Medical Emergencies

The Kenyan education system considers medical doctors, including dentists and pharmacists, to be our best and brightest. In our competitive—and elite-making—public education system, medical doctors are the cherry on top, the prize, those who have proved themselves worthy. Medicine is not considered a vocation; I write this understanding how the term “vocation” can be misused to obfuscate important questions of labor and compensation. To be a medical doctor is to have achieved a dream—to have received a crown. These days, a paper crown.

Kenyan doctors are on strike.

Rather, Kenyan doctors who work in the public sector, in government hospitals, are on strike.

They are on strike because they do not have the equipment, facilities, and supplies to perform their jobs. They lack drugs and bandages and clean needles and sterilizers; they lack dialysis and MRI machines; they lack adequate medical insurance to keep themselves healthy; and they lack adequate compensation that values their contributions to Kenya. Indeed, to stretch a metaphor: the government has equipped Kenya’s doctors, the best and brightest, with First Aid boxes and told them to heal the nation.

And so our doctors are dying because they lack access to medical care and Kenyans who rely on public hospitals are dying because the doctors do not have the facilities to treat them.

Meanwhile, the Kenya government is twiddling its thumbs and buying expensive chairs (each Kshs 200,000, approximately $2,000). And saying, perhaps rightly, that there is “no money.” We are fighting a war so there is “no money.” Even as we set up more and more and more expensive “very necessary” committees to run the country.

If nothing else, the weeks of the PEV violence proved that Kenyan politicians are mostly indifferent to ordinary suffering. We killed each other as our leaders played “who has the biggest dick.”

More to the point: Kenyan politicians and their cronies do not need public hospitals and the doctors who work in them. Kenya has very nice, very expensive private hospitals, for those who care to be treated here. If not, South Africa, India, the U.S., the U.K. For those with money, public hospitals are a rumor. A place where one’s domestic servants might go if they require care.

As doctors strike to improve public healthcare, those of us who rely on private healthcare blithely move on with our lives. There is no crisis. Nothing to see here. And if doctors choose to strike, if our best and brightest try to argue for a more ethical, more humane medical environment, well, clearly, they did not get the memo: in our new era, “best and brightest,” “medical school degree,” “public health,” these are all nice phrases to be used in polite company and when we solicit money from donors.

The promise of the “best and brightest” has always been that they will provide the leadership we need to “improve” the country. Even as our history demonstrates that we would rather treat the “best and brightest” as unpaid or poorly paid laborers, people who work because they believe in “sacrifice.” That is our benign history. We also like sending them to jail and into exile.

What we forget—what the government forgets—is that Kenyan doctors in the public sector have chosen to work for Kenya. They could go abroad, seek other opportunities, leave our already depleted medical services even more depleted. We have, I believe, 2,300 public medical doctors for a population of 40 million. More eloquent writers can say more about the medical situation.
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This medical situation raises an ongoing question about what it means to work in Kenya’s public sector. And, more specifically, why it is that the people I have long admired as the “best and brightest” do not work for the public sector. I wonder, also, why average people like me do not work for the public sector. What does it mean to envision public sector jobs as sites of intense, ongoing struggles to survive, let alone thrive? What does that struggle mean for Kenyan academics? And why do we expect academics and public sector workers to “sacrifice”?

“Sacrifice” becomes more than metaphor when patients and doctors are dying because they lack adequate supplies.

It’s not clear to me why the government would praise education and laud those who are well educated—as it does—only to ignore their needs and recommendations. Why should it be “unrealistic” for the government to ensure that public hospitals have adequate supplies? This at a point when, if Raila Odinga’s figures are to be believed, Kenya is spending 200 million a day to fight a needless war.

And what happens when the “best and brightest” and the “average and lucky” choose to leave public service and work elsewhere? I am not arguing that the public sector is the only place from which one can work for Kenya; I am interested, however, in what happens when the public sector becomes an impossible space for the “best and brightest” and the “average and lucky.”

