Job crisis and indecision

Nearly 3 months in and it looks like we've run out of work here. We've submitted a proposal for an academic department of Family Medicine and are waiting for the University and Ministry of Health to respond. They need to make financial commitments to the training and employment of generalist Medical Officers who can provide medical and surgical care in the rural level 4 Health Centres. This is all actually ministry policy but Museveni promised everyone the earth before the elections in February and it is now clear that spending on health is frozen at least until the next election looms in 2011. As we've said before health spending is 3.5% of GDP and a fraction of what is necessary to run even a basic service.

We are also submitting a proposal to the Dean and Hospital Chief Executive on Thursday for a Clinical Department of Family Medicine to take managerial responsibility for the very busy Outpatient Department here. This one doesnt really need funding just a commitment to change in an organisation that is resistant to change. The outpatient department is a chaotic, anarchic and riotous mass of bodies in all stages of ill health. There is no overall manager below the hospital chief executive and the staff come and go pretty much as they please. Government wages are low (£30 pcm for a nurse aid, £100 for a registered nurse, £150 for a clinical officer (physicians assistant grade) and £200 for a Medical Officer. Nobody can run an average sized Ugandan family and pay school fees without moonlighting in at least one other job and all the medical officers and clinical officers have a substantial private practice that takes them away from their government commitments. Understandably they're not keen on a couple of muzungus waltzing in and expecting some commitment to timekeeping.

So, effectively we've done a needs assessment and feel like nothing else is likely to happen here for at least a few months. We've asked VSO to give us details of other job opportunities and will be touring around looking at the options over the next week or so. We have a comfy social life here so a move feels difficult but we need to get our teeth into something more substantial so we'll see.........

The outpatient department is the building on the right in this picture. The crowds have taken cover from the torrential downpour. It feels like the rainy season has just finished with no rain for several days now. The next one is March to May.