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When a country abandons her brightest minds

UREPORT
By Stanley Aruyaru | December 31st 2016

It is the last day of 2016, 27 days since the doctors went on strike crippling an already troubled health sector. Forty-eight days ago we knew it would happen, but we wished it away and somehow thought things would be sought out in some way.

We thought we had time. With 48 hours to go we realized time was not there after all. So we executed Kenya’s favorite maneuver. We sought a court injunction to the strike. Never mind we had 504 hours to do the same or something else.

This is not the 1st doctors’ strike in Kenya. It is the 3rd nationwide strike in less than five years. It looks the most far-reaching of all these. It is ‘the worst health workers strike in 32 years’, as per the words of a cabinet secretary.

The first of these strikes was in 2011 against a banner of major healthcare reforms. Numerous emotive but hardly quantified demands to improve the public healthcare were advanced by the doctors. Maybe the only figure the doctors had was 15%.

 This is the percentage of GDP that should be assigned to health care as per the Abuja task force which the Kenyan government was a signatory to. The doctors could not understand how a government could violate a signed agreement even before the ink dries. Well, now they do. Maybe they see it as the government’s way of doing things.

On Jamhuri day ( celebration of the birth of the republic) of 2011, a return to work formula would be signed, adding roughly 700 US dollars to the doctors' monthly pay besides setting in place a mechanism to document their grievances through a task force report and establish a matrix through which to address them.

 Several months, interviews and sitting down the line, a task force report would be penned between the government and the doctors. If I was the government, I would be very grateful.

 How many unions will force themselves into helping a government lay down a policy document? That’s for expatriates and technocrats at the cost of exorbitant sitting allowances at a five-star hotel conference rooms.

The recommendations from this taskforce look like a singular formula to fix the public health sector: 15% of GDP annually assigned to health, infrastructure improvement, medical supplies, human resources for health training, establishment of national ambulance service and a constitutional amendment to establish a health service commission that would be charged with the management of human resources for health.

This was in January 2012. The government would slip back into bureaucratic inertia and shelf the report at the ministry’s cathedral road headquarters.

Twelve months later, this inactivity would spring up the second doctors’ strike in December 2012. This was protracted. The government sacked all the striking doctors and advertised their positions.

Through brokerage by influential senior colleagues and the political leadership, timelines to draft a binding collective bargaining agreement (CBA) between the union and the government were proposed. The strike was called off. And the process of the CBA negotiations began in earnest.

Fast forward to December 2016, Kenyans have since elected a new government in 2013, the CBA has been concluded and signed by both parties and health services have been devolved as per the constitution of Kenya of 2010. Problem solved, you might think. Not quite.

The devolved governments have made a circus of the health sector. There have been 43 county strikes in the life of the current government according to union sources. Doctors have gone for half a year without salaries in some counties, while the release of Maybe for postgraduate training has been often ethnicized and politicized.

The brightest minds in the world have been dragged into a muddy circus between the national and county governments. The latest budgetary allocation to health (with a GDP of 63.4 Bn USD, we assigned 0.6Bn USD to health for 2016/2017 financial year) from the national government is a mockery of the Abuja declaration.

 The deadline for the millennium development goals came and we moved on, Sub-Saharan Africa having failed to meet the targets for the health-related MDGs.

The CBA was concluded in 2013 and signed by both the government and the doctors’ union. After two years without its registration in court (a prerogative of the government) despite The welfare lobbying by the doctors, the doctors sought a court order.

A year in the corridors of justice culminated in a ruling directing the government to engage the doctors to fast track registration and implementation of the agreement. The same script would play out.

Frequent reminders and reaching out from the doctors to the ministry of health as one arm of government ignored another. Thirty days for appeal elapsed, 45 days for the salary review body to respond to the court ruling elapsed. And it is 10 days to go before the 90-day red line is crossed.

Then, according to the court ruling, the CBA automatically gets deposited with the labor court and is registered. And the employer will have to honor it.

The contents of the CBA again are wide ranging from training, posting and transfer of personnel to infrastructure improvement. If this was a private business, this is the kind of stuff called turnaround strategy for struggling companies. Which other union does this? The welfare of populations above the welfare of its members?

Recently when asked in a TV interview whether the doctors should consider the suffering of patients even as they agitate, the secretary general Dr. Ouma Oluga had this to say, ‘the only suffering we are going to discuss is that of doctors.’

And that resonated with every doctor, seeing how much what they are agitating for includes healthcare improvement besides better remuneration and working conditions.

The equation that won’t add up is why a government negotiates and signs a CBA, absconds responsibility to register it, contests it in court, loses the case to the doctors, does not appeal the ruling but still disobeys the same courts that they have now implored to declare the doctors’ strike illegal.

