Something that has been of great concern to me for a long time is the state of the Zambian health system. I get routinely baffled that medical personnel with many years of experience can make school boy mistakes with sometimes very bad consequences.
I have seen everything from wrong diagnosis, overdose prescriptions to deaths caused by pure negligence. How can a doctor who has spent 7 years in medical school, done a year of internship, been mentored by senior doctors with decades of experience and has worked for several years fail to know basic things like what dosage of a drug to give?
Then there are the many foreign doctors who are very ignorant of tropical diseases and local conditions and end up giving wrong medical opinions, like one white doctor at Victoria Hospital who prescribed a cream and bandage to cover second degree burns from hot water when he should have removed the burnt skin and applied an antiseptic. This was done at UTH later.
Another foreign doctor at Pearl of Health Hospital was treating a woman with severe malaria and instead of putting her on a drip with Quinine, gave her an oral drug that was new on the market. She was dead within 6 hours. I know of more than ten cases of negligence at POH leading to death (some involving my own friends and relatives).
As a parent, you are forced to become a “parallel doctor”, seeking second and even third opinions plus consulting Google all the time. I have gone through plenty of clinics and hospitals, both government and private and found them all wanting, including the high priced ones. Surviving in Zambian hospitals is often a throw of a dice, no matter how rich you are. That’s why rich people and politicians are always evacuated to South Africa and India.
The private hospitals will attend to you quickly with very friendly service but are quick to give you huge quantities of medicines you won’t finish and they want you to go into theatre at every opportunity so that they charge you nicely. When admitted, they are slow to release you. Most of their specialists are from UTH who come on designated days of the week. Call them out on any other day and you get slapped with an extra charge.
UTH has the best doctors (especially for kids) but is overloaded and you have to suffer waiting in long queues to be attended to. Even at the so-called high cost, they are often lacking in medicines which are found in the low cost. The pharmacy at the UTH Paediatrics wing closes at 16:00 hours which seems odd because official government working hours go up to 17:00.
The labs also close by 17:00 hours and over the weekend. Once it gets to Saturday 14:00 hours, most of the doctors in Paediatrics vanish until Monday at 08:00 hours. If you get admitted on Friday, you are not coming out until Monday since there won’t be a doctor to sign the discharge slip. Getting sick over the weekend is not a great idea.
So what are the solutions?
1. I think the management of big General hospitals like UTH or Levy Mwanawasa should be outsourced to private operators. This is not a new idea. The management firms can get a management fee that is a percentage of sales. It can also be tried out in district hospitals as a pilot program. I doubt the wisdom of having a medical doctor run a big hospital when there are professional managers out there.
2. There should be introduced a minimal fee for everyone, including the poor. Something like K5 should do. Michael Sata when he was Minister of Health tried this and UTH was positively transformed. Paying a small fee will make people a little more responsible because people always abuse free things.
3. Education in schools on basic hygiene should be intensified because many diseases are preventable.
4. Sanitation and water systems should be drastically improved. Some studies say that half of all diseases can be eliminated by dealing with this.
5. Government can experiment with some unorthodox ideas like Public Private Partnerships whereby the government puts up prime land and property developers do the building of big hospitals which are fully private but also have a low cost section just like UTH. GRZ does not have the money necessary to build quality health facilities quickly enough. Getting Eurobonds is just a recipe for corruption.
6. The Civil Service should be depoliticized. We often hear stories of how plans are made by technocrats to build health facilities after many years of consultation and then just before being built, politicians demand they are moved into certain areas in their constituencies to win votes, disregarding the original reasons for the locations.
7. Garbage collection should become ubiquitous. This is already happening in shanty compounds but it should be stepped up and enforced. Piles of rubbish at markets or in residential areas should not be tolerated. People should be collectively fined when they do not comply.