Medical interns: Young doctors who 'carry weight of health care'

The Kenya Medical Practitioners Pharmacists and Dentists Union holds a procession in Nairobi advocating for the posting of medical interns and Postgraduates for fee payments. March 4, 2024. [Jonah Onyango, Standard] The controversy over medical interns has put Health Cabinet Secretary Susan Nakhumicha and the Salaries and Remuneration Commission in deep trouble, especially among medics. And the debate has laid bare the role of interns, who medical professionals described as the workers who "carry the weight of emergency health care as well as routine care" in hospitals. The young graduates are also government employees, contrary to Ms Nakhumicha's assertion. According to the Medical Council's Act, they are government employees working under supervision but doing all services of a doctor. "Internship means a prescribed period of employment during which a medical or detail graduate works under supervision to fulfill registration requirement," reads a section of the Medical Practitioners and Dentist Act. Doctors are now accusing the CS and the commission of belittling the medical interns. "CS Nakhumicha spoke on TV with a lot of ignorance for having not experienced internship, or not engaged in the process that undertakes somebody to be an intern. I am also witnessing ignorance of law," says Kenya Medical Practitioners Pharmacists Dentists Union (KMPDU) Secretary General Davji Atellah. An intern is attached to a hospital during the third year as a medical student. After years of study, depending on the course or university of training, medical students graduate as doctors, and proceed on internship programme on an employment basis. During posting, they handle health roles on their own and only seek guidance when need be. The role is done with close monitoring by consultant doctors. "Consultant in hospitals play other roles. It is not like the intern doctors are with them all the time, unless they encounter complicated cased," says Dr Atellah. He adds: "Intern doctors are certified to offer healthcare, after taking an oath of practice. The only thing they lack is a licence to practise, which is issued after one year of internship". Their significant role is demonstrated by the fact that most counties depend on them for care, and they are on call for 24 hours. Doctors, who are on nationwide strike demanding posting of interns, have vowed not to report at work until 1,300 intern doctors are posted. KPMDU says internship is a global requirement. According to the CS, interns do not deserve a salary. "Interns are supposed to provide their duty under supervision of specialists or expert medical officers. In this case, we are not supposed to speak about remuneration as these are still students," she said. Initially, according to the 2017 Collective Bargaining Agreement (CBA) signed between doctors and the Ministry of Health, an intern doctor should earn Sh206,000 a month. But SRC has slashed the pay to between Sh47,000 and Sh70,000, earning the wrath of the health workers. The doctors also scoffed at the Health CS over remarks that she had received calls from about 50 intern doctors ready to work without stipends just to be registered. Prof Lukoye Atwoli, an expert in mental health, said medical interns carry the weight of emergency health care as well as routine care in Kenyan hospitals. He said it is also wrong for SRC to convert intern doctors' salary into stipends. "So six days ago, the Chairperson of the SRC...signs a letter that says the new salary scale for these fellows will now be Sh47,000 to Sh70,000," he wrote on social media. Anjela Nambiro, 28, who graduated from Moi University after eight years, said although a ballot (placement of internship portal) indicates she is supposed to move to Baringo, she is yet to receive an official posting letter. She also said the new remuneration was too little. "I have never been to Baringo and my family is in Butere. Just how enough is Sh47,000 for relocation and affording my needs? Will they still deduct 2.75 per cent for medical scheme and other taxes?" she posed. Her study was marred with numerous strikes and Covid-19 pandemic and she was looking forward to starting her career after graduating in December. "I feel hopeless. I feel like my dreams have been crushed, and going to school for seven years has been a waste," she said. "It disturbs me that the government is killing my profession and morale. My grandfather is more frustrated," she added. Dr Abdi Adow, also waiting to be posted, wondered: "What will I eat, what will I pay rent with? How can someone operate in a hospital without money? I will faint due to starvation."

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