Three weeks into the strike, all public hospitals including the largest referral hospital in east Africa that boasts of being the first in sub-Saharan Africa to carry an operation to separate Siamese twins remain grounded.

Mission and private hospitals are overwhelmed with an influx of patients. Our health ministry has been rocked with claims of mega corruption and voted among the most corrupt, while the health cabinet secretary (a former CEO of a top notch private hospital) has received a head of state commendation.

Public health sector is not a priority to the political elite. We have seen them fly to South Africa and Europe for the treatment of minor injuries that could be treated by Kenyan doctors. I would not mind if they used their monies. And then there is the indifferent Kenyan middle class.

I once had a talk with such a Kenyan. He had no idea the strike was nationwide, only thought it was in the capital. My colleague went to a catholic run hospital in the rift valley, I went to a similar one on the slopes of Mt Kenya. The message was the same-they are chocking with the influx of patients.


The middle-class people don’t know this. For a while, I thought we all had given up on the country’s leaders. That we have decided to turn a blind eye when political leaders call media to cover them launching an electricity pole, or an expensive Christmas tree. That they don’t care when reports surface of members of a county assembly travelling to Israel to see where Jesus was born.

But then a recent electoral law amendment takes place in our national assembly and I realize no, Kenyans have not been blunted. They just have been brainwashed. Politics equals life.

That is our life now. Infrastructure, health, public land......we cannot make noise about these. They don’t bother us, do they? Only politics is worthy our attention and comment.

From united opposition to clergy to foreign agencies to civil society to media houses. To the ordinary citizens. We are now staring at ushering in 2017 with city demos against the amendments to the electoral law. God forbid if such should turn violent and demonstrators suffer injuries when hospitals are closed.

How can a people allow politics (and bad politics for that matter) to be a way of life so much so that we forget dockets crucial to our human existence? When did all this happen?

 I will be going to my village for the prize giving at my former primary school and I fear if I stand and speak with some authority, people might request me to vie for the county or national assembly.

When recently a medical fraud was arrested carrying out dangerous surgeries on the unsuspecting public, his villagers instead of baying for his blood blessed him to vie for the county assembly. He was short of being assured of going in unopposed next year!

Maybe in the current national health crises, we can see the doctors as a people to remind us of our humanity. We can see the doctors’ leaders literally beaten up, threatened, trailed and issued an arrest warrant and court summons. And yet they stand their ground, emboldened, still focused on a cause that benefits the country more than the individual doctors.

A week before the strike I was discussing with a professor. He thought the strike was too militant for the decorum of a doctor. He thought we could just agitate and lobby and try all the shades of diplomacy. Three weeks into the strike he understands why doctors took this option. His prescription has not worked for half a decade, even in overdose.

The government, the public, and multiple other sector players have pleaded with doctors. They have invoked the humane heart and the Hippocratic Oath. But the doctors have quickly asked, why can’t you be human to the doctors?

As one union official writes, doctors don’t owe you healthcare provision. The Kenyan government does. Immediately after graduation, I signed my Hippocratic Oath. Then I framed it and hang it over my reading desk. I belief so many colleagues did as much. They know every line of that oath.

As we stand private hospitals are in crisis mode, calling doctors on locum and hiking the payment rates. How has it been that the board recommends locum rates at 3000 KShs/hour yet hospitals pay the doctors at 700KShs/hour? Only willing to increase it to 3000KSh/hour because of the shortage!

Maybe it’s time the country took a pause and said sorry to the doctors. How can you pick your brightest minds, subject them to 6 years of twins remain intense training that puts them through extremes of physical and emotional endurance, where a split second decision literally makes the difference between life and death, and still deny them their dignity?

 Let’s not even speak about pay here! Let’s speak about the female colleague carrying her sick baby on her back to perform a life- saving operation because no other doctor is available at her station. And in that county, there is no money for hiring more doctors or releasing her for post-graduate training!

Since no one is fighting for the doctors, let them fight for themselves. A medical career takes away most of social and family life. Going through internship takes away the very basic functions like eating and sleeping, yeah and going to the bathroom is no longer subconscious when you’re in a 10 hour operation. And going through residency to become a specialist?

I don’t know what happens as you grow old, for I have heard some older colleagues say this is our nature. That they went through worse! That can’t be enough reason to legitimize an illegality. I hope as I grow older I can turn to this piece and remind myself. The dignity of a human being first, before being branded a doctor.

So Kenyans, let doctors be. You have got no slightest idea what you have put your brightest minds through. Yes, I know they chose it. And so have they chosen to sanitize their house. The solution to your healthcare problems is political, not clinical. Demand good healthcare with the same zeal you are demanding (good) politics.

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