DOCTORS MUST STAND UP FOR HEALTHCARE IN KENYA

[hannali]

DOCTORS MUST STAND UP FOR HEALTHCARE IN KENYA

It takes a lot of bravery, courage and strength to even attempt to become a doctor, Doctors are perceived and regarded as highly knowledgeable on issues pertaining to health. It is therefore odd to observe that many doctors are ignorant about their rights and wellbeing, hence we are perishing in silence with passion. The Health system in Kenya-Both Public and private is imperfect, We need serious resuscitation and rehabilitation of this mockery called healthcare in Kenya. The private sector may wish to behave like a holy cow or an island, how can it sustain itself without the public sector? Where will it dump patients whose medical insurance and fortunes it has milked dry? The accessibility, availability and more importantly affordability is beyond the reach of many doctors let alone Kenyans.
It requires a mega dose of prophylactic antidepressants for any human being to talk about healthcare in Kenya when doctors, other health professionals and patients have lost hope in their hospitals – spelling a serious crisis.
Many poor people would rather die prematurely with dignity rather than risking their lives in our hopeless hospitals.
The medical profession which I dare call the core of the entire healthcare system faces serious challenges
• Doctors are called essential service providers without essential treatment
• Doctors are overworked and seriously underpaid
• We are expected to save lives while killing the doctors
• Working under inhumane conditions
• Incompetent management
• Leaders who care less about the dying poor and their doctors but care a lot for political power and tenders (read - Kenya medical association (KMA))
• Contractors who make money doing shoddy work while putting peoples lives at risk
• Worst of all-Being denied the very basic equipments and life saving medication to respond to out noble calling to take care of the sick

A case to point is the Minister of Medical services boasting to the nation of accessing the best cancer treatment facilities in the United States while pitying the average Kenyan has to wait eight months to access any treatment at the single public cancer treatment centre in Kenya.
The plethora of challenges has pushed many doctors completely out of the medical profession begging the question if this was a missed call or a wrong number.
It is common practice-actually a fundamental prerequisite to enter the medical profession with an exit plan. Many dedicated doctors have given up and some have warned us that we will suffer the same fate. This phenomenon is known as “professional apoptosis” – self inflicted septic wounds that haunt the medical profession. The government has succeeded in dividing and ruling us. We are few in numbers yet we fragment ourselves even further-there is nothing wrong with diversity though but we ought to have a common goal and purpose.

Our selfishness and political ignorance tear us apart. We end up fighting against ourselves instead of facing our common challenges. We dismally fail to run smoothly even small things like departmental units. We constantly fight for supremacy among our disciplines.

We perpetually fight political battles with the government using poorly thought out medical, legal and scientific approaches and tactics that yield no positive outcomes at a huge financial cost and big failure while the supposedly dim witted politicians make a mockery of us and torment us with glee while we propel ourselves to commit embarrassing deeds and mistakes.

Time has come for us doctors to live up to expectations. It is said you can’t give something you don’t have. How can we give good health intervention to the nation when we ourselves don’t enjoy good healthcare?

We need to first unite in our diversity. It is only the medical profession that tears itself apart-teachers and other professionals do better. This has to stop!
We need to peak with one voice, move with one step and punch above our weight with our combined power. Unity is indeed power, If we are unified, nothing can defeat us be it our negotiating and bargaining power for better pay, better facilities, better working conditions, not even the lawyers who prey on us or the burden of disease that face us can triumph against us if we are united.
We will take back our medical profession if we are united
• First we must form our own medical union and leave the one that was led by selfish self servers
• Second we move out of our unfavorable bargaining chambers and negotiate our own salaries
• Third we explore health economics, why should doctors remain money making machines for others? We don’t even own the hospitals, medical waste management companies, drug manufacturing and distributing companies and many other business opportunities in health

The first step however is going to be the toughest: Building a united and powerful organization championing our interests without a compromise or failure
We should also bring back the professionalism that made us the envy of the world: punctuality, honesty, hard work, positive attitude, good work ethics, caring, excellent research acumen, constant reading, learning and teaching.

It doesn't make any difference to me which side of the government is sticking a gun in my face and taking the money out of my pocket then raping me, Doctors must take a lean, mean, vicious and ruthless attitude in combating a system that is riding on our backs and taking us for granted.

Revolution begins at an individual level, let us build unity in our wards, then take it to the departmental level, the hospital, district, region, province and national level

[hannali]

A piece by a young doctor Wahura Kanyoro


Why I am UNASHAMED to be supporting the doctors' strike.
by Wahura Kanyoro on Monday, December 5, 2011 at 2:55pm
You will forgive me if I skip between points and use caustic language because of how angry I am at the government.

To Those Against The Strike

Even if doctors were in hospital, the typical public hospital experience would be as if they're not in anyway because of how bad the system is. (And I'm not talking about Kenyatta. Bad as it is, it's on the far better end of the spectrum.)
If you came in sick, gloves would be missing so it would be about 15 minutes before anyone comes to attend to you to examine you. There wouldn't be enough IV catheters so it would be another 5 or 10 minutes before someone runs around the hospital to find one. You'd also probably need fluids, which would be another 20 minutes. The doctor would then probably have to tell you to get your family members to go buy some of these things for you.
If it's at night and electricity is gone, you'd probably be getting examined by candle light because the generator's not been fueled. You're also likely to be getting examined by someone who hasn't slept in 30 hours. Or someone who is sick but was told by the same hospital he works every day for to sort himself out. Yes, it doesn't make sense but doctors can't afford the services they give. Medical cover for a doctor is about sh.1700 per month. That can't even buy a full dose of a simple ORAL drug regimen, leave alone intravenous drugs. You'd also probably be getting examined by someone who last had use of a working full blood count machine when he was in med school. Trust me, YOU, as a patient, don't want that. You'd probably also find that you have to wait another ten minutes for the nurses and doctors to attend to you because water to wash their hands with hasn't been bought yet. Yes! Outside of Nairobi, fresh and clean flowing water is not a guarantee.
I found out today that there is a hospital where the shortage of gloves is so bad that they clean used gloves with spirit and cotton wool. I will reserve my comment on that lest I end up cursing worse than sailors supposedly do.
You're also likely to be getting examined by a doctor who's recently bereaved but couldn't get leave to go participate in the funeral preparations because of the ridiculous shifts imposed by this stupid system. I have a friend who could only get three days off when her mother died. The three days it took to travel up country, bury her and come back.
With the insult of a medical cover they get, the diseases they are exposed to, their own children at home, with no gloves to work with, trust me you will sit in that waiting room for a loooooong time because no one is willingly going to expose his family to something if he can help it.
If it was Kenyatta, you'd probably then get admitted and given a bed to share with another patient with another person sleeping on a mattress beneath your bed.
Bottom line is, this system sucks. Doctors know what patients should be getting but don't. Patients don't! Patients blame doctors for any bad experiences they have and that makes sense because that's the person they see in hospital. So it only follows that it's the doctors that would be demanding these things from the government.
Unfortunately, the press is being used to confuse people. The strike is not only about salaries. The issue about salaries is point number 10 of a 13 point proposal. The union is not illegal yet NTV keeps reporting that. Monday was wasted debating its legitimacy instead of negotiating to avert the strike and it was settled anyway. KBC has been reporting that the strike has been called off to make us look confused but it hasn't. Nation has been reporting that the Civil Servant's union is the one that's supposed to represent doctors. That's poppy cock because until the new constitution came in, doctors were not unionisable (I know it's not a real word). Add to that the fact that until last week they have always been silent about the fact that despite being civil servants, doctors work twice as long as others. The law dictates that civil servants work 40 hours a week. Anything extra gets you over time. Doctors works over 100 hours a week WITH NO OVER TIME. Yet they've never tried to get that changed for us.
You may not be aware of it but the majority of the doctors in Kenyatta are unpaid workers. The masters students who basically run the hospital are not paid anything at all. And I'm not talking about a situation where they get allowances. Uh Uh. NOTHING! Yet they are expected to pay fees (over sh. 200,000) and rent to KNH. It took forever to convince my mother that I wasn’t just being sensationalist when I told her that.
Nyongo dares to say Kenyan doctors are not up to international standards yet the government recently withdrew sponsorship for masters students. If you can believe it, it stopped sponsoring even those it had already begun supporting. When those unfortunate ones finished with their studies they were informed the government had not been paying up and they couldn't graduate without paying it out of their own (very empty) pockets. In other countries, including African countries mind you, masters students are paid higher than medical officers to encourage people to seek further education. Yes. That's your Minister of HEALTH!

And please, be sure, saying that we're a third world country is a very irresponsible excuse. Accepting things as they are is irresponsible complacency and it's cowardly! God isn't going to transform things if we don't do our part. If you don't prepare for an exam and you pray, God's not going to make you pass because that's IRRESPONSIBLE!

