Kobusingye’s book, The Patient reminds Ugandans ‘You Are on Your Own’

https://observer.ug/viewpoint/65121-kobusingye-s-book-the-patient-reminds-ugandans-you-are-on-your-own

June 3, 2020

Written by Yusuf Serunkuma

The publication of Dr Olive Kobusingye’s book, The Patient: Sacrifice, Genius, Greed in Uganda’s Healthcare System, coincided with the arrival of Covid-19, making the book exceedingly timely.
Narrated from the vantage point of health workers, Kobusingye’s contention is that Uganda’s healthcare has been in a perpetual condition of ailment – causing many medics to flee either the profession or the country.

But while the period 1960-1980s saw medics especially at Mulago suffer political challenges, emanating from direct conflicts with political leaders, the 1980s-onwards saw “internal work” challenges as the major afflictions facing health workers.

And this is not due to lack of resources but, rather, misguided political priorities. While the 1960-80s challenges including mostly direct threats to life of health workers, involving assassinations and imprisonment, the “internal work” challenges of the 1980s include shortage of equipment, shortage of drugs, salary issues, poor working conditions, etcetera.

Both of them dangerous to the industry. But this switch in the causes of pain to doctors speaks to a theoretical-historical shift in the logic of social policy in Uganda, and needs to be emphasised.
Consider the painful stories of Dr Kibukamusoke and Dr Obache who were murdered by State Research, or Dr D’Arbela, and Dr Kanyerezi who had to flee for their lives.

These stories are as painful as the stories of a young man selling curtains in downtown Kampala, who had abandoned the medical profession as an intern student.

The young doctor “had lost three babies in one night because the Intensive Care Unit had no oxygen. After running around Mulago to find oxygen, the young doctor narrates that he “went back to the ward to find the third baby gasping. The mother was wailing.
“I left the ward and did not come back the following day. But by the time I had made up my mind to either leave the country or the profession.”
Also painful is the story of Dr KK, who also recalls “many distressing nights during which she swore to leave medicine altogether.”

In both periods, doctors are fleeing the profession, fleeing service to their country. But the reasons for fleeing are a product of different regimes of power. From reading Kobusingye’s new book, you quickly realise that despite the political challenges of the time, the 1960 -1980s public service/social policy was rooted in an anti-colonial longing for national cohesion; there was a competitive developmentalist incentive.

The anti-colonial intelligentsia who dominated this period wanted to make sure things worked. Slogans of pan- Africanism, African renaissance, Marxist chants against exploitation animated this period. Even the much-maligned President Amin made sure things worked.

Kobusingye narrates that, “Amin singled out the doctors and judges for unexpected favours. He gave senior consultants Mercedes Benzes, and other doctors got cars as well. As the self-declared economic war was intensified and commodities disappeared from the market, Amin created a special outlet for doctors in Industrial Area. From here, doctors would be allocated sugar, beer, salt and rice at very low prices...Likewise, Amin had a fuel pump installed at Old Mulago close to the Polio Hostel for the exclusive use of doctors.”

The 1980s onwards then saw the arrival of Structural Adjustment Programmes (SAPs), which actually not only obliterated African economies, but also ushered in a new consciousness. Citizens became private individuals, which then privatised livelihoods.
I argued in The Observer column (May 27), the pain of structural adjustment is not simply the corrupt-ridden dismantling of cooperatives and parastatals, which actually ruined many economies – as had been predicted.

It is neither the absurdity of governments abandoning key public goods and services, leaving them in the hands of ordinary folks. It is the culture it created: “You Are On Your Own.”

Being on one’s own even in things clearly so big for a private person became the normal consciousness. This is why we hire private security guards for our homes (even when we proudly hail Museveni for “giving us” sleep). This is why private health clinics are in big business, even when Mulago now has four branches.

Private schools are flourishing despite the rolling out of Universal Primary Education (UPE) and Universal Secondary Education (USE). Quality or true social welfare is found in the private, the personal. The logic that drives public service/social policy presently could be summarised in the phrase, “you are on your own.”

Covid-19 found us in this blighted state. It is not surprising that government relief supplies come as a favour, and not an obligation. But there is more: SAPs in Uganda found a leadership of former rebels who simply saw an opportunity to enrich themselves.
Like hungry hyenas, they devoured all assets that had hitherto supported the public good: plots of lands and houses in Kololo and Nakasero, Uganda Transport Company (UTC), Uganda Railways, Uganda Electricity Board (UEB), Uganda Coffee Marketing, were all eaten in a terrible pursuit of primitive accumulation.

Presently, this has reached vampirish levels of stealing cash in shady officially sanctioned deals: Kobusingye reminds her readers of the $12 million that was stolen in Global Fund money meant for the treatment of HIV, malaria and tuberculosis; millions meant for immunisation stolen in the ministry of Health (GAVI scandal).

Recently, Lubowa Specialised hospital had $379.17 million misappropriated. But the annexation of Entebbe Grade A hospital in 2011 by State House, which meant closing the hospital’s doors to over 100,000 patients, captures agency of individuals even more sharply: inspired by the capitalist logic of leaving individuals to themselves – with many indirect taxes – accumulation by dispossession has become more the norm.

And you can say pretty much the same things about other aspects of social welfare.

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