Dr Margaret Mungherera, the former president of the World Medical Association, died of cancer last week. As a tribute to one of the world's most respected and outspoken health rights activists, we republish this feature about Mungherera by BAMUTURAKI MUSINGUZI first published by The Observer in January 2014.

When Ugandan psychiatrist Margaret Mungherera was voted unopposed as president-elect of the prestigious World Medical Association (WMA) – the event conjured up bitter memories when she was refused to practice medicine in Britain 28 years ago.

Mungherera had travelled to the UK to pursue a diploma in Tropical Medicine and Hygiene at the London School of Tropical Medicine and Hygiene in 1984, after completing her internship at Mulago hospital a year before.

In 1980 the General Medical Council in the UK had banned doctors from a number of countries, Uganda inclusive, from working in England for various reasons, including the insecurity in Uganda then, and an alleged decline in standards here. Hence while Mungherera’s classmates from India, Nigeria and Ghana were allowed to practice, Ugandans were rejected as unworthy.

“For us personally as doctors we felt sort of downgraded and humiliated. It meant that if you could not work in England, then you could not work in Germany, France or Europe,” Mungherera says.

She recalls that even when they were admitted, they were told they could not touch patients, meaning that it was going to be a theoretical course.

“It was OK that we were not allowed into courses that were clinical at the time. It must have been up until the 1990s when we struggled and we were recognized again.”

Mungherera’s highest personal recognition came in October 2012, when she was voted WMA president-elect for 2013-2014 at the association’s annual General Assembly in Bangkok, Thailand. A year later, in Fortaleza, Brazil, she was installed as president at the WMA general assembly.

WMA, acting on behalf of patients and physicians, endeavours to achieve the highest possible standards of medical care, ethics, education and health-related human rights for all people.

“When I was taking up this post, the people who actually looked for me were from the British Medical Association. I also had doctors from the American, German and South African Medical Associations who actually rallied and convinced me to take up this challenge. And so when I was declared unopposed at the meeting in Bangkok last year, the first thing that came into my mind was how I felt that afternoon when I was not allowed to register in the UK,” Mungherera says, remarking what a “wonderful thing” it is that the British now think a Ugandan can lead.

Mungherera is only the third woman to head the 66-year-old association, after Dr P. Kincaid-Smith from Australia (1994-5) and Dr Kati Myllymaki from Finland (2002-3). And she is the second African president, after South Africa’s Bernard Mandell (1996-7). She sees this as more evidence to a gender-imbalanced world – that women can ably lead.

“As president, I am going to be the ambassador of the association. I will be the mouthpiece and spokesperson. I will represent WMA at the United Nations and World Health Organisation meetings and other bodies that have a relationship with the association. I will also be visiting national member associations especially where health workers have challenges. If, for example, they have unfairly detained a health worker or where rights of health workers are being violated,” she says.

Mungherera has been a medical doctor for over 30 years and a psychiatrist for 20 years. She specializes in forensic psychiatry at Mulago teaching and referral hospital. She also has responsibilities as the clinical head, directorate of Medical Services (departments of Internal Medicine and Psychiatry). In addition, she is a senior consultant psychiatrist at Mulago hospital, in charge of psychiatry emergency services.

Mungherera is a founding member of the Association of Uganda Women Medical Doctors and was the first woman to be elected honorary president of the Uganda Medical Association (UMA) since its formation in 1963. She is also its longest-serving president – 1998-2005 and again from 2010 to-date. As WMA boss, she hopes to tackle the challenges of delivering quality healthcare to millions around the world. And she articulates the problem clearly.

“I think the main challenge is that there is a human resource crisis all over the world whether you are talking about high, middle or low-income countries. The most affected areas are the low and middle-income countries. In terms of migration there is a lot of internal and external migration. People are migrating from the South to the North. People are even migrating within their countries from rural to urban areas. So, there is a lot of inequality in terms of distribution of health workers,” she says.

“I also think that the profession has low numbers but also there is a shortage of skills. The skills that are necessary now are to do with the new diseases that have emerged. For example, we as doctors should no longer keep sitting in our clinics; we should be out there doing advocacy, public awareness and health promotions.

