What ails you?

Dr Nancy Okinda is one of less than 10 haematologists in the country. She says that Kenya sorely needs more doctors like her; if studying medicine, perharps this is an area you could consider
When most people hear the word “pathologist” the first definition that probably comes to mind is a medical doctor who conducts post-mortems. Pathology, however, encompasses so much more than that; in a nutshell, it is a medical study of the causes and effects of diseases for diagnostics or forensics.

Dr Nancy Okinda is a haematologist, a specialist in the area of diagnosis and treatment of blood disorders. She is one of less than 10 haematologists in Kenya. Haematology is a speciality area in pathology. Interestingly, Nancy wanted to become an engineer, not a doctor. But her mother was intent on her becoming one.

“She accompanied me to the University of Nairobi and ensured that I changed my course option from engineering to medicine,” she recalls.

Her first two years of study were a struggle.

“I had been forced to study a course I didn’t enjoy, and so I had a difficult time with my studies,” she explains.

In her third year of study, she was introduced to pathology. And promptly “fell in love with medicine”.

On graduation in 2004, she served her mandatory one year residency at the Kenyatta National Hospital, after which she was posted to Pumwani Maternity Hospital. She did not find her daily work routine of delivering babies as intriguing as haematology, and so after six months, she resigned from the hospital and moved to the private sector.

In mid-2005, she moved to Gertrude’s Children’s Hospital, and a year later, to the Aga Khan University Hospital. At that point, her yearning to specialise in haematology was unrelenting. She began to consider travelling abroad for further studies.

In 2006, an opportunity arose. The Aga Khan University Hospital launched its medical school and introduced two master’s degree programmes in pathology; clinical and anatomic pathology. Nancy quickly signed up for the former, and spent the next four years studying microbiology, chemistry and haematology.

On graduation in 2010, with a Masters in Clinical Pathology, she decided to pursue haematology in depth, joining the University of Cape town, South Africa, in 2011, where she worked at the Groote Schuur Hospital and received certification in her area of interest; haematology. Besides being a practising haematologist, she is also the Programs Director, Department of Pathology, in the faculty of Health Sciences at the Aga Khan University Medical College in Nairobi.

What does it take to be a pathologist?

You need to finish medical school and one year of internship first. After that, join a respected and certified university that offers a master’s degree in Pathology.

Other than the medical skills, what other skills should one have to become an effective pathologist?

Pathology is hard work. For example in anatomical pathology, you will be looking down the microscope all day, every day, for the rest of your life. You need to read a lot and be extremely diligent. You also need to manage time well to ensure you release test results on time. You also need to be a good leader because you may teach and guide lab technicians and other medical graduates interested in the field.

Why does any society need a pathologist?

Pathologists help with diagnosis. We understand the basis of the disease and inform the clinician what the patient is actually suffering from. For example, an anatomical pathologist will look at body tissue to diagnose the cause of your ailment. The autopsies that a forensic pathologist conducts help to improve management and care of patients from the facts that they find during the post-mortem of a patient.

This information provides guidance on how to treat and manage similar diseases found in living patients to avoid unnecessary loss of life. Without a diagnosis, clinicians can’t treat anyone.

A 2013 report noted there are less than 80 certified pathologists in Kenya with even fewer than 10 forensic pathologists in Kenya. Has that number increased since?

We are less than 10 haematologists in Kenya. Unfortunately, all are based in Nairobi, which is a cause of concern. General pathologists are almost nearing 100, which is still a small number. This means that patients in other counties have to travel all the way to Nairobi because there are no pathologists to diagnose their condition in county hospitals.

To serve Kenyans well, what would be the ideal number of pathologists?

Each county hospital requires at least two pathologists; one clinical and one anatomical pathologist.

What areas need improvement in teaching medicine in Kenya?

Some institutions don’t have all the specialists required to train medicine well. Institutions shouldn’t run medical programmes if they don’t have the trained specialists to instruct the courses. These institutions should be shut down.

What is the average income range of pathologists in Kenya?

In Government, under the new doctors collective bargaining agreement (CBA), a pathologist may earn a gross salary of Sh400,000. In the private sector, it depends on your experience and seniority. Income range between Sh400,000 to Sh1.5 million.

What is your advice to those interested in studying medicine?

Don’t study medicine because it seems glamorous, or because of the money you’re likely to make. You need to be passionate about it. It is that passion that keeps you going when you face challenges. It truly is a calling.

For you to practice good medicine, you need to focus on optimal care for your patient.