Letter to the President on intern doctors

Mr President, this is choosing an easy way out but the long term impact is potentially disastrous.

Your Excellency, the genesis of the current problem of “very high number of interns” is failure of the government to plan for and appropriately regulate medical training in the country especially after it allowed private businesses to run such training. 

First, the population of Uganda is increasing rapidly and so, we cannot expect the number of trainees to remain stagnant. Secondly, our health metrics are so poor that even the increasing numbers are insufficient. 

Third, although it should be planned for, the high number of young people training into highly skilled health-workers should be considered a blessing. It is unfortunate that we see this as a problem.

When the government took a decision to liberalize health-workforce training, it should have had in place the appropriate framework and infrastructure for internship and sufficient regulatory measures to ensure quality and safety of the population. 

Today, medical schools are all-over the place with inadequate infrastructure impacting quality of training but regulation is only half-hearted. Almost anybody with some money and who can pay fees in a private medical school can join and train in medicine. 

As if the government did not expect it, it is now acting surprised at the high numbers graduating. The answer is not in curtailing paying interns but re-organizing the system.

Mr. President, let us peek into what the immediate future will look like. We shall be sending a poorly fed, hungry, and unhoused young lady, whose parents in Namutamba literally sold everything to see her through Mbarara University Medical School to Arua hospital for her first six months of internship and then to Kabale Hospital for the next six months. 

We expect her to rent herself a house, dress and feed herself and at 3am safely operate on a mother with obstructed labour or safely resuscitate a convulsing child the next morning!

Moreover, we asked the Senior House Officer or trainee specialist, a mother of two whose children slept hungry and who we also decided should not be paid for the next three years, to supervise and mentor the intern in these procedures. 

Can we imagine what will be happening in our hospitals and the safety and security of Ugandans? This is exactly why you agreed to pay them when we met you in 2021 and 2022.

Beyond the short-term, this spectacle is extremely damaging to the profession. Right now, nearly 2000 highly trained young graduates, some of who are the best brains this country has and not students as some would have you believe, have been seated at home for nine months stressed, demoralized, many now with mental health issues wondering why they ever chose to train in medicine. 

Another nearly 2000 will join the  in June and July. Is this what we want to see in the people who will treat us in future?

Today, even the medical students we teach are so worried about what will become of them. I foresee large scale emigration of graduating health workers. But more worrying is the impact on children in secondary schools. 

The images of the recent violent arrest of interns who were protesting their delayed deployment by police is all over the media and is particularly traumatizing. Mr President, many children in high school are now reconsidering their career choices away from medicine!

Let us sort out this problem.  

Let our hospitals function and function well. Employ the specialists and promote those due for promotion. Let us cut down and put a cap on the unnecessary referrals abroad. 

The money that can be saved by carefully selecting who to refer abroad for healthcare alone is sufficient to pay all the interns, the senior house officers and employ and promote the specialists in all the General, Regional Referral and National Referral hospitals.

Mr Richard Idro is an Associate Professor of Paediatrics, Child Health and Paediatric Neurology.