Yesterday, only yesterday, there's a doctor in Kenyatta, NATIONAL REFERRAL hospital who spent 15 minutes searching for gloves.
Early this year, I had a patient who died in a few hours because in Casualty, in THE NATIONAL REFERRAL HOSPITAL, only one port for oxygen was working that night.
There was a time for TWO FULL WEEKS, the full blood count machine in Kenyatta was not working. Kenyatta which makes millions a day. Please tell me how that makes any sense at all. The patients are lucky that we're in Nairobi because we were taking blood samples and sending their family members with them across the road to Nairobi hospital or private labs around for the test. My friend in Western told me they actually get surprised when the machine is working, which is very rare anyway. These things must end. Things are getting worse.
A friend of mine had to perform a lumbar puncture on a patient earlier this year without the use of spirit. Lumbar puncture is meant to be a sterile procedure to begin with. Because we don't have the facilities to do it as such, we make do with what we have. Even then however, surgical spirit must be available. The patient needed that LP ASAP. He searched for spirit in other wards but found none. He eventually had to do it using water and cotton wool to clean the site. Fortunately the patient didn't get a new infection but the toll it took on my friend is WRONG because he couldn't get over the fact that he'd just performed an LP WITHOUT SPIRIT! Guess which hospital this was? Yep! That's right. Your NATIONAL REFERRAL HOSPITAL. By the way people, you've been lied to.
A cardiologist I know told me in the 90s, she and a group of her doctor friends formed a committee to try and improve things in public hospitals. They picked a small one (can’t remember which), got computers, got financial advisers to streamline the hospital's records etc. The revenue tripled and they were able to improve things.
They then thought, if that could happen with such a small hospital, how much better for Kenya would it be if they could improve Kenyatta? So they began. There's even a country that donated computers to Kenyatta for this.
She told me every member in that committee began receiving death threats. Not as a group, but as named individuals. The thing that people don't know is that the doctors aren't the ones who receive and deal with the money in hospitals. Administration is NOT made of doctors. The administration is the final word on who will ACTUALLY get admitted, and what will be done using money collected. In Kenyatta, as they soon found out, there's a system by which large crazy amounts of money disappear.
The government did nothing, absolutely nothing, to protect the people in this committee. Did nothing to help them achieve their goals. Did absolutely NOTHING! She quit government and went her own way. And who can blame her? Her government wasn't going to help or protect her. She told me there was a time patients who needed dialysis could come with an overnight bag to Kenyatta, get admitted, and be back to work with a toxin-free body next morning. Now, the reality is that even if you need dialysis, you will definitely miss a day of work per week, and you most definitely will have to buy materials, drugs and reagents to be used for dialysis because Kenyatta doesn't have them. Kenyatta which makes millions per day off of the public.
Like I said, IT DOES NOT MAKE SENSE!


And if you're thinking there really must be another way for respectable professionals like doctors to do this, woi! I'm pleading with you, give us ideas. And none of the ones that make sense because the government has proved resistant to all of those. Like negotiations? Like proposals? Like dialogue? Ha ha ha. I don't think my phone even has the capacity to type out the things running around in my mind.
Doctors have never been unionisable. Before the constitution came in, that meant we didn't have the legal ability to form a body that could discuss with the government our grievances. Yet we still tried. It's been over ten years. Case in point

www.nytimes.com/2001/10/07/world/kenya-losing-needed-md-s-as-low-pay-causes-flight.html

Once we could form a union, we did. There were many parties that tried blocking registration, including the Civil servant's union that apparently is meant to defend us, but we managed.
The proposals we had, all 13 of them, have been around amorphously since forever so preparing and sending them to government was a breeze. To all parties concerned including Ministry of Finance.
According to the Abuja resolutions, African governments are supposed to provide 15% of the budget for health care. In the 90s it was 9%. 2009 it was 7%. Last year, 6.5%. This year it was an insulting 5.4%. News flash! Your 'Government' doesn't care about your health care because like Nyongo, they can each afford to fly out to hospitals that are fully equipped. (On a side note, I felt like jumping into my telly to raise hell when Nyongo said Kenyans are dying of cancer because they don't have medical insurance. He was insulting practically the whole of Kenya because only a small fraction can actually afford insurance!)
Equatorial Guinea spends 353 dollars on its citizens for health. Kenya spends a whooping…12 dollars on each citizen on health. Because they care about us so much. <gag></gag>
Your government and Ministry of Health does NOTHING when private hospital administrations charge you 2 million for a one month stay. A friend's dad racked up a bill of 4 M for a 2 month stay. That DOES NOT MAKE ANY SENSE! Yet our wonderful leaders do nothing.
The strike notice was issued a bit of a longer time to allow for negotiations because doctors going on strike is just wrong. The government however doesn't actually think we'll go on strike.
Why? One, most doctors came from high schools that would almost never go on strike, eg, Precious blood, Starehe, Strathmore, etc. In Campus, when the University would be on strike, a lot of medics would be finding out about it first on TV a day after it's begun. Three, doctors striking would generate public outcry and anger which they're hoping will be enough to avert it. And the press is making damned sure of that by reporting half truths, twisted stories and flat out LIES!
Another thing that's happened is the nurses' union calling for a strike. Our union asked them to join us in agitating for better hospital conditions. They refused. Last week they announced a strike, asking for 300% increase like us. They called their strike off on Friday evening. The conditions they accepted, if carefully analysed, are things that they were supposed to have had ANYWAY. The government brought nothing new to the table yet they called their strike off. A group of nurses yesterday actually went to a doctor to ask her why our strike is still on. They said they thought calling theirs off would make ours weaker. These nurses were actually surprised that the strike is for real. I'm not talking about some fictional world. This happened YESTERDAY!
On Monday last week, you would think the government would be serious about averting the strike by engaging in negotiations. Monday was wasted discussing the legitimacy of the union. Surprise surprise, the conclusion was that it is.
Tuesday found the union officials receiving news that 95 doctors' salaries had been stopped. You see, when the government is displeased with a doctor demanding for their rights, they either re-post you to some remote island accessible only by a tiny boat, or they stop your salary. It's actually so common to hear of our leaders to be treated this way that we accept it. So Tuesday got wasted with the union demanding that their salaries be re-instated.
Come Wednesday, news arrived that union representatives were getting transfers. Another scare tactic. So Wednesday got wasted trying to correct that situation.
I'm not too sure about Thursday's meeting but Friday brought what just sent me into a rage. That’s when I cracked. I was so angry at the government I know I'll NEVER EVER EVER respect any of those people for as long as I live.
On Friday they said they've finally seen our proposal and that negotiations should start on Monday. What on EARTH?! That proposal was sent ages ago. My goodness. It's just that I think it's stupid to use curse words but my mind is full of extremely colorful language right now.
Nyongo recently said on a breakfast show that interns' house allowance is sh. 40,000. That makes me want to punch him because guess what? That's the whole salary!!! Yet he feels no shame saying that on TV.
Please be sure, BE SURE, your government does NOT care that you might need to get dialysis and only FOUR public hospitals in a country of 40 million, have dialysis machines.
We've called tomorrow Dr. Gatune day. This man worked in Busia District Hospital. He went to visit his family in Kiambu and got malaria. A few days later, he got acute kidney failure. Kiambu DH couldn't help him. He died on the way to KNH because that was the closest public hospital with a dialysis machine. Because he couldn't afford to get admitted in a private hospital with one. It doesn't make any sense!
Last week, Dr. Hassan fell ill. I won’t go into the whole story but he got admitted in Kenyatta. Because he’s a doctor, his people were appealing with Kenyatta to admit him in the private wing and allow for funds to be raised with time.
You see the thing is, the wards in Kenyatta are so bad that after surgeries, I’ve had many patients ask me in desperation whether they’ll be able to go home immediately without having to go back to the ward. When dignitaries visit Kenyatta or choirs go to sing there, they are sent to the cancer ward which is all done up in nice colours with nice looking facilities. Not to the harsh reality of the public wards.
You would think that with a doctors’ strike in one week, Kenyatta would want to be seen to be doing something to alleviate doctors’ suffering. NOT SO. Because Dr. Hassan could not afford it, they refused to admit him in the private wing.
As doctors we decided to bail him out, collected funds and had him transferred to Equator hospital. He’s now better thank God and will be able to continue with his wedding on 10th December.
Dr. Gatune was not so lucky.
We must stop situations in which doctors like Dr. Gatune and Dr. Hassan are being treated like they’re not important to this society.
Just this weekend, NTV was reporting that nurses backed out of the strike to make it seem as if we had a joint strike and we're the heartless ones refusing to back down. Like I said, poppy cock.
Nation online last night quoted our Secretary General as having gone down to half our demands so as to call off the strike. The stupidity with that is that number one, he never said any such thing. Two, the government was actually offering an allowance of sh. 7000 for us to call it off. And three, most annoying of all (I'm going to SCREAM!), they haven't even STARTED addressing the other 12 proposals dealing with improving the whole system.
KBC, as late as yesterday, was still reporting that our strike is off. I've had to completely ignore the press now because they're just spreading lies.
KBC and Nation today are reporting that our union is illegal and the strike we had was illegal. I will remind you that that is what Monday last week was wasted on and the conclusion was that everything is in order.
Today parliament announced that there will be a retreat to discuss infant and maternal mortality. Let me even stop discussing that before I vomit.
While we were outside Ministry of Finance today, we were listening to our chairman speak. The demo turned out to be even more peaceful than my hopes and prayers. So there we were silently listening and two GSU vehicles came out of nowhere. The drivers were moving their vehicles back and forth into the crowd as if to ram into us and they whipped out their guns and started running at us brandishing them. At that very point my rage was so complete the only reason I moved from where I was is that I'm so tiny I got pushed out of the way by the crowd of people running off to the sides.
The stupid people were revving their engines at us as if we'd challenged them to something. Whooosaaaah! Apparently they were transporting money. I don't think that's enough of a reason to almost run people over and brandish guns at them when their attention wasn't even directed at you in the first place.
Sigh! You know what. Let me just pause and leave it at that because I'm getting very riled up now. Suffice it to say, there's a world of wrong with this government and its attitude to health care.

