Dear Osman,
I have read with interest what you wrote today on Alsudani newspaper.
I find it hard to believe that the Sudan constitution (or any constitution) may endorse bestowing unlimited power or authority on the medical profession (or indeed any other profession). I think it would have been fairer to say that the rules regulating the medical profession, which should be there to protect patients, are not clear and therefore not easily enforceable by law.
Doctors in Sudan are held in high regard by the society and this makes most of us (the public) shy away from questioning their authority. This is further complicated by the fact that spiritual and religious dimensions to illness and death in our society make it easier to accept these events even if they were a direct result of medical negligence!! This is particularly a powerful coping mechanism for many bereaved relatives in Sudan; especially we all believe that every one of us live numbered days in this world. However, I fully subscribe to the notion that doctors and -other professionals- should be held accountable for their acts whether good or bad. The question is how to create accountability systems for each profession in Sudan?
I agree with you that uttering a few words in a ceremonial atmosphere is not worthy the effort and money spent in such gatherings. Instead, we should be seriously looking into establishing accountability within the healthcare system whereby doctors (and nurses, midwives, .. etc) are judged on their performance. For example, here in the UK we have what is known as clinical governance system which aims at ensuring the highest possible safety and quality of clinical care in each hospital by using certain tools. A good example of such tools is clinical audit (in which doctors/nurses etc compare the outcomes of certain aspects of their clinical practice with an agreed national standard of care). Clinical audit has indeed enlightened the practice of many doctors and helped bring about changes that contributed to better quality of care. By contrast, national standards of care are almost non-existent in Sudan (I will be pleasantly surprised if somebody proves the opposite) let a lone the practice of audit in itself. Furthermore, the number of private practitioners in Sudan has rocketed over the past decade and this poses more difficult questions than ever as to how to regulate their practice.
The tradition in Sudan, and other countries, has been to rely on national medical councils to regulate the practice. Of interest, this concept is being increasingly challenged in the Western hemisphere as the medical council (usually led and partly funded by doctors through regular compulsory subscriptions) is by definition committed to promoting the interests of doctors and therefore cannot be seen as an impartial referee in disputes or complaints made against doctors. In response to such concerns, most Western medical councils have got lay members (selected from the public) represented in various committees in order to bring a sense of balance. However, some doctors view the council as unfair and heavy-handed on doctors whenever a dispute arises and they think this is driven by a desire to please the public at the expense of their careers.
On reflection on the Sudan situation, the medical council in Sudan found itself in the media spotlight on several occasions recently because of reports of medical mishaps or misconduct in the profession. This is certainly indicative of rising awareness among the public with regards to their basic rights and we should all welcome this. A note of caution, however, is that trying to demonize doctors is not going to be particularly helpful. We have to remember that the vast majority of doctors work in poorly resourced healthcare facilities and that they have to make ends meet in their day to day life (just like anybody else) in order to support their families.
The challenge facing the medical council in Sudan now is to rejuvenate itself, engage in a constructive dialogue with both doctors and patients, and work towards protecting patients’ interests whilst promoting good medical practice. This process should be matched by a similar effort from the Ministry of Health to establish transparency and accountability within the existing healthcare system. Medical schools should also play a key role in ensuring that our would-be doctors have good grounding in communication skills (doctor-patient relationship, bedside manners, etc) and medical ethics (patient’s right to confidentiality, respect of patient’s autonomy, etc)
I have no doubt that the Sudanese people deserve first class healthcare services but we need to work TOGETHER to fulfil this objective. Of course, everybody should be conscientious when they go about their daily jobs as this is part and parcel of our religious and moral values. Therefore, I would expect not only doctors but also shopkeepers, plumbers, mechanics, local politicians, …etc.. etc to bear this in mind when we (the public) ask them to serve us!
For the full article by Osman Mirghani, please click on the link below
