I would like to respond to a clarification by the director of the Health Monitoring Unit (HMU) of the president’s office in The Observer of July 24, 2015, about the arrest, continued detention, denial of bail by the court and interdiction of Dr Gerald Mwesigye of Kiryandongo hospital.
This case sets a bad precedent and shows that the handling of issues of medical ethics, negligence, errors and malpractice has a long way to go in Uganda. With the absence of clear mechanisms on how to handle patient safety and healthcare quality grievances in Uganda, the handling of such cases has been left to HMU, police and courts of law.
But the simpler and right way would have been involving the health professional councils such as the Uganda Medical and Dental Practioners’ Council, the Allied Health Professionals’ Council, and the Uganda Nurses and Midwives Council as well as the Private Practitioners’ Council.
These would work with the quality and safety department of the ministry of health that has the constitutional role of monitoring the ethical conduct of different health workers. However, this role has mysteriously been taken over by HMU, whose modes of operation are unknown to the health workers, thus creating a silent war between the professional bodies and the monitoring unit over who should take the lead.
The HMU commonly employs the ‘fault-based system’, where they look out for an individual – sharp end – to blame. The blame culture, however, may not solve the problems caused by health system failures and thus no tangible results might be realized since the causes of such problems are never identified or addressed.
In cases where the sharp end have been convicted and interdicted, this has created further human resource gaps, hence increasing the risk of more errors. Operations of HMU, which in many occasions end in convictions and litigations of culprits, have left health workers demotivated and working under terror, with fear of being the next victims of the blame system should failure arise.
Medical errors are a result of a multitude of systemic failures, and hence require a review of inputs, processes and outcomes to determine their causes. Like in this case of Dr Mwesigye, it would require to review the availability of inputs required to handle this case such as the health personnel, drugs and supplies; infrastructure such as the theatre, generator and fuel.
For the case of health personnel, they must have been well trained and capacitated to offer the care that was required. The review of the processes would require investigating how care was actually given and whether it was given according to professionally-known standards.
In this case, where referral was done, it would be prudent to investigate why the referral was ordered (lack of fuel in the generator as mentioned) and how it was handled. Still with the system thinking, the outcome of this case, which is death, must also have been investigated to find out why it occurred.
The input challenges public hospitals face are known to many who have interacted with these facilities; and these could affect the other parts of the health system.
Health systems that Uganda struggles to emulate have for long abandoned the blame system of handling patient safety issues.
They have adopted the no-blame system where health services managers handle grievances amicably between the victims, benefiting either party – ‘victim’ and ‘offender’.
Of course this may not apply where true cases of negligence and malpractice have been proved by the professional bodies mandated to supervise health workers. It should be recalled that “to err is human” and health workers are human beings. The only challenge is that health workers’ errors may have catastrophic repercussions, like what happened in this case.
However, health workers’ erring may be due to other health systems’ failures rather than individual failures, warranting a systems check and address. Let us not forget the good work these health workers have done for the country and castigate them for a single failure that might have been due to other system loopholes.
Further tackling of patient safety issues in this manner may lead to further loss of health workers to other countries with an excuse that it is not appropriate to work in a system where failures are blamed on individuals rather than carrying out health system evaluations.
The potential high risk for litigations that the profession now faces may also scare away young people who would have wanted to join the medical profession.
The author is a lecturer and coordinator, of Msc Hospital Management at the faculty of Health Sciences, Uganda Martyrs University.