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How Cuban experiment changed Kenya’s healthcare


When Cuban doctors leave...

Although non-local medics are filling a critical gap in the system, the specialist shortage remains unaddressed. What next when they leave?

BY DAILY NATION TEAM

They are referred to as the “army of white coats”, they are Cuba’s most lucrative export with 55,000 Cuban doctors working across 67 countries, including Kenya.

When Kenya imported them, the Cuban doctors were expected to change the face of healthcare in the country given the shortage of specialists.

And so they were afforded the comfort they needed to work in the country, and the State and the county government signed a memorandum of understanding.

From the memorandum, the government and the counties agreed they would offer the Cubans furnished homes, airfares for holidays, pay utilities and transport on top of their salaries.

The 100 Cuban doctors, to work for two years in the country, are provided with accommodation, furniture, kitchen appliances and utensils and their utilities like electricity, water and gas are paid for.

Much to the dismay of local doctors, counties also cater to their local transport expenses while the government pays their airfare to and from Cuba when serving their 30-day annual leave.

The preferential treatment may seem much, but outgoing Health Cabinet Secretary Sicily Kariuki says they are worth every penny and they have changed how Kenyans access healthcare.

“They have performed 200,000 procedures and more than 600,000 Kenyans have been attended to by these doctors. They have settled in well, with some speaking the local dialects,” she says.

LOCAL LANGUAGE

And, indeed, the patients’ side of the story seems to confirm the impact of the specialists.

In Homa Bay County, for instance, Dr Juan Ramos, an orthopaedic, was dispatched to the referral hospital and is credited with transforming how accident victims are treated at the facility

In the past, the health facilities referred accident cases with fractured bones to Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu or Moi Teaching and Referral Hospital in Eldoret. However, that has changed since Dr Ramos was dispatched to the hospital.“ We used to waste a lot of time, risking the lives of patients. We never had specialists who attended to patients who fractured their bones,” says the hospital CEO Dr Lilian Kocholla.

Mr Dan Onyango, a rider who recently got his third bone fracture, said the care he got from the hospital was different from the past. “In the past, doctors at the hospital referred me to Kisumu. I am happy I was attended to here in Homa Bay this time round,” he says.

The Cubans have also made a great effort in settling in and have even learnt local languages to connect with their patients as in the case of Homa Bay.

At Chuka County Referral Hospital in Tharaka-Nithi, patients are grateful for a Cuban anaesthesiologist deployed there. The anaesthesiologist has been of great help at the renal unit because the facility didn’t have a specialist despite receiving dialysis equipment from the national government through Managed Equipment Services programme.

Nakuru residents praised the Cubans at the county’s level five hospital for their efficiency. The hospital has two Cuban doctors: a family physician and a cardiologist.

Jessica Nyawira says she was almost losing hope when she started her therapy at the hospital, but the Cuban cardiologist, Dr Yanelys Soto, was of great help. “I needed to undergo surgery at Kenyatta National hospital, but I couldn’t go due to financial issues. My family was losing it, but Dr Soto came in handy,” she recalls.

In Siaya, two Cuban doctors- radiologist Jorgeluis Zamora and family physician Yaquelin Matamaro were posted to assist in medical care provision. Dr Matamaro’s ability to quickly learn Kiswahili, which she now speaks fluently, has endeared her to her patients.

The Cuban doctor notes down her patients’ contacts and personally tracks them to monitor their progress, a method residents find of great use.

At Nyamira referral hospital, two Cuban doctors, Dr Edy Suco (cardiologist) and Dr Yunia Ricardo (family physician) have plenty of work to do at their clinics because of the huge number of patients in need of specialists.

In Kakamega, there are two Cuban doctors working at the hospital, one of them serving as a specialist in the ICU while his colleague is a family physician. Patients say they are interacting well with the doctors.

RELEASE DOCTORS

The stories paint a picture of a health system in dire need of specialists. However, stakeholders have poked holes in the Kenya-Cuba deal. Concerns have been raised about the country’s inability to train its own specialists as well as the cost implications of the deal for Kenya.

According to the 2019 Kenya Medical Practitioners and Dentists Council report, there are 7,974 doctors and 838 dentists in active practice in the country today. Of the total, 2,560 are specialists and the number is far less than what the country requires.

Kenya’s doctor to population ratio is nowhere near the 1:1,000 recommended by the World Health Organisation. The Health ministry, however, argues the 47 specialists and 53 family physicians will make all the difference in the world.

Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) deputy secretary-general Chibanzi Mwachonda, however, sees no reason Kenya had to import the medics given that 450 local doctors are unemployed.

He takes issue with county governments for failing to release doctors who want to advance their studies, with only 23 out of the 165 who applied for postgraduate studies during last September’s intake being allowed to do so by their employers. “They do not want to release doctors for postgraduate training despite a worrying shortage of specialists. The ministry was to take up the salaries of the 1,153 doctors and enable devolved governments to hire medical officers as others undertake postgraduate training, but failed to do so,” says Dr Mwachonda.

The country still has far less than the requirement and the additional 47 Cuban specialists are not enough, he adds. “We need to train more Kenyan doctors. In the next year, the Cubans will go, so who will fill those gaps?” he asks.

LOW MORALE

Since the Cubans’ arrival, morale among local doctors has dipped, an observation he blames on “the preferential treatment” the non-locals get. “You have someone doing the same job yet earning way more than you and getting all these perks. Some doctors were kicked out of their houses to make room for the Cubans. Basically, what we negotiated in our collective bargaining agreement was handed to them instead,” he said.

The ministry has done everything in its power to ensure the Cuban doctors are comfortable and in August last year when they seemed like they were not fully acclimatised, Health Principal Secretary Susan Mochache sent a memo stating that Kenyan doctors should be paired with a Cuban. “To realise full benefits of programme, it is important to ensure they are paired with Kenyan doctors for mentorship,” she said.

This was not well received among Kenyan medics, with the Kenya Medical Association Secretary-General, Dr Simon Kigondu, saying this was evidence of failed outcomes of implementing deals without involving the local doctors.

Dr Jedidah Kiprop, the medical superintendent at Burnt Forest sub-county hospital, says while the Cubans have been helpful, a home-grown solution would address the specialist shortage once and for all.

The two Cuban doctors posted to Ziwa and Burnt Forest sub-county hospitals are husband and wife. “Some Cubans have been helping, others not so much. But, looking at their pay package, four or more local doctors could have been employed and trained to speciality level. Why not train our own, attract and retain them?” she asks.

The ministry has been cagey about how much they pay the Cubans, with the outgoing CS saying the deal puts the medics in Job Group S. In the CBA signed between the doctors’ union and the government in 2018, a medic in Job Group S is on the top of the tier and is by far one of the highest earners in the medical field.

The qualification of Cuban medics has also been put to question. The doctors’ union says the medical council did not do a peer review in the country, but Cuba instead. Through peer review, doctors evaluate the quality of their colleagues’ work to ensure prevailing standards of care are being met.

It emerged that the general comprehensive medicine programme offered in Cuba falls short of the family medicine programme in Kenya. The two-year course in Cuba does not offer surgical disciplines, therefore, fails to match with Kenyan set standards.

Dr Mwachonda says the lack of transparency is most likely why the council revoked the licence of Dr Ricardo Sanchez for absconding duty in Turkana County.

MEDICS ABDUCTED

The idea behind importing the Cuban medics was to get specialists and doctors to work in hardship areas such Mandera and Turkana, but that has changed with the kidnapping of two of the specialists, stationed in Mandera, by suspected Al-Shabaab terrorists.

Following the kidnapping, the ministry deployed Cuban doctors from five counties to Kenyatta National Hospital, National Spinal Injury Hospital, Mathare Mental Hospital and Kiambu hospitals.

The 10, who were stationed in Isiolo, Tana River, Garissa, Lamu and Wajir, were recalled due to insecurity.

In Tana River, the departure of the doctors has forced hospitals like Hola Referral Hospital to refer patients in dire need of critical surgeries and services of a physician. The county government has, however, realised the importance of having their own specialists. They have since given four medical officers leave to pursue further studies in efforts to replace the Cuban doctors.

Following the redeployment of the Cuban doctors in Wajir, a radiologist and a family doctor, the county also employed two consultants to take over their jobs after they left.

This move by the counties to employ local doctors and even allow them the time off work to advance in their studies is what the country needs, says Dr Mwachonda. “The secret is we need a health service commission. The commission, which would mirror the teacher’s commission, can ensure that doctors are not only employed, but are also deployed to every corner of the country,” he says.

Reported by Nasibo Kabale, George Odiwuor, Ruth Mbula, Benson Amadala, Dickens Wasonga, Stephen Oduor, Phyllis Musasia, Ian Byron, Edith Chepngeno, David Muchui, Waweru Wairimu, Alex Njeru, Bruhan Makong, Ndung’u Gachane and Irene Mugo