15 March 2017

Kenya: Strike Is Over! but the Pain, Deaths and Costs Will Be Felt for Many Years

In January, Mr Jared Onyimbo called the Nation newsroom asking for coverage to get money to save his 11-year-old son's life.

Fredrick Otieno was suffering from Leukaemia and had been referred to Moi Teaching and Referral Hospital (MTRH) in Eldoret from Kijabe Hospital, which could not handle the case.

There were no doctors at MTRH, and he did not have the money to seek care in private facilities.

The little boy died on the eve of the publication, surrounded by his distraught, helpless family, and away from the much-needed medical care that would have eased his pain as life ebbed out of his little body.

The impact of the 100-day doctors' strike, which was called off on Tuesday after the signing of a return-to-work formula between doctors and national and county governments, has been nothing short of gut wrenching.

Last month on the 23rd, a few days after Master Fredrick Otieno breathed his last, a 15-year-old pupil gave birth outside a private hospital in Mombasa after being turned away from public hospitals.

Earlier, in December, Ms Tabitha Bitali had also been turned away from MTRH, where she was scheduled to undergo a goitre operation.

Sadly, apart from these personal accounts of patients and families who have been to hell and back over the past three months, there is hardly any empirical data to analyse the impact of the strike. Neither is there any data available to quantify the effects of all the other four national doctors' strikes -- in 1971, 1981, 1994, and 2013.

PREGNANT WOMEN

One thing, however, is clear: pregnant women, accident victims, cancer patients and hundreds of thousands of outpatients have been on the receiving end of the industrial action.

In their pain and agony, some of these patients were turned away from public hospitals while others were abandoned in the facilities as doctors stayed away from their duty stations.

But probably the biggest losers in the quest to have the government sign a 2013 collective bargaining agreement, and the show of might between the two warring parties -- doctors and government -- were patients suffering from cancer and kidney failure.

For them, each day of the cumulative 100 days has resulted to days of psychological torture as they cling onto hope. The country's largest referral hospital, Kenyatta National Hospital (KNH), just like other public health facility across the country, shut its doors.

The only resort these patients had was to go to private facilities, where the cost of accessing radiotherapy or chemotherapy was unbearable.

And when issues at the discussion table became heated, some private facilities also decided to have a go-slow in solidarity with government doctors on strike, further plunging patients into despair.

COMPLETELY SHUT DOWN

In some hospitals, entire sections were completely shut down, while private clinics opened but did not offer medical services, leaving patients to their own devices. So, what was the true cost of this strike?

Dr Lukoye Atwoli, associate professor and dean of the medical school at Moi University and honorary secretary of the Kenya Medical Association (KMA), believes it goes beyond the deaths to include the financials.

"Count the number of patients that seek outpatient and inpatient services from a hospital and multiply that by the amount of money each pays for the services," he said, explaining further that "it would give you an idea of how much a hospital and the economy lost in a day".

Data from KNH shows that, in 2015 alone, it attended to 568,174 people seeking outpatient services, which is about 1,556 people a day.The inpatients were about 84,460, an equivalent of about 231 people being hospitalised in the facility every day.

One of KNH's busiest departments, the maternity wing that conducts more than 40 deliveries on a busy day, remained empty throughout the strike, and Ms Raheli Mukhwana, who is a midwife at the facility, told the Nation that nurses, who remained on duty, did not admit patients.

DEFAULTING ON PAYEMNT

The suffering of patients may have been heightened around Nairobi because the corridors of other high traffic public hospitals such as Pumwani, Mbagathi and Mama Lucy were ghostly.

Neighbouring private hospitals such as Nairobi West reported a surge of patients, some of whom ended up defaulting on payment.

But even so, some people have argued that the biggest gainers of the industrial action by doctors in public services were private facilities.

But Dr Timothy Olweny, secretary-general of the Kenya Association of Private Hospitals, disagrees. In an interview with the Nation 'on Tuesday, he said contrary to the notion that private hospitals have had a booming business it has been business as usual.

"When the strike begun, many patients were not even aware of it but after the information about the strike trickled in, some would go to private facilities to be stabilised," said Dr Olweny.

After stabilisation, the patients who needed more care would be referred to smaller private facilities where they would afford treatment.

"As the days progressed and people saw that the strike was not about to end, they stopped going to hospitals altogether. So most of the private facilities have just been taking care of the clientele they have been having," added Dr Olweny.

PRIVATE FACILITIES

To him, some private facilities instead of making money incurred some expenses for offering critical care like emergency services and stabilisation of patients for free.A 2005 report by the Ministry of Health and USAid showed that government-sponsored centres only account for a third of all health facilities.

But the majority of patients, especially those requiring specialised care, attend public hospitals.

The reasons for the strike was, among many other things, demand for better pay, working conditions and fiscal support for research.

Last Tuesday, immediately after the Devolution Conference in Naivasha, the Ministry of Health sent messages to medics indicating that it had honoured the financial demands, giving junior doctors a pay increase that would see the least paid earning Sh196,244 from Sh127,910 (53pc rise). The highest paid in job group T would earn Sh592,980.

In their CBA, the proposed additional Sh10,000 risk allowance has been removed.

Also, the extraneous allowance in the new deal is Sh30,000 across all the eight job groups, which differs from the 2013 CBA, which had proposed that medical specialists in job groups S and T receive a Sh40,000 extraneous allowance.

The new agreement made no mention of the other "non-human resource" demands that the doctors asked for.

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After 100 days of deaths, pain and despair, the doctors' strike is set to end this evening. Read more »

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