by D Demeke
Ethiopian government is basking from the praise it received from the international organizations and sponsors on its basic health service achievements in the country. One example is the recent statement by the World Bank on the achievement of reduction of child mortality by the government of Ethiopia. This has to be welcomed, if the stated data is accurate. However, the focus of the government seems to ignore secondary and tertiary level health care because it does not seem to attract foreign aid. As a result, the state of the secondary and tertiary level health care can be considered non-existent in the country.
There are about 37 hospitals in the capital, six are owned and operated by the government, while the rest are private. My experience in two private hospitals is less than impressive. One will assume that there must be government policies that guide, direct, and force these hospitals to provide, safe, clean and be a fitting place to treat people, but to the contrary, many hospitals are dirty, cockroach infected not fit for anyone to leave there, it is the worst place for a week and seek person.
The first thing anyone will notice is in the hospital is the master-slave relationship. It is glaringly clear that the doctors are the kings and all the rest nurses, cleaners, hospital technicians, and even patients are treated as slaves. It is heartening to see how the doctors’ vulgarity particularly when addressing the nurses. I witnessed a female doctor addressing a nurse in complete contempt and vulgarity (I cannot repeat it here), they look down on everyone, and they think that they will save lives single-handedly. They have a power over anyone working or having treatment there. No one challenge them of their unacceptable behaviour. Simply because people are scared of them, people are afraid of them on what they can do to their loved ones. Civility of communication is non-existence, the doctors seems to consider their patients as if they do not exist when considering consulting them. Patients are there to answer questions and explain their problem to the doctors. However, doctors do not seems, or bother to explain himself or herself to anyone including the patient. Patients will be informed to give more samples or take medication. Ask any patient, after they see their doctors, what their ailment is, they do not know because no one bothers to explain their problem.
As a carer, if you ask a simple question, or what the treatment plan is for the patient, you get this look, a kind of why are you asking me kind of a thing. Some even ignore you completely. They have forgotten that they are made of from the same clay like everyone else. This is true for almost most of the doctors, but there are some exceptions. One character which is exhibited by almost all doctors is that they gloat with extreme superiority. Others have knowledge and contribution to society, health professionals should in theory work as a team to provide the best possible health care system, respecting other team members should be the start of creating a good team. This will create a pleasant environment this enable patients to treated with dignity and respect.
Let me tell you another very pressing issue, everyone will advise you that any test result may not be correct, in my own experience, a simple blood test was conducted to see the sugar level, based on the test result, diagnoses were made and medication was prescribed. However, the second repeated test with different testing instrument resulted in a negative result, the prescribed medicine stopped. The surprising thing was that, the doctor admits that the error was because of a faulty test instrument. Further discussions with the doctor also indicate that, there is no regular test to make sure that equipment and systems used in patient care are operational, safe, and properly configured to meet what the equipment is designed for.
The same equipment will be used on another unlucky patient and will be prescribed a medication for a non-existence ailment. The patient will have all the side effect of the medication without any advantage. In my own experience, nurses also verified this, one of the nurses was trying to measure the routine blood pressure, temperature and oxygen saturation on a patient, and getting unrealistic reading, when she was consulting with her colleague, she was informed that the particular testing equipment is faulty and advised to use another one. The equipment was left on the corridor for a while, but before long, it was taken to be used by another nurse. It seems that the doctors are using incorrect test results to diagnose illness. Doctors are the last protection a patient has, that doctors should demand that these test instruments are maintained properly and tested regularly. If this is not the case it amounts to professional incompetence and negligence, doctors knowing that the instrument used to test samples are not reliable even faulty do nothing about it amounts to absolute negligence.
Have you checked the expiry date of your medication? It seems that you are the first and the last person to check before the medication is used. If you fail to do so you are condemning your loved one to suffer. One thing for sure is missing here, the organisation which is supposed to do this on behave of the patient does not seem to be working at all. There is a great deal of mistrust between the public and the pharmacies. Did I tell you that almost all pharmacies are privately owned, so first comes profit and then the rest follows. I am not suggesting all are like that, they will sell you expired medicine; you need only few bad apples to have significant effect on the health of the nation. Furthermore, you will be politely reminded to buy medication manufactured in USA or Europe, the reasons are poor quality control of manufacturing of medicine in the country and medication imported from India. One thing for sure is that there is a magnificent level of mistrust of pharmacies, and all the supply chain compounded with the luck of effective control mechanism by the government.
