Planning to study medicine? This degree won’t make you a doctor

 They decided to study Clinical Medicine. They were wrong [Photo: Courtesy]

Ruth Waruguru Wanjohi had an instatiable desire to one day become medical doctor. But that dream took a hit when she missed the required cut off marks needed to study for the Bachelor of Medicine and Bachelor of Surgery (MBChB) at the university as a regular student.

With her options thinning, the only other choice was to undertake the course under the module II programme. But at Sh500, 000 per year, this was not an option. She had to scratch her head together with her family for some something; anything equally gratifying.

Hundreds of kilometres away in Likoni, Naima Muia Namai too had a dream of studying medicine. Ruth and Naima, although worlds apart, were brought together by this single dream — to hold the stethoscope and help create a healthy society.

Determined to grant their wishes, their families went on a mission; combing, asking around and even sifting through papers for an alternative course; something that would bring equal joy to the hearts of these two girls who had passed their KCSE exams.

With their qualifications, Ruth and Naima would have opted to study Bachelor of Science in Nursing, Bachelor of Pharmacy or Dentistry. Other alternatives would have been a diploma in nursing, pharmaceutical technology, laboratory technology among others. But determined to land their dream course, they decided to study clinical medicine. They were wrong as they would soon find out.

 Where it all started

Kenya embarked on training Bachelor of Science in Clinical Medicine and Community Health in 2009; a degree course for clinical officers. However, the clinical officers’ training in Kenya dates back to the 1920s during the colonial era.

 

 They were wrong [Photo: Courtesy]

“The black man (Africans) could not be trained as doctors then,” says Prof. Lukoye Atwoli, Dean Moi University School of Medicine. “Only the whites and later Indians could become doctors. Africans were trained as clinical officers to assist the doctor who was white.”

Some physicians then, were concerned that training of such personnel would result in ‘professional dilution’, and hence their reference to this cadre as sub-assistant surgeon, sub-dispensary attendant, senior native medical assistant among others.

This is what is termed as non-physician clinicians, a notable example being in the west, where they are an equivalent of physician assistants in the health system. In the USA, more than 300,000 non-physician clinicians practice alongside physicians.

The British trained apothecaries, who dispensed medicines and often assumed additional clinical duties. Health workers known as dressers and dispensers were trained to provide basic surgical and medical care. The non-physician clinicians are known as clinical officers, health officers, physician assistants, nurse practitioners, or nurse clinicians with different roles depending on the countries that they are in.

The Kenyan cadre of Clinical Officer is broadly in two categories, that of general COs (RCOs) and specialist COs (SCOs). Specialist COs are those that have undertaken further training in a medical field, usually a higher diploma, like in anaesthesia, ophthalmology, ENT, Reproductive Health, etc.  COs are regulated by the Clinical Officers Council, an institution mandated under the Clinical Officers Act, CAP 260 to oversee their training, registration and licensing in Kenya.

 ‘Substitute clinician’

In Kenya though, the clinical officer is a like a ‘substitute clinician’, a role that has been the subject of tensions within the health ecosystem. Despite playing a critical role in the public health system as health providers, the role of COs in Kenya is one that is not very well understood, causing conflict in the system.

Kenya has so far churned out close to 20,000 clinical officers at both diploma and degree level. In fact, the number of clinical officers in training is three times that of the medical doctors in training.

 It is cheaper to train a clinical officer [Photo: Courtesy]

“It is cheaper to train a clinical officer than a medical doctor.” Peter Mwaura, Dean School of Clinical Medicine at Mount Kenya University commented. “Degree Clinical Medicine is a five year course, four years at the university and one year internship.” This costs at least Sh200, 000 per year at a private university.

The diploma COs training takes three years at KMTC and 1 year internship, at a cost of  Sh500,000 for the three years. Compare this with the training of a medical doctor which takes six years at the university and one year of internship. The parallel degree programme costs at least Sh500, 000 a year.

The rationale behind the KMTC training of this cadre of COs was that with the shorter period of training, that is three years compared to six years taken to train a medical doctor, they would temporarily plug in a health workforce shortage.

“They were to bridge the gap as the country trained medical doctors, but this transition to phase out the training never happened. Invested interests in KMTC became apparent,” Prof. Atwoli says.

This was a rapid deployment medical personnel that was to be phased out as need for medical doctors increased and that of the clinical officers decreased. What is being witnessed now in the country is an increased training of clinical officers as opposed to that of doctors. Between 2010 and 2012 for example, the number of clinical officers increased from 450 to 1500, an 86 per cent increase, compared to that of medical doctors that increased marginally from 365 to 491, a 16 per cent increase.

“There are thousands training in the clinical officers’ bachelors degree programme after MKU started the programme. Initially, it was meant for the diploma holders to upgrade, but now intake is after KCSE,” Prof. Atwoli says. “This is just an avenue for some universities to make money out of students and parents who lack the right information.”

Naima and Ruth joined a University which pioneered this course and as at 2017, had graduated 434 students. To them their training was no different from that of the medical doctors. Their internship was also no different, doing the 52 weeks of internship like the medical doctors. Unlike diploma CO, they were trained on how to carry out Caesarian Sections and other surgical procedures which have traditionally been the purview of the medical doctors.

In practice though, the degree CO and diploma CO are the same, offering the same services. In fact, the degree CO have had a much more difficult experience in the job market compared to their counterparts with diplomas.

Wrong call

“What I expected is not what I got. When you tell someone you have a degree in Clinical medicine, first they ask you, ‘what? Where did you get that?’” says Ruth.

“It is a bit painful, the time you take to educate a child, the finances involved; and after that the child is stranded,” Omar Namai, Halima’s father, laments.

“I have some regrets, what I expected is not what I got. But I don’t regret that much since I have something to hold on,” Naima says.