It's an insult to our intelligence and it would be a tragedy for doctors to let this continue.

In conclusion, here is an article by Barrack Muluka as a letter to Nyongo. It's such an awesome piece.
www.standardmedia.co.ke/columnists/InsidePage.php?id=2000047676&cid=489&government.

[tnk]

==
The issue about salaries is point number 10 of a 13 point proposal.
==

is this proposal available

i have confidence that these guys have done their best to create an environment for resolution but the govt has simply not engaged because whatever deal they cut, treasury will not be supportive.

hannali would you be having a copy that you can publish?

[job]

Dr. Wahura Kanyoro's lamentation takes me down memory lane; into misery filled, run-down hospital rooms and theatres. And true, every doctor who passed through the bureacuracy of medical school and M'Afya House identifies with Kanyoro's real-life-and-horrid story...searching for gloves for 15 minutes and such. Each one has likely asked the why/what/how/where(s) about a doctors' union. I'll watch the KMPDU with cautious optimism. Many in the fraternity have probably wondered about KMA. Some have occasionally taken consequential - sometimes painful, sometimes rewarding - decisions in response.


Sadly, times like these provide perfect climate for yet another exodus of essential health professionals. Dissatisfaction among doctors, nurses, clinical officers & other allied healthcare workers invariably hurts healthcare quality.


The bold truth is that KMA ain't no guardian of doctor concerns. Its very history tailored it towards this sad situation. Unlike the early 1960s when even intern doctors would afford a reasonable middle class lifestyle (decent house and pay), offering the incentive to diligently serve patients, things started to spin off soon after independence. Aggressive liberalization of healthcare later altered the landscape completely.


If a former intern of 1963 who served at King George VI Hospital were to visit KNH to assess the working and living conditions of today's interns, they would meet a galore of shocks. As soon as Dr. Njoroge Mungai turned the precursor of KMA into a state rubberstamp-entity, during the period he served also as Minister of Health, KMA essentially became impotent on doctor issues.


Whether an intern, MO, Consultant et al., there's virtually no prosperity guaranteed in Kenya's public healthcare system...unless you serve in an administrative capacity..(MOH, Superitendants etc)...with access to tenders (if you know what I mean in Kenyanese). What I further find baffling is a Minister of Health's derision of Kenya's post-graduate medical training that he's supposed to bring up to international standards. Trust me - a Hopkins or Mayo-trained physician won't do much at KNH searching for gloves for 15 minutes after each patient... and without the aid of functioning MRI, CT-SCAN, & other modern diagnostic equipment. Kenya needs to do even more about training excellent nurses, clinical officers and preventive medicine personnel who run the numerous rural heathcare outposts.

[hannali]

@ tnk


KMPDU PETITION TO THE MINISTRY.


We the Kenyan doctors under The Kenya Medical Practitioners Pharmacists and Dentists Trade Union (KMPDU) are committed to improving healthcare provision in our country Kenya. We however note
with concern that there currently exist certain situations that are an impediment to any such commitment:
1. Shortage of appropriate health facilities
That anyone should have to travel 400km to a health facility at the level of the two referral hospitals 48 years after independence is, in a self explicable way, unacceptable. Upgrading of peripheral hospitals means more than to change the signboard to read a higher level than it previously did. Existing hospitals must be upgraded in terms of staff, equipment, medication and infrastructure. In addition, at a total cost of approximately 37.6B, just slightly more than the cost of the Thika Super highway, 47 new state of the art hospitals should be built, one in each county, perhaps two in the most expansive counties.

We need to emphasize that 90% of Kenya’s population cannot afford meaningful private care. It is therefore imperative upon the two ministries of health to ensure that care in public facilities is as good as that which they could expect for their families elsewhere. Given that this is the key responsibility of the two ministries, KMPDU demands that the construction of these facilities be embarked on in the immediate term.


2. Inadequate equipment
Equipment for basic yet lifesaving procedures remain absent, inaccessible or run down. For example dialysis machines exist in only four towns and total twenty four in number. Compare this with the more than four thousand kidney failure patients who require dialysis up to three times a week. KNH with its out of date machine remains the only therapeutic radiotherapy centre serving a population of forty million. Functional ICU’s are to be found only in the two referral hospitals. Level 5 hospitals still use oxygen cylinders while many district hospitals have none. Whatever class of medical equipment one may think of, there is a gross shortage. KMPDU demands that the ministry lays down a clear plan to address these shortages over a period of 12 months with an immediate upscaling inn certain centres to show seriousness.

3. Poor staffing
Our country Kenya faces a shortage of 32,000 doctors as there are approximately 8000 doctors in the country. Of these, only 3000 are in public service! The country similarly faces a shortage approximately 40,000 nurses. There are only approximately 17,000 in public service, and this is while there remain thousands of unemployed nurses in the country! Public institutions are greatly understaffed. There is gross shortage of personnel ranging all the way from specialists to cleaning staff. There is a constant, unchecked exodus of trained personnel from public service resulting from non-progressive and sometimes blind board room policies. The two ministries of health need to get to the ground and see the true needs which they will then have to address in appropriate and lawful ways. KMPDU demands that the ministry immediately employs all the available and qualified medical personnel and sets out a clear plan with a timeline of how the remaining shortages will be addressed. It is noteworthy that the ministry has recently resorted to introduction of slavery edicts to try and forcefully retain staff in public institutions. Meaningful staff retention can only be attained when staff stay willingly because of fair treatment, work conditions, personal development opportunities and fair remuneration.


Staff training
In healthcare, training of personnel is mandatory. There is no magical way through which specialists and skilled nurses will appear except by training. The shortages in these areas are devastating. Patients suffering operable head injury in road traffic accidents are referred from the City of Kisumu to Nairobi for the surgery because there is nowhere else to find a neurosurgeon. Needless to say, most of these patients have suffered irreversible brain damage including brain death by the time they get to there. The ratio of specialists in public service per population ranges from 1 in 600,000 to 0! in 40,000,000! Some ministry officials have been reported as saying that Kenya does not need specialists. This demonstrates a great degree of either lack of concern or lack of information, or both. Either way, there must be no room for this degree of incompetence in any ministry of health anywhere. For the sake of the Kenyans the ministry purports to serve, the number of specialists to be trained per year should be quadrupled. KMPDU demands that the ministry sets out a clear plan with timelines of how it intends to bridge the shortage of specialists.

5. Enslavement of specialists in training
While it should be clear the great need there is to train specialists, while every effort should be made to encourage doctors to go back to school and acquire the necessary skills to bridge the aforementioned gap, the Ministry, in collaboration with individuals and the two referral hospitals, has adopted, propagated and sustained a policy of exploitation and enslavement of specialists in training, coupled to typical slave era like intimidation of those who dare oppose this. Contrast this with Israel which, as part of the agreement to end the recent strike is paying doctors a large financial bonus to undertake specialist training. If that is too far out, contrast that with the Agha Khan University Hospital here in Kenya where their specialists in training not only pay no fees, but also take home nearly twice as much as a government doctor, alone in the periphery. Undoubtedly, industrial and civil action against both the ministry and individuals to the extent of abuse of office – KMPDU intends to pursue individual responsibility wherever possible rather than have the taxpayer meet the cost of individual profligacy – is forthcoming. Having made the request for the last one year to your ministry that this issue needs to be addressed without any response, KMPDU is under no illusion that your ministry cares what we the doctors think. However, be guaranteed that for as long as the free world follows the policy of compensation for work done, KMPDU intends to see the end of this madness – slavery of a country’s citizens by its ministry in the 21st century! This is an absolute goal.