Private hospitals primary aim is to generate maximum possible profit. To maximise profit all units of the hospital required to be kept as busy as possible to generate maximum profit. For example, a laboratory that is not testing samples is untapped resource for the hospital owner. The hospital owners are paying for a laboratory technician but not getting the most possible profit from it. One of the most shocking discoveries, in my personnel experience is that doctors are given incentive to prescribe as many tests as possible. They are paid a percentage from the entire test they have prescribed to patients. It is difficult to get exact figure but they are getting between 20 – 40 % of the payments made by patients for a laboratory test. Furthermore, at the end of the treatment when patients are discharged, in my own experience, doctors are requesting payment for a procedure which has never been conducted on the patient.
The current arrangement between the doctors and the hospitals, create ethical, moral and legal issues that threatens the relationship between the doctors and their patients. Doctors in principle, their first priority is to save life. I believe that when doctors joined their medical school, the aim is to serve their fellow humans, reduce their pain and sufferings cure them from ill health. When doctors are paid a proportion based on the number of tests they have prescribed raise an ethical and moral issues. It clearly creates conflict of interest. Is it ethical for a doctor to be paid a proportion of the test he\she is prescribing to their patients? Furthermore, is it moral for a doctor to enrich himself or herself in this way? The third question is, is it legal, should it be allowed to have such agreement between the doctor and the hospital owner.
Patients put their trust on the doctor; they believe that what is all done is an attempt to cure them. All what is prescribed tests are only for the sole purpose of diagnosing the source of the illness. However, when the doctor is benefited from the tests, then patients have doubt, whether the test is to diagnose an illness or whether is it aimed to enrich the doctors.
In my own personal experience, the same test was performed repeatedly, when I requested explanation from the doctor, the response I got was “I do not believe the results are correct.” Though the tests are coming with the same result repeatedly, the response from the doctor remain the same, the only plausible explanation is this is done to enrich his pocket and the hospital owners. This is can be considered as an organised robbery of vulnerable patients and their family, supported by the law of the land.
The horror story of medical accidents, and blunders made by some doctors is almost a daily discussion when families and friends meet for a coffee. There are numerous cases collaborated by many people that intoxicated doctors treat patients in accident and emergency wards particularly in the evening shift. There are some doctors who openly chew chat (khat) when treating patients in both private and government owned hospitals. These situations further escalate the frequency of medical accident. I was wondering if there is anyone who is disciplined or stopped from practising as a result of professional misconduct, one of my practicing lawyer’s friend, informed me that there is no a single case he know of, that doctors are found of negligence of their professional practice for causing pain, suffering, disability or even death to their patient. The fact is that there are some doctors, in every country, that they are not fit to practise for many reasons. In many countries, there are mechanisms and procedures to bring these doctors to face the law, or remove them from practising before they cause mayhem and distraction. The case in Ethiopia is that the profession as a whole is covering up its bad apples and as a result all doctors are seen with suspicions. As in all walks of life in the country, the government will not allow to have strong civic organisations. The medical profession is not the only one, take for example the journalist, law society, teachers associations all are banned or operated to be the mouse peace of the government. The results of the above makes the health care system not fit for the purpose it is designed for, on the contrary it becomes a source of extreme pain, suffering, and death on an epic scale.
The level of negligence by the government amounts to a mass murder. One has to ask why the government is not putting any effort to solve the basic problems of the health system. The reason is glaringly clear to anyone; let me explain. Government officials are not users of the health care system. None of them has the trust or confidence of the health system of the country, almost all of them will travel to USA or Europe to be treated in very expensive hospitals, yes paid by the tax payer of the Ethiopian people. The former prime minister chooses the Belgian not the Black Line hospital.
The writer can be reached on firstname.lastname@example.org
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