{UAH} A Good Friend, Dr. Muniini K. Mulera, Speaks

Doctor, you have two options: Do good or do no harm!

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Posted  Tuesday, May 12   2015 at  01:00

Dear Tingasiga,

This column has defended the rights and honour of Uganda's hard working doctors and other healthcare professionals. We continue to do so not out of blind loyalty to professional colleagues, but because we know that the vast majority are dedicated people who do their best under very difficult circumstances.

However, our defence of the profession's rights must always be subordinate to the rights of the patients. When doctors or other healthcare professionals engage in conduct that risks the lives of patients, or brings the profession into disrepute, colleagues have a duty to censure them and seek corrective remedies.
An example of such a stain on the profession occurred on October 19, 2013, when Florence Nakamya, a 23-year-old healthy mother of one, went to Mukono Health Centre IV in labour. 
Mary Namatovu, a midwife at the government-owned health centre, advised Nakamya that she needed a caesarean section, for the baby was too big to be delivered naturally.

To transfer her to the appropriate hospital, a bribe of Shs250,000 was required, payable to the midwife. To Nakamya's relief, Dr Christopher Bingi, an off-duty doctor at the Health Centre examined her, satisfied himself that a natural birth was possible, and offered to deliver the baby at his private clinic at a discounted fee of Shs100,000. After some further bargaining, the parties settled on a fee of Shs90,000. 
Nakamya was moved to Trinity Clinic Services, Dr Bingi's private clinic in Nassuuti village, Mukono. After many hours of labour, attended by a nurse, Nakamya ruptured her uterus.

It was not until 7PM that evening that Dr Bingi found his patient in a state of shock due to excessive bleeding. He placed her into his own car and transported her to Mukono Church of Uganda Hospital where she and her baby were pronounced dead.
Dr Bingi was arrested and charged with manslaughter. However, Her Worship Joy K. Behinguza, the presiding magistrate, found him not guilty because the prosecution had "failed to prove to court beyond reasonable doubt that Dr Bingi neglected his duties causing the deceased's death."

Whereas I do not have adequate information to make an informed comment on the magistrate's finding of "not guilty", there is no doubt that Dr Bingi's conduct fell well below the standards of the profession. 
Central to the practice of medicine and surgery is the motto: Primum non nocere (First, do no harm.) 
Every time a doctor (and any other healthcare professional) encounters a patient, there should only be two options on the plate. Either you do good or you do no harm. 
This demands the humility to know your abilities and limitations; the professional support and tools available to you; the capability and ministry-mandated functions of the facility where you are; and whether or not what you propose to offer the patient would be appropriate for your own spouse or child.

One question that must never, ever, arise when faced with an acute situation, such as the imminent birth of a baby, is whether or not the patient can pay for the service. When all is said and done, the practice of medicine must not be about making money at the expense of people's lives.
The moral weight upon the shoulders of those who are privileged to be medical doctors prohibits monetary considerations in the face of a patient's urgent need. 
Bargaining and offering discounted fees in order to beat a corrupt demand by another professional simply reduced Nakamya to a commodity. It dehumanised her and her baby, which may well explain the subsequent events that led to her very premature death.

Nakamya and her baby were victims of an extreme greed that has engulfed Uganda, with many people of all ages and professions subscribing to the desire to "get as rich as possible, as quickly as they can, anyhow." 
Their death, along with those of thousands of others, invite legislation to compel all institutional deliveries to occur only in facilities that are capable of emergency interventions, including caesarean section under general anaethesia. 
This means a major overhaul of the system so that all institutional deliveries would only occur in appropriately staffed and equipped Health Centre IVs and hospitals.

Given Uganda's severe shortage of emergency ambulance services, deliveries in these small private clinics, even with a doctor present, should be prohibited by law. 
Furthermore, facilities where babies are born must have a fully trained team dedicated to the resuscitation, stabilisation and safe transfer of a newborn infant. At least one member of the team must be capable of placing an endotracheal (breathing) tube into the baby's windpipe. 
These are some of the relatively inexpensive measures that must be taken in order to reduce the very high maternal and neonatal mortality rates in Uganda.

In the meantime, I trust that the Uganda Medical and Dental Practitioners Council will come down very hard on any and all doctors who have lost their bearings and have become merchants in the black market that trades in people's lives. 
Dr Mulera is based in Toronto, Canada. muniinikmulera@aol.com

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Gwokto La'Kitgum

"Even a small dog can piss on a tall Building", Jim Hightower

Le Montréal d'amour d'I

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