Health workers have made good on their threat to boycott work to push the government to implement a collective bargaining agreement (CBA) they signed in June 2013.
This is after the 21-day strike notice they issued on November 14 expired on Monday.
Dr Fredrick Oluga, the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) secretary-general, on Monday told NTV that union members were keeping off hospitals because the government had dishonoured the CBA for three years.
He and other KMPDU officials officially launched the nationwide strike at the Public Service Club in Nairobi.
Wearing lab coats, masks and theatre caps, the medics arrived armed with empty sacks that they said they hoped would be filled with their arrears like those of Josephine Kabura, who reportedly carried National Youth Service loot in bags.
"Tunataka tulipwe kama tender (we want to to be paid like tender (people))," they chanted, ridiculing the record time some tenderpreneurs implicated in mega graft, including the NYS scam, were paid.
"We have nothing else to lose, nothing will come between us and the CBA," Dr Oluga, who has accused the government of losing billions to corruption and failing the agreement, told members.
Their strike is in defiance of a temporary order issued by the Employment and Labour Relations Court on Friday stopping industrial action, and calls by Health CS Cleopa Mailu and the Council of Governors to work as talks continue.
1: 16,000 RATIO
The medics are pushing for a review of job groups, promotions, deployment and transfer of medical officers, as well as remuneration, according to the inked CBA.
In particular, the document addresses understaffing, with the ministry asked to hire at least 1,200 doctors yearly over the next four years to reduce the doctor-patient ratio.
There is one doctor for at least 16,000 Kenyans.
Coast region union deputy chairman Gitau Kagona urged members not to report to work, accusing counties and the Health ministry of failing to show commitment to improving the working conditions of health staff.
Dr Kagona said KMPDU has been pushing stakeholders, including the Salaries and Remuneration Commission, to implement the CBA but their efforts have failed to bear fruit.
“We cannot continue to work in an environment which does not support growth of staff. We will support this strike because we want to demand our rights and we will not relent until we are heard,” Dr Kagona said.
He said the poor patient-doctor ratio was a big issue affecting most public health facilities in Kenya.
“We have a big shortage of doctors yet our counties are sending doctors away, saying they cannot hire more doctors. We cannot have good service delivery in hospitals because of this challenge,” he added.
The strike by the nearly 5,000 doctors, nurses, pharmacists, dentists and interns in those groups is likely to affect services at over 2,700 public health facilities — including Kenyatta National Hospital and Moi Teaching and Referral Hospital in Eldoret, where most Kenyans seek emergency medical care.
Also on strike are consultant and specialist medics, medical superintendents, county directors of health, doctor administrators and sub-county medical officers, meaning a total shutdown of public-health services is looming if nothing is done to end the job boycott.
A spot check by Nation.co.ke on Monday revealed that public hospitals were slowly catching the paralysis bug.
In the North Rift, for instance, doctors at Moi Teaching and Referral Hospital began their job boycott at 10am, affecting services at one of the largest hospitals in western Kenya.
At Kisumu County Hospital, women in labour cried for help in vain as striking nurses refused to attend to them.
One nurse was heard telling a woman to go to Jack Ranguma, the Kisumu governor, apparently to express her frustration with the county government's failure to address their demands.
Patients were desperate at Kakamega County Hospital after they were asked to leave at the start of the industrial action.
No doctor or nurse reported to work and by 8.30am most wards were deserted as patients were collected by relatives to seek treatment at private facilities.
A patient was reported to have committed suicide in a toilet next to Ward One, but Nation.co.ke could not independently verify whether the death was linked to the strike.
The man's wife, Merceline Konga, said her husband had complained that his condition was getting worse and he could succumb to his illness if taken home.
County executive for health Peninah Mukabane and Health Chief Officer Brendah Makokha visited the hospital to assess the situation.
At Kenyatta National Hospital in Nairobi, nurses and doctors had not reported to work by 10am.
The hospital's management was holed up in a crisis meeting.
Meanwhile, most wards at Samburu County and Referral Hospital in Maralal were empty hours before the health worker’s strike kicked off on Sunday midnight.
Relatives were transferring their patients to Wamba Mission Hospital, a private facility in Samburu East.
Among those caught up in the standoff between the government and the health workers was Lokupuny Lobolia, who was nursing gunshot wounds after he was attacked by bandits in Natiti Village, Baragoi.
“Lobolia was ambushed while grazing the family's livestock in a nearby forest next to Baragoi Polytechnic by the bandits mid last month,” his cousin Benedict Lokidong'oi told Nation.co.ke.
He said the family had no other option but to transfer the patient though they did not have any money to pay for services at the Catholic-Church-owned facility on admission.
Expectant mothers awaiting caesarean-section deliveries and children in incubators, among other patients, had been transferred to other private facilities in Nyahururu, some 130 kilometers away.
Journalists were on Sunday evening barred by hospital administrators from taking pictures of the private ambulances picking up patients at the government facility.
Doctors from the Coast region are expected to join their colleagues in Nairobi as nurses converge on Coast General Provincial Hospital for instructions from their union officials to join the strike.
In Kisii, no nurse or doctor could be seen at Kisii Referral Hospital and patients had been left to their own devices.
