Wednesday, March 22, 2023
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Foreign Doctors with Rising ill-advised Medical Opinions in Somali Cities

By Abdulkadir Hussein

Somalia is a long time fragile and low-income country. It is now tussling so hard to build a world-trusted structure of statehood through an aided systems reform revolution supported by the World Bank, International Monetary Fund (IMF), African Development Bank (AfDB) and other bilateral partners. The national borders, including the ocean and space entry points, have gotten very little safeguards. They are all porous open fields, badly exploited by organized criminal networks. The very basic territorial protection mechanism in place, that the country established not long ago, is often compromised in corrupt and illegal practices, primarily motivated by weak rule of law enforcement mechanisms that is limited in urban settings. Often times, the protection system at borders is manipulated by the very hands entrusted to enforce laws over the public.

Penetration in the country by mode of air into cities is well regulated, but far inland corners of the country, access is economic incentive, suggesting soft safeguards for manipulation. A pool of self-claimed technical professionals who are billed as being demanded for working in various sectors of the country are granted work permits. Nevertheless, more or less, this is happening with a disadvantage passing over the general mass. Absence of well performing national quality safeguard infrastructures, which would implement the regulations and vetting process applicable to the services and skills sourced outside of the country, keep the chances of naively tricking locals alive.

The critical areas significantly manipulated by unverified international technical profession is the healthcare sector. There are increasing number of expatriate health professionals who operate at the local hospitals. Some are meaning to the claimed skills, while there are cases of misinformed technicality. In 2022, had I not insisted on not to trust the first opinion, I would have undergone wrongly counseled operation.

Yardimeli Hospital, Mogadishu

I am not underestimating the fact that well-trained foreign healthcare professionals are also employed in the country, who dispense reliable medical service. However, the less reported stories of poorly-handled medical cases in quite several places of the country are getting traction lately. For my case, since I rescued myself from this profit-oriented industry of private healthcare services in the cities of the country with little liability to their ill-treatment, I wasn’t vigilant enough to turn this trend into writing. But a few months ago, when I learnt that one of the hospitals in Mogadishu, which would happen to be the same that incorrectly ordered me to perform operation, had a lady suffer a medical practice to a level of life endangerment–an incident that raised my eyebrows.

People in Mogadishu are shocked with the degree of skill crisis in the healthcare sector when it surfaced the news that Muna Axlaa was about to lose her life as a consequence of improper medical surgery she went through. To my knowledge, Muna was a member of civil groups who is vividly remembered in a peace promotion movement in Mogadishu during end of 2021, when armed uprising fiercely opposed President Farmajo’s unconstitutional term extension with violent confrontation. Some local journalists who are privy to her situation spread the case of the lady in social media platforms. The news of her story disclosed she was erroneously operated at a scale she had to shift between local hospitals to curb the dangerous aftermath, and which she had to eventually be airlifted out of the country for a serious medical evacuation. Her case is standing and she might seek for legal settlement against the physical damage she was subjected to.

Residents of Mogadishu demonstrating against the medical malpractice in the case of Muna

In Somalia, two disciplines are racing tightly. A mindset oriented for profit and material value contests egregiously with moral values. Nearly all of the social services are accessed through private offers purchased from commercial providers. To a large extent, the educational service is extended by private associations in most regions of the country, who are formed for economic goals. The other essential sectors like the healthcare, utility and transport sectors follow the same suit and becoming among the world’s most expensive and privately owned public services.

Relatively, if there are no effective regulatory system in a given society that govern the market to demarcate parameters, it must be expected a bitter contest to play between moral discipline and material targets. That is what has been the practical life in Somalia ever since Somalis dismantled effective governance apparatus. You may wonder if you hear that medical prescriptions at hospitals are bargained or negotiated before accepting it, so the patient can slump escalated costs and undue examinations ordered.

To meet the financial targets, owners of the service points stare through the horizons, the race drives them madly, forcing them to breach circles of morality, social responsibility and above all spiritual confines. I heard cases recommended for outside Somalia operation, but later concluded as a wrong opinion in abroad hospitals. Taking advantage of the inexistence of laws and consumer protection body, value for money for the buyer is violated. This is experienced in the quality of medical stuff catered in the country, they are of substandard and unreliable to attain diagnostic objectives, while traded with prices exceeding the average purchasing power of the locals. And by the way, remember, Somali families are known for aiding the sick and poor kinfolks through traditional safety nets where contributions cover one’s emergency medical situation.