What happens when the designation “best and brightest” is rendered meaningless by government action and inaction? How might this reverberate through an education system that is already in a state of crisis? What might it mean to devalue what is considered the pinnacle of academic achievement in Kenya? And what might it mean to tell those who want to dedicate themselves to public service that their education, their achievements, and their labor has no value?

Many messages are being sent by the government: messages about the value of education, about the value of public service, about the value of human life. None of these messages are the least bit encouraging.

23 thoughts on “Medical Emergencies

  1. So well put! Took the words right out of my heart. It’s a sad day when it comes to doctors having to put down their tools (well what they actually have) for the government to listen to them. I thank them for being brave enough to stand up for me and all other Kenyans.

  2. I’m probably too pragmatic about this and that has been my failing.
    First, I agree with the doctors that their working conditions should be improved. Our leading referral hospital is a mess, no one should have to work there.

    However, on matters of personal remuneration,I need several clarifications made.
    First, do they have to work for the govt?Don’t we operate in a free market economy? The answers I have gotten here so far are two. That they’ve sacrificed to serve the people (in which case they should realise sacrifice can be pricey) and the second, that the government is paying for their Masters so they have to work in government. At that, I thought, they’re almost lucky these doctors, free education is unheard of. Is there a third reason?

    Second issue. Poverty. I’m reading compelling stories of how poor doctors are. Maybe I walk on different streets from other Nairobians, but I’m yet to meet a poor doctor. I gave an example of my friend, a masters student at KNH, who does time at Nairobi Hospital and drives a Mercedes, the ultimate sign of wealth. Sure, no one should have to do two jobs, but is this unique to doctors?
    Right now, the so called servants of the people will hardly be found on duty in the public hospitals, because they say they need the money to feed their families. What about teachers who take home 10,000bob, yet they’ll be found in school? How do they feed their families? How much will doctors need to be paid so they drop lucrative side jobs?

    I’m I needlessly bitter toward doctors?Maybe. My thinking is, service comes first. When I almost bled to death at Kenyatta Hospital with no doctor in sight (as have many patients before), I don’t think my doctor who was probably doing time elsewhere was adhering to ‘first do no harm’.
    You argue that you can’t afford to live on the KNH salary, then quit!! Quit en masse, after all, people are dying anyway. Its no different from what’s happening now, and maybe when you do that,we and the government will take you seriously.

    And yeah, when you show me a poor doctor who is serving the people selflessly too.

    Final question to the doctors. Since you’re civil servants, if the govt harmonised your pay to match fellow civil servants, then used the rest of the cash to fix the hospitals, would that be ok?

    • @ Kellie….you concerns are noted.

      However, a few issues which if you forgive me I would consider distorted facts, or better still half-truths.

      This is what happens, most of us middle to upper class Kenyans have had very little interactions with our public health system. This is because most of us have the chance to go to the private hospitals.

      I am a doctor myself, employed by the government and doing my masters degree, well the fact is I do not know who told Kenyans that we do not pay school fees, we do!!! When someone is doing their masters in the clinical subjects, they are referred to as registers, and in the course of doing this they do a lot of clinical work…. across the globe, registrers are taken to be workers, who are ussually paid for the hours they work in the hospital. At our teaching hospital in KNH and MTRH, these two hospitals, have taken advantage of this and have refused to employ, their own doctors and to pay the registrers, This is in contrast to the even Agha Khan Teaching hospitals…..which pays its registers about 1,000.00 USD per month. Now the issue is that the lack of pay has pushed the doctors working in government out of post-graduate studies to the extent that upto 75% of these students now are taken up by students who have stable backgrounds.

