Week 8- (Un)Qualified

I began part II of my research plan this week.  Part I involved interviewing 4th and 5th year medical students at Makerere University to understand the ethical challenges they’ve faced during their clinical rotations at Mulago National Referral Hospital.  Part II involved observing wards at Mulago to better understand the context for the stories I had heard and to observe any other ethical issues that students did not address.  I decided to focus on pediatrics wards because of the many stories I had already heard about ethical situations involving informed consent, rationing of medicine, and patient autonomy.
    So, I addressed up (tie included) and went to a pediatric ward that I had been given permission to observe.  I was required to wear a white coat (as all doctors do) on the ward while observing despite the fact that I was only there to observe, not treat.  This white coat turned out to be more trouble than I had ever anticipated.  I still don’t know whether it was because I was wearing the coat, am a mzungu (white person), or because of severe under-staffing that I was asked to help diagnose and treat patients.  It’s probably a combination of all three reasons.  From the moment I was introduced to the person I was shadowing I was perceived as having medical skills that I in fact do not.  It took 5 minutes and many different attempts before I successfully explained to my guide that I was not qualified to help and that I really only wanted to observe despite the fact that she would allow me, if I had agreed, to help diagnose patients by listening to the heart and lungs, taking medical histories, etc. After talking with many interns and master’s students, it is evident that the idea of “just observing” seems silly and unproductive to them.  Why would I not want to learn how to treat patients? Why could I not help them?  Why was I there if all I wanted to do was watch? Why should they take the time to talk with me if I couldn’t provide some help in return? These were all the questions that I was directly and indirectly asked throughout the day.
    As someone who is interested in ethics, I felt strongly that it would be unethical to try to treat patients without proper training despite the fact that it would have been much easier to simply take basic diagnostics to appease the staff.  At the same time, I had to question whether my presence was causing an undo burden on the staff and on the patients. I kept asking myself, “Am I taking away from time the staff could be using to treat patients? Am I indirectly harming the patients?”  This was particularly hard when I went to the acute pediatrics ward as I felt even more in the way and less prepared to handle what I saw.

Location: Kampala, Uganda