Doctors kept off Thika Level Five Hospital in Kiambu and patients were being served by the nursing officers.
Services were also paralysed at Makueni County Referral Hospital in Wote Town after doctors and nurses sailed to report on duty.
Patients remained abandoned as the hospital administrators held a crisis meeting.
In Tharaka-Nithi, relatives of patients at Chuka County Referral Hospital were seen collecting their kin and taking them to private hospitals and homes.
Patients seeking outpatient services were also stranded after finding hospital doors closed.
"I was surprised to find that there were no doctors or nurses just two weeks after they resumed [work] from a three-week strike," said Judy Muthoni, a patient at Chuka County Referral Hospital
James Njeru said there was no doctor or nurse to give him his kin's medical record so that he could take her to a private hospital.
The hospital medical superintendent, Dr Elijah Kameti, was not at the hospital and could not be reached by phone for a comment.
Tharaka-Nithi County Health Executive Magdalene Njeru said she had directed clinical officers to remain in the hospitals because they are not members of doctors' or nurses' unions.
"Clinical officers will handle [a] few cases and refer the rest to private hospitals," said Ms Njeru.
She added that she had called the private hospitals in the county and asked the management to accept those being referred there.
However, a Nation.co.ke spot check established that even the clinical officers had not reported to duty.
In Taita-Taveta, nurses have announced that they will join doctors in the strike.
Boniface Mrashui, the Kenya National Union of Nurses branch secretary-general, told Nation.co.ke that the county's 300 nurses would down their tools.
The nurses accuse the county government of failing to address their grievances.
Mr Mrashui spoke even as county health services executive Gifton Mkaya held onto the hope that the doctors and nurses would agree to negotiations and abandon the strike.
"We have alerted hospital managers to be on the lookout Monday morning," said Mr Mkaya.
Among the issues raised were pending payment of locum, escort and overtime allowances and promotion of nurses.
“None of these issues have been tackled. The agreement was that they were to be resolved before December and failure to honour the agreement had consequences,” he said.
He said the union had given the John-Mruttu leadership enough time to address the issues raised but nothing was forthcoming.
“The county government has proved they cannot honour their promises. We cannot work efficiently because of many challenges facing us at work,” he said.
Moi Hospital in Voi, the largest health referral hospital in the county, has 60 nurses and faces a shortage of 140 patient care-givers
Mr Maya said the county government was set to hold a meeting on the strike.
“We plan to hold a departmental meeting this morning to see how we will be able to manage the situation if the doctors and nurses fail to listen to our request to suspend the strike,” he said.
In Malindi, desperate patients lined at the emergency wing of Malindi Sub-County Hospital for the better part of Monday morning as doctors converged for a meeting at the new laboratory hall.
Kenga Ngombo, 55, said he was told to wait until the meeting was over to know the fate of his 13-year-old son admitted to the facility with a broken limb.
"I travelled from Tana Delta with my son to seek treatment but no doctor has attended to him since 7am when I arrived here," he added.
By 9am, hundreds of patients seeking treatment had returned to their homes after doctors failed to attend to them.
Public hospitals in Nakuru and Nyandarua counties remained deserted too.
Patients seeking treatment continued being turned away by security guards as there was nobody to attend to them.
At Nakuru Level Five Hospital, which serves as a referral hospital for Nyandarua, Narok, Samburu, Laikipia, Baringo and Kericho counties, a few patients admitted to the facility earlier were being "discharged" by their relatives and transferred to private hospitals.
All other wards, including the maternity section, were empty except for ward 10, which admits patients with fractures, and Ward 8, which admits psychiatric patients.
Ward 10 had a few unattended patients, who appeared to be in pain.
The psychiatric ward also had unattended patients, most of whom were asleep.
Other areas, including the casualty section, remained deserted.
A source at the hospital said patients who were scheduled to undergo surgery had been advised to seek help in private facilities.
“There are no nurses or doctors around and we are only here to help those visiting the facility to transfer their loved ones to private hospitals,” said a security guard who sought anonymity.
John Kamau said he was planning to transfer his father, who is suffering from a fractured leg, to a private hospital.
“It is very costly to seek such services from a private hospital but he is in pain and we can’t take him back home,” said Mr Kamau.
At Langa Langa Health Centre in Nakuru town, only nurses working under the Aphia Plus programme were attending to patients, mainly women and children.
Nurses and clinical officers kept off the facility.
The situation was the same at JM Memorial Hospital in Ol Kalou where the few patients who had turned up were left on their own.
Medics have defended the strike, blaming the government for ignoring their demands and the signed CBA.
Dr Oluga on Sunday said doctors would not resume work until the government meets their demands.
“We are fighting for wananchi because the agreement will see the number of doctors increase and that they are better trained,” said Dr Oluga. “We have been lenient with our demands.”
Reported by Charles Lwanga, Magdalene Wanja, David Macharia, Reitz Mureithi,Harry Misiko, Angela Oketch, Elizabeth Mehrab, Eunice Kilonzo, Alex Njeru, Godfrey Oundoh, Wycliffe Kipsang, Pius Maundu, Lucy Mkanyika, Gerald Bwisa, Mary Wambui, Nyaboga Kiage, Benson Amadala and Njeri Rugene.