      Second, I beg to differ, but unless your friend is very lucky, he cant have made that money from practice….let me explain this, the government pays a senior medical office about 70,000.00 net per month. Nairobi hospital pays about 4,000.00 for the MO, locum per day? Consider that if it is true that your friend is doing masters degree he/ she cannot be moonlighting all the days!!! Sincerely speaking how long do you think, someone would take netting about 120,000.00 per month to live such a flashy life!!! I cannot dispute he drives a Mercedes Benz and he lives the flashy life, but, it beats my reasoning how he has got all that from his profession. Normally the people who are making that amount of money are the consultants who have been in the system for decades, and for survival they have to form cartels, and secure all consultancy work in the big hospitals; NOW IS THIS WHAT BEING PROFESSIONAL IS ALL ABOUT???

      As I mentioned I have in in public service, yes the market is free and for sure, about 80% of doctors quit, some actually change careers, for example 3 of my classmates are pilots with KQ!!!! Now the big question I would wish to ask you, is this what you wish for Kenya, that the situation looks calm and fine , yet you train doctors, then they end up being absorbed into either private hospitals, or other career??? Personally I feel this is quite some irresponsibility from the part of the government.

      Sorry if I wrote too much, but my wish is that do not think that every doctor who runs a parallel practice is our role model, actually thats what we would really wish to end so that people can give their concentrated time on their patients.

      I stand to be corrected.

    • Hey Kellie
      Edwin has pointed out most of your concerns. Mine is to assure you that there is no doctor who loves ‘hospital hopping’. Some private hospitals have paid their consultants real well to stick to their facility and do researches etc. I know of several university lecturers who are doctors and had to quit private practice to dedicate their time to research and knh. Many doctors will tell you that with 300000 they see no need to hop from one hospital to another. Then who said that the private hospitals pay any better? That’s why they need to come up with strategies once salaries in govt are ammended. In January this year, I was offered a job at 2 leading private hospitals,one offering 115K,and the other 120K,and the govt with my 5 years working experience,was offering 103K . Advantage is that you get to work the fixed 42hours and get a medical cover and you get to work in a system that is functional.
      We cannot run away from issues. We have to face issues head on. Coz our parents and relatives back home need these services.

  3. Whoa Kellie!

    You certainly have an eye for cutting through to the heart of the matter devoid of emotion. That trait will serve you well.

    Now, I have heard that a 13 point proposal has been forwarded as the basis of negotiation. Can someone point me in the direction of what the doctors demands are?

    And I do agree with Kellie on one key item. Do not mix issues. Lets focus on what has been allocated to Healthcare and how that is being used.

    • Please have a look at the petition;

      http://kmpdu.org/index.php?option=com_content&view=article&id=129:kmpdu-proposals&catid=1:latest-news

      As I said earlier I am a doctor, doing my masters degree, and definitely after I am done, i would wish to make quite some cash!!! Unfortunately the set-up we have is pushing me in the wrong direction!!!
      Having side practices is not my wish.

      The issue of free market…..well the results are evident from the maternal mortality we are reporting!!! if you go to Voi District hospital, 7 medical officers were posted there last year, as we speak only one remains!!! The big picture is as for me I have paid a health insurance with UAP, and the free market has directed all these doctors to Nairobi hospital and God knows where else!!! Now what happens to the poor 100,000 citizens who live in Taita Taveta who cannot afford this insurance. Is it just moral for us as citizens to fuel this capitalism at the expense of those who cannot afford???

      Anyway, I would suggest that we reconsider our approach!! Lets face the reality!!

  4. @ kellie I’ve been seeing that ‘It’s a free market, just quit’ argument quite a bit. Mostly from the same people who talk about how medicine is a calling and a sacrifice. I suppose the real problem here is that we’ve employed human doctors who have their own needs, dreams and families to take care of instead of automatons who would uncomplainingly work around the clock in frustrating conditions for frustrating pay, and never search for a better alternative elsewhere.

