By Wezi Gausi:
The offences vary – from demanding money from patients for a service that is supposed to be free, to misdiagnosis leading to complications, deformity and deaths of clients, to giving treatment that is different from a health condition one is suffering from, to abandonment and stigmatisation of patients and to sexually abusing them.
The culprits are from every rung on the ladder of medical practice – from interns, to mid-ranging medical practitioners to the highly-educated, experienced and decorated in the field in the country.
The penalties? From a warning letter to deregistration to suspension from practice – in some cases lasting up to five years.
And the unethical conduct is happening in both government, church and private-owned facilities, including those of high repute.
These findings make part of the contents of a report of Medical Council of Malawi (MCM) disciplinary hearing for medical practitioners for June 2021.
The list of sanctioned medical practitioners in our possession include two of the country’s most respected, we can report – with one of them being deregistered for five years while the other’s case is pending. (We have the names of all medical practitioners involved.)
Some of the cases
According to one of the charge sheets in question, this top doctor who has been deregistered for five years, while working as specialist doctor at Mwaiwathu Private Hospital in Blantyre, induced labour in one client and failed to monitor its progress on time.
This led to a delayed decision to perform Caesarian Section, resulting in what it calls “foetal distress and neonatal death from aspiration pneumonia”. The incident happened on 15 August 2020.
In January this year, a clinical officer at Kamuzu Central Hospital (KCH) refused to provide postmortem services unless he was paid K200,000 for the service.
At the same hospital, in December 2019, another medical practitioner charged K400,000 from a patient who needed treatment for a leg fracture.
In a number of cases, pregnant women were subjected to medical negligence resulting in ruptured uterus, fistula and still births.
And there are also some cases of mishandling of patients that resulted in their deaths. For example, in May 2019, a clinical officer at Zomba Central Hospital misdiagnosed a known cardiac disease patient, leading to his death.
In another case at Mzuzu Central Hospital in April 2020, a doctor misdiagnosed a patient with Covid-19 disease. This resulted in her being abandoned by medical and nursing staff, leading to her death. The patient had presented a negative Covid-19 test but had pneumonia.
The list in our possession comprises 30 complaints, with 9 practitioners found not guilty. But as per the council’s indications, the list does not present the full picture of the unethical conducts by medical practitioners in the country’s hospitals.
Registrar for the council, Richard Ndovi, said the number of complaints about unethical conduct of medical practitioners and hospitals has been rising over the years, doubling during the Covid-19 pandemic.
“[In] the previous years we had [between] 20 to 25 complaints per year but since 2020 we are receiving above 50 complaints per year and we respond to them immediately,” he said.
Ndovi said it is mostly urban clients who lodge complaints with the council. And according to Ndovi, “there are many unethical conducts happening in our health facilities”.
“They border on professional misconduct, disgraceful conduct, medical negligence related to medical practice and institutional medical negligence where the institution does not provide adequate equipment and supplies such as diagnostic sets, resuscitation equipment as observed in Covid-19 treatment centers exposing practitioners to poor working conditions,” Ndovi told Malawi News.
These shortfalls, he said, lead to unintentional medical negligence.
‘Healthcare workers need tools’
Executive Director for Malawi Health Equity Network (MHEN) George Jobe agreed with the council’s findings, arguing that Malawians are regularly being exposed to injuries and untimely losses of life at the hands of medical practitioners.
He also agreed that in some cases these practitioners are being failed by the health system itself.
“Healthcare workers need tools to perform their duties satisfactorily. The tools include proper buildings, equipment that includes beds and ambulances, medicines and medical supplies.
“Inadequacy or malfunctioning of such tools have failed medical work and healthcare work in general, causing injuries and/or deaths of patients,” Jobe said.
In the council’s report, for instance, a specialist doctor in family medicine at Shifa Private Hospital in Blantyre failed to resuscitate a patient with delivery related complications which contributed to her death.
According to the report, part of the problem was that the department was not set for emergency preparedness as some resuscitation equipment was not working.
The doctor was found guilty for negligent management of a patient.
To complement the council in handling complaints for patients at hospitals, government established the office of hospital Ombudsman in public facilities.
But Jobe said while the initiative is progressive, it is hampered by the fact that the office holders are employees of the same health systems.
“This affects people’s confidence on whether they are impartial or not and whether they can report the bosses that are in the wrong.
“The best would have been to have ombudsman officers who are not employees of the Ministry of Health so that they enjoy independence. If they belonged to the office of the Ombudsman that would be better and they would be handling issues of all sectors beyond the health sectors at district level and at community level,” he said.
The hospital Ombudsman is empowered to investigate, mediate and provide remedies to complaints lodged by service users. The cases the hospital Ombudsman can handle include breach of confidentiality, negligence or carelessness and failure to ensure availability of essential resources such as drugs, equipment and staff.