By Julius Mugaga Tukacungurwa/ Umoja Standard.
MULAGO, UGANDA: Prof. Damalie Nakanjako, the Principal of Makerere University College of Health Sciences based at Mulago expressed a great need of having a memorandum of understanding with relevant Institutions like MDAs, Health Organizations, Health Training Institutes to upgrade the quality of clinical training in Uganda.
She made these remarks in a close door meeting with Hospital Directors of Uganda.
Present were the Director of Kawempe National Referral Hospital, Mulago National Referral Hospital, Kiruddu National Referral Hospital, Mulago Specialized Women and Neonatal Hospital, Uganda Heart Institute, Butabika National Mental Referral Hospital and others.
“In our meeting with directors of hospitals where clinical training occurs, the hospitals work well with Makerere University and we have agreed that we are going to make these relationships standardized. The hospitals would like us to have memorandum of understanding and these will be jointly developed with the Ministry of Health and Ministry of Education and they can be signed off as MOUs for training with government institutions.” Prof. Damalie.
“Again, we have discussed that Ministry of Education and indeed the Universities, We need to recognize and count the teaching load of clinical students that is offered outside the normal 8 to 5pm teaching hours because clinical teaching of a health professional requires hands-on experience in theatre, in the wards, which even happens in the emergency ward and at night when the doctors are on duty. This is how we teach Health workers to handle emergencies. So this needs to be recognized by the universities when they look at clinical training, because clinical training is not limited to classroom training only. ” She added.
Prof. Damalie said that they expanded from training just fewer than 50 doctors now to helping over 3,500 students of different professionals. Doctors, pharmacists, dentists, surgeons, nurses, speech and language therapists, medical engineers, medical scientists, psychologists and all this is to respond to the needs because we know doctors don’t work alone, they work with different health professionals, hence the quality of work sciences which is known as for health professions training, not only medical schools. it’s now progressing many times and now have the School of Medical Sciences, School of Medicine, School of Public Health, School of Health Sciences and the School of Medicine and School of Dentistry.
Our vision is to be a leading and transformational institution for academic excellence and innovation of health sciences in Africa and our vision is to improve the health of the people of Uganda through innovative teaching, research and provision of service responsive to society needs. So, training students in the hospitals only doesn’t prepare them well for the communities where they work the hence the community-based education research and service program that was introduced over two years ago to train our students in their communities. This has been very transformative and our graduates get out when they know what to find in the health facilities.
“As you know from the past, we started with Mulago Teaching Hospital but because of the increased needs, all these units have come up and they support training right from the Uganda Heart Institute, Butabika Hospital, Infectious Disease Institute, the Uganda Cancer Institute, Kawempe, Kirudu Hospital, Mulago Specialised Women and Neonatal Hospital and other collaborating local and international collaborators where our students go for rotations and faculty as well. So today is the first time that we are meeting together and to me this is the very important meeting for us to meet.” She highlighted.
Representing Ministry of Health in the Meeting Dr. Olaro Charles is the Director Curative Services cited that there is no deliberate funding for graduate training and says is one of the greatest concern. ‘Under the inter-ministerial committee, we have had an engagement with the Ministry of Education but for them they are still stuck, they have for certificate, diploma and Undergraduate training because we had sought as a ministry, that government has invested in tertiary care but for us to be able to achieve benefits of that tertiary care, we also need to invest in training specialist and super specialist. So we had thought that they could be able to channel some of the resources from the certificate training, don’t shut it completely, probably you just can shift.’
‘So this is one of the areas which we’ve seen that probably we could get a much bigger body and engage ministry of education that whereas we may not have the budget here, but within the resources we can be able to work, realign them to graduate training because many people who are coming on their own initiative, do not have work support.’
“The other thing which had driven some of them to come was that 2.5 million challenge which was not sustainable, so we need to be able to deliver it. So I’m looking at how we add up all our voices as advocacy and see that there is a deliberate budget for graduate training. The other aspect which as the ministry we are interested in, is building local capacity for specialist and specialist training.” He stressed.
He said, whereas for specialists, they have kind of like built capacity but now when it comes for specialists theyt need to do that because training outside is very expensive, ‘Uganda Heart Institute is doing this, Uganda Cancer Institute, can we have other fellowships? so that it would be better for us just to send people who will be the teachers, who can come up and open up the training trainings within here.’ He revealed that, PS wrote to the Vice Chancellor regarding that request that ‘let’s build capacity here either in critical care or we need to be able to see that how do we move the nursing home so that we can have specialists, so that if you have cardiac nurse, then that’s your specialty, Pediatric nurse, that’s your specialty, an oncology nurse, public health nurse so that we don’t just shift them from one discipline to another. So we need to be able to do that.’
He added that, as a ministry, they are happy that they have students placed from the university to these big institutes, ‘so if you deploy them, say, to Kawempe, that’s upstream and what are they doing there? They are now managing complications which are arising from the downstream. So we are looking at how universities work like with the city health facilities so that we address things that downstream.’
Professor Dr. Ignatius Kakande (Ssalongo)- a senior Surgeon observed that so many schools tell students that they are doctors but the materials on which they treat patients are becoming fewer and fewer so it is becoming difficult. He expressed disbelief that a University like KIU can teach 600 students and be real doctors and its on this note that he sought the ministry of health be serious on the matter of ensuring that proper clinical training is enforced.
“What I have learnt is that we have to be flexible, flexibility is very important not to depend on bedside teaching because you can’t have 300 students taught like this. I think we need to look for a way of training clinical students without necessarily having a patient even if you used senior students as patients, we should do that. What we have to do is to train undergraduates very well to be able to handle emergencies to know where to refer the patients and I think Makerere University should emulate the seven principles of an eagle.” He advised.
