With public sector doctors and the government at an impasse, patients are beginning to overwhelm private hospitals.
Kijabe, Kenya – At the bottom of a winding, tree-lined road, a crowd of patients spills out of the entrance of a private hospital waiting room on to a patio and a dirt parking lot. It begins to rain, and a man on crutches tries to hobble into the cramped building for cover.
Sitting in a wheelchair outside the door is Dorcas Kiteng’e, a 25-year-old woman suffering from cancerous growths in her ovaries.
“They’re pressing down on the spine, they’re paralysing her,” says Mwende Mutambuki, Kiteng’e’s sister-in-law. “She can’t walk. Back pain, leg pain – I’m hoping it hasn’t spread.”
Kijabe is the third hospital they’ve visited since they arrived in the Kenyan capital Nairobi last week, looking for an oncologist who could perform the surgery, only to be turned away.
“They sent us to Agha Khan,” says Mutambuki, referring to the private Nairobi hospital that’s regarded as one of the nation’s finest. “But we know we were not going to be able to afford that.”
She fears time is running out to save her sister-in-law: “It’s a matter of life or death.”
Two months ago Kenya’s public sector doctors walked out on strike, and millions of Kenyans who normally depend on them are beginning to overwhelm the nation’s private hospitals, particularly in rural areas.
One nurse in the accident and emergency ward at Kijabe estimated they were taking in twice as many patients as before the strike began. Each 12-hour shift has turned into a nonstop frenzy of activity. Meanwhile, people with non-emergency health issues are being triaged. “We’ve been here for five hours,” said one worried-looking mother sitting with her adolescent son in the hospital’s waiting room.
Outside Kijabe Hospital, north of Nairobi, Mwende Mutambuki, left, waits with her brother and her sister-in-law Dorcas Kiteng’e to learn whether doctors will perform surgery to remove Kiteng’e’s ovarian tumours. Since public sector doctors went on strike in December, Kenyans have overwhelmed private hospitals, leading to long waiting times for procedures. [Jacob Kushner/Al Jazeera]
In 2013, Kenya’s government agreed to increase salaries for doctors, dentists and other medical professionals. Currently, starting doctors earn as little as $14,800 annually. Under the new agreement they would earn a minimum of $37,700. Mid-level doctors would see their annual salary go from $15,700 to $40,000.
The agreement was also intended to bolster Kenya’s public health system, setting aside money to fund medical research and to provide doctors with ongoing training to improve their skills. It would also create 400 new residency positions, establish overtime pay, create a grievance procedure for equipment shortages, and hire 1,200 new doctors each year for four years to address the severe nationwide shortage.
But four years on, officials still haven’t begun to implement any of those changes.
Hundreds of medical workers descended upon Nairobi’s federal courthouse last week demanding clemency for the eight medical union leaders who face jail after the court ruled last month that the strike they’re leading is illegal.
Whistling, shouting and waving signs blaming Kenya’s health ministry for failing to provide Kenyans with adequate public healthcare, the doctors chanted in unison the letters “CBA” in reference to the 2013 Comprehensive Bargaining Agreement.
Last month, in an attempt to end the strike, President Uhuru Kenyatta offered the medical union an across-the-board salary increase of 40 percent, but did not address all of the agreement’s other terms such as hiring new doctors or improving conditions for patients. The doctor’s union refused. On Tuesday, union and government officials announced a new round of talks to see if a compromise could be reached.
“It is not their wish to see the suffering stop,” said Health Cabinet Secretary Dr Cleopa Mailu, speaking of the doctor’s union.
“We are open for negotiations with the doctors within the law,” said Mailu. But “when a union agrees on a position and changes it the next minute, it becomes very hard for us to negotiate.”
A federal labour court threatened to jail the leaders of the doctors’ union that organised the walkout. Although their agency agreed to the changes in 2013, Kenya’s top health officials now say the doctors’ demands are unreasonable. One labour court judge who ordered doctors to return to work last month said the union leaders were “stinking of sewage” – and many ordinary Kenyans agree.
“I’m so mad. The doctors, sometimes you wonder if they really are fighting for themselves or for us,” says Mutambuki. She had now spent more than six hours waiting to learn whether doctors at the private hospital in Kijabe would agree to perform the surgery on her sister-in-law.
But Mutambuki also faults Kenya’s government for making a promise it didn’t keep. “I think the ministry is to blame because they signed an impossible agreement,” she says.
“I think they just have to swallow their pride and appeal to the doctors on behalf of the people who are suffering.”
Kenya’s Principal Secretary of Health, Dr Nicholas Muraguri, and Cabinet Secretary Mailu did not respond to requests for comment.
On January 31, outside the courthouse in Nairobi which is deciding whether doctors may continue their strike, doctors carried signs blaming the health ministry for the untold number of patients who aren’t receiving treatment as the standoff between the medical union and the ministry drags on. [Jacob Kushner/Al Jazeera]
Kenya boasts one of world’s fastest growing economies and a national budget of about $16bn.
In 2015 more than a quarter of that budget went missing entirely and only 1 percent was spent legally, according to a comprehensive audit by the independent auditor general. Of the $4.4bn that disappeared, $53m came from Kenya’s health ministry. Doctors say if officials can swindle that much money, they can come up with the funds to implement the 2013 agreement.
Critics of the government point out that during the same years in which the government was deliberating over whether to raise doctors’ salaries, Kenyan politicians voted repeatedly to raise their own. Parliamentarians now earn about $5,000 per month and thousands of dollars more in annual perks. They are the second most highly paidpoliticians in the world.
That hasn’t stopped government officials and the Kenyan media from denouncing the doctors as unethical. Leading national newspapers such as The Nation and The Star have painted the doctors as unreasonable, wildly exaggerating doctors’ demands with erroneous information about what the agreement would entail.
One false rumour that took hold in Kenya was that if implemented, the agreement would pay starting Kenyan doctors more than their British counterparts, whose starting salary is about $70,000. Under the agreement, the minimum Kenyan pay would increase to $40,000. As early as 2011, Kenyan news outlets reported incorrectly that doctors were asking for a 300 percent salary increase, and recently this inaccurate demand has been reported in international news outlets. In fact, starting doctors would earn 129 percent more in nominal value, and in reality just 96 percent more when accounting for inflation.
But as the standoff between doctors and Kenya’s leaders drags on, it is ordinary Kenyans who are suffering.
“These people can’t fly out to South Africa like our leaders do for treatment,” says Mutambuki, glancing around at the dozens of other patients waiting outside. “That is our taxes. We should have the same treatment too.”
Last month at one public hospital north of Nairobi, nurses struggled to make decisions well beyond their qualifications in an attempt to treat the 100 or so patients who remained.
“The death count so far has been hidden from the public,” one female doctor who works there told Al Jazeera on condition of anonymity for fear of reprisal. “In my estimate, thousands of people have died in the last 50 days directly because of this strike.”
She says one patient who was turned away from an overcrowded private hospital was transferred to the public hospital, only to die before her eyes. “It was just too late.”
Similar scenarios are playing out across the nation’s 47 public hospitals on which the majority of lower and middle-class Kenyans rely for their medical care.
Outside the Kijabe hospital waiting room, Mutambuki made a plea to doctors to return to work so that people such as her sister-in-law, suffering from ovarian cancer, as well as thousands of other sick Kenyans could resume treatment.
“I would ask them to put their grievances on a shelf and think about the ordinary person who is suffering,” Mutambuki says. “They should do that for the wananchi,” the people, in Swahili. “They’re pushing the wrong people.”