6. Intimidation
For the last one year, we have urged that the policy of intimidation should end and areas where doctors have been wronged, such as in the wrongful, unprocedural dismissal of Dr. Onyimbo, should be reversed. One area where we must give your ministry marks is consistency. You have consistently ignored our opinion as doctors and carried on with whatever action, programs or policies you wished. That public health provision is inadequate is not a secret – high school students note as much in their debates. Roadside declarations arbitrarily transferring doctors, stopping their salaries or dismissing them altogether with the intention of instilling fear in them has not ended. Why then should a qualified doctor be threatened, interdicted and summarily dismissed for suggesting ways of improving this system? While KMPDU considers the extent of criminal abuse of office Vis a Vis civil litigation against individuals in several of these cases, we demand that the ministry puts a stop to this.
7. Retention of officers who have failed to deliver
In a recent newspaper supplement by the ministry of medical services, published on the day of the official opening of the Lucy Kibaki hospital, there is mention of 71% satisfaction by the public with public sector health care delivery. All ministry officials responsible for this attempt at deception should be dismissed. This misinformation is the kind that gets to the principals and other players in other sectors giving the false impression that the health sector is doing well for its citizens while the tragic reverse is the true version. In fairness, let us judge trees by their fruits, individuals by their results. The public health sector is in tragic place. The shortages in staff and infrastructure are catastrophic, maternal mortality has gone up, anyone born in Kenya has an 11.5% chance of dying before the age of 5 years, funding of healthcare as a percentage of the national budget is on the decline, counterfeit drugs fill our shelves, all this contributing to bringing the country to the brink of a doctors strike for the first time in 17 years and potentially on the brink of an unprecedented and catastrophic health sector wide strike. Surely, this points to colossal failures by the so called technocrats who have also been accused severally of being opponents of meaningful change. We propose that it is insane to do the same things, the same way with the same people and not expect the same results. In the health sector, this insanity will result in further needless deaths of ordinary Kenyans and must be stopped.
In line with encouraging results and best practice in other sectors such as the judiciary, key management positions in the ministry including the directorate of medical services, must be advertised, competitively applied for and the interviewees publicly interviewed by people with a track record of good performance in the health sector.

8. Management of Public sector health institutions
There is a current push to have doctors out of the management of public health institutions the reason given is that they are not trained as managers and therefore make poor managers. We appreciate the fact that someone was looking at ways to come improve the situation and hence the suggestion. However, in medicine given the high stakes involved, trial and error, which is what the current situation in KNH amounts to, is not an option. Decisions must be made not based on ideas, but on research and on facts. We put it that this policy was ill though out and poorly researched for the following reasons:
The largest currently available research in the area of hospital management by various professionals Vis a Vis outcomes is the 2008 research by McKinsey and Company and the London school of Economics and Political science which concludes that hospitals ran by managers with a medical background are better run and have better outcomes. Other studies have come to similar conclusions. These studies were either not sought or were ignored.
Attributing the major failures of, for example, KNH to its director not only amounts to passing the buck to junior officers (junior to senior ministry officials) but also demonstrates a catastrophic lack of understanding of the problems afflicting the national hospital. We thought the following would be obvious but we will enumerate nonetheless:
The most striking and visible problem with KNH is that it is taking care of patients way in excess of its capacity – patients sharing beds, on the floor, waiting more than a year for surgery, terribly long and overwhelming queues and so on. The reason for this is that there simply exist no other facilities capable of handling these cases. To remedy this, should the director turn away patients to nonexistent facilities or should the ministry replace him? None of the above is KMPDU’s answer. The solution is to build other institutions capable of handling these cases and take the extra load off.
The referral hospitals are underfunded. The total development allocation for the two referral hospitals in the 2010/2011 budget was 100million. Given the innumerable shortfalls in equipment and infrastructure, this amounts to a not so funny joke.
There is a shortage of personnel. More than half of the doctors in KNH and upon whom the hospital depends are unpaid slaves. The director does share responsibility for this but only together with your Ministry.
The principle on which this policy is based is itself flawed. Private hospitals are businesses and it makes sense to have business managers run these institutions so as to make the maximum profits. However, the primary concern of public health institutions is to provide health services. It is necessary to have health service providers run these institutions as they understand best what health programs will impact the general population’s health in what way. This is critical but was overlooked. We cannot commercialize public hospitals nor privatize healthcare.
There exist medical professionals who have gone further and done Masters in Business administration. This group of professionals would address both qualification concerns but there seems to be an irrational obsession with removing medical professionals from the running of these institutions, therefore having a medical degree has been made a disadvantage in these applications.
The policy is discriminatory against and disparaging of doctors. Nobody is going to argue that because Dr. Willy Mutunga is a lawyer, he is not qualified to run the judicial system, nor will they argue similarly in other professional companies. It is only doctors who are singled out as inept at everything else except treating patients, a clear insult.

9. Working hours
Most civil servants work 40hrs a week. Many doctors work in excess p of 70hrs a week. In addition, doctors know nothing like public holidays, weekends, or nights. They work when duty calls, often at great cost to their own health, families, and relationships. KMPDU demands that working hours as stipulated in the labour laws be adhered to when it comes to doctors. Any extra work done as necessitated by the unique nature of the work be calculated and paid for as stipulated in the same laws.
10. Fair remuneration
The new constitution entrenches each individual’s right to fair remuneration. Looking at the training required to be a doctor let alone a specialist, the value of a doctor’s work, the extraneous nature of a doctor’s duties, the shortage of doctors meaning that the few available are overworked, the risks to personal and family health involved and in comparison to remuneration in other health systems in other countries, it is clear that the Kenyan doctor is grossly underpaid. KMPDU recommends the following as the gross pay for the various cadres of doctors in Nairobi.
Lowest paid doctors (interns)
¡ Gross income 214,000
Intermediate level doctors (medical officers)
¡ Gross income 285,000
Specialists from day 1 out of school
¡ Gross income 428,000
Senior specialists, Lecturers and Professors
¡ Gross income 856,000
(All income subject to full taxation as per income tax law)
In addition to these gross values, the further from Nairobi one is, the more they should earn. This is to encourage urban to rural posting of medical professionals. There should also be a 6 – 8% automatic annual increment so that the longer serving doctors earn more than the newer doctors.
Doctors are not the only poorly paid medical professionals, nor are they the only ones working in the highly biohazardous and hence risky hospital environment. While we don’t represent the other cadres of staff, their work and presence are critical to a functioning health system and are key complements to a doctor’s work. We recommend that the current gross income for the currently underpaid, overworked, unmotivated and negelected nurses, clinical officers and other paramedics be quadrupled to stem their exit from the public service and thus support doctors better in their work.

11. Comparisons with other civil servants
In denying doctors their rightful dues, doctors have often been compared to other civil servants. One such comparison is with others in the same job groups; whether proposed income increases would not be way out of the job group. KMPDU derives from this the logical conclusion that doctors are currently several job groups lower than they should be and this should be addressed. A second comparison is at the entry level where intern doctors are compared with other doctors in other professions. The current PS often gives stories of when she was an intern. KMPDU wishes to point out that the only similarity between an intern doctor and any other intern is in the word “intern.”Beyond that, there can be no comparison. For example, how many yet to be born babies, stuck in their mother’s wombs threatened with potentially fatal birth complications do other interns deliver alive and healthy, to their grateful mothers? How many baby’s at risk of dying by the end of the day from dehydration do other interns save? Perhaps the more important question is how do life-protecting and lifesaving roles compare to other roles? KMPDU demands that these nose-length comparisons aimed at devaluing the work of doctors end.
12. Health service commission
This country is witnessing revolutions in the judiciary and education sectors. These changes can be attributed to the meaningful work done by bodies such as the Judicial service commission and the TSC. A similar body, the Health Service Commission, must be created in the health sector.
13. Underfunding of healthcare by treasury.
While not absolving individuals who have demonstrated great ineptitude at the two ministries of health, a lot of the shortages in the health sector can be justifiably blamed on underfunding by treasury. The two ministries of health must play their part in pressuring the treasury into meeting basic health funding levels as laid out in the 2001 Abuja declaration and as recommended by WHO. The passive approach hitherto adopted has cost lives and its continuation portends disaster for many families who are stuck with public healthcare.

The recommendations made by KMPDU are reasonable in the eyes of any objective observer. Having made similar requests for the last one year to your Ministry without any meaningful response, KMPDU is under no illusion that your Ministry cares what we the doctors think. We do however hope that you will find compulsion from whatever quarters to satisfactorily and in good time address these grave issues.
KMPDU on its part will continue to support all initiatives geared towards the attainment of meaningful healthcare Kenya.

[tnk]

good grief

that proposal is selfless and has very many actionable items that are easily achievable and in any order of priority. generally that proposal is calling for measures to help improve health of a nation

its shameful and misleading that the only item that the press and politicos want to address is salary.

hannali

thanks for the information, i concur the KMPDU recommendations have merit, the next logical process is to team up with lobby groups to sustain the pressure

there is talk of setting up nuclear plants yet basic health requirements achievable at a fraction of the cost cannot be met. where does v2030 lead to if the population is unfit. there is a budget of several billion to fund engaging some several thousand rag-tag outfit outside our borders.

i dont know what kind of economics are cooked at treasury, but boy do we have priorities messed up

reading through that petition it appears that the underlying troubles in kenya remain as they were before kibaki but only that a lot more gloss/sheen has been applied to the surface to fool those that can be, that progress has been made

there's talk of infrastructure development, more health facilities, better equipped and yet roads are still impassable when it rains, etc etc

these 10 years might turn out to be yet the greatest scam of all. bigger than anything we know. the scam, sham, shame and schism legacy. ....aaarrrghhh !!! acha ikae

[adongo23456]

Good insight from the docs in the house. This is a matter of life and death literally. When I first came to Canada a guy who was a lecturer in Kenya for two years and told the medical fellows they take you to that I have actually never met a doctor except my friends at UoN and the Immigration doc in Dar es Salaam who took a ton of my blood for tests they thought I was joking. But it was true. I only saw those UoN nurses once in a while. At home in Bondo seeing a doctor was out of question. Today things have changed as long as you have money to get private care.

