From graduation to limbo: The plight of unplaced medical graduates

Failure to place medical interns means many hospitals now have no junior doctors, impacting patient care. [iStockphoto] Imagine burning the midnight oil for eight years with the unwavering goal of becoming a doctor, only to be met with the harsh reality that you may never get the chance to touch a patient or step into the corridors of a hospital. This is the disheartening situation faced by more than 3,000 medical students who are yet to get internships several months after graduation. Irene Auma Otieno, who embarked on her Bachelor of Medicine and Bachelor of Surgery (MBChB) journey at Maseno University in November 2016, is one of them. "I was admitted to Maseno University on November 7, 2016, and was supposed to have completed my studies in 2022 but due to Covid-19 we had to stay home for one year," says Auma. The global pandemic forced Auma to earn her medical degree in May 2023. When Auma graduated from medical school, she was a source of pride for her family and hometown as she embodied the hopes and dreams of her entire village. Having benefited from fundraisers by the community, Auma represented hope as her medical degree was not just an individual honour, but a collective achievement. "I am here today as a person who actually contributed to finish her medical school," she says. "As the only girl that has gone to university from my village and graduated with a medical degree, it is a shame that I cannot practice," said Auma With a degree in hand, Auma feels only regret, despite passing exams and training for the esteemed career: her doctor-to-be dreams still hang in the balance. "I don't have a license. I am unposted and I cannot do anything. I am hoping the government will hear our cry and let us have our posting letters as soon as possible so that we can start serving the community," she said. On February 20, hundreds of interns converged at the Kenya Medical Association Centre (KMA) to question the delay in their postings for compulsory professional training and licensing by the Ministry of Health. During the protest, the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) issued a strike notice to push for the interns' posting. KMPDU Secretary General Dr Davji Bhimji Atella said they will down tools from March 1. "On Feb 29, 2024, all medical interns will go to the Ministry of Health to collect their internship letters failure to which from March 1, doctors will down their tools in solidarity with the interns or a notice will follow," said Dr Atella. In a letter addressed to the Ministry of Health on January 12, KMPDU expressed disappointment and highlighted the violation of sections of the Collective Bargaining Agreement (CBA). KMPDU officials led Secretary General Davji Atellah issued a nationwide strike notice over their pending CBAs. [Boniface Okendo, Standard] According to the CBA, the Kenya Medical Practitioners and Dentists Council (KMPDC) and Pharmacy and Poisons Board (PPB) should clear all medical officers, pharmacists, and dentists for posting to internship centres within 30 days. The guidelines for internship posting require that medical students get placement a month after completing their studies. The procedure for posting interns is detailed in the National Guidelines for Internship Training of Medical and Dental Officer Interns (2019). "Interns shall be posted within a month upon successful completion of their training and passing of the final examination, graduation notwithstanding; or passing of Council's Internship Qualifying Exams," the guidelines read in part. It is, however, emerging that the graduates may not get absorbed soon as Health Cabinet Secretary Susan Nakhumicha said her ministry requires Sh4.9 billion to implement its annual internship programme. Nakhumicha said the amount would cover one year of internship salaries for all the 3,580 January graduates at the current monthly rate of Sh206,000 mandated by the recent CBA for medical interns. "Somehow, the interns and the unions managed to put internship in the CBA which they reinforced themselves a salary of Sh206,000 per month," she said. She spoke while appearing before the National Assembly's Health Committee on Thursday to brief MPs on the ministry's 2024 budget policy statement on medical services. Nakhumicha emphasized the difficulties her ministry would encounter in deploying the cohort without the necessary funding. The compulsory professional medical training and licensing process is overseen by the Ministry of Health. It has now left the future of thousands of graduates in limbo, with some waiting even longer. Stalled dreams Fresh out of medical school, Dr Salim Adan expected he would dive right into serving vulnerable communities in Mandera, fulfilling his passion for healthcare and motivation behind pursuing this noble profession. A year after graduating from Uzima University in Kisumu, bureaucratic delays have derailed the promising young doctor's career dreams. Adan remains barred from obtaining his license without finishing the mandatory one-year hospital internship. "The reason I took medicine was to make a difference. Now seeing two years lost due to delays, I cannot even motivate peers from Mandera to pursue this field," says Adan. Adan pleads for policy reform. "We have spent heavily in time and money for this training to uplift our community's health. Now youth lose years to delays, risking disillusionment," he says. After graduating from medical school in December 2023, Harry Otieno, 26, expected to begin his supervised training and licensing to become a practicing doctor. Eight months later, Otieno's dreams remain stalled while his expertise goes untapped. "I completed my studies on July 7, 2023 and subsequently graduated on December 15, 2023, the current internship posting policy states that graduates should be posted at least a month after completing their studies," says Otieno. He says lack of clear guidance and the inability to utilise their hard-earned skills has left them aimless and depressed. "Most of us have spent seven to eight years in medical school for our various courses. This basically means that most of our youthful years have been in school. We hope of getting posted in good time and be able to serve the country's healthcare sector," said Otieno. The Ministry of Health says it needs Sh4.9 billion to be able to implement its annual internship programme. [Elvis Ogina, Standard] Nicole Sophie, 26, expected she would immediately dive into hands-on training to become a licensed doctor. Six months after graduating top of her class from Egerton University, Sophie remains stuck at home, dreams stalled by delays as she awaits deployment approval for her compulsory internship. "I completed my studies in August 2023 but the policy clearly states intern assignments should come within 30 days. Here, I am still home," says a frustrated Sophie. Sophie's family struggles to support her financially post-college, believing she would begin earning. But without a license, she cannot even take up locum jobs at clinics despite her qualifications. "I am a risk to patients until licensed. Apart from the frustration of just doing chores at home, there's no one to employ me," Sophie adds. But more worrying for her is how bottlenecks in deploying medical interns are straining Kenya's overburdened hospitals and healthcare. "Many hospitals now have no junior doctors. This greatly impacts patient care and public health," she said. This delay in obtaining mandatory licenses prevents these graduates from embarking on supervised hospital internships, a crucial final step in their hands-on residency. Thousands of promising young physicians completed all educational requirements long ago but still find their careers stalled, unable to utilise skills Kenya desperately needs, as they languish awaiting government approval to begin hands-on practice in hospitals. In its letter, KMPDU said: "The timely posting of interns is not only a contractual obligation of the ministry but also a crucial (aspect) of the effective function of our healthcare system. The delayed deployment of these healthcare professionals hampers their licensing as doctors as well as the delivery of essential medical services to the public." Despite being cleared for deployment by the KMPDC and PPB, the graduates say their career progression has stalled. "Medical interns are the backbone of this country's healthcare system and it is going to be a huge crisis if interns are not posted soon," says Muinde Nthusi, the Chairman of Association of Medical Students of the University of Nairobi. Nakhumicha said that the ministry may revise its internship policies to enable a smooth transition for medical graduates from university coursework directly into year-long hospital training programs. The CS has made proposals to pay them in the same range as other interns in Kenya.

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