More pain for patients as doctors in referral hospitals join strike

KMPDU secretary general Davji Bhimji Atellah (C) accompanied by other medical practitioners, addresses press on 18th March 2024 at Blue Violet Plaza in Nairobi. [Edward Kiplimo,Standard]

The crisis in public hospitals is set to worsen after doctors who have been working in referral hospitals announced that they are joining the ongoing strike.

On the day the doctors vowed to stay put, the court ordered them to appear for a meeting called by Head of Public Service Felix Koskei to resolve the crisis.

The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) on Wednesday announced a halt to all medical services at the Kenyatta University Teaching Referral and Research Hospital and all referral facilities countrywide.

Speaking at the hospital, KMPDU Secretary General Davji Atella said their intention was not to make patients suffer, but to push for better working conditions and implementation of agreed labour policies.

"We have resolved to close even the bare minimum services at KUTRRH until the hospital stops the casualisation of doctors through locum-short-term contracts that deny them dignity and pension," said Dr Atella.

The move follows a proposal by the Salaries and Remuneration Commission (SRC) to reduce medical interns salaries by 91 per cent on Wednesday. This, the union says, contravenes a 2017-2021 collective bargaining agreement (CBA).

The union said the proposals would exploit medical interns who account for 30 per cent of the workforce in the healthcare system. "If you check an intern's logbook, you will be amazed by the amount of work they handle. They do everything. When the CS says interns earn a lot and request a review of interns salaries without involving us or the commission, it smacks of hypocrisy and malice."

A document by the Ministry of Health and the SRC places a medical intern at the lowest end of cadres. The document proposes a stipend of Sh27,000 for the lowest earner and Sh70,000 for the highest.

But the union insisted that this proposals contradicts the ministry's claim that it needs Sh4.9 billion to implement its annual internship programme. The union leaders said the figure by the ministry goes beyond its demands.

"We were given slots for 2,000 medical interns and we only need Sh1.4 billion to pay the interns in the current CBA rate. The internship policy and the CBA is locked. We are not going to be frustrated into revising the progress on the CBA backwards.

"The government has been lazy. We met the Ministry of Health on Monday only to realise they were playing ping-pong games with us," Dr Atella said.

He cited the ministry's plan to post medical interns on April 1 while simultaneously reducing their salaries by 91 per cent as an example of 'conmanship' from the government side. He also criticised a recent meeting with the Ministry of Labour, claiming 18 lawyers were present with no concrete offer to the union.

Dr Malindi Chao, KMPDU Branch Secretary at Mama Lucy Kibaki Hospital in Nairobi, said staffing levels are "nowhere close to World Health Organization Standards".

"We have doctors who have been working on locums (temporary contracts) for the last seven months with no salary, yet they have responsibilities. We also have discrimination where doctors don't get the same pay for the same job despite working more than 40 hours a week," said Dr Chao.

And at the Employment and Labour Relations Court in Nairobi, Justice Byrum Ongaya ordered all parties in the standoff to appear at the Kenyatta International Convention Centre pavilion from 4.45pm.

Justice Ongaya said the meeting should provide an amicable solution to the ongoing strike and differences on intern doctors attachments and pay.

In the meantime, the judge said that those who will meet should endeavour to discuss the strike notices and how many doctors should be serving Kenyans when there is a countrywide strike.

The judge also directed the Federation of Kenya Employers, Central Organisation of Trade Unions and all governors to join the meeting.

Meanwhile, patients seeking treatment in specialised consultant clinics and admission wards at various public facilities were not attended to.

At the Nakuru Level Five Hospital, The Standard established that the facility had made arrangements to have a few doctors providing services as the rest continued with the strike. A spot check at various departments revealed that patients were being served by fewer medics than usual, causing a delay in service delivery.

"I am glad that I have found a doctor who has attended to me. In my engagement with him, I established that he was seeing more patients than usual as his colleagues were absent," said Benson Maina, a patient.

At the casualty, emergency, and special clinics there were shorter queues than usual.

"Many people know that the doctors are on strike. That is why they have kept away from public hospitals. They are unaware that a few doctors are available to treat them," said Jane Mukami, a patient.

The patients criticised the government for not taking the strike seriously. "The government has misplaced priorities. Instead of focusing on the primary needs of Kenyans that are life-saving, they are looking at their pay and housing projects and laws," said Teresa Wangui.

The Standard established that only a few doctors were available at the in-patient section, leaving relatives of some of the patients contemplating transferring their loved ones to other facilities.

"The services being offered are not enough. We need more. If nothing will change in two days, I will have to transfer my mother to another hospital," said Stephen Karanja.

At Nyeri County Referral Hospital and level 4 facilities, emergency services and outpatient services continued while clinics for non-communicable diseases such as cancer, hypertension, diabetes, and orthopaedics remained postponed until further notice.

Operations went on as usual at the hospital's outpatient wing where patients suffering from common ailments were attended to.

Joseph Maina from Chaka said he was experiencing chest pains and could not be attended to because he required a specialist doctor and he was asked to return on a later date.

At Mt Kenya Hospital, operations went on as normal as the public sought medical services that included children's clinics and immunization.

In Trans Nzoia, doctors stayed away and desperate patients were turned away from the facilities. Rose Sanja from Kolongolo said her cousin, Martin Barasa, needed surgery after an accident.

A spot check at Vihiga, Bungoma, and Kakamega County referral hospitals showed nurses and clinical officers attended to patients with common ailments. Private hospitals in the region continued to record high numbers of patients seeking treatment.

[Reports by Maryann Muganda, Noel Nabiswa, Kamau Muthoni, Kennedy Gachui, Purity Mwangi, Martin Ndiema and Mary Imenza]