There is no country in the world that can develop without good and functioning medical care services and systems. In Kenya medical services are private commodity for those with money. The doctors who work in public hospitals are seen as makers of their own misery. It is like what are you doing there. Go to a private hospital and make money or open your own clinic. We forget that public health is public wealth.

If medical care becomes a commodity that only those with money can afford we may as well crawl back to the stone ages. It is bad enough as it is. Kenyans have to stand up with doctors and other medical practitioners willing to work in public medical institutions. It is a fight for us more than for them and it is a matter of life and death if I may repeat.

[njugunajohn]

In any disagreement there are two sides to the story.

Dedan Kimathi was regarded as a terrorist by most of the Western world; whereas, he was considered to be a freedom fighter by Kenyans.

The doctors story has two sides and who else to tell it than Medical Services Anyang' Nyong'o who has suddenly ended his silence: twitter.com/anyangnyongo

[subsaharanite]

If I were in the government, I will duly honor the Dr's demands or plead with them reason being, that even if they were to be fired, they will quickly establish themselves elsewhere with ease unlike other professionals like teachers who may need time to find a job. This is one group of professionals that the government cannot outrightly threaten. Proposal or no proposal, the government should be ready to swallow its pride in this case.

[hannali]

The blue revolution is on. There is a very strong message that doctors and a people united cannot be defeated.

Doctors are prepared for a long fight.THE Govt. is using propaganda.They call us declaring that they have a deal to negotiate.While we are still in a meeting they give the media misleading figures to our shocking disbelief. I am stunned by this tricks and treacherous tactics.
How can a Goverment tell LIES straight through their teeth??? this is amazing!
It is not only about salaries as they are misleading Kenyans, it is also about proper equipment,facilities, training and motivation of staff so that kenyans dont have to do harambees to seek healthcare in India, South Africa, Europe or America

We will win this fight.

[tnk]

Dec 7, 2011 23:49:49 GMT 3 hannali said:

The blue revolution is on. There is a very strong message that doctors and a people united cannot be defeated.

Doctors are prepared for a long fight.THE Govt. is using propaganda.They call us declaring that they have a deal.While we are still in a meeting they give the media misleading figures to our shocking disbelief.
It is not only about salaries as they are misleading Kenyans, it is also about proper equipment,facilities, training and motivation of staff so that kenyans dont have to do harambees to seek healthcare in India, South Africa, Europe or America

We will win this fight.

hannali

many of us are with the doctors on this

i would like to suggest/advice/recommendation the following

a) in the short term, the strike/mass action has certainly got the ears of the govt and pricked the conscience of the few who care in parliament. in the long run its unsustainable for a variety of reasons. therefore a plan B must be put in effect for long term and attainable goals (i.e avoid being hoodwinked by the govt)

b) consider obtaining assistance from seasoned lobby groups to pursue relentlessly key items (benchmarks/milestones) such as formation of the health committee to take over the lobby groups etc

c) the 13 point proposal is a great guideline but needs fleshing out with more details e.g breakdown of facilities, e.g which ones need rehabilitation, where new facilities are needed, etc and a phased out implementation proposal taking into account the limited resources that the govt may have. for this, your organisation need to have candid talk with M'Afya house officials and Treasury officials to get realistic projections otherwise, all you will get are smoke-and-mirrors. remember whatever deal cut must be followed up and enforceable or legislated in parliament else all you get is political hot-wind good only until the next general election

d) alternatives to cash out - in general i agree the doctors and medical workers in general are grossly underpaid however in some cases there are other more immediately accessible alternatives that can cushion workers from economic hardships even where there is no increase in salary. but certainly do follow up on the govt flashing its wallet.

[kamalet]

The petition by the doctors has a mix of good things that a union should be dealing with and others certainly outside the remit of a union.

Now the problem of such a petition leading to strikes is that it only helps in losing focus into the key labour issues concerning the doctors and opens up to the non-labour issues being used by an employer to justify failure to come to agreement.

When the doctors get into the key labour issues that would justify the strike, they fumble and completely mess it all. On the working hours, they seem to be addressing the public for sympathy rather than their employer. Doctors do not work 70 hours a week and actually work 40 hours - something that the days off for doctors is the envy for when the doctor is away during the day. But we also know that they will do night shifts which is the justification for the off-days. Now these working hours are something known by the employer and the issue should have been a simple case of invoking the civil service code which provides for what happens when one works overtime. The issue in the petition would have been that the employer is refusing to pay for the extra hours!

As regards the salaries, the figures are quite interesting. They are perhaps up there with some of the developed countries. The entry level pay for an intern is proposed to be US $28500 annually. Just what is the comparative salary paid to an intern doctor in say Botswana or India or any comparative countr serving in the public service. As interns cannot work in private hospitals (I stand to be corrected) we can perhaps look at the pay for "Medical Office", i.e. a registered doctor. The proposal by the union is US $38,000 for such a doctor. The comparative they should have offered is how much a similar doctor would be paid in the private sector or in comparative countries to Kenya to clearly show the disparity. It would appear that the figures when unsubstantiated appear as they are only a thumbsuck amount bandied about as the negotiation baseline!

And this is why mixing up all the issues the doctors raised beats their petition if the claim was not just salaries. The matter has been reduced to one of salaries and the government is offering 1.3 billion shillings to cover his which was increased to 1.9 billion before the talks collapsed yesterday. What the doctors should know is that this money is not like it was hidden in some socks for a rainy day. This is money that was voted by parliament for the medical ministry - perhaps to buy drugs or the equipment the doctors moan about or even improving the service - that will be taken away from one vote to the salary vote. So in reducing the doctors' "noise" to a salary thing, the government robs Peter to pay Paul. Doctors 1 - Patients 0!

So as Kenyan, we moan the poor medical facilities, poor medical servce, poor pay of the doctors and other people in the health service. Which is why I think we have some dunderheads in government who cannot deal with a simple matter such as this - especially when they are strapped for cash.

The doctors invoke constitutional right to strike and fair remuneration. How about the government obeying the constitution and if it did not get parliamentary approval for a vote in its approved estimates for increased salaries then it should invoke the same constitution and the requirement for its obedient by the executive!

Once the rights are established...then perhaps common sense can prevail and sensible talks to ease the suffering of Kenyans unable to get medical attention in public utilities.

[hannali]

