How Corrupt Ugandan Doctors Connive With Indian Hospitals to Defraud Ugandan Patients

When Dr. Nuwa Masinde Muliro, a senior surgeon in Kampala, referred his patient to what he believed to be a reputable Health Centre in India, he did not expect anything except a consultation report and, hopefully, news of a good outcome. Instead the first communication Dr. Muliro (not his real name) received from the lead consultant in an Indian hospital was an e-mail requesting his banking details.
“When I enquired why they needed my bank details,” Dr. Muliro wrote last week, “the Indian consultant informed me that they often paid ‘consultation fees/benefits’ to the referring doctor.”
Dr. Muliro was incensed by the offer and told the Indian doctor that such dealings were unethical. “I have never sent any more patients to that institution,” he wrote.
The Indian consultant was probably surprised by Dr. Muliro’s refusal to participate in a lucrative, multimillion-dollar scam that has enriched many doctors in Uganda and India. It is a scam that is an international version of India’s vast domestic corruption in the medical services, where kickbacks to referring doctors are normal practice. They call it “Cut-practice.”
Many Indian medical specialists and hospitals offer cash incentives to Indian primary care doctors to send them referrals. This cut-practice is so competitive that commissions are reported to be as high as 40-60 percent of the consultation fee. (Other literature reports lower commissions in the 10-15 percent range.) There are reports of Indian specialists literally going to primary care doctors’ clinics, cash stuffed envelopes in hand, to solicit referrals.
The international version of the scam is orchestrated by Indian business coordinators, the vast majority of whom are not medically trained. Over the years, several of them have set up health tourism companies in Kampala and have established unethical partnerships with Ugandan doctors to operate a rather straight forward scam.
The Indian businessmen, together with their Ugandan partners, network with Ugandan doctors, offering them promises of commissions on each patient referred.
Patients that could be effectively and successfully treated or operated on in Kampala get referred to India. Whereas patients and their relatives often initiate the request for referral, the doctor in the scam does not try to persuade the patient to get the treatment locally. He is very happy to facilitate a trip to India.
The doctor prepares a referral letter that he sends by e-mail to the Indian business coordinator – usually a non-medical person. The latter forwards the mail to a doctor in India, a member of a given chain of hospitals. The patient is accepted, the Kampala doctor is advised, and he relays the news to his patient.
The patient, armed with a letter by her doctor, seeks a visa from the Indian High Commission. The diplomats are very happy to assist and a visa is granted. An Emirates air ticket is purchased and the patient, together with a relative, travel to India. She pays her fees on admission, a percentage of which is immediately sent to her Ugandan doctor’s bank account. She then receives the same treatment that was available back home.
Even more tragic are the cases of patients with very advanced diseases, such as terminal stage, inoperable cancers. After review and investigation in Uganda, a patient is informed that she has, say, pancreatic cancer that has spread all over the body. This is one of the most aggressive cancers, with poor outcome even in the best centres in the world.
Like most human beings, the patient wants “everything done.” The Bakiga-Banyankore call it okutaaga (pulling at straws.) Money is mobilized, and her doctor activates the Cut-Practice system.
When the terminally ill patient arrives in India, her Ugandan doctor gets his big kick-back from the fees. The patient embarks on chemotherapy. Her condition deteriorates. She dies within two weeks of arrival in India. Her family is devastated, but they are comforted by the knowledge that “everything was done.” The cost of returning the body is five times that of a living person’s air travel.
A Ugandan doctor, whose word I trust, told me last week: “I know a so-called senior doctor who has sent ‘rich’ patients to India for sham treatment. On getting there, they go through all the investigations, then they are told to go back to Uganda because they are fine!”
This Indian Cut-Practice is most definitely unethical. It has attracted the attention of the international medical community, with very many publications in peer-reviewed journals, including a long editorial in the November 16, 2013 issue of The Lancet, a leading medical journal.
The scam is so lucrative for all in the chain – the referring doctor, Indian middleman, Indian Hospital and doctor(s), the broader Indian economy – that it is very difficult to arrest. In Uganda, of course, the chain is joined by government officials and others who are involved in approving funding for politicians and other public servants.
Whereas the Code of Ethics of the Uganda Medical and Dental Practitioners Council is vague about receipt of commissions for referring patients, a careful reading of Rule 17(e) suggests that it prohibits this practice. The similar Code of Ethics Regulations of the Medical Council of India more explicitly prohibits giving or receiving such commissions. This is consistent with the international standard for medical ethics.
The conduct of these doctors also violates the cardinal principle of medical and surgical practice, namely, Primum, non nocere – Above all, do no harm. The practice harms patients by impoverishing them to enrich greedy doctors. (The Ugandan doctors are paid hundreds, even thousands of dollars per patient!)
The Indian profiteers direct the patients to their partner institutions, not necessarily to the best doctors or surgeons. The practice sometimes offers hope where none exists, knowingly subjecting patients to unnecessary and expensive investigations and ineffective treatments. The profit motive becomes the driving force, not the patient’s interests.
One Kampala doctor wrote last week that some terminally ill patients are duped into thinking that their conditions are curable. They are told to “go to India, get fixed and live on.” They are not told about the outcomes, life after surgery, gross complications, risks of death and so on.
This doctor has seen patients return from India in their last few days “disillusioned and impoverished following a referral for ‘cure’ of terminal cancer, stem cell transplant therapy, cardiac surgery and so on. The theme has been the same: they are not told the truth and, if any truth, half-truths.”
Adopted from:

Dogs can be trained to sniff out malaria: researchers

Dogs can be trained to sniff out certain cancers, people at risk of a diabetic coma and now, children with malaria just by smelling their socks, researchers said Monday.
According to the findings presented at the American Society of Tropical Medicine and Hygiene annual meeting in New Orleans, dogs were trained to sniff out malaria parasites in African children who tested positive for the mosquito-borne disease but did not have a fever or other outward symptoms.
Malaria kills some 445,000 people worldwide each year, and is caused by parasites that are transmitted by infected mosquitoes.
Cases of malaria are on the rise, globally. The World Health Organization said there were 216 million cases of malaria in 2016, up five million over a year earlier.
“Worryingly, our progress on the control of malaria has stalled in recent years, so we desperately need innovative new tools to help in the fight against malaria,” said co-author James Logan, head of the department of disease control at the London School of Hygiene and Tropical Medicine.
“Our results show that sniffer dogs could be a serious way of making diagnosis of people who don’t show any symptoms, but are still infectious, quicker and easier.”
A total of 175 sock samples were tested, including 30 malaria-positive children in The Gambia and 145 from uninfected children.
Dogs were able to correctly identify 70 percent of the malaria-infected samples.
The canines were also able to identify 90 percent of the samples without malaria parasites.
Principal investigator Steve Lindsay, a professor in the department of biosciences at Durham University, said this showed a “credible degree of accuracy.”
More research is needed, but experts are hopeful that the findings could lead to a “non-invasive way of screening for the disease at ports of entry in a similar way to how sniffer dogs are routinely used to detect fruit and vegetables or drugs at airports,” he added.
“This could help prevent the spread of malaria to countries that have been declared malaria free and also ensure that people, many of whom might be unaware that they are infected with the malaria parasite, receive antimalarial drug treatment for the disease.”

New Beside Care Services Opened in Uganda

A new and first of its kind bedside care services have opened in Uganda.
Located along Kironde road in Muyenga Kampala, Trehas Bed Care Services which was officially launched yesterday Friday will be offering home care treatment and bedside care services to Ugandans in a move that will revolutionize the country’s heath system.
During the launch, Edwin Basoga the company’s business development director noted that this is aimed at helping many of the middle age and young generation can’t find time to help and take care of their sick parents and their elderly parents because of their full time work schedule.

Trahas Bedside care service professional care takers willing to serve you.

“Many of our middle age and young generation nowadays work full time yet they have elderly parents to look after, young children to care for, sick loved ones to comfort and a host of unemployed dependents with varying demands. Basoga said.
Mr Basoga adds “there is a need to have an independent professional and dedicated help from a known service provider to take care of them. That’s why we are here to take home care and bedside services closer to the said categories of people.”

He explains that Trahas comes in with an aim to bridge  this gap mostly by addressing five key aspects which include physical care, mental care, health care , nutritional care and any form of assistance that its care takers must handle while offering care services to its clients and affordable fee.
The director further narrated that Trahas Bedside Care Ltd targets families that are childless yet they don’t have children or immediate family members to look after them in their old age.

Trahas’ senior nursing officer Mrs Nakiyaga displaying some of the medical equipment for use

The company in addition to other specialized services offered by professional nurses and service care agents, it has an ambulance to quickly deliver clients to specialized health facilities.
“You don’t need to rush home in traffic jam to pick a loved one to a hospital when we are here. Mobility and quick delivery of our clients to specialized health facilities is what we have invested in heavily because when you hire our services, you rest assured that any time we can transport your loved ones to a health facility. “He added.

Trahas business development director Mr Basoga displaying some of the wheel chairs available for use to their clients

According to Mr Basoga, their nurses will be stationed to the client’s home full time at only affordable fee of shs 25,000/- per day.
Key care services offered by Trahas Bedside care include  bed bath, nursing care, patient feeding, physical fitness drills, timely drug administration, monitoring blood pressure , monitoring sugar levels, monitoring temperature levels, monitoring vital signs and changes, postnatal care like care to babies and mothers after delivery, care to Cesarean mothers after delivery among others.

Trahas Bedside care service offices located along Kironde road in Muyenga, Kampala

Muyenga/Kironde Road
CONTACTS: 0707400021/0707400018/0707400019