When doctors make mistakes: blame technology or ethics?

In my opinion, it is acceptable when I go to a doctor with a complicated illness and he says “I don’t know what this illness is” or “sorry I can’t help but I will refer you to another hospital…” instead of misinforming me. Giving a patient the wrong information whether good or bad news is not acceptable under any circumstances when it comes to health.

A few months ago my sister was pregnant and through her antenatal care she was advised to take a couple of tests to monitor her developing baby. One of these tests was the ultra sound scan. She did the first scan at Rubaga hospital (one of the National referral hospitals in Kampala, Uganda). The results indicated that she was expecting a baby whose sex was not yet clear.

Because she was anxious to know the sex of her developing baby, when the pregnancy clocked 6months she decided to do another scan. This time she did it at Kadic Clinic in Nakulabye – just about 10 minutes walk from my house. Kadic is one of a handful of high profile clinics (ok let’s say reputable private hospitals on Ugandan standard) in Uganda. This day is still fresh in mind. After the test she couldn’t wait to break the news to everybody, at 11am immediately after the scan she called to tell me over the phone: “guess what? I just finished the scan and I am going to give birth to TWINS! Two boys!” she said with emphasis. The results of this scan indicated that she (my sister) was expecting twins. She was excited about the news; actually the news of twins is exciting in Uganda (like in many other African countries I believe). From this day on, we all started expecting the first set of twins in the family.

Quick Forward:

Last week my sister’s pregnancy was due so she went to Rubaga all ready for the twins – personally, I was excited about the first set of twins in the family. The news came in at 11pm January 21st from my mother over phone, my sister was operated on and that she had given birth to a baby girl! Now this came as a (good) surprise considering that we were all expecting twins. So, I started spreading the news to my friends via social media. I cant forget the comments from: Siena “CONGRATS! But how is it possible that two boys became one girl. This is not possible!” and Nelly said “Congratulations!!… My, she is going to be a smart kid that one.  She tricked us all!! ”

Flashback:

Now that this happens I remember the time when my mother took my 8 year old nephew to the same clinic – Kadic for an ultrasound scan. He had complications in the stomach so his doctor recommended Kadic Hospital to do the scan. The results of the scan show that he had sores in the stomach. The results went on to show that even though the doctor was not sure about the cause of the sores, he was pretty sure that the sores were quite severe and that he needed serious medical attention.

When my mother took the results back to my nephew’s doctor (who had in fact recommended Kadic), the doctor said that the results didn’t make sense – “this young boy can’t have sores in his stomach or I should have realized in my examination”. So, the doctor asked my mother to take my nephew to Mulago Hospital (the national referral hospital) and do another scan from there. The doctor said that he needed to be certain about these results before he could cause alarms or make recommendations. My mother was already worried about my nephew – the results were already traumatizing and this meant that the young boy’s life was in danger.

The following day my mother couldn’t wait to see the doctor at Mulago Hospital to examine the young boy and do the scan. The results from Mulago indicated that the boy’s stomach was doing just fine – no complications. Now my mother was confused: which one of the two doctors/ results to believe. She needed to go back to my nephew’s doctor before she could draw any conclusions even though she was already terrified by the results from Kadic. “All along I was thinking: How do you tell your eight year old grandson that he has sores everywhere in his stomach? And what health implications would that have on his life?” said my mom.

So, my mother went back to my nephew’s doctor, she presented the results from Mulago hospital – the doctor keenly compared the two results before saying to her “not to worry, the young boy is alright he could have had some minor complications in his stomach but it’s nothing serious – no sores”. He said that the results from Mulago were correct. The boy’s tummy didn’t have any sores as indicated in the results from Kadic.

None of my family members has been back to Kadic to seek an explanation about the controversial results. This is because when we realized that Kadic’s ultrasound scan has provided wrong results in my nephew’s case, we all took an assumption that this was a negligible mistake. And now with my sister’s incident, I think we should have taken the results seriously and hold Kadic accountable; try to find answers from them.

Blame it on technology or ethics?

Until the present day, I am still wondering how a trained doctor could make such a mistake – causing a false alarm. My nephew and sister’s cases are just two of the thousands of patients who get the wrong results every single day not just from Kadic but from different health centres around the country.

One question keeps crossing my mind: “What went wrong with the health sector?” Now I know technology fails (sometimes) but what happened to the professionalism and ethics? Aren’t doctors supposed to double check the findings of their tests before they break the news to the patients?

To all doctors out there: I want to remind you that when you break the wrong news to the patients/ care takers about their illness, you not only cause panic, you (could) cause mental damage, confusion sometimes leading to more serious illness which could cause sudden death! We trust you with our lives and lives of our loved ones – you should treasure that trust.

There is definitely need to raise more awareness about health consumer rights to help patients learn how to deal with such incidents when they happen. It’s a shame because a lot of patients have no idea on how to handle with situations like this.

For the patients/ people out there, know your right as a health consumer/ user; Speak out!

Inside Uganda: mHealth or eHealth?

