second day that applicants for medical internship were attended an induction workshop but they were not aware whether they had got placement or not.

“I don’t know where I’ve been posted,” said Lillian Ajuna who is pursuing a Bachelors of Science in Nursing from Mountains of the Moon University in Fort Portal. She came to Kampala after seeing an announcement in the papers calling those who had applied to report for induction.

Ajuna was as anxious as her colleagues. Perhaps she would not have been that anxious if the Ministry of Health had not moved to amend the guidelines for one to get placement – only to be stopped by a court order following a petition by five of the interns.

Among the new guidelines presented to the Parliamentary Health Committee by Minister Jane Ruth Aceng are a requirement for sitting a pre-internship exam and bonding those who studied under government sponsorship programme to serve in public facilities for two years; one year at a general hospital and one at a Health Center IV. The amendment also proposes erasing payment of stipends to medical student interns who are privately sponsored.

Dr. Ssentongo Katumba, the registrar Uganda Medical and Dental Practitioners council told The Independent that interns make a big contribution to the functioning of public hospitals and the ministry wants to ensure they are the crème de la crème and have mastered the theoretical aspects of their profession.

“The quality of the final medical doctors we get is dependent on the depth of their internship,” he said, “The healthcare industry needs hands-on.”

Like Katumba, Dr. Anthony Mbonye the Ag. Director General of Health Services at the Ministry says the country needs responsible, reliable and respectable professionals that meet both regional and international standards. He said that is why the ministry is taking steps to get rid of unqualified medical interns in health centers.

When the list was finally released ahead of the Oct. 03 official reporting date for interns across the country, of the more than 1000 applicants, 745 students had got placement in about 30 different hospitals. About 156 of these were attached to the Mulago National Referral Hospital.

Even though over the years, it has come in bits that at times interns get some money after going on several strikes, they are entitled to a gross of Shs1, 050,000 in allowances per month to cater for their welfare for the period they spend training.

A minimum of 12 months of internship is a prerequisite for anyone to practice as a dental surgeon, a graduate nurse, medical doctor or a pharmacist. Others can go for up to two years.

Dr. Fauz Kavuma, the President Medical Interns at Uganda Medical Association is against the new guideline on stipends going only to State House sponsored scholars, student loan or government facilitated students. He says all students need to be given allowances because while they benefit by getting skills, the hospital gains more as they are more inquisitive and eager to know which makes them more dedicated to work more than staff they find at facilities. He adds that when interns arrive at their stations pressure on medical workers reduces because interns fill gaps and in some cases do most of the work.

Mulago Hospital’s Public Relations Officer Enock Kusasira seems to agree. He acknowledges that the hospital largely depends on interns as they complement a medical staff that is already overwhelmed by increasing patients’ numbers.  Last year alone, the hospital attended to 829,817 outpatient visits, 761,573 inpatients and 61,568 emergencies. It grapples with a staffing deficit of 581 workers.

Generally, doctor to patient ratio in Uganda is estimated at 1:24,725 with a nurse to patient ratio of 1:11,000 yet the World Health Organisation (WHO) recommends one physician per 1,000 people. Experts say Uganda has failed to make significant strides in reducing unnecessary deaths because it has not addressed the challenges posed by conditions of service of health workers who are the engine of the health system. Many experts say Uganda has a lot of improvement to make, even at the level of medical internship.

A specialist at the neurosurgery department of Mulago hospital who preferred anonymity told The Independent that because of the work load and increasing number of patients, they end up not supervising interns yet according to guidelines interns are supposed to strictly work under supervision.

“Everyone knows specialists are few. In addition to seeing hundreds of patients, we are supposed to supervise junior staff and then the interns. Unless you are a magician, there is no way you can offer your best to all of them. At some point one of them suffers,” he said.

Such confessions raise concerns about the fate of patients in government hospitals being put in danger as trainees are left to conduct medical examinations and procedures such as scans, X-rays and other professional services.

When interns do not get supervised hands-on skills required, it leads in the long run to the standards of care dropping.  So calls for quick interventions have been increasing as growing enrollments in medical schools across the country put pressure on the Ministry of Health budget, the few specialists, and even the few hospitals that can offer internship.

Already some hospitals, like Kagando and Kabale in western Uganda, had stopped accepting interns. They only resumed their internship programmes recently. The Private Not for Profits hospitals have put a cap on the numbers they can admit at any particular time. On the flip side, hospitals like Mulago may suffer an intern over flow and the population will end up with interns who were not properly supervised becoming doctors.

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