“The diseases have changed; we should be talking about lifestyle, more than infections. [Of] course infections are important but lifestyle is a very important issue now. The other challenge as new diseases and epidemics emerge, there is reduced resources for health care. In most countries health care resources are going down,” she added.

To address these challenges, Mungherera suggests that governments should show more commitment and increase funding for the sector. And the private sector, too, should be more involved in providing solutions.

“For example, a lot of governments have signed the Abuja Declaration, which requires all countries to allocate at least 15 per cent of their national budgets to health. It is not happening in any of the low-income countries and even some middle income countries.”

Mungherera also stresses that research has to be the pillar of efficient healthcare systems.

“We need to be providing services that are based on evidence. So, in many of these countries there is very little money for research. And a lot of research is done by institutions elsewhere. A lot of research is not being translated into policy and action; so, there is a lot of wastage of resources for research. We need to get more money but also target the money to where it is needed to influence policy and action.”

UP TO THE TASK

According the former WMA president, Dr Cecil Wilson, there is no doubt Mungherera will make a great president.

“In talking with Dr Mungherera about her vision for the WMA, what comes through loud and clear is a dedication to bringing the disparate member organisations of the WMA together,” Wilson wrote in his blog posted on the WMA website.

The principal medical officer in charge of mental health at the Ugandan ministry of Health, Dr Sheila Ndyanabangi, describes Mungherera as a charismatic, driven, outspoken, and truly emancipated woman.

“She has fought for the medical profession and the rights for women, men, children and health workers. She was a pioneer in starting health services for after-rape victims,” Ndyanabangi told The Observer. “Therefore, I think she has a lot to offer in coming up with new approaches in empowering health workers in general but also the medical doctors to fulfill their potential in as far as they can contribute to the wellbeing of the population.”

A particular area of concern for Mungherera is the delivery of psychiatric services in Africa, which are hindered by challenges such as the stigma associated with mental illness.

“Stigma also leads to limited resources provided by families, communities and governments. And our services are still rudimentary if you compare them with those in the West. We need to do more work with traditional healers because we know they have a role to play. We need [to] train, educate, and reorient them on what our different roles should be.”

“We need to educate the masses about the common causes of mental illness and how they can recognize mental problems. We also need to integrate mental care into primary healthcare so that every health worker can recognize the form of condition and to give some sort of treatment and know when and where to refer.”

Mungherera notes that immunization is not the responsibility of the health sector only but a multi-sectoral issue that calls for adequate funds for social mobilization.

“If we do not put enough money and effort in social mobilization, we are not going to get the results we want as far as immunization is concerned.”

Mungherera observes that the medical sector in East Africa is developing with the input from the private sector but more resources are required to gain higher growth.

“Things would move faster if we had more resources and especially the human resource. However, in the last 20 years a lot has changed in the way we manage and prevent diseases, and the number of skilled professions has increased. With more resources we can actually get where we can say it is of good standard,” she adds.

Mungherera has expertise in training health professionals and community health workers (CHWs), mental health and forensic medicine research, human rights advocacy, non-profit organizational governance and development.

In 2000, Mungherera initiated discussions between national medical associations in Uganda, Kenya and Tanzania, a move that culminated in the formation of the Federation of East African Medical and Dental Associations.

A significant achievement of the federation has been to bring together for the first time national medical associations to work with their regulatory bodies in the Eastern African region (Uganda, Kenya, Tanzania and later Rwanda and Burundi) to strategise and plan for a joint effort to promote standards in training of doctors, regulation, continuing professional development, cross-border disease surveillance and emergency response.

President Yoweri Museveni appointed Mungherera a member of the Judicial Commission of Inquiry into the Global Fund for HIV/Aids, TB and Malaria (2004-2005) and member, Public Universities Visitation Committee (2005-2006).

Mungherera, who was born on October 25, 1957, has five siblings, including four medical doctors. She is married to Richard Mushanga, a retired banker, and she has an adult step-son and four grandaughters.

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