  5. I am not a doctor, but remuneration is point 10 of a 13 point document found here

    http://kmpdu.org/index.php?option=com_content&view=article&id=129:kmpdu-proposals&catid=1:latest-news

    I support them for simple reasons. I pay my taxes and I know my rights. The constitution under economic and social rights says “Every person has the right to the highest attainable standard of health, which includes the right to health care services […]”. Health care is a right period. I have health insurance, I don’t go to Kenyatta hospital because I know I will have to wait forever, probably bleed to death like you almost did if god forbid something happened to me. Why? There is one Kenyan doctor for 20’000 Kenyans! It should be one doctor for every 1000 Kenyans. So that’s why you didn’t see a doctor – there are simply not enough! But I shouldn’t have to go to Aga Khan for treatment. I pay my taxes, I should be able to go to the biggest referral hospital and get quality healthcare from a doctor who hasn’t worked a 36 hour shift and getting a pittance of a salary at the end of the month. Even with regard to that, the constitution states “Every worker has the right to fair remuneration, to reasonable working conditions […]”. I am also very alive to the fact that majority of Kenyans can’t afford private health care and it’s the governments responsibility to provide said quality healthcare. So yes it’s a free market, but if all public hospital doctors quit, where do you suggest majority of Kenyans go for medical attention?

    As for your merc driving doctor, I could be wrong – but I highly doubt he is representative of doctors in Kenya.

    My problem is that I know the government can afford to give better health services. They choose not to. They choose to buy chairs for themselves worth 200’000 shillings and in the same breath say the country has no money for healthcare. Doctors are not just asking for a pay hike. They are demanding 12 other things to improve health care. But even on the one point where they do address pay, I fully support them!

    • Thank you very much for that.

      I like the point that the Mercedes guy is not a representative of Kenyan doctors…I am a doctor, who has had good exposure to private and public practice.

      I stand to be corrected, but there is no doctor doing their masters degree who lives that kind of flashy life!!!

      Another point, lets face the reality, we have heard of stories of patients being kicked out of private hospitals because insurance cover has been exhausted!!! Or the myriad of exclusions…..
      Wouldn’t we be happy to know that even if our loved ones needed ICU hospitalization for years that would not be a worry!!!

      Yes we pay tax, and we have to feel secure and cared about!!!

  6. Today I remember the NARC victory party at uncle Moody Aworis.After much merry and a good day, the waheshimiwas got unto the Cessna and unfortunately came tumbling as the run-away( Michuki says) was too short.And these honorables required urgent medical care. Their platinum covers could not help them. My friend Dr. Maingi in Busia had to attend to them, imagine him ask, Madam Hon Karua, ‘unaumwa n…a wapi mum? ‘Mgongo, kifua na tumbo’, answers the MP. ‘Nitakupa panadol juu Pethidine na Diclofenac ni O/S. Una relative akununulie crepe bandage na Floxapen coz ni O/S pia’? Then he turns to attend to the more injured Late minister ( God rest his soul), and leaves an intern CO to stitch my mheshimiwa with catgut no.2, nylon is unheard of. That is why doctors are saying things must change. No matter the size of your cover, your nearest facility must function. So, those of you assuming high moral ground must remember that once an MI catches with you, it is that guy in the rural area who will sought you out?

  7. I am a doctor working in the private sector and this, for ten years. As a rule, the free market argument collapses once the doctor and the patient meets at the Accident and Emergency unit of a private hospital. You have a sh5 million medical cover, but there is an exclusion here and there sneaked in by your insurance provider and which you overlooked as it is in medical jargon, so when you thought this is it, I have to give you a small referral note to a government hospital. Or you need an ICU bed, and all ICU units at Nairobi, Mater, Aga Khan and MP Shah are full so despite your excellent cover, the only ICU bed available is in KNH. So I politely explain to you that KNH it has to be. Or your medical cover runs out so we have to effect a transfer from your comfortable ward bed in Karen Hospital and you end up sharing a bed with someone at Mbagathi District Hospital. Or you are too poor and the credit control officer labels you as a credit risk, and advices we politely ask you to go and seek care elsewhere. Now, being a doctor is not definitive of what we are. Being human is. Honestly, can you look your fellow countrymen and women each day, tell them they have a serious illness and then proceed to give them a referral to a government hellhole. Humiliating fellow citizens by reminding them they are too poor to afford decent care, and you expect me to remain sober?