As we often see, Somalia’s porous and unregulated market inspire illicit behaviors in various fronts. Unverified foreign health professionals’ penetration in Somalia’s health sector rose lately since the country made some infrastructural progress institutionally, but credibility of their skills is challenged by growing number of failed case handling. Is it that they are deliberately disguised as competent physicians by the health facilities, so they can import cheap labor to fill in critical and expensive services with the intention to gain more and spend less? Or, in contrast, the owners are themselves unwittingly employing expatriates whose credentials and experience had been misinformed against their quality standards. If the whole process of employing external health workers to dispense critical health service in the country is formed on trusting set of documents by the applicant or through recommendations by fellow networks, the danger is then bearing in weak solicitation method that the hospitals commission.

Like a case heard from Hargeisa some months back, a communication gap which sometimes erupts between the doctor and assisting national coworkers poses also grave hazard, which can cost a fatal cause to patients. In the hyperlinked video, a victim trended at a public forum deliberating quality standards of local Medicare services in Somaliland. He lauded he luckily survived a tube mistakenly left connected for about two months inside a surgery wound that he was operated at a hospital in Hargeisa. The discovery of this horrible mistake was found after the patient developed incremental pain around the operated part of his body, which later spurred him to thrust to neighboring Ethiopia for enhanced examination. The doctors in Ethiopia demonstrated him tubes inside him whose period of stay should not have been more than a few hours after the time of surgery, and repaired the wound safely. That traumatized him, he trailed back to the hospital after his return to home, but only meeting the foreign doctor shifting the scandal of himself; referring that he instructed on the papers in writing the nurses should have detached the tubes before discharging him from the ward.

In the end, Hargeisa patient lamented he dropped off the case owing to his consensual pre-operation agreement over lack of liability should the surgery turn harmful. This single-sided prerequisite, compulsory conditions abolish patients a chance to pursue legal challenge for compensation.

In an expanding entrepreneurial health market in Somalia, defective communication occurring between the foreign doctors and assisting national co-workers may continue risking lives. It may lead grave health implications to many. The bizarre thing is, except for a few facilities who try to learn and restructure, management of the clinics pay less effort in ensuring conducive atmosphere allowing foreign doctors to transmit and receive sufficient communication at the workplace. It is often seen being rough. This is as important as procuring state of the art equipment as insufficient information can lead to a fatal assumption.  

Professionally, it is too unethical to drag the patient into a conclusion that the nurse may be perceived as the patient’s target point during interpretation. This is observed. As hospitals in Somalia are overflowed, patient is hurried by the nurses, to hastily communicate his condition during appointment with the doctor. The nurse and the doctor know the long queue awaiting outdoor, for the next patient reminds that by opening the door impatiently repeatedly to inspect if patient inside is getting over. Occasionally, more than one patient can concurrently enter for the doctor resulting in an awkward mood, limiting patient-doctor frank consultation. Such inconvenient space makes the patient vulnerable into being dragged for a conclusion he is not sure enough that it was his ultimate point.

Somalia is well below the global standard of doctor and nurse density, reasonably inflating the influx of external professionals. There are only four healthcare professionals for every 10,000 people. Unless remarkably a miracle happens, Somalia will take time to regulate and scale up its healthcare sector to meet the demand for a healthy human capital. There is a categorical correlation between country economic productivity and stability and healthy society. From a nutritious early childhood preparation until healthy adolescent life, investment in this chain builds proper brains which could represent responsible and measured citizens.

A whole generation born and raised in the collapse of public services in a country whose crop production can only provide 22% of the per capita cereal food need, it is understandable  this situation may have impacted the brain growth of many children who are useful to the country’s economy and stability. Countries are doubling sectoral transformation efforts by availing the natural resources in home to raise living conditions of their people. Somalia is profusely blind of its resource since its state inception. That can arguably be correlated to human capital intelligence capacity, because measured and responsible citizen would at some points have agreed to move their country forward – a whole nation fizzles to tidy own house. International missions play own role instead! President of Rwanda, Paul Kagame, cited saying “If owners of natural resources go around begging, then you should know there’s something wrong with their minds.

Abdulkadir Hussein
Email: [email protected]

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