Doctors’ strike: Kenya government is killing poor people

"I'm admitted in St. Mary's Hospital, Langata, Ward 1, Female Medical Ward. Unfortunately, it appears that I took one of the last available beds, if not the last one. The doctors' strike means that most public hospitals are not admitting patients ... Those who will come after the last bed is taken will be turned away. A few lucky ones will get into another hospital. The majority will go back home to wait for the strike to end. Some will survive; some will die.

“What are healthy Kenyans doing to help their fellow Kenyans who need healthcare services now? Or, perhaps, you're sitting on the sidelines watching the horror show for entertainment and political incitement? Good. Do nothing; after all, this sort of thing – illness - happens to someone else. I, too, once was in that comfort zone.”

Kenyan social justice activist Wangui Mbatia wrote these words on her Facebook page on 10 January 2017. She died of cancer exactly a month later, on 10 February. (A tribute to her appears elsewhere in this issue.)

Perhaps Wangui’s life could have been saved. Perhaps not.

At the best of times, most of Kenya’s public hospitals are simply death houses – despite all that jazz about Kenya being a middle income country and the “economic powerhouse of East Africa”. From time to time, media reports carry depressing tales of hapless patients dying miserable deaths in those hospitals for lack of basic medical equipment, drugs and personnel. Late last year, a Catholic nun based at Kenyatta National Hospital, which is famously described as “the largest referral hospital in East Africa”, recounted to us how she painfully watches patients die daily in the hospital’s corridors for lack of attention. On that day she had counted four deaths.

With a hugely successful doctors’ strike that has paralyzed the crumbling public healthcare system nationwide for the third month now, only God knows how many poor Kenyans have needlessly died while seeking medical services.

Workers’ strikes are very common in Kenya. In addition to doctors, clinicians and public university lecturers and non-academic staff have also downed their tools. In a terribly mismanaged economy characterized by massive theft of public funds, a ballooning public debt, mass poverty, a tiny manufacturing sector and soaring unemployment, one group of workers or another is always up in arms demanding better terms and conditions of work. In this setting, it is easy for the public to dismiss the doctors’ strike as just another industrial action.

Highest attainable standard of health

But contrary to the perception – created, no doubt, by the government and its attack dogs – that the doctors are making unrealistic demands driven by greed, in reality the strike is a struggle for the right to decent health services for all Kenyans. The Constitution of Kenya Article 43 (1) (a) entitles every Kenyan "to the highest attainable standard of health, which includes the right to health care services, including reproductive health care". There is little to show that serious efforts are being undertaken to attain this ideal.

Medical doctors resorted to strike action on 5 December 2016 after the government refused to implement a collective bargaining agreement signed with the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) way back in 2013 – a few months after the current rulers took power. Looking through the CBA, one easily concludes that the government doesn't really care about doctors in its service – and, by extension, about the majority of citizens who seek medical services in public health facilities. It is astounding that the government has never bothered to iron out basic employment issues such as basic pay and allowances, hours of work a week, promotions and continuous professional development of its doctors. Why would a government supposedly committed to the provision of adequate healthcare for its people consider it pointless setting up a medical research fund for its doctors?

Is it too much to ask that “each doctor in whatever facility shall be reasonably equipped with the tools and equipment necessary for the performance of his/her job?” Or that “each facility shall have a doctors’ room adequately furnished with a computer, Internet access, lounge chairs, etc”? Or that “a doctor should be provided with adequate health professionals and other support staff for the performance of their duties”? How are doctors expected to discharge their duties in the absence of these things?

Deplorable terms and conditions of work are responsible for the exodus of doctors from public service witnessed in Kenya, leaving many poor people who go to public hospitals without adequate medical attention. In 2015, for example, the doctors’ union reported that about 2,000 doctors had quit public service over the previous year. In 2011, 80 percent of newly qualified doctors quit government service before the end of their first year at work.

Realities of a Kenyan ward

One of these is Dr Onyimbo Kerama, now working in the Democratic Republic of Congo. Upon graduation he was posted to Thika Hospital, some 50 kilometers from Nairobi. His horrific experience, which offers a snapshot of the typical Kenyan hospital, deserves sharing at length:

"Nothing had ever prepared me for the realities of a Kenyan ward. Dr Magutu and I had to work 18 to 24 hours, seven days a week, to manage the ward. We tried. We had a strong sense of service, the energy of new doctors and the desire to be the change we believed in. But quickly, the disappointments started to build up. Dr Magutu once resuscitated a baby from 9pm to morning…

“In the outpatient clinic, there were many children with cranial palsies. This is a brain-damage condition that affects newborns when they are deprived of oxygen during birth. Such mothers should in normal circumstances go through caesarean section but these were delayed due to poor staffing. Many pregnant women leave government hospitals with a fresh stillbirth or children with irreversible brain damage due to inadequately managed foetal distress…

“Diabetes cases always came too late, with chronic renal failure or with amputations, etc. Malignant cancers presenting with metastasis. It was terrible. Surgical wards were the most tragic of all. Due to delays caused by lack of enough doctors, many cases ended up in amputations. With one operating room, one or two surgeons against more than 10,000 Kenyans needing surgery, it could take up to six months to operate. Many are those who died before they could get the life-saving surgery.”

