Looming crisis in public hospitals over shortage of medical interns

Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) officials and other union officials march in Kisii town on March 4, 2024, over the delayed deployment of medical interns. [Samy Omingo, Standard] Kenya's public hospitals are staring at a looming crisis due to a shortage of medical workers attributed to the ongoing standoff on medical internships. The Kenya Medical Practitioners and Dentists Union (KMPDU) has warned that public hospitals are set to suffer critically in the provision of essential medical services due to a thinning workforce. According to the union, 27 per cent of healthcare workers in public facilities constitute medical interns, and their absence will cripple healthcare provision. "What we are faced with is a huge crisis in the making. Public hospitals cannot operate normally and it's bound to get worse should we fail to address the delay in posting interns to hospitals," notes Dr Dennis Miskellah, KMPDU's deputy secretary-general. "Medical interns are essentially doctors working under supervision. They do almost everything that a doctor does, from making calls, receiving casualties, they go to the theatre, and they perform all the crucial tasks," he adds. Nationwide strike The union's warning comes amidst the push by the government to avert this week's nationwide strike that was called for last Wednesday by the doctors' body. Calls for dialogue by Health Cabinet Secretary Susan Nakhumicha appear to have fallen on deaf ears as the union's Secretary-General, Dr Davji Atellah, last Wednesday signed the strike notice from his hospital bed. For the over 4,000 medical interns, it's been months of turmoil and desperation on end. Medical internship is a mandatory one-year programme before one is licensed as a doctor by the Ministry of Health. But for the current crop of aspiring doctors, the chance to practice comes with pitfalls. The recurrent internship stalemate has been longstanding, especially since the advent of devolution. The Ministry of Health has stated that the deployment of the current batch of medics will require Sh4.9 billion. The plot is set to get even thicker come July, this year, when an additional 4,000 new medical students are expected to graduate. The widespread demonstration by medical interns has attracted the attention of both local and international media since the attack on Dr Attelah on February 29. Both the government and the union have been unwilling to back down on their clamour. Speaking from his hospital bed, Dr Attelah reaffirmed KMPDU's position and accused the State of slowing down investigations into what he calls an attempted assassination. "The police who directly projected the teargas canister on my head had an intention to eliminate me because the moment you target someone's head, the damage is quite severe. It's out in the open that this person is known. However, I feel like enough is not being done to guarantee justice," said Dr Atellah. Human rights groups have mounted pressure to have the officers implicated face justice. "Article 37 of the Kenyan Constitution is explicit about the right to protest, to assemble, picket and to present petitions to public officials. In this case, KMPDU did issue a notice. They actually presented that particular notice to the police station and it was received. However, despite having all the legal requirements, we all know what happened. We submit that the secretary-general was particularly targeted," said Khalid Hussein, the executive director of Haki Africa. A day after the attack, Health CS Nakhumicha said Dr Attelah was not targetted. "That was an accident. I don't think anybody intended to hurt the SG and I called him myself. Nobody wanted to hurt him. It was just meant to disperse protestors but by bad luck it hit him on the head," she told reporters while on an official assignment in Narok. County hospitals such as Machakos County Referral Hospital and Kisii County Hospital have raised concerns over the strain without interns. The Machakos County health facility hosts 15 interns, including medical officer and clinical officer interns, and those in other cadres. "Without the interns, we fall short of the capacity to provide emergency care," says Dr Supa Tunje, a consultant pediatrician at Machakos County Referral Hospital. Intern doctors constitute the bulk of first responders for new admissions at county hospitals, and their absence is being felt. "The requirement is that every hospital that is an internship centre has a consultant to be able to supervise interns. Based on the number of consultants, a hospital can have an appropriate number of interns that they can be able to supervise," Dr Tunje says. Currently, Machakos County Referral Hospital has 40 specialists and requires approximately 20 interns across five rotations. Dr Tunje urges the Ministry of Health to expedite the issue of posting interns. "The Ministry of Health really needs to expedite this issue of posting interns so that we don't leave a gap in terms of care for the patients," she says. According to Dr Linda Kemunto, the KMPDU treasurer for the Nyanza branch, hospitals in the region are grappling with a strained workforce. "We have seen county governments not hiring doctors and health professionals, citing low budgetary allocations or a ballooning wage bill," she says. "We have also seen some hospitals taking matters into their own hands by hiring doctors at low pay and nurses on a locum basis," she adds. In medical parlance, a locum or locum tenens, is medic who fulfills another expert's duties on temporary terms. Extra shifts In Kisii County, for instance, doctors have been forced to take extra shifts, working longer than 40 hours a week, while others have been denied leave days due to shortage of healthcare workers. "We have seen doctors suffering from burnout and other mental health-related issues," Dr Kemunto notes. "When you have your doctors and nurses being overworked, it means that you don't receive quality services. Patients have to queue for a very long time, and this puts them at risk," Dr Kemunto explains. As the standoff persists, patients across the country are waiting to see who blinks first.

Looming crisis in public hospitals over shortage of medical interns

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