From South Africa

www.safpj.co.za/index.php/safpj/article/viewFile/1424/1580

The results of such an action (strike) would result in avoidable
harm including the death of patients
It is quite difficult to separate fact from exaggeration during doctors’
strikes due to media hype and the variety of players involved. Proximity
to life and death, and contractual obligations are put forward as the
reasons doctors are judged by standards higher than ordinary mortals.
In social myth or reality, a doctor is ‘there’, present in the absoluteness
of death. Although one may question the moral relevance of temporal
or geographic distance, the fact of a death whilst doctors are on strike
is not afforded any clarification. Rationally speaking, the value of human
life is treated by society in relative terms although when doctors’ strikes
occur, its sanctity is professed in terms of the absolute. By relative terms,
we refer to deaths occurring in wars, revolutions, resource battles,
domestic hostilities, road-deaths, and substance abuse. Yet, even in
viewing life in relative terms, in the context of medical practice how
might moral justification for strike action by doctors be argued?
From a utilitarian perspective, strike action can only be justifiable if
there is evidence of great long-term benefit to doctors and their families,
a positive improvement in health care delivery9 and the concurrent
increase in benefits to those who are the most in need of health care.10
This calculus rests on the application of the Principle of Utility. In other
words, what is moral relies on the production of the greatest amount
of happiness/good/pleasure for the greatest number of people. But it
is not as simple as it may appear for we are obliged to weigh the likely
harms incurred because of strike action with that of the probable good
that may result.
For patients, some of the harms occurred may include the following:
work-loss (if employed), wasted money for transport, treatment delays,
prolongation of suffering, irreversible damage to health, dangerous drug
interruptions and death. Concerning the latter, death may or may not be
the ultimate harm as no one has returned from death to state the outcome
categorically. On the other hand, benefits may include non-care of the
patients who tend to seek unnecessary medical treatment in the first place
and those who might be better off not seeing a doctor in circumstances
where equipment or facilities are beneath an acceptable level.
Concerning doctors, some benefits of a strike action may result in
financial gain, improved working conditions which may contribute to less
emotional pressure11 and even a degree of dissuasion from emigrating.
Negative responses however may be generated from public opinion.
Because of the nature of the practice of medicine doctors are placed
in the proximity of intimate human emotions, the fragilities, strengths
and weaknesses of patients in life and death. As witnesses to such
powerful situations, the image of the doctor as the key figure in what has
been termed a “healing relationship”12 runs the risk of being tarnished
in cases of strike action. However and interestingly, public responses
do not always look at strike action in a negative light13 particularly if
the strike action identifies the exploitation of doctors.14 The problem of
course, lies in weighing the pros and cons. One cannot know for certain
if the benefits will, in fact, outweigh the burdens.
Strike action breaches the implicit social contract between
doctors and patients
Doctors are deemed to work under a special ethical commitment because
of the nature of the doctor-patient social contract15 which places them in
a distinctive moral position to care for their individual patients. Medicine
has a similar contract with society. Doctors accept this special obligation
of fidelity by declaring publicly their commitment to place the interests
of patients, particularly the vulnerable, above those of all others. This is
generally accepted as preclusion against strike action. Yet, it is important
to recognise how this maxim is placed under stress in contemporary
medical practice.
Medicine is now practiced in many different ways, such as the advent
of wage-contracted doctors, rationalised work, administratively imposed
limitations of privatisation, corporate cost-containment programmes, and
imposed production norms.16 Most likely as a spin-off of employment in
such spheres, doctors have increasingly sought unionisation as a means
to protect themselves against proletarianisation and corporatisation,
ingredients of what is broadly termed ‘Organised Medicine’.17
Moreover, in countries where medical care is largely geared towards
provision of care to the majority of the population at minimal or no
cost e.g. socialised medicine, its provision and the inferred contractual
agreements becomes a joint responsibility which includes the doctor,
the hospital and the government. In such cases the system is such that
if one of the entities by de facto fails then the remaining others will
bear the consequences. For example if the government fails to meet its
obligations then the sanctity of the other limbs of the contract suffer.18
Concerning this, it is not uncommon to point to the whole claiming that
the responsibility for its failure is the sum of all of the shared individual
responsibilities, or contributory group-fault: collective and distributive.19
But this may be misleading because the morality of the role structure
which makes up this collective as well as the role-acceptance, rolecompetence
and role-enactment of the individuals who act or choose
not to act in this collective are pertinent as well.20
Private practice should be the area where doctors are in a better position
to maintain their social contract (be their doctor-patient relationship
formulated as a covenant, or accord) in keeping with more traditional
practices. However, while the tendency at present to act more as
‘technocrat’ than ‘doctor’ is through medical education initiatives being
somewhat abated, and relationships with patients have become less
strongly paternalistic than in previous times, concurrently patients have
become more prone to take legal actions against doctors – for right or
wrong. The response to this has been that doctors have become more
defensive. Thus, the character of the social contract even in private
practice is again altered.
Recognising that the circumstances of contemporary medical practice
have changed and agreeing that the medical ideal of a social contract is
under stress may lend understanding as to why doctors engage in strike
action. However, focusing only on the idea of the social contract presents
a rather simplistic view of medical practice where moral boundaries are
not so easily defined.21 Doctors do have special obligations to individual
patients who they take under their care and this is reciprocated by the
patient in trust. In keeping it becomes a fiduciary duty of the doctor to
provide her skills and work always in the best interest of her patient. This
also implies a continuation of her care, or a transfer of care to an equally
competent doctor should she be unable to continue. The doctor is, in a
sense, always “on call” to the patient because of the mutually accepted
commitment implicit in the doctor-patient relationship. Even in the event
of a strike action, this duty cannot be discarded. For example, should
that particular patient be in the doctor’s room in consultation when strike
action is called, the doctor cannot morally abandon the patient and rush
to picket.
The type of contract doctors have with greater society is different in the
sense that a doctor is bound to act responsibly and caringly when he is
present in hospital in a clinical encounter. However, he has no duty to
be present for all patients under all circumstances. When doctors are
employed by the state, which is of course composed of and managed by
CPD Article: Doctors and strike action: Can this be morally justifiable?
SA Fam Pract 2009 308 Vol 51 No 4
individuals, the provision of health care becomes a joint responsibility.
This shared commitment to the provision of good medical care does not,
even in times of great disarray, remove a doctor’s primary responsibility
to provide the patient with the best care possible. However, the structure
of the health care enterprise as shared does lend itself to support the
position that doctors should not be viewed as the only bearers of blame
for making the decision for strike action. When facilities, equipment,
and personnel are substandard, when mistakes are made which are
identifiable because of administrative blunders or political gain, which
are out of the control of doctors, ‘continuing to hold doctors to the sanctity
of their professional commitments becomes morally questionable’.22
Thus far we have pointed to the nature of the doctor-patient relationship
which entails a special moral contract with a doctor and an individual
patient. A question arises which asks if doctors have the same moral
obligation towards individuals who through no mutual accord may
become their patients in the future. In state-run hospitals mere chance
and symptoms often determine patient assignment. If this special
contract is applied to all society then it would be immoral to engage
in strike/go-slow action. It would also be morally questionable for a
doctor not to be present whenever that particular patient returned to
hospital – day or night – or sought her assistance. If a doctor were to
leave the practice of medicine, transfer to a different medical system,
be on vacation or absent from duty she would not have any special
obligations to patients who presented to a state-run hospital during
her absence.18 The institutional context of medical practice by its very
nature limits the ideal notion of a doctor-patient relationship. This is not
to say that in state-run institutions doctor-patient contracts do not ever
exist. Yet a doctor’s contract with society to act dutifully and responsibly
in patient care is limited by the circumstances of a shared structure
of responsibility.
Frequent and misunderstood statements that doctors are bound by the
Hippocratic Oath and as such they are in breach of their ethical duties
always arise in strike actions. What is not sufficiently understood is that
the Hippocratic Oath was sworn by students and is patient-benefitting
in doctor-patient relationships on an individual level. Against this it can
be argued that doctors have a greater responsibility to the public’s health
(particularly the vulnerable) than they have towards the treatment of an
individual under their care. Doctors should not perpetuate the provision
of substandard care even if betterment can only be achieved through
strike action. One might even argue that it is immoral for doctors not to
strike under substandard and patient-endangering circumstances.
Ethical guidelines, which are largely descriptions of a doctor’s duties,
identify particular prima facie obligations which are alleged to guide
moral behaviour. In medicine, two important principles are the duty
of fidelity (obligation to keep promises) and beneficence (obligation to
try to do good, to actively help others). These and some of the other
principles of medical ethics would appear to stand against any strike
action. Of course, arguments can be made that keeping promises and
trying to do good/actively help others applies to current, not future,
patients and benefits may be viewed both in the short and long term.22
Yet such arguments aside, there are other duties which may be viewed
as supporting strike action, for example, justice. Justice is often defined
in terms such as fairness and equity. Yet justice is not limited only to
others, but also to oneself and family. So it is possible for an argument
to be made that strike action is ethical if the injustice caused by it to
the patients is outweighed by the justice done to the doctors and their
families. Again, the problem is finding the right balance.
Professional activism
Advocacy in medical practice concerns promoting health care values
rather than government or institutional policies which undermine the
medical profession. As the practice of medicine in contemporary life
becomes more complex (e.g. in systems which involve government,
hospital and doctors) just how to ensure the three entities meet their
moral obligations to society is the singularly most important issue to
address. One side cannot endlessly support the others. Smouldering
behind the strike action are failures on all three sides: failure on the part
of the employer to act in accordance with its stated recognition of the
importance of health care, failure on the part of institutions to support
their personnel, hospitals and clinics to reach their optimal potential,
and failure on the part of doctors to consider seriously their duties and
obligations to selves, patients and profession.
Advocacy, dissent and even disobedience are tools which should precede
any strike action. When a situation comes forth which is ethically
catastrophic then exit from professional duties can be justifiable. In
such situations patients are likely to be harmed so the justification, as
in ‘whistle blowing’, must be made on moral grounds. The only moral
ground is that health care will overall be substantially improved for
the greater population. Can strike action by doctors ever be morally
justifiable? Yes, it can. But always at a cost.

Conclusion
We hope that this article has provided some insight on the doctor-patient
and the employer-employee relationships when doctors embark on strike
action. A strike action is a failure on the part of the employer to act in
accordance with its stated recognition of the importance of health care,
failure on the part of institutions to support their personnel, hospitals and
clinics to reach their optimal potential, and failure on the part of doctors
to consider seriously their duties and obligations to selves, patients and
profession.

[hannali]

For those opposing the strike the doctors are complaining that ‘the conditions are appalling’... ‘Patients sleep on the floors at night’... ‘no linen’... ‘an affront to human dignity’... .....reminding us that ‘all that is necessary for the triumph of evil is for good men to do nothing

[jakaswanga]

Dec 9, 2011 21:10:28 GMT 3 hannali said:

For those opposing the strike the doctors are complaining that ‘the conditions are appalling’... ‘Patients sleep on the floors at night’... ‘no linen’... ‘an affront to human dignity’... .....reminding us that ‘all that is necessary for the triumph of evil is for good men to do nothing

Doc,
Labour unrest in the vital sector does bring some of the most difficult moral dilemas. Limited strike allowing for emergencies? or total shut down leading to higher rates of preventable deaths?
Most doctors are private too: so, reject offering services at public hospitals and accept the same patients at private practice?
But okay, the strike is on, so we look at it in all dimensions, not just the ever urgent perspective of patients.