Massive corruption and inadequate allocation of funds to health means fewer and poorly paid staff, lack of required supplies and a very strained health infrastructure, Dr Kerama says.

Government doesn't care

It all comes down to lack of commitment by the government to provide proper health services to its citizens. In other words the government doesn't care. The government always seems to be able to somehow find the money for huge spectacular projects but never has enough to pay some of its most critical workers. It would rather spend huge sums of money on mega-projects – where it is easy for well-connected politicians and bureaucrats to steal funds – than pay doctors well. A few days after Kenya launched a $420 million medical equipment project for local hospitals in 2015, it emerged that five doctors in Lamu County had tendered their resignation, leaving just one doctor tending 100,000 citizens.

Does it make sense to accuse doctors of being greedy and insensitive to the plight of patients when the four-year-old CBA the government refuses to honour provides that, “The Ministry shall endeavor to retain the doctors currently under its employment. The Ministry shall additionally endeavor to employ one thousand two hundred doctors per year for the next four years to reduce the current gap in the number of doctors in the public sector”?

Doctors are justifiably frustrated by the government’s Machiavellian tactics in handling this issue. There have been lots of trumpeting by the Uhuru Kenyatta regime and its backers about massive investments in the health sector, without a single word about improving the terms and conditions of work of health workers in public service to attract and retain the best in the business.

Attempts to delegitimise the genuine struggle of doctors for Kenyan people against a self-absorbed regime by casting them as uncaring and money-minded are cynical and pathetically shallow. The same people propagating this sick narrative would complain about the poor services of a doctor or nurse who is tired, demoralized, inattentive and frustrated by too much work and little pay in deplorable working conditions in public hospitals where poor people are taken to simply die. Where are the health workers expected to find the energy and motivation to give high quality professional care if they themselves are neglected?

From deference to defiance

The current crisis is a political one – in the sense that the priority in allocation of public money is about the welfare of the rich and the ruling classes, and putting up of mega-projects for political show, and not providing basic services like health care to the majority poor.

Moreover, the mind-boggling looting spree presided over by Kenya’s despicable excuse for leaders, Uhuru Kenyatta and William Ruto, belies any tall tales about lack of funds to give health workers a decent pay.

This crisis should jolt Kenyans up from their slumber to see the desperate need for a competent and people-centred leadership in this country.

The doctors’ struggle mirrors the struggles of the poor people in Kenya. Citizens must reflect honestly, without giving excuses, about how misrule in Kenya has plunged people into needless misery and death.

This is squarely a class issue, not one of tribe, gender or creed. It is not only that doctors, after years of schooling, are paid far less than Members of County Assembly who only require a secondary education; millions of people in Kenya go to bed hungry, cannot afford a good education for their children, cannot find a job, have no access to clean water and sanitation, good clothes or decent housing.

Kenyans are heavily taxed, directly and otherwise. Billions of shillings are borrowed in their name each year. The country is currently groaning under the weight of a humongous public debt. But what do the majority of the citizens have to show for all that money?

One of the most disappointing things about the doctors’ strike is that most Kenyans seem to treat it as a matter of concern to the medics alone. For weeks as the strike dragged on, there was little public support for the doctors. That is why from her hospital bed, Wangui Mbatia asked this searching question: “What are healthy Kenyans doing to help their fellow Kenyans who need healthcare services now? Or, perhaps you're sitting on the sidelines watching the horror show for entertainment and political incitement?”

It is completely unthinkable that this life-and-death strike now in its third month has not provoked a national uprising in Kenya. So many poor people dying in the corridors of empty public hospitals, while the national leadership is busy traversing the country campaigning for re-election in August, is supposed to be normal? Throngs of citizens turning up at rallies to listen to and cheer these politicians, without a thought about what would happen to them or their loved ones if they fell ill? TV stations interrupting regular transmission to cover just these rallies? This is alarming. Kenya has a long-standing glorious history of resistance to oppression. What could be happening to this tradition?

Wangui’s voice, now silent, should goad us to realize that the struggle is much bigger. It is not just about doctors, or teachers, or students. Kenya’s robust labour movement itself needs to understand the broader context of worker oppression, extend their organizing beyond welfare concerns and build strategic solidarity with other movements engaged in the struggle for the liberation of Kenya. The oppressors are the same. They are motivated by similar interests. This is a call to action, a call to organize; a call for solidarity and sacrifice to liberate Kenya from the shackles of self-interested elite misrule.

* Henry Makori is an editor with Pambazuka News.

* THE VIEWS OF THE ABOVE ARTICLE ARE THOSE OF THE AUTHOR AND DO NOT NECESSARILY REFLECT THE VIEWS OF THE PAMBAZUKA NEWS EDITORIAL TEAM

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