OPINION: Medical interns are not like other interns, pay them or risk our lives

Ruth Aceng, Uganda's health minister said, "We must note that medical internship is a training. It is not work and they are not public servants. They are free to take a decision not to train. They are the ones who stand to lose; we don't stand to lose anything," amidst the impasse between medical interns and the government. I've found the minister's comments short of thoughtless.

For one to become a medical student in Uganda, they must first opt to study Biology and Chemistry at A-level. In Uganda, only 10% of learners at A-level opt to study sciences generally, and 90% opt for Arts.

Since one has to specifically study Biology and Chemistry to become a medical student, and that the 10% includes even those that study other science combinations such as PEM, MEG, PCM, BAG, MEE and others, the percentage of students who opt for Biology and Chemistry is certainly lower than 10%.

Of the students who opt for Biology and Chemistry at A-level, very few pass with the requisite points to join medical schools. It, therefore, means that the supply of medical students is low and apparently, it will continue being that way. The low supply of medical students is, indeed, reflected in the national statistics.

Uganda’s doctor to patient and nurse to patient ratio is approximately 1:25,000 and 1:11,000 respectively. This is way below the WHO recommended doctor to patient ratio of 1:1,000. Although WHO has not pronounced itself on the recommended nurse to patient ratio, 1:11,000 is still inappropriate considering that most developed health care systems have a doctor to nurse ratio of 1:2-5.

Are medical interns special? I think yes. Demands of studying Biology and Chemistry are far more draining than than those of studying other science subjects, which largely explains the exceedingly low number of students who opt for the two subjects. And, the intensity of work during medical internships in the Ugandan context is surely greater than of many other internships.

Being in the sphere of medication -- one of the fundamental needs to sustain human life -- makes medical interns even more special. So, I find it important to put motivation packages at every level of the medicine course.

It's true that when medical interns don't train, they will not be registered and therefore unable to practice their profession. Most of the medical students, I suppose, joined the profession out of received passion and a few out of true passion.

Now that most of them have grown and are facing realities of adulthood, passion (or the desire to heal people) could no longer be the motivation but money -- one of the reasons why medical doctors at Mulago and other government hospitals look at patients in excruciating pain and ignore them. Clearly, the desire to survive is stronger than the passion to heal people.

If the passion still exists in some, it should be facilitated by money in form of decent payment and other motivations such as better working environments and sufficient equipments for their safety as they execute their duties.

So, what happens if there are no motivation packages along the course?

Because now the desire to survive is stronger than the passion to heal people, medicine graduates will opt for alternative sources of income because, just like in Law, it's possible to graduate without practicing.

A person with a valid degree in medicine can be employed in other fields after simple and brief training on the job. Yes, the options might be few but medicine graduates could even be fewer. The same person can upgrade to fields that don't require practicing certificates or fly abroad for better working environments and motivations.

This will further reduce the supply of medical doctors and nurses directly by reducing the number of medical students who qualify for practicing certificates, and indirectly by discouraging students at lower levels from joining the medical fraternity.

Aceng said that if medical interns don't practice, they are the ones that stand to lose and the country doesn't; if the students opt for other routes to income, what will they have lost? Will they lament about not healing people even when they are earning from other options? I highly doubt.

Can Uganda opt for other options of treatment? At a national level, can we substitute our doctors with ingesting Mululuza, Aloe vera and other medicinal herbs? In the end, who will have lost? The medical students or the country?

When the supply is low, the demand is certainly high. The demand, in this case, should be reflected in better payment and motivation. If the payment is admirable, and motivations are maintained, the supply may increase or at least remain steady.

Let's not sabotage the supply of medics!