Health sector's crisis deepens as doctors reject 40 per cent pay rise

On a normal day, the Emergency and Accidents Unit at the Kenyatta National Hospital (KNH), Nairobi, is a depressing place to be for an ordinary person, as it handles cases of people clinging to their dear lives after road crashes.

On Friday afternoon, however, the department was unusually quiet, thanks to the ongoing doctors’ strike. The 9,734 registered doctors and 1,149 dentists – according to Health Management Information System – working in Kenya’s 10,062 hospitals have been on strike for about a month.

Industrial actions are a rare occurrence in the medical field. Kenya has only had three: A six-month strike in 1994, a week-long one in 2013 immediately after devolution, and now this one, which enters its 32nd day on Saturday.

As of Friday, more than 10 hours of long meetings that had been held to solve the impasse had come to naught. The medics rejected the allowances that President Uhuru Kenyatta offered them, one that would have increased the pay of the least paid doctor at entry level from Sh140,244 to Sh196,989.

Stories about the impact of this strike have been swirling around, some a bit exaggerated. However, that of Ms Anne Kabuchi, a cancer patient, is as real as the strike itself. Her chemotherapy at KNH was interrupted, and she had the option of seeking treatment from private facilities where cost implications would have to make that decision for her.

An oncologist told her that skipping two or three sessions might have resulted in the cancer bouncing back in her body with fury.

Many Kenyans who could otherwise have been saved have died during the strike as there were no doctors to attend them.

A senior consultant at the KNH’s new- born unit, said that although he had not reported to work since the strike began on December 5, last year, he knew that babies need round-the-clock monitoring on administration of antibiotics or taking care of situations like apnea, where a baby ‘forgets to breathe’ and has to be resuscitated. They also have to be kept hydrated. This has not been happening since the strike started.

Prof Lukoye Atwoli, the secretary-general of the oldest medical group, Kenya Medical Association, warned that beyond the deaths, there could be “irreversible damages to a person’s health when there were no medics to attend to patients”.

BLESSED CURSE

Senior medical consultants consider this strike a blessed curse; it has brought to the fore the ills that have plagued the health-care system in Kenya so that they can be addressed but the halt is about to interfere with other services such as medical training and surveillance of diseases that rely on functional public hospitals.

Referring to the document at the centre of this disagreement—the Collective Bargaining Agreement – Dr Elly Nyaim-Opot, a surgeon and lecturer, told Nation that the monies are the least of the concerns of medics.

“The CBA would have been a template of the many issues that have thwarted quality health care provision in Kenya”.

Indeed, the document signed on 27 June 2013 calls for adjustments in the public health system from human resources to infrastructure.

The doctors would like entry level for interns to be raised from L to M and then progress to N immediately they graduate, a request that they may have been granted already.

The doctors demanded that they should not be transferred more than once in two years unless in special circumstances such as upon request. They also wanted to work 40 hours a week and be compensated for extra hours.

Last year, the Nation’s audit of public health in 23 hospitals revealed that doctors were overworked and burnt out. In Bondo Level Four Hospital, Dr Joanne Ahero attended to more than 200 patients in a hospital with a catchment of over 130,000 people, barely getting a minute to eat or take water.

That can be explained: If calculated against the population, one doctor attends to over 4,500 patients in a public hospital, assuming that all of those who are registered practise. The World Health Organisation recommends one doctor to 600 patients.

This means that one Kenyan doctor does eight times the work of a counterpart in countries such as Cuba that have met the WHO threshold.
Then there is the issue of money.

As of January 2013, the lowest level of medic (Group L) earned a minimum of Sh127,910 and a maximum of Sh149,880 with leave included. The CBA now asks for a minimum of Sh327,730 and a maximum of Sh342, 770.

HUMAN SUFFERING

While the highest paid group, T, earned a minimum of Sh328,060 to Sh538,980 and now they want a minimum of Sh852, 000 and a maximum of Sh946,000.

Economist David Ndii said that the issue cannot be discussed in monetary terms.

“The idea that human suffering can be quantified is repulsive. We can’t quantify human life. I think it is evil and immoral. You can’t put a number on human suffering,” he said in a phone interview before swiftly getting to the crux of the matter.

In a precious interview, Dr Ndii refused to compare the fat salaries of members of County Assemblies, who are sometimes high school graduates earning more than doctors who work as long as 16-hour shifts.

He said that the government needs to make medicine as attractive in terms of remuneration just as being an MCA is. Unlike the other strikes, this time consultants have joined in, worsening the suffering of patients.

Prof Tom Kwasa, a neurosurgeon who has practised medicine for more than 40 years, said that he feared that the training of medical students will be hampered.

There are about 3,493 doctors and 320 dentists in training who rely on public hospitals for practical studies who do not have patients and graduate doctors to supervise them.

Dr Ndii warned of an exodus of medical practitioners to countries that offer more favourable terms.

“I wouldn’t be surprised if the doctors seek work abroad, like they did in 1994, when left the country to go work in Botswana.”

or Ghana or South Africa. The fact that they have been ignored by the government for over a month is testament to how demoralizing this are for the doctors.”

The economist said the right to health care comes early in the constitution, “almost after the right to life.” According to the constitution, the government has the mandate to provide emergency medical service to every citizen.

For those Kenyans who have lost their lives due crisis, their Right to Life as enshrined in Chapter 4 of the constitution- The Bill of Rights was violated.

Analysts say that on top of the reported numbers, which are already very high, many more unreported deaths have been witnessed across the country. Infants have probably been affected the most, together with individuals with conditions that require specialized handling like those who need dialysis.

Any average Kenyan who in the past one month required to be admitted to an Intensive Care Unit (ICU) is probably dead right now.

In many private hospitals you can’t get admitted into any private facility’s ICU without depositing Sh300, 000. Even at KNH, the ICU costs are usually high, but not to those levels.

The alternatives for Kenyans during this have been to self-medicate; pharmacists\ chemists in low level estates and slums and villages have dispensed more drugs than they do during normal times.

A staggering number of patients sought treatment at mission hospitals which are not as expensive as private hospitals. In fact, most mission hospitals have been struggling to keep up with the large number of patients that they’ve had to handle.

A phone call to Mathare Mental hospital was received by a grim sounding lady on duty who categorically stated that they do not accept any new patients.