Ill-equipped hospitals and poor pay drive 4,000 doctors away
Dr Charles Wambulwa, an emergency physician at Howard University Hospital in Canada, yearns to return to Kenya and work in a local health facility.
But fears that he could end up suffering from depression from watching patients die from easily treatable diseases because of lack of equipment are making him hold back.
As a student at Starehe Boys Centre in the 1990s, Dr Wambulwa was delighted when the school, through its career development programme, found him an attachment as a volunteer at Kenyatta National Hospital.
â€œAt the end of the attachment, I changed my mind after seeing patients not being attended to for what my mentoring doctor said was lack of equipment,â€ he recalls.
The worst case involved a patient in his 40s who lay on the floor for three days while dehydrated. â€œWhen I asked why, the doctor said the hospital did not have enough beds,â€ Dr Wambulwa said.
â€œSeeing patients suffer needlessly made me swear I would never be a doctor,â€ he said.
But destiny came calling years later after he moved to the United States and completed a degree in Liberal Arts. He enrolled at Howard University College of Medicine.
Today, Dr Wambulwa works for a month every year at a public hospital in Kenya. He says conditions have improved but the situation is still dire.
â€œI once worked at a hospital where babies shared beds,â€ he said. â€œThis is unacceptable in health, worse still at a referral facility.â€
In such cases, Dr Wambulwa said, a baby can be treated but then leaves the hospital with another disease.
Dr Wambulwa has worked at KNH, Moi Referral Hospital in Eldoret, Kitale General Hospital and Kakamega Provincial General Hospital.
His story may sound exaggerated but it underlines the problems local hospitals face which the government of President Uhuru Kenyatta face.
The Jubilee manifesto, which the new government started implementing this week by ordering free maternity health care, agrees with Dr Wambulwaâ€™s statement that easily preventable diseases like malaria, tuberculosis and HIV/Aids claim too many lives each year, largely because hospitals are ill-equipped.
â€œHospital services must improve, with better pay and conditionsÂ for healthcare professionals and a higher standard of care and treatment for patients being central to our health sector reform agenda,â€ the manifesto says.
So bad is the situation of inadequate facilities that Dr Daniel Ondiek, who graduated from the University of Nairobi, quit for aviation after just three years on the job.
â€œWhen you lack very basic equipment, you end up counting avoidable deaths;Â you end up living with a heavy heart that someone died of an avoidable cause,â€ he says.
Dr Ondiek also says poor salaries were driving medics to other countries or in his case, other professions.
The entry salary for a pilot is Sh400,000 while a medical intern starts with a measly Sh45,000.
A Saturday Nation survey of major hospitals established that though the Kibaki administration did a lot to equip hospitals and provide adequate staff, a lot still remains to be done.
At Kakamega Provincial Hospital, the only referral facility in the region, a shortage of staff has driven patients to private hospitals.
The hospital has 15 consultants and 250 nurses who are overwhelmed by the large number of patients.
Patients also have to make do with crowded wards and lack of medicine.
Lack of equipment, including delivery couches for expectant mothers, baby coats and warmers for the newly-borns, can dishearten any doctor.
At some health centres, expectant mothers have to make do with hard wooden delivery couches.
Nyeri Provincial General Hospitalâ€™s old equipment does not conform to the current norms and standards, Superintendent Dr Kimani Mwago says.
Dr Kimani says the equipment was too old to be of any use in tackling emerging disease patterns.
He also said the hospital did not have adequate space for delivery rooms, maternity wards or pharmacy.
In Nyanza, the biggest problem was lack of adequate bed space.
Director of Medical Services in Nyanza Dr Lusi Ojwangâ€™ agrees health facilities in the region are still ill-equipped despite massive investment by the Kibaki regime.
Dr Ojwangâ€™ said a Sh98 million maternity facility will be built at Bondo in Siaya County.
He complained about inadequate support for cancer management in the region, saying most cases had to be referred to hospitals out of Nyanza.
Kenya Medical Practitioners and Dentists Union secretary-general Boniface Chitayi says the shortage of experts resulted in avoidable deaths and poor healthcare.
A survey by the US-based Centre for Global Development shows that nearly 4,000 Kenyan doctors are working in the UK, US, Canada, Australia, South Africa, Spain, Belgium and Portugal.
This is twice the number of doctors working at the two national referral hospitals â€” Kenyatta and Moi â€” and the two Health ministries.
This makes Kenya one of the top six countries in Africa exporting doctors, a worrying trend given that the doctor to patient ratio in the country is 1:17,000 against the World Health Organisation standard of 1:1,000.
Ms Sara Were, an officer with the Kenya Medical Practitioners and Dentist Board, says last year alone, 48 doctors applied for a certificate of status of residence, which is an expression of interest to migrate.
Currently, she says, there are about 6,000 registered doctors in Kenya.
The Jubilee manifesto acknowledges the problem and promises to put in place measures to stop it. â€œStrategies must be developed to stem the brain drain to ensure the maximum possible utilisation of the skills of Kenyan-trained doctors for the benefit of our own citizens,â€ says the manifesto.
Besides pay, doctors cite lack of basic medical supplies for seeking greener pastures.
â€œI worked at Nakuru Provincial Hospital where there was one life support machine. God forbid, if an accident happens and two patients are brought in.
â€œYou put one on the machine and pray for the other. Itâ€™s like supervising patientsâ€™ deaths,â€ says Dr Victor Ngâ€™ani, who works in the intensive care unit at Mater Hospital.
Medical personnel spend a lot of years in school only to be posted to facilities without equipment, he says.
â€œBabies dye because there are no incubators, patients die because of lack of blood for transfusion,â€ says Dr Ngaâ€™ni, who is the unionâ€™s chairman.
Dr Mohamed Abdi, who owns a private hospital in Nairobi, says a doctor without equipment is reduced to the â€œclerical jobâ€ of referring patients for conditions he or she can treat.
â€œEventually the passion for medicine dies because you keep referring patients to Kenyatta National Hospital for things you can do,â€ he said.
â€œWhy should I refer a patient with a broken leg to Kenyatta because there is no X-ray at the facility I am posted to?â€
Doctors last year went on strike for not only higher pay but also the hiring of 700 doctors across the country.
Dr Ngâ€™ani said the government should invest in the health of citizens through adequate staffing. â€œHealthcare is a right that should be easily accessible to all,â€ he said.
â€œThe government must invest in healthcare or else go home,â€ Dr Ngâ€™ani said.
He said an additional 700 doctors would go a long way in bridging a deficit of 32,000 doctors.