“As we train. We should think about mentoring, I think its not formal, I think these people are very good not because of what they are but be because of role models. These days you don’t find many role models so leadershimp and mentoring is very important. We have to learn from others. We are not an island. In the developed countries, like the US, medicine is a graduate degree but here we take students simply because they did PCB were at a certain school and the score is so well but really medicine is not really medicine is not their calling. I think its high time we think about medicine as a graduate degree and should be interviewed to see whether they will make good doctors.” He added.
To Judith Caroline Aujo who represented the Executive Director of Mulago National Referral Hospital expressed that they wanted to embark on harmonizing the entry and exit of students from Mulago Hospital and the students community were offended but the hospital wanted to streamline students, capture statistics of all the students who come through Mulago, how long they stay, what are they are doing, and also to give them some orientation. ‘We know that students go through orientation in different units they have but there must be people who would like to give their orientation at a particular level. We want to make the students aware of that in regards to training.’
“We have achieved success from different institutions, but we have not really moved far with Makerere University. So we have a system that could take place that also needs to come to Mulago. First of all, they should go through the DPT office. The office also from time to time visits the different units just to see how our things are moving on but we’ve not been able to get a cooperation book, adequate cooperation from our university, especially in terms of factoring the statistics, number of students that come through. The other thing, the hospital now acknowledges that we have many students that come to use because probably they would like to make it from the experts that is here and we acknowledge that the wards are overcrowded sometimes but the hospital really wants to get all these number of students and they will see how they plan these rotations.” She said.
“You have like 40 students each learning how to put a cannular, how to do this, so things run out. Students who come to other units, they bring some small contribution in terms of consumables like plaster, gloves, cannulars, these things that keep running out especially those from government institutions who don’t pay money for training. So we’ve not been able to get through to the Makerere group much though we acknowledge that there’s a lot of research, we’ve made with one another.” She stressed.
“But we would appreciate if the students come on board and we are able to give you a list of the few little things that we would like the student who is going to the green collars to give to the board and then we would also like to have a list of coordinators for all the courses, all the different students because now we have two managers or coordinators from all the different institutions that will always liaise with.We want to bring your attention about that office and what the office is doing, we would like the students to go to that office, we would like to capture statistics, we would like to have coordinators and then we would like the MOU to do it.” Dr. Caroline.
Speaking to stakeholders in Hospital Directors meeting, Dr. Juliet Nakku, the Executive Director of Butabika National Referral Hospital revealed that Clinical training is going on as usual at Butabika Hospital. Butabika Hospital is the only mental health training institution around Kampala for the bulk of students in Uganda, so there’s a lot of clinical training going on there, not only for Makerere. ‘We have a wealth of knowledge that we can impart because we have very many students rather very many patients that can provide hands-on for our students.’
She said, the hospital is very big so we can take in, we have quite a number of students ranging from undergraduate to postgraduate, both doctors, nurses and clinical officers. ahe adde that they also teach other people who are important in mental health care like social workers and clinical psychologists and occupational therapists at the hospital.
However, expressed concerns on the the patient load, the student load is also huge. ‘Our biggest challenge is that we still have few specialists. We need for government to recruit more specialists who can be available to teach these students because we are teaching hands-on things in the care of a patient with mental health problems. So if the number of teachers would increase, then we would be able to handle our student.
Like others, Dr. Evelyn Nabunya, the Director of Mulago Specialised Women and Neonatal Hospital cited need that MOU because ‘a number of times when we come here they ask how are you related with MOU because this is our daily life. We need clear engagements that will help. When students come, how are they facilitated? How are these hospitals facilitated?, So how do we work together to help one another?, I believe this will come out in the MOU.’
on the other hand, she expressed that they see themselves as a center of excellence in specialized reproductive and neonatal healthcare in Africa so we commit to provide and promote highly quality, highly specialized reproductive and neonatal care with advanced training. We offere services in maternal medicine, gynecology and others.
“For the last five years, we have had a lot of advances and success stories going on for-example, our surving baby was born at 24weeks and weighed 500grams, In June this year, made one year weighed 2 kgs and successfully treated but we also have PhD students and fellows doing gyna oncology from Cancer institute, neonatal fellowship from Makerere University and hope for more fellowship.We also have in-service this training. We do have nurses that are coming in when the ministry of health is rotating, we see ourselves developing in the arthroscopy training center and other areas of training. The training is core, Through training we improve but I am looking forward to that MOU with each of us.” Dr. Nabunya.
WHAT YOU NEED TO KNOW.
Supervised medical work for one year is a mandatory stage for graduate medical doctors, pharmacists, dentists, and nurses before licensure. In Uganda, intern doctors, also known as junior house officers (JHOs) work with a provisional license under the supervision of senior medical doctors in the fields of surgery, internal medicine, pediatrics, and obstetrics and gynecology for one year. Thereafter, the new doctors are fully licensed by the Uganda Medical and Dental Practitioners Council (UMDPC). The current graduates who are waiting for internships (pre-interns) finished their education about a year ago and are awaiting deployment by the MOH of Uganda.
Senior house officers (SHOs) are qualified medical doctors who are registered and licensed by the UMDPC. However, they are undergoing postgraduate training to become specialists in various fields of medicine. The JHOs and SHOs make up over 75% of the human resources for doctors in regional referral hospitals, national referral hospitals, and many private not-for-profit hospitals, and they are almost always the first responders. They deliver more than 90% of emergency obstetrics care in regional and national referral hospitals where 78% of all maternal deaths occur.