History and data: Fact checker on President’s speech on doctors

My government wants you (doctors) to have the very best conditions, not just for you but your patients as well…

Posing as patients in May 2015, the Nation shadowed doctors in 11 Level Four and Five hospitals in Kenya.

The cloying scent of disease hang around the 63-bed Bondo Level Four Hospital in Siaya County that served more than 200 patients a day and only had two “active” doctors then.

The two alternated between being in the hospital for a week and conducting post-mortems and being an expert witness in courts. From as early as 6.30am, about 34 patients had been the outpatient area. At around 7.30am, Dr Ahero came into her office, which has some broken-down furniture.

She headed to the maternity ward, where four women shared a bed with their legs dangling. She then went to the four general wards on her rounds, passing by the outpatient-cum-casualty area, where patients lay on the dirty concrete floor.

Data pinned on the wall showed Dr Ahero’s expertise was needed by 41,215 people as at 2013. Then, the hospital did not have a surgeon. 

In the likely event that there is an emergency at night, Dr Ahero will be called.

At 4pm, Dr Ahero  remarks lethargically in Dholuo that she is hungry. She asks a support staff to buy her a soda and a doughnut from across the road.

A similar script played out in Mombasa, Nyeri, Embu, Kisumu, Homa Bay and Meru.

While progress has been made, the 1:4,546 doctor-to-patient ratio is far from the World Health Organisation-recommended 1:600. Local public doctors take the work of eight in the US or Cuba, where the threshold has been achieved.

Coupled with ill-equipped facilities — like deciding which of the three critically ill patients gets put on the one oxygen, as in the case of Alex Madaga — cases of burnout and drug abuse among junior medical staff, as reported at the 2016 Kenya Medical Association annual conference in Kisumu, are not farfetched stories.

One of the challenges we have had is the persistent doctors’ strike…

Kenya has had five national doctor strikes since independence: In 1971, 1981 and in 1994, for three months, with the deadliest in 2013, soon after devolution, and the current one that began last December 5.

Doctors’ strikes, as medical anthropologists and historians have recorded, are traumatic in the developing world, where chronic shortage of doctors are still far from optimum. In all cases, the motives were mixed and oscillated from a desire to change the health system to a need for better pay.

At the beginning of all national strikes, they had immense public support. After the second month the backing waned amid adjectives such as “rude”, “proud”, “egotistic” and “unrealistic” in the public discourse.

The June-September 1994 strike yielded nothing more than 600 of the 1,200 public doctors emigrating abroad.

You must remember that we still remain a developing country with a long way to go…. They are better off, they still have care while poorer Kenyans must do without....

Indeed, a comparative analysis of Kenyan doctors’ salaries, at $1,400 (Sh140,000), shows they earn much more than most in countries at the same level economically —  Zimbabwe ($400$), Malawi ($610), Liberia ($1,200), Uganda ($2,014) and South Africa ($7,282).

Memoirs of doctors — as physician Hilary Ojiambo noted in 1992 — show these interruptions in health provision were a result of progressive alienation of doctors and other professionals.

Interestingly, Hansard records of Parliamentary debates show that the 1981 strike was triggered by the government’s attempt at barring its doctors from running private clinics. But health experts say the ongoing strike has not hit Kenyans so hard thanks to the private facilities.

The doctors’ union officials, most notable the KMPDU secretary-general, Dr Ouma Oluga, accused the private sector of interfering with the talks so as to benefit from the strike. But head of Kenya Healthcare Federation Amit Thakker said that could not have been farther from the truth.

We are paying these people and we have offered these people more money than even doctors in the private sector…

Dr Timothy Wala, a consultant kidney specialist and in private practice, told the Nation of the intrigues of working in private and government facilities.

Private facilities, he said, peg doctors’ salaries slightly more than the government’s. Eventually, public doctors end up earning more because they are allowed to work in other hospitals, unlike their peers.

British expert in African history John Iliffe writes in his book East African Doctors: A History of the Modern Profession (African Studies) that the Ministry of Health has always controlled the placement of doctors, sometimes posting them far to “promote national cohesion and ensure fair distribution of medics across the country”.

Wishing to stay close to their families or unable to cope with the strain of their work station, most resign to work in private hospitals or set up clinics.

This, President Kenyatta termed as hypocrisy.