I continue below.

[jakaswanga]

CAN THE KENYAN ECONOMY DELIVER AT CURRENT LABOUR DEMANDS?

Actually there is a pattern of general labour unrest in Kenya. And the doctor's strike is the latest slot in the series. Barely two months back it was the teachers and lecturers, then other medical staff, then floweR-farm workers, and a little while ago it was the dock-workers. And the list goes on.

If the the unemployment rate is 40% as some statistics allege, one then hesitates to think of how this peniless group, let alone those in some kind of employement, expresses their dissastisfaction with their current earnings, and life conditions!

What is important today, is the professional sector which has found it necessary to use the instrument strike. They don't come more prestigious than doctors, the group which now is on strike. So this is a deadly symptom of an underlying malaise. After doctors, the only other shocker is the police or some other armed force.

These [lecturers and docs] are groups which have hitherto been insulated from economic destitution, but now stare into the abyss which has always been the preserve of the scum, the lumpen making ends meet with their wits on dangerous streets. The erosion of their real income in the light of Kibaki's mythological economic miracles, is a life and class threatening event. Desperacy has hit them too. They have been purged from, or are in the process of expulsion from the upper class.

But perhaps it is the feeling that the national cake is not being fairly distributed that further aggravates this epidemic of strikes. With the political elite having apportioned themselves salaries past American senators, given themselves tax exemptions which sound like bonuses to corporate executives in the capitals of Capital, there could be a feeling a feast --on the blood of the tax-payer is goin on, and only real loosers will be left behind in the blood sucking pecking order.

So these strikes are part of a feeding frenzy. [some demand 200% rises; unheard of margins in the realms of labour politics in real economies!]

If we conseder our GDP --from CIA fact book, or Africa confidential or Ministry of Finance [$30B, then take a look at the public debt [$8B] as an UNHEALTHY percentage of it [~27%], and add in other woes like the weakly shilling, the question rises: for how long more can Kenya raise funds by borrowing [from an international financial market already jittery by defaults by such betters as Portugal and Spain and Greece?]. What else can we sell to scavengers with cash like the Chinese and Indians? This question must be asked.

All these pay-hikes can only be funded by borrowing, if you recall even Ouru's trillion infra-structural upgrade budget aimed at 44% external funding. We are leaving beyond our means, and these salary hikes [which imply borrowing to fund consumption], are a further inflationary impulse in the same self-destructive direction. THERE IS NEED FOR AN AUSTERITY PACKET that fairly distributes the burden of poverty, but rekindles investment. Such a packet, for it to be broadly acceptable, starts by slashing the outrageous salaries paid to politicians and a host of bareaucrats. It also edits the tax [VAT] on primary commodities of economic activity. Fuel, power, small and petty retail businesses.

With interest rates exorbitant --(reducing investment as capital becomes too expensive), it is likely a stagnation is in the offing. That narrows the economc base further. It is with these things in mind that, even as I support the docs, my heart grows fearful.

No such thing as a free lunch they say. But in Kenya we seem to think there is! Will we print money like Zimbabue to finance ourselves?

NB: For those of us who have repeatedly been to public hospitals --I am well versed with the rot of Russia in Kisumu, the view one may have of doctors is not that of a bastion of public care! If one were to investigate deaths in Kenyan public hospitals and insist on a pound of flesh, I am not too sure many doctors would remain on the free side of iron-meshed bars. Negligence due to demotivation is rampant, casualties too.

1. Why have they as a professional group allowed the public hospitals to rot completely before raising the red flag?

2. Most of the medical superintendents who have been in management of these hospitals are medics. Poor management [even of academic hospitals like Eldoret] is an issue to ponder as we work this situation out.

Can't blame the government for everything!

[hannali]

@ Jakaswanga The strike is all about patients rights, how long must we continue to accept mediocre services? counterfeit drugs? inadequate or absent facilities and supplies?

it is immoral for doctors not to strike under substandard and patient-endangering circumstances.

What is not sufficiently understood is that the Hippocratic Oath was sworn by students and is patient-benefitting in doctor-patient relationships on an individual level.

Against this it can be argued that doctors have a greater responsibility to the public’s health (particularly the vulnerable) than they have towards the treatment of an individual under their care. Doctors should not perpetuate the provision of substandard care even if betterment can only be achieved through strike action.

[hannali]

A patient's story


SOLDIER ON DOCTORS!!!!
by Margaret Ayienda on Saturday, December 10, 2011 at 9:11pm

My first unfortunate and very personal encounter with the public health system was about two years ago.This is the time my mother was diagnosed with cancer,cervical cancer to be precise.I must say it was a long heart rending journey that has and will always be etched in my life.

We first consulted a gynaecologist at the KNH doctors plaza who then referred as to an oncologist immediately,who in turn told as that a sample of the growth was needed for accurate diagnosis and staging of the cancer to enable her to know what course of treatment to prescribe.It was a simple procedure,she said,and it only required that my mom be put under for about 30 minutes and it would cost some Ksh.5000 at KNH compared to private hospitals which would charge at least Ksh.20000.

We opted to for a private hospital due to the urgency and the procedure was done and we got the results in 5 days.The pathology report confirmed our worst fears and here began our never-ending trips to KNH.It was a stage 3 highly aggressive cancer.The oncologist ruled out a hysterectomy and chemotherapy citing it would be in vain because it had already spread to the surrounding areas and mom was to frail.The only option left was radiotherapy everyday for six weeks.

The radiotherapy sessions cost Ksh.330 per session at KNH compared to an average of Ksh.1200 at other private hospitals.Therefore we settled for KNH because the other hospitals were beyond our reach.We were given an appointment time of 8.00a.m everyday.Little did we know that it would translate to 12pm onwards.We would be at KNH by 6.00am but find at least 20 patients already in the waiting room..This was due to the long queues at the radiology department.The technicians would come in at 8.30am.Hitherto,i still shudder at the thought of that waiting room.Most patients were critical,with all types of cancers and worst of all the smell was sickening,nauseating to any healthy person.The washrooms were not any better and any sane person would have to go there with gumboots so as not to pick an infection.

More often than not,we were required to carry our own gloves because the radiology technicians always said they were out of stock.It was either you buy the gloves or if you are the caregiver,undress your patient and ensure the diseased part is exposed under the machine before they put in on.After each session was complete,the caregiver would be called upon to dress the patient and wipe the surface with a disinfectant.I recall, that with time i had to force mom to wear adult diapers simply because one of the side effects of radiotherapy,diarrhoea would not let up.I did this for her and myself to avoid infections from the washrooms because she had uncontrollable diarrhoea and could soil herself anytime of day.

After a gruelling one week of radiotherapy,the oncologist stopped mom's sessions since she had become too weak due to a dangerously low hb of 6.She consequently ordered a full blood count,fine needle aspiration of the inguinal nodes and a doppler because her thigh was swollen such that she couldnt walk.All these tests were carried out in different parts of KNH as i discovered that day.You can imagine my frustration having to take someone who cant walk even 50metres to the farthest ends of Knh for these tests.I got a 'good samaritan' (cleaner) who volunteered to get me a wheelchair for Ksh.50 so that i could take my patient for the various tests.We became' good friends' with this cleaner as he would provide me with the wheelchair everyday,of course at a fee,as eventually mum coudnt walk.

Results which were due the next day got lost.They had supposedly been sent to the prescribing doctor who in turn said she had not seen them.I was only given the doppler results that day.So i concluded they were lost and crossed over to the privatley run lab at doctors plaza where i got tangible results within an hour.Afterwards i came to discover that they would take blood for testing while in fact the blood count machine was faulty and non-functional most of the time!

Within those six weeks of radiotherapy mom got 4 blood transfusions of two pints each, definitley not at KNH.Our thinking was if the blood count machine wasnt working,what other machines were not working?How do they test blood types and anything else to do with blood?I dont know, but at that time we were unwilling to take the risk of a wrong blood type being administered.All this while,the oncologist would change mom's medication at will due to the adverse and worsening side effects.Up to date i still remember all the 15 types of medications by name. Amazingly,I only got two in the KNH pharmacy,immodium and morphine, the rest were out of stock.Surprisingly the prices of even the 'out of stock' medications would be pinned on the wall!Why even bother,i would wonder.All these medicatons would cost at least Ksh.1000 per day owing to the high retail prices in town.