    • Yes Dr. Kago.

      I really feel your sentiments.

      The problem in our health care system is that capitalism has taken over due to the lack of the governments concerns.

      Most of these hospitals are cash generating organisations which do not even care about the quality of healthcare they provide.

      The insurance company on its end makes the best of the situation, crafts good documents, yes as you said, highlighting the exclusions as befits them.

      the patient on the other end feels that they are getting the best of health-care because when they go to these private institutions the presence of good care is hidden behind the unnecessary investigations, hospital admissions etc…..yes the hospital benefits!!!

      Now it becomes a triad a three groups who think the benefit from this setup!! The insurance company gets good profits!!! The hospital gets good profits!!! The patients thinks they get good care….the most unfortunate thing is that as you said when this patient needs an ICU bed…things turn around!!!
      Anyway GOD HELP US BUT THIS CAPITALISM MUST END!!!

      My suggestion would be let doctors also be entrepreneurial, lets join hands and open and run these facilities!!!

      • I like that Edwin. I could tell my story from KNH to the running out of my cover, but let’s reserve that for another day. Who will open and run these institutions? When you leave govt,will you resist the alure of riches in consulting?

    • Hi,Daktari,am carryingout a research on the issue u just mentioned.could u kindly assist mi to identify specific cases where this has happened.patients in emergency cases failed to received medical care due to lack of deposit,insurance,or any other commitment.0750 774 508

  8. O free market proponents! You are really going to be the death of me! I say this, of course, with utmost love, the sort of love Kamotho and Shariff Nassir used to profess for Baba over the microphone.

    Onward!

    I really appreciate hearing from the medical staff and those who know about the medical clusterfuck—allow my French—in the old country.

    @Edwin you are right that about the only way to make money (and we should unabashedly talk about money making here) is for doctors to get into cartels. We see it at private outfits: you see the gastro-entorologist who recommends the dentist right next door—I am exaggerating here. And, as you know, these cartels don’t treat the poor, which is what most public service doctors do. The free market almost always hikes up the price, leaving the poor out. There was a time in the old country when I had malaria (malaria!) and almost died because I couldn’t afford one of these private cartels and the line at district was too long. Imagine that.

    I think we should also drag the IMF and World Bank into this conversation: http://www.pambazuka.org/en/category/features/34800

    The article is a little dated, but it drives the point home. In a mercedes.

  9. simply put like @edwin said, doctors the world over get paid while doing masters. the job is the training!!!
    i cannot speak for Mercedes-driving doctors. i don’t know any who are not consultants. truth!
    and while we live in a free market, to apply that model to healthcare is too simplistic even in concept! there is a reason many countries cannot figure out medical schemes that work, also why the the best mediplans in the world are based in social democracies.
    and would someone please read the Petition!! we can’t keep dwelling on the pay thing. move on. doctors are not selfish pricks just out for blood and benzes!
    @kellie pole about having no one to sort you out after your horrific ordeal but in the end, wherever you ended up, you went to a doctor who is a by-product of the same system we are trying to amend. it should be better, whether doctors earn 1 million per procedure or 40 K per month, period. and the Kenyan who is not you and would have no where else to turn, deserves better.

    • Thanks so much for clearing stuff up, unlije on Twitter where I was accused of being bitter against doctors and their Mercedes. :-)

      Final question. From history,strikes don’t really lead to permanent change here in Kenya. Teachers have been at it since we were kids. Why don’t you all quit en masse and force the govt to hire you back on your terms?

    • Thanks so much for clearing stuff up, unlike on Twitter where I was accused of being bitter against doctors and their Mercedes. :-)

      Final question. From history,strikes don’t really lead to permanent change here in Kenya. Teachers have been at it since we were kids. Why don’t you all quit en masse and force the govt to hire you back on your terms?

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