Kampala, Uganda – days after an emergency cesarean in a private clinic, Barbara Kwarikunda felt atrocious pain.
“I couldn’t eat,” she said. “I felt pain whenever someone touched me. My stomach was swollen. I felt like something was bursting in my uterus.
Visits to the clinic did not help. An examination in a public hospital revealed that the people who operated on his left cotton and his gauze in his uterus. They also slightly broken his intestine, which caused internal leaks. She needed another surgery to remove cotton and cause, and repair the cut.
It is not clear if the employee who carried out the surgery was authorized to do so. But the private establishment where Kwarikunda underwent his emergency cesarean, Cleveland Specialized Clinic, was under the spotlight after a local media investigation allegedly alleged that the clinic operator, Ken Nyombi, used someone else’s references to practice medicine. The clinic is now closed and Nyombi is in prison. He was not allowed to speak to the media when he appeared for an audience.
His case is one of the 10 cases under survey by the Directorate of Public Prosecution for Illegal Medical Practice and Related Fraud, said Irene Nakimbugwe, head of assistant public relations and chief prosecutor. Other cases, she says, involve incidents in public and private health care establishments.
Such cases have increased because the country’s health care system fights with limited resources and regulatory negligence.
Unqualified doctors use gaps to illegitimately obtain medical licenses, while others manage private clinics without license. They do not only basic medical care, but sometimes surgery and other complex procedures, leading to serious errors and patients’ deaths. In a case that drew the attention of international media in 2019, an American missionary without medical training organized a license -free center for malnutrition children in Uganda, where, according to trial documents, medical procedures have cost hundreds of children.
The culprit, according to a 2021 report commissioned by the government’s inspection, is generally corruption. Unqualified people can often be hired in health care roles by paying bribes. Although there are strict rules for the licenses of health workers and private clinics, authorities can ignore missing documentation and politicians can influence recruitment. Pharmacies that do not meet standards can buy licenses, and inspectors can ignore the storage of inappropriate drugs – at the right price.
This does not help that the regulatory organizations are stretched, according to a report by the Ministry of Health. They do not have the resources to effectively implement requirements, which means that unskilled people can easily process patients without distrust for years.
Uganda Medical and Dental Practitioners Council, which licensors health workers, has not responded to several requests for comments.
Emmanuel Ainebyoona, head of public relations at the Ministry of Health, said that the ministry is based on professional organizations such as the medical council to validate the skills securities.
“You must be in this graduation book of the institution on the date on which you say your diploma,” he said.
Employers are also supposed to check the academic documents with issuing institutions before hiring someone, but that does not always happen, explains Dr. Innocent Ssemanda, epidemiologist and researcher at the Ministry of Health. This includes those who hire government, he says.
“(People) know that no one will go to (the Board of Ugandan national exams) to confirm that you are what you claim to be,” he said.
These gaps allow an unskilled person to practice medicine with the references of another person.
It even happened to Ssemanda. An impostor used his documents and his license for more than a decade, he said.
In 2020, he said, he went to renew his license, only to note that even if the skills titles in the government archives were his, the photo belonged to someone else. A staff member confirmed that someone else had asked for a license using his academic identification information. He contacted the registrar of the medical council, but there was no immediate action. In 2022, after the medical advice digitized its system, Ssemanda received an alert that someone had downloaded their license. He visited the registrar’s office and corrected his contact details. But in 2024, colleagues informed him that someone who claimed to be attended him a Ministry of Health Training.
This time, he turned to local media. He sparked an investigation by a local television channel and the authorities were involved. The person who would identify him with the identification was the owner of the Cleveland Specialized Clinic, one of the cases under survey by the Directorate of Public Prosecutions and where Kwarikunda underwent sloppy surgery.
In some cases, everyone must pose as a doctor is a laboratory blouse.
Dr. Warren Namaara, director of the State House Health Supervisory Unit, a government body, said there have been cases where a person will simply enter a public health care establishment and start treating patients to earn money. They can bribe security personnel for entry.
Most hospitals are in sub-employment and health workers are too busy to pay particular attention, explains Namaara. The current doctor / patient ratio is 1 for 1,400 people. The World Health Organization recommends at least 2.5 medical staff for 1,000 people.
It is shocking that anyone can enter a hospital and start treating people, explains Flavia Zalwango, program director at the human rights awareness and promotion forum.
“How can staff enter and start offering customers, and you don’t know?” Said Zalwango.
To eliminate the problem, everyone, including the public, must be involved, explains Nakimbugwe, the chief prosecutor. They must report any dubious conduct of the doctors of their communities, she said.
The government is already on alert, explains Namaara, adding that the state monitoring unit of the State House has a free line for the public to report these cases.
“It cannot be resolved in one day,” he says. “It must be a sustained effort.”
But Kwarikunda believes that he is on the government to eliminate fraud. As a Ugandan is looking for medical treatment, he trusts that the government has already checked the person who treats them, she said.
The professional medical fault can be expensive. Kwarikunda’s sloppy surgery and the related treatment cost it 1.3 million Ugandan shillings (around US $ 354), which it paid in its pocket.
In January 2024, Peter, who prefers to be identified by a single name for fear of stigma, took his wife to the specialized clinic in Cleveland. She had missed her rules several times but had been under contraceptives, so they did not think she was pregnant.
The health care worker recommended an ultrasound, which, according to the results presented to them, showed that she had fibroids and needed an operation. They asked for a second opinion from the Kasangati Health Center.
It was not fibroids. His wife was pregnant and has since delivered a little boy.