Whether the patient lives or dies, what is a fair medical bill?

Tell me, please, whether this is a blessing or a curse. “May you succeed, prosper and make a billion dollars, and may you spend it all on medical bills.” A different and shorter version of this is, “May you win the national lottery, and may you spend it all on doctors.”

Such double-edged formulaic utterances are common in Yiddish orature, where they seem to be an established sub-genre of the communities’ lore. Yiddish is a Hebrew-derived language that people of the Jewish Diaspora developed as they migrated to and settled in various European lands. It is famous for the subtlety of its communication codes.

You will not be surprised by my preoccupation with medical bills in these troubled times, when the main global problem is obviously medical. I will let you into the details of my thinking in a while. But let me first share with you two brief and related personal health matter narratives, in which medical bills play no part.

Senior Nursing Sister Efulansi (Frances) Mukasa passed away last week at Mulago National Referral Hospital in Kampala, where she had served devotedly as a ward sister for several decades. You have probably heard of Mulago, which is also the teaching hospital for Makerere University’s Medical School, where most of East Africa’s pioneer medics had their initiation. I am thinking of such stalwarts as the late Dr Wilbert Chagula, my Principal in Dar es Salaam, and Prof Joseph Maina Mungai, the second Vice-Chancellor of UoN.

Senior Nursing Sister Mukasa’s death at Mulago, in these times when we are losing squadrons of our gallant healthcare givers and fighters, might have struck me as just another statistic in the grim harvest of the Covid-19 reaper. Indeed, Sr Mukasa apparently succumbed to the disease, which she probably contracted in the course of attending to her patients. Mulago is the largest treatment centre for the patients of the third wave of the pandemic, which the country is currently battling.

Personal loss

Mukasa’s death, however, was a personal loss to me on two important counts. First, she was a professional born and bred from the same neighbourhood as I. Indeed, her mother and mine were close friends when they were bringing us up. More specifically, and partly because of the above but also certainly because of her professional commitment, Sr Efulansi Mukasa took unforgettably good and tender care of my mother, when she was admitted to her ward at Mulago Hospital during her final illness.

My mother, whom Sr Mukasa referred to as “my Maria Salome”, died of respiratory failure, as her death certificate indicates, but it was not due to Covid-19 complications, and I am not just being in denial. I put my mother’s condition and final departure to the tough life she had lived, cooking for hours on wood fires in smoke-filled “kitchen” shacks and lighting up her nights with korobois (paraffin-fuelled tin “candles”) in poorly ventilated houses. This was the lot of the typical rural housewife at the turn-of-the century.

Maria Salome, you see, passed away, at age 78, in May 2000, and that was a little before the advent of Covid-19. One of my dearest memories of that sad event, however, as I was saying, remains the solicitous attention that our newly-departed Sister Mukasa devoted to my parent. I also clearly recall that the sister and her assistants kept a steady supply of oxygen available to her patient as long as she needed it. In any case, essential medical supplies were always available, and free, in all public health facilities, even in those lean years.

This brings me to the crux of the matter. We keep receiving worrying reports of shortages of medicines and other medical requirements in our health facilities in East Africa. The coronavirus epidemic has only heightened and aggravated the problem. Even worse, we hear of cases of corruption, scams and thefts of drugs and equipment from government stores, hospitals and health centres. Have we reached a point where some people do not care whether their fellow human beings suffer and die so long as they, the murderous thieves, make money?

Hippocratic Oath

Even where institutions appear to be operating with expected professionalism and efficiency, disturbing tendencies are emerging. The crowding of public medical facilities in Uganda, for example, has forced many patients, including Covid-19 ones, to resort to private hospitals. This has apparently led the owners and operators of many of these facilities into the temptation of hiking their charges and fees to frighteningly high levels, definitely way beyond the reach of any average citizen.

There are reports in the Ugandan press that private hospitals are charging an average of five million shillings per night to handle Covid-19 patients. That is a lot of money, even in Ugandan currency. There was also a recent report of a patient who passed away at a faith-based facility the very night she was admitted. The next day the administrators slapped her husband with an eleven million shilling bill, and they would not release the body to him until he had paid.

These excesses have led some of the highest offices in the land to intervene and try to arrest the situation before it gets completely out of hand. The times are definitely out of joint, and treating and managing victims of a scourge like Covid-19 is neither easy, cheap nor safe. But our healthcare givers must understand that “fair” recompense must not be the first thing on their minds. Saving lives remains the top priority of their calling, according to their Hippocratic Oath.

There is no acceptable monetary price tag to any human life. It is priceless. We cannot pay our health caregivers “enough”, except in respect and gratitude. Nor should they expect to charge us anything “sufficient” in relation to their attempts, successful or otherwise, to save our lives. We can only give what we can afford.

Neither the medical workers nor we their patients would like to spend all our resources on medical bills.

Prof Bukenya is a leading East African scholar of English and literature. [email protected]