Tori Meier's Blog Post
On Thursday, May 31st we visited the Anglican Church of Uganda Diocese and Mukono Hospital. Mukono has approximately four physicians and 32 nurses at their facility and sees upwards on 5000 patients. We toured the hospital and saw patient rooms, the labor ward, the laboratory, the maternal and child healthcare department, the dentistry area, operating rooms, and more. The hospital had a gangrene patient there who was waiting with a painful, rotting foot for a specialist to arrive and perform an amputation. Additionally, students were given the opportunity to peek through the window of an OR and watch surgeons perform a hernia repair.
In America, HIPAA (Health Insurance Portability and Accountability Act: provides privacy and security provisions for safeguarding medical information) would restrict much of what we were able to do last Thursday- ie. seeing patients without their consent, watching surgery without signing confidentiality forms, etc. Why do you think Uganda doesn't have these regulations? Do you think they do have them and simply aren't enforced much like other laws and policies in Uganda?
Dr. Simon mentioned that the medical profession in Uganda is not attractive to people for various reasons. In your opinion, what factor causes this unattractiveness most and what do you think can be done to address the issue?
Lastly, Mukono doesn't have epidurals for mothers in labor and only uses local anesthesia in surgeries. Do you think this is an injustice for women and patients or do you think it is not a substantial issue considering they are used to their conditions?
Thank you for your time, consideration, and smiles. Once again- this is TORI, not Jared. I mean Jarrett. Okay bye love you all.
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I wrote in my journal about how I found a difference with HIPAA. My best friend at home works at a nursing home and is not able to even share names of her patients. At the hospital the doctor spoke of a patient before the tour and then during the tour he pulled back a curtain and said, "This is the patient I was speaking of earlier". This was kind of uncomfortable for us because we were not used to the lack of privacy, especially in hospitals. It was nice to be able to get the extended view of the hospital so that we could get as much knowledge as possible.
ReplyDeleteAfter going to the hospital, I realized that the doctors and other medical professionals may see the other country's equipment and would rather work at a place with more resources.
The lack of medical professionals not only in Uganda but many developing countries is an important sustainability issue and critical to global health. I think the main issue is that those who do have an interest in the medical profession know that there are better opportunities in developed countries like the U.S. This is simply because the medical industry is better developed in these countries and health and is more prioritized (for example, health expenditures are a larger portion of government spending). Another issue is the education aspect. Class room sizes are large and it is difficult to get a medical education here in Uganda. So, people may have an interest in the medical profession, but there is a lack of access to education. One NGO that I recently found out about is taking a new approach to US doctors going abroad. Instead of providing medical care, they teach medical classes to Ugandan students so that the medical workforce in Uganda grows. Programs like this, as well as improvements in education, can help improve the lack of medical professionals in Uganda. As the medical sector grows, hopefully there will be more incentive to stay.
ReplyDeleteI too was very confused by the lack of patient confidentiality. It was odd to me that we were able to just walk into patients' private spaces and watch them. It was uncomfortable when considering HIPAA regulations in the U.S. and the access we had, but it was beyond fascinating from a health care standpoint. When it came to the labor ward, I was surprised by what seemed to be a lack of equipment. It doesn't seem too crazy to me that epidurals are unavailable, but I am very concerned that there are only 12 anesthesiologists in the country, according to Dr. Simon.
ReplyDeleteI found it extremely uncomfortable being able to see mothers nursing their children in plain sight as we were being shown around the hospital. I can't imagine not being given the right to privacy as I'm being treated for an illness or having a child. Both are extremely personal and private, not something that should be exposed to a group of tourists. I've woken up in a hospital before, not remembering how I got there. That in itself is traumatizing and hard to deal with. I would be especially freaked out if someone were to be observing me with a camera as I woke up. I never realized how privileged America is to have HIPAA.
ReplyDeleteI think that medical privacy laws, like many other regulatory laws in Uganda, are either difficult to enforce due to lack of policing resources, or the police force simply ignores these laws and sees them as a waste of time. This pattern of selective legislative attention is interesting to me because it indicates that there is no ingrained respect for constitutionalism or rule of law in Uganda, it is a more informal game of exhibiting power. In terms of unattractiveness for doctors, the general impression I have is that it is a field that takes too many years of training for too little pay or recognition, and is too underdeveloped in terms of medical technology for even people interested in health sciences to take an interest in. Those motivated individuals who do pursue a career in health sciences I would assume contribute to what is known as the brain drain, where the most talented and educated members of lesser developed countries seek a better life for themselves and take their talents to more developed countries. This is not always necessarily a bad thing as they are then able to send the income they receive back to their family in their home country. I think that the lack of privacy is an injustice to patients, but perhaps the idea of privacy is not as culturally important to Ugandan patients as it is to individuals in America who are more sensitive about medical histories, and may see certain conditions as signs of weakness or disabilities.
ReplyDeleteI think it is a cultural thing. I remember Dr. Bishop telling me that the culture in Uganda is not very private. That was why we could look in on surgeries and the patients did not have any say. I also think they do not need any regulation even if they have them because the majority of the hospitals in Uganda are very small and not very well taken care of. This does not give the patients to know anything else except open air hospitals where strangers can walk around freely and see what they want. I think if they could give epidurals they would. I do no think they have the correct amount of resources and they have to pick and choose what resources they can have.
ReplyDeleteI think it may have something to do with the culture of the US and how wiling we are to file lawsuits against these facilities. If we feel uncomfortable and think that the process that we pay so much for is not confidential, then many people think a lawsuit is the way to go. In Uganda, lawsuits are not even close to an option, especially for the common class. Also, people in Uganda didn't seem as violated as people in the United States may have.
ReplyDelete