Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Gretchen Berland

Subject Area(s)

Medicine, Medical ethics, African studies

Abstract

This essay explores the practice of imprisoning patients in private health care facilities. Despite the Ugandan government's promise to provide free basic medical services to all as a fundamental human right, the nation's inadequate health infrastructure is forcing many patients to seek assistance in a private sector, which most cannot afford. Underpaid by the government, many Ugandan physicians open private clinics, where they also struggle to recover the costs accrued by the many impoverished patients they treat. Employing an age-old strategy akin to debtor's prisons, these physicians then choose to detain patients who fail to pay their bills immediately with the hope that their family and friends will bail them out. In this essay, I will examine the historical, cultural, and political origins of this practice. I will first demonstrate how the provision of health care in Uganda has become both a commodity and a right. I will show how physicians in Uganda's private health sector feel an obligation provide patients with services, but which is at odds with their socio-economic survival. I will argue that Uganda's private physicians today have developed a role similar to that of creditors during the colonial period in Africa. These creditors were particularly essential to native peoples during times of famine, and employed two indigenous forms of debt bondage, pawnship and panyarring, as the predominate means of recovering loans from a destitute population. In connecting the practice of patient detainment to these historical practices, I will illustrate how a lack of alternative, legal methods to regain costs has contributed to its persistence today. I will end the essay by describing how Uganda is not alone in wrestling with the issue of detainment for medical debt.

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