As technology continues to roll out in Uganda, Ugandans are becoming more and more innovative in use and application of the available technologies for development.

Over the past few months I have attended the Mobile Monday Kampala (MoMoKla) meetings and followed the MoMoKla activities. I must say that is has been fun being involved in such a lively platform of mobile application developers, users, doctors and health consumers.

Mobile Health Uganda group which was formed recently is trying to lobby for cheap mobile applications to facilitate access to health information. The group is looking at how best a mobile phone can be utilized to enhance access to health information and use of mobile phones to improve on health facilities through cell phone based surveys and other applications.

The mobile phone is a very handy device, affordable and very user friendly. This justifies why the mobile phone remains a very popular and yet important device in both rural and urban areas in many corners of the developing world.

here are some of the useful link:

David Gelvin mobile_monday_presentation

Laiton OPENXDATA_DEMO MobileModay

mHealth MoMo Presentation sean blaschke

MoMoKla-TTC

Nayantara CHW Reporting_MobileMonday_V2

Bravo to the phenomenal Mobile Monday Kampala group for your effort.

I am looking forward to more and more innovations.

Lake Katwe – The Salt “Gardens” in Uganda!

On a small lake – Lake Katwe located in Western Uganda, Kasese district-located in the East African rift valley region. The water in this lake is 60% salty. The region is semi-arid and the soil doesn’t favour agricultural activities. Therefore the major economic activity here is salt mining.

Salt has been extracted from this lake since the 13^th Century. It’s mined from small plot. When I saw the plots I got surprised. They are not the common plots of land like the ones you will find in central, Eastern or other parts of Western Uganda. These “plots” are ponds 10 by 12 feet or so wide and 3 to 5 feet deep. They are demarcated on the shores of the lake, owned by private individuals or families and inherited. Mining in the center of the lake is only done by licensed individuals. The association for Rock Salt Extraction issues the licenses for extraction of rock salt from the middle of the lake. This type of arrangement was made to ensure that the salt is extracted in an orderly process without causing extinction.

"Plots" on the shores of lake Katwe

There are three major types of salt mined from this lake:

1. Crude salt for animal leak
2. Edible salt (sodium chloride)
3. Unwashed salt

Two types of activities take place in this region and the roles are specified for the women and men.

• Salt winning (winning salt from the plots – done by the women).
• Rock salt extraction is done by the men – 3 days a week.

The women scrap the bottom of the garden to scoop the salt. They use their feet to crash the salt to form small/fine crystals and then wash the crystals forming edible salt (washed salt/ sodium chloride).

Some of the ladies who work in the salt mines.

“In this village mention rain and people will curse you to death! We don’t like rain at all. Last night it rained that’s why people are all relaxed now and not working. Our major source of power is the sun. When it rains the gardens flood and the salt takes longer to form. The sun on the other hand makes the process of salt formation faster”, said Nicholas as he was taking us around the lake.

Health implications:

The smell of hydrogen sulphide is all over the place (smells like rotten eggs).

There are health complications in this job however. For the women when the female reproductive organs get in contact with this salty water more often, they develop uterus complications.

On average one man extructs up to 1,000kgs of salt per day and he earns Ugx3,000 (USD1.50). On the side of the path are the plots (ponds) where the salt is mined.

The men on the other hand are also affected. When the male organs get in contact with this salty water, they itch. This makes them scratch their male organs causing wounds.

The men enter the water at 8am and work up to 5pm. They work for three days a week and each man extracts more than 1000kgs per day.

“We are lucky that in this village we have never had any health complications caused by lack of iodine in the body say goiter”, said Nicholas as he was taking us around the lake.

Solutions?

“At the moment we don’t have a permanent solution to these problems. However we have tried to improvise temporally solutions to both the male and female problems in regard to the health implications”, says Nicholas a tour guide. “The

Stacks of unwashed salt

women have been advised to use pad before they enter the water. This helps to reduce on the amount of “salt water” entering their reproductive organs.”

“For the men, we are using the wrong tool (condom)”. We call it the wrong tool because it’s meant for a totally different purpose. But under the circumstances we have nothing to do about it. The men fit the condom with a rubber-band on the upper end to make it firm” explains Nicholas. This prevents salt water from getting in contact with the male organs.

Apparently a company called International Power Foundation is designing a more permanent solution for them in form of “protective suites”.

I took the liberty of talking to a few locals both men and women. When I asked about the major problems in this area they said that they still have problems accessing medical care. Malaria remains a very big threat to both the adult and children. They have a small health centre which they feel is not

plots - locally known as "ebibanja"

enough. The nearest governmental hospital (Kagando Hospital) is 14 kilometers away and in case of an emergency transport to the hospital is a big challenge. Kilembe hospital (another big hospital) is located 30 or so kilometers away.

The environment is dirty, plus the luck of pit latrines, cholera outbreaks are also very common around the lake/ mines.

The total population in this area is over 20,000 people of whom 10,000 benefit directly or work on the 4,000 plots around the lake in this salt mine.