The uneasy calm on the corridors of Jaramogi Oginga Teaching and Referral Hospital in Kisumu, or Russia as it is known to many here, could be misleading. Everything seems to be in perfect order. The usual helter-skelter is no more, no wailing babies in the wards, and no long lines in the waiting bays.
But this order is deceptive. Nurses in Kenya’s public hospitals have been on strike for 36 days now, and Russia has emptied as a result. And, like other government hospitals around the country, almost all major health initiatives — including antenatal and postnatal care, vaccination, and outpatient services — have ground to a halt.
The true cost of the current nurses’ strike might never be known, but its effect on the nation’s health indicators is likely to be felt for years to come. Mortality rates, for instance, are projected to rise in the coming months, and with newborns not receiving important vaccination, the effect is likely to be life-long for the unfortunate babies.
Doctors, who say they cannot operate without nurses, told HealthyNation that there is no public uproar regarding the nurses’ strike because most people underestimate the value of these caregivers — long acknowledged as the backbone of any medical industry in the world — to the provision of universal healthcare.
Kenya National Union of Nurses acting secretary-general Maurice Opetu has said that the striking medical workers will only resume work after a Collective Bargaining Agreement with governors is signed and deposited in court.
Nurses are demanding monthly allowances totalling Sh25,400 each. The demands include Sh15,400 health risk allowance, Sh5,000 extraneous allowance, and Sh5,000 responsibility allowance. The health workers also want a Sh50,000 uniform allowance, paid once annually.
But the Salaries and Remuneration Commission, which must approve the salary demands before they are effected, has said it will not do so as the drafters of the CBA ignored its advice.
Governors, who are the employing authorities of the nurses as healthcare is now devolved, have said they will not approve any pay increase due to the large sum of money involved.
Council of Governors health committee chairman Jack Ranguma says the county bosses are already feeling the pinch of the huge expenses occasioned by demands by doctors, whose strike was called off following an agreement to increase their pay in March 2017.
Mr Ranguma says it would cost the taxpayer Sh40.3 billion to implement the nurses’ CBA in the next four years.
“If we agree to go by the CBA, then it means that we would be paying around Sh10 billion annually. This is far too much. We have other bills to take care of, not nurses and doctors alone,” says the Kisumu Governor.
Just before the 25,000 nurses went on strike, we witnessed first-hand the daily grind of the average Kenyan nurse. The workload may differ depending on the department, but the job philosophy remains the same across the country.
TWICE THE WORKLOAD
With the introduction of free maternity services in public hospitals in June 2013, Anastacia Odhiambo’s work doubled. When we walked into her office, the maternity ward had 29 women against a capacity of 14. Her department used to attend to 350 mothers a month, but that figure shot to 470 after the announcement.
Then an administrator, she doubled as a record keeper, capturing the time labouring mothers were brought in, the state they were in, and every medical intervention that was given.
On the visitors’ book, something stood out. It was a record from December 16, 2014 by a Dr Jane Wakahe. “The staff are burnt-out,” wrote Dr Wakahe. “Consider having in-house medical officers and anaesthetists because of the many emergencies.”
And with that short entry, Dr Wakahe captured the state of nursing care in Kenya. Nurses in public hospitals are overworked, leading to poor services as they become irritable and burnt-out.
According to the Kenya Healthcare Workforce Report, the current ratio of practising nurses to the population is 8.3 per 10,000, compared with the World Health Organisation recommendation of 25 nurses per 10,000.
Of the 51,649 nurses below 60 years who have been ever registered, only 31,896 are active in hospitals. As a result, a Kenyan nurse does the work of three in Cuba or America, yet studies have shown that adjusting the nurses-to-patients ratio in departments such as intensive care and neonatal units can positively affect health outcomes.
The 2014 Kenya Demographic Health Survey shows that neonatal mortality stands at 22 per 1,000 live births, and has exhibited the slowest rate of decline, at 33 per cent, compared to other indicators.
It is no wonder that Caroline Obonyo, a nurse, is cagey even as she leaves her station for a glass of water. She asks a colleague not to take her eyes off a young mother feeding her child.
“She seems to be in a hurry,” says Ms Obonyo. “She will kill that baby.”
The baby is being fed through a tube — known as a nasogastric tube. The mother seems to be in a hurry to finish the feeding, and so is pouring liquid after liquid food into the tube, running the risk of choking her baby to death.
Ms Obonyo and her colleague, Abigail Nyatogo, are the only qualified nurses in the ward, looking after 31 babies with various birth-related complications. They get much needed help from nursing interns.
Every three hours they have to check the babies’ vitals and administer intravenous and intra-muscular injections to some of them as prescribed by the in-house paediatrician.
They also ensure that the temperatures of all the 12 incubators are at 31 degrees, supervise feeding of the young ones, and document every little activity and nursing care given to each.
These notes will be given to the next nurse, who will also need to brief the doctor who prescribes the medicine that the nurses administer.
Russia’s medical superintendent, Dr Juliana Otieno, is aware of the shortage.
“The nurses are overworked,” she admits. “They really are.”
And now that these important cogs in the wheel of medicine are on strike, doctors are feeling the pinch, and have asked the Council of Governors to resolve the matter as they cannot work without nurses.
Kenya Medical Practitioners and Dentists Union secretary-general, Dr Ouma Oluga, says health staff in public hospitals are already few, and that they cannot function without nurses, who form a pivotal part of the system.
“I prescribe, but it is the nurse who administers the drug,” says Dr Oluga. “We operate, but it is the nurse who gives the critical post-surgery care.”
His sentiments are echoed by a medical officer at Mbagathi Hospital in Nairobi, who requested anonymity.
“I cannot work, and no doctor can, without nurses,” he says. “You can ask the clinical officer to step up and treat a patient when a doctor leaves, but when the nurse leaves, everyone is stranded.”
The doctor is stranded, and, by extension, the patient.
In honour of Kenya’s first registered nurse
As the nursing fraternity in Kenya marked the International Day of Nurses — celebrated around the world every May 12, the anniversary of the profession’s Florence Nightingale’s birth