Mom completed the radiotherapy sessions successfully as the growth had shrunk substantially.But more was yet to come since she was still in immense pain.So our oncologist,not one to give up easily, prescribed a procedure called brachytherapy, but on the other hand she was quick to inform us that the machine at KNH had not worked for at least 1year.This procedure,she said,was strictly for pain management in mom's case.Other private hospitals that had the machine charged at least Ksh.200,000 for the 24hour procedure.Frankly,my family was financially,emotionally and psychologically drained.But what were we to do?We would go to the end of the earth if it meant mom would be pain-free.The oncologist suggested Mulago hospital in Uganda which did the procedure at way less than its kenyan counterparts.This,i can say was the worst time for mom because she starved herself for 2 days prior to the trip reason being she didn't want to soil herself during the trip.Nothing or no one was able to convince her to eat but she would still take her pain medication,which in essence made her crazy.She even refused to put on the adult diapers during the journey and God was on our side because she didn't soil herself in the course of the 12-hour bus ride.To cut a long story short,we went and had the procedure done then resumed our ever endless visits to KNH.It was downhill from there as she developed kidney failure and subsequently general organ failure.

Mom succumbed to her illness two months after the brachytherapy procedure,that is six months after the diagnosis.

In my opinion,anyone who has never had a critical patient at a public hospital should zip it!!They should not under any circumstance, condemn the doctors intimating that they are selfish.You who has never seen the walls of a public hospital,have no moral authority to criticise.The working conditions at this public hospitals are deplorable,to say the least.The basics like gloves and disinfectants are lacking.Patients lose their lives due to treatable diseases like malaria.These doctors have a right to work under a conducive working enviroment,they are no more human than you or i.

And doctors out there bravo!I can say you are doing a damn fine job with the little that has been availed.Thank you for fighting for the right to better healthcare,thank you for fighting for our children and thankyou for fighting for us all.
Unlike · · Unfollow Post · 5 hours ago

[kamalet]

Dec 10, 2011 19:01:09 GMT 3 hannali said:

@ Jakaswanga The strike is all about patients rights, how long must we continue to accept mediocre services? counterfeit drugs? inadequate or absent facilities and supplies?

it is immoral for doctors not to strike under substandard and patient-endangering circumstances.

What is not sufficiently understood is that the Hippocratic Oath was sworn by students and is patient-benefitting in doctor-patient relationships on an individual level.

Against this it can be argued that doctors have a greater responsibility to the public’s health (particularly the vulnerable) than they have towards the treatment of an individual under their care. Doctors should not perpetuate the provision of substandard care even if betterment can only be achieved through strike action.

Hannali

If you are the doctor's voice on Jukwaa, and you believe that the strike is about patient right, then you lie to yourselves and also to Kenyans. The most important thing about the strike and what the noise has been even when the doctors went to the streets was matters of the stomach.

Talks with the ministry collapsed not because the ministry could not guarantee original drugs and fresh linen...it was because of a disagreement on MONEY.

But the labour unions in Kenya need to learn from the coal miner's strike in the UK during Thatcher's time. It was perhaps the longest drawn out strike in UK history that ended in the collapse of the coal industry in the UK. In more recent times labour unions have had a more sensible approach to the right to strike. They no longer go for long drawn out strikes but do staggered out strikes when they withdraw services. The 2 day strike by civil servants in the UK had most services shut down. Another 2 day shut down is planned until the government talks. I have been a victim of similar 2 strikes by British Airways staff in the UK when they have had labour issues. BA had several shutdowns of 2 days each and at the end of it all the unions resolved the dispute. The disruptions achieve their objective but do not kill the organisation!

So coming back to your little lie about patients rights - when they die for lack of medical attention from striking doctors, then you can no longer talk about thinking about their rights.

Just bear in mind, Kenyans love forgeting things and moving on. Just look over your shoulder and you will find that not many Kenyans remember that university lecturers were on strike after they went to work and no specific deal was made to them apart from a Kibaki directive to have the matter resolved soon. Their cause was taken out of the media limelight and that is what doctors will find themselves left with.

You have a labour issue, but do not alienate yourselves from the Kenyans for when they start dying you and the government will be enemies of the people.

[jakaswanga]

Dec 10, 2011 19:01:09 GMT 3 hannali said:

@ Jakaswanga The strike is all about patients rights, how long must we continue to accept mediocre services? counterfeit drugs? inadequate or absent facilities and supplies?

it is immoral for doctors not to strike under substandard and patient-endangering circumstances.

What is not sufficiently understood is that the Hippocratic Oath was sworn by students and is patient-benefitting in doctor-patient relationships on an individual level.

Against this it can be argued that doctors have a greater responsibility to the public’s health (particularly the vulnerable) than they have towards the treatment of an individual under their care. Doctors should not perpetuate the provision of substandard care even if betterment can only be achieved through strike action.

Hannali
Where we are now, I will support the doctor's strike, even as I wrestle with the practical moral dilemas. Like when patients start to die as the strike goes on.

But I think the general issue is a re-organisation of the health system. A total transformation. And in that process, even the doctors and medical personel will have to undergo a mentality change no less thorough than the useless politicians. Because I think the professionals in the industry are as much to blame for the collapse of the system, as the politicians.

I remember the days when doctors at Kenyatta NH had private clinics in town, and they would write a recept for a patient, and the drugs would come from the Hospital, but be paid for privately!
Dilemma: Should doctors, as entrepreneurs while still practicing medicine, be allowed to own pharmacies?
In a certain country they say no: reasoning that the docs, for good business, will over-prescribe in the rule, to increase drug sales, and the business profit!
How should we reason in Kenya?
I am aware of doctors holding privately paid consultations in their offices at public National Hospitals. Without paying rent... or at a local arrangement.. What do we do to streamline such... moonlighting?

I have many issues since I have friends who are docs and we have talked many a night over the contradictions of the system. But first things first: better pay and working conditions! then I can ruthlessly narrow down on you, docs! [if you promise not to suspend your Hip oath and inject me wrong in revenge!

[hannali]

@ Kamalet

Did You read the 13 point KMPDU PETITION TO THE GOVT i posted above? remuneration is point number 10!...
The govt has chosen to talk about this to the public and media as propaganda and to make us look ungrateful and uncaring!
Anyang Nyong today is blatantly lying through his teeth about the petitions by doctors...calling us interns when even the most senior consultants in the country are participating in the strike. www.standardmedia.co.ke/InsidePage.php?id=2000048131&cid=637

He is safe in UCSF carlifornia doing a check up on his PSA and getting androgen deprivation therapy (chemical castration in layman terms). What about the ordinary Kenyans who cannot fly out? have to share beds in threes with two more sleeping under? Have you been to KNH?? MTRH?? any district Hospital in Kenya?

Robert Green's 48 laws of power must be the script serikal is reading from "When faced with a difficult demand,Negotiate your way out of everything,negotiate by buying time and wearing out your opponent, If you have a younger and youthful opponent.. Time will wear him out, he will lessen his demands and accept whatever is thrown at him and he will be easy to distract." They are in for a shock!! WE WILL NOT WAIVER & WE WILL NOT FALTER.

At the end of the day it is the same Kenyans who say we are selfish who will enjoy quality health services when we succeed, therefore the Hippocratic oath commands me to take strike action so that i cannot perpetuate or be part of a substandard and dangerous healthcare system needlessly killing Kenyans which by some strange twist could end up killing me (YES- I have delivered babies from HIV + women using plastic bags because there were no gloves in the hospital). I will not be Good and do nothing and maintain STATUS QUO.........Remember Evil triumphs when Good men do nothing

[Titchaz]

Doctors at Coast general hospital in Mombasa assembly at the administration block in this picture taken on December 5, 2011 as they start their strike demanding for a better pay.

The Coast region secretary of the Kenya Medical Practitioners, Pharmacists and Dentist Union (KPMDU) Dr Abidan Mwachi addressing the striking doctors at Coast general hospital on December 7, 2011.

Public hospital doctors led by the Kenya Medical Practitioners Pharmacists and Dentist Union leaders, during the third day of the strike on December 7, 2011 in Nairobi.

Chairman of the Kenya Medical Practitioners Pharmacists and Dentist Union, Dr Victor Ngani, addresses doctors as they held demonstrations Nairobi on December 7, 2011.

A police officer walks past demonstrating public hospital doctors on December 7, 2011.

[Titchaz]

Doctors demonstrate along Haile Selassie Avenue in Nairobi demanding better pay

Doctors protest outside Treasury House in Nairobi demanding to be addressed By Finance Minister Uhuru Kenyatta over their salary increment on December 5, 2011.

Dr Atwoli Lukoye (centre), Mental Health Specialist (Consultant) at the Moi Teaching and Referral Hospital in Eldoret town, Dr Elias Onditi second (left), Kenya Medical Association's Eldoret branch chairman, Dr Richard Mogeni second (right), Kenya Medical Practitioners and Dentist Union for Eldoret branch, Secretary General and the union officials in Eldoret town address the press during the doctors strike for North Rift Region that entered the fourth day on December 8, 2011.

Striking doctors from New Nyanza provincial hospital carry placards on Kakamega -Kisumu road on December 5, 2011.

[Titchaz]

This one had me rolling........ ;D ;D ;D

Doctors from Western Provincial General Hospital Kakamega outside the hospital on December 6, 2011.

[Titchaz]

Doctors from New Nyanza provincial hospital on Kakamega -Kisumu road on December 5,2011.

Doctors protest outside Nyeri provincial headquarters where they sought to be addressed by Central Province Director of medical services Dr Gichuyia M'Riara on December 5, 2011.