Dear Diary, Don’t Even Think About Medical School


Dear Diary,

Look, this is the first time we’re ever interacting but right off the bat, expect this to be long. Super long. That, and whiny too, because that’s just how I roll. Let’s get into it, shall we?

I don’t know what it is about someone wanting to go to medical school that gets me unsettled enough to advise them otherwise, like some kind of worn-out harbinger who only exists to tell of doom. My compassion for humanity has dwindled to the barest minimum but something about some naïve idealistic person wanting to get into this “noble” profession sets bells ringing off in my head. I can’t help but want to warn them away. Yes, this is yet another one of those pieces that whines almost endlessly about medical school. To be specific, my experience with medical school.

Perhaps my caution comes from the soul-sucking work involved, or it could be the ridiculous hierarchy system (as if it’s the Nazi military). Maybe it’s the ever-present sexual harassment or even the exploitation. Ah, but that exploitation is a machine of its own. It’s on Lucifer levels (dude somehow managed to convince hordes of sweet lil’ angels to go against the baddest boss there is; that’s some master-level manipulation right there). This exploitation is almost beautiful in its efficiency. It’s like an ancient culture passed through thousands of years of medical supervisors until this date. Let me tell you.

We shall start with the medical interns.

We call them interns but they are in fact doctors who have finished medical school and are now doing a last rotation under supervision, to fix any kinks the five goddamn years of medical school didn’t iron out. You know, because your health is important to us. Now the medical interns this year were fed the same bullshit we’d all received, about how the government couldn’t support them anymore and so wanted to reduce the number who were allowed into internship. At this point, I’ll state the obvious that no, you cannot get a practising medical license unless you’ve finished internship. Not in Uganda anyway, and no one will just sign that shit for you; you have to do the rotation because, again, your health matters to us.

Anyway, the interns were like “nah bro, that shit ain’t gonna happen. They’ve been threatening this shit for years but always back down after a strike or some shit like that” (Something about medical school that reduces people’s eloquence, I’m telling you).

Well, the Ministry of Health was like

Therefore, they upped the ante and told these freshly minted doctors that some would be kept in mint condition. That is, they wouldn’t be allowed to progress to internship. Of those who would do internship, the government would only pay the ones who were sponsored by the government originally but these sponsored students would be bonded to village health centres for 2 years at the very least before they could get their practising licenses. The private students could get their licenses after their one year of internship without pay. If they managed to be amongst the lucky few who got that opportunity anyway.

So the medical interns were like
And damn, I am proud of the way these kids handled themselves. They organised protests and refused to be intimidated into signing any contracts. Gwe, the government doesn’t play and was going to keep this a secret. The plan was to have these kids show up to their respective hospitals for internship, be intimidated into signing these bonding agreements/contracts (if they didn’t, they’d be kicked out and remember, there were hundreds who would be waiting for that spot), and then be forced to work. Anyone who has been to a government hospital knows that the interns are the basic workforce yet here they were, being treated like second-rate citizens. Well, word got out and the interns levelled up and sued the Minister of Health because, fuck that shit!

They won, in a way. And no, I’m not linking to any of these stories because I believe anyone in Uganda for whom health is an important issue, should have known about this. The idea was to have these young doctors bear the brunt of the medical work for several hours on end, without pay, and then expect them to do that for 2 more years with minimal pay (trust me, the taxation on doctor’s salaries on the government’s payroll halves whatever the newspapers say doctors earn).

I didn’t write about any of this during its climax because I didn’t want to take away from their narrative with my own tunnel-vision opinions, but I had also gotten used to swallowing the bitterness that would rise within every time I thought about doctors in Uganda. And now, we shall move onto my current storyline.

Working the most yet having no pay is a reality when it comes to medical residents. These are the doctors who are doing their masters and you might be thinking that yeah, they’re in school, why should they be paid? Well, the truth is that we’re more like undocumented skilled workers. We definitely have more experience than the interns and do what the specialists do, but we don’t have the certificate to get specialist jobs. Oh and these dudes have a field day with us. Most of the specialists in the teaching hospitals only show up when their private patients are around, and then they expect the residents to do the grunt work.

Oh, and the residents don’t have holidays like normal school-going people. Yes, medical residents work all year round, seeing all the patients interns can’t see.

“But you,” you may say, if you’re in the know, that is. “The president specifically said the other day that medical residents were to be paid.” Well, he did say that but efficiency is of mythical existence here in Uganda and execution of that directive is poor. In fact, the only time I ever heard about that salary issue was when the Medical Director of our hospital said that if they pay anyone, they’ll be paying residents without scholarships.

Now let me tell you, I’ve been a scholarship child since I finished high school and the idea that I have to be punished for this merit that I have earned, is pure malice. Heck, I’d even go so far as to say that it’s the sort of thing you’d expect the devil to say. If I reached hell and had the devil say to me “now Denise, you did share your water with a dude during a marathon and that’s an achievement but sadly, I have to gut you for it now because I won’t have that shit down here,” I wouldn’t be surprised. I mean, who wouldn’t want to gut people who run marathons just for fun, anyway?

The government is saying that those it sponsored ought to be bonded and hey, that sounds fair enough out of context. I’ll remind you though that these kids are sponsored because they performed highly and forcing the smartest people to work for you with minimal pay is some American shit right there. That’s not a good thing, just to be clear. I’m sure some of these kids would have turned down the scholarships if it meant menial government work for extended periods of times, but I digress.

Yeah, we don’t get paid and that’s a shame but I’d learned to live with it because I am doing ophthalmology and I think my department is filled with some really nice people. Nice people who happen to be diabolical puppeteers as well. Let me tell you. Again.

Every now and again, people with far too much money on their hands will offer skilled workers a chance to do some charity work. For pay, of course; this is Uganda we’re talking about here. Thusly, every now and again, we have what we call surgical camps, where announcements and advertisements are made for all patients to show up at a particular place to get a particular kind of service. In our case, it was at our department, for free eye care, including surgeries. Yes, the response was as hearty as you’d expect and hundreds of patients showed up. Then the ophthalmologists vanished.

I’m serious, the camp was set up and after the specialists divided most of the work amongst the residents, they disappeared. For a whole week. I like my department and I’m sure that if everyone did their fair share, we could have run this camp efficiently but that was not to be. Each day was the same, with patients lying, pushing, and doing all kinds of shady things to get free eye care. We missed lunch almost every day and by the time evening approached, we were barking orders to the patients. It didn’t matter anymore that there were people who actually couldn’t afford a drug of 10,000 or a surgery of 100,000, despite desperately needing it. We just wanted to get it over with because we were exhausted and the cherry on top of all of this was that we weren’t getting paid.

The ophthalmologists were getting paid though. Everyone else was getting paid including the nurses, optometrists, and clinical officers. Heck, even the cleaners were getting paid but we, the major work force, were not. I remember deciding one day that I was simply too tired to continue after having been in theatre the entire day, only to reach the OPD to find hundreds of patients still waiting to be seen. I joined the cluster of my bleary eyed, dehydrated, and hypoglycaemic colleagues and started going through the motions. By the time 7 p.m. had reached, my eyes were doing that special blurry thing they did whenever a migraine was coming on and I decided enough was enough, I was going home (yeah, I do Judas-y stuff like this all the time). I grabbed my bag and practically limped through the patients waiting outside only to reach the parking lot and not see a single ophthalmologist’s car around.

The fuckers had long since retired for the day, after a hearty celebration with the Minister of Health on how well our unit was doing while we slaved away for them. They’d gone without so much as a “thank you” or a “here, let me buy you lunch.” One would say that we were gaining experience but we weren’t, not really. Not when you’ve got to limit your time to 5 minutes per patient. Not when my brain is too overworked to be curious about an interesting case.

Then we have review meetings where we’re told how lazy all the residents are and I have to keep my mouth shut lest I make enemies of everybody because, truth being told, no one would back me up anyway. We’ve all been beaten down severely.

Recently the residents of Mbarara University decided that they wouldn’t put in one more day’s work if the administration wasn’t going to fix the problems with the hospital. We’re told that we are there to study but are instead treated like ungrateful hospital employees. They give you no basic materials, not even gloves or sutures, and expect you to prevent maternal mortality, like you’re going to check cervical dilatation without gloves. (No, the answer to that is no, you won’t check the dilatation without gloves. Just in case you got confused there, my sweet diary). They expect to flip the bird at the incoming interns and when those brave kids refuse to work on their terms, they want us to fill the gap and believe me, it’s an excessively large, incredibly exhausting gap to fill.

Do you know what the Vice Chancellor did when the residents officially informed him of their decision? He refused to meet with them to discuss terms and then dictated a letter in which he reminded them that medicine is a calling, and made a thinly veiled threat of not letting them graduate if they didn’t work. Of course, like the asshole all people in power are.

Well, I think that’s settled then. Perhaps what really bothers me most about medical school is the exploitation. Each day is like entering hell and hoping that today, at the very least, you stop on the 5th circle and because this cycle isn’t about to end, don’t think that these will stop any time soon as well. There’s a bad joke that goes around our hospital. You’re advised to take care of yourself first and leave work if you need to because should you become depressed and kill yourself, or get an infection and die, they’ll say “poor you” and then advertise for a job opening in the newspaper the next day. Without even attending your funeral (because, having been dead inside for years, they know where all the dead go).

That last part was all me, just in case you didn’t notice.

Till next time then.

Written by Denise Kavuma

I AM DENISE!!! nuff said!

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