The Training of a Ugandan Doctor

Like so many other Doctors in the UK, I have been known to complain on the odd occasion about how hard my job is and the fact that I feel more like a paper-pushing administration monkey than an actual doctor. However, after spending the last two months working alongside Uganda doctors, I think it is fair to say that we definitely have the better deal; with an almost unmanageable patient load, limited diagnostic options and even fewer treatment choices, life as a Ugandan doctor is far from easy. Yet, despite this relentless workload and the near impossible expectations that are placed upon them, the doctors that I have met never appear to complain, and are instead passionate about their career and grateful for any opportunity presented to them. 

I have therefore decided to write my next two blogs with the aim of highlighting the difficulties that a Uganda doctor faces not only during their training, but also throughout their daily working lives. It is my hope that if any of my colleagues in the UK read this, they may be convinced that we really do have very little to complain about, and instead should be grateful for all the opportunities and support that we have received during our medical careers; suddenly the endless discharge summaries or the occasional missed lunch-break appear almost insignificant compared to what a Ugandan doctor has to endure on a daily basis.

Medical Training in Uganda

 

As in the UK, Ugandan medical school lasts for five years, and consists of two non-clinical years and three clinical years. However, unlike British medical students who have little responsibly and tend to turn up to a ward when it suits them, Ugandan medical students are each assigned duties and patients to look after, and are very much included as part of the medical team. Furthermore, whilst we had very little exposure to clinical procedures outside of the usual cannulation, catheterisation or, if you were lucky, the occasional bit of suturing, medical students here are expected to learn how to perform procedures that are technically more advanced, such as minor operations or caesarean sections. Also, unlike the UK where over sixty percent of classes are now made up of girls, Uganda is still a country where medical students are predominantly male (despite girls getting an extra point on their application form – just for being female). 

In the UK, once you take into account all of those who fail their finals and have to repeat the year, everyone who graduates will ultimately end up with a foundation job (albeit somewhere they may not want to be). In comparison, although there are theoretical jobs in Uganda for all of those who graduate, the government cannot afford to fill all of these vacancies. As if to prove this point, during my time at Kagando there was a final year Ugandan medical student who was on her last placement before qualifying. Whilst she was here she found out that of her forty seven class mates, only eleven of them had been successful in finding jobs; unfortunately she was not one of them. For those medical students who are fortunate enough to secure themselves a job, medical school is followed by one year of internship (the equivalent of our two years of foundation training). During this year they will be expected to complete rotations in paediatrics, obstetrics & gynaecology, medicine and surgery, and whilst these rotations are often in separate hospitals spread throughout Uganda, they are only given two weeks’ notice of where their next placement is to be (the six months’ notice that I was given before starting my foundation training in Dorchester doesn't seem so bad now). As with our foundation programme, this intern year is supervised and the trainee is expected to fulfil certain criteria before being allowed to pass the year. However, compared to the UK where the first year is mainly about paperwork and you aren't allowed to so much as sneeze without your seniors being aware, a Ugandan intern has much greater clinical responsibilities. For example, by the end of their first year as doctor an intern would be expected to be able to carry out a certain number of surgical procedures on their own, including a caesarean section (something which you wouldn't be allowed to perform by yourself in the UK until you had completed at least several years of obstetric training).

Following the completion of their internship year a Ugandan doctor becomes a Medical Officer; similar to a ‘staff grade’ in the UK, this position is not included as formal training and lasts for an indefinite amount of time. During this period they rotate through the different specialities, gaining more experience before eventually applying for specialist training.  Despite being qualified for as little as a year, a Medical Officer has a great amount of clinical responsibility, and can often be the most senior doctor of a particular speciality in the hospital. This is true for Naomi, the surgeon who I have been closely working alongside; she had been working as a medical officer for a little over a year, and since our Consultant left at the end of April she has been the most senior surgeon in Kagando.  However, despite only being qualified for two years she is incredibly competent and can perform most procedures that a British surgeon could only do after three or four years of surgical training, such as a complicated skin graft or emergency laparotomy on young children. 

For a Ugandan doctor to become a specialist, they must first complete a three years Masters in their chosen field. However, unlike the UK where our specialist training is free and we still earn a decent wage whilst we are learning, a Ugandan doctor must find sponsorship to pay for their training programme. Furthermore, despite having to work and study full time, they don’t receive a salary for the whole three years, and instead have to find night or weekend work to cover the costs of their daily living; somehow having to pay for exams and membership fees in the UK doesn't seem like such a bad deal now. Following the completion of their three years Masters programme a Ugandan Doctor will become a consultant. However, unlike the UK where a Consultant is very specialised, due to the high number of patients and shortage of doctors in Uganda they must remain a generalist. For example, whilst a surgeon can operate on a perforated bowel one minute, and perform a complicated thyroidectomy or mastectomy the next, they still retain enough general medical knowledge to be able cover the medical and paediatric wards when required. Can you imagine telling an orthopaedic consultant in the UK that that they had to cover the acute medical ward, or asking a paediatrician to perform an emergency laparotomy?  Whilst this would never happen at home, is more than an occasional occurrence in Uganda!

 

Whilst the training of a Ugandan Doctor is difficult, some may argue that their daily working lives are even tougher. I have been fortunate enough to have a small insight into the many barriers and difficulties that they face, although I have too much to say to be able to include it all in this current blog. Instead I plan to write a second entry that will allow me to share some of these experiences with everyone at home. However, it is my last week in Kagando and while I hope to finish it within the next few days, with a special ‘Vesicle Vaginal Fistula Camp’ planned and some loose end to tie up, I will apologise in advance if it takes a bit longer than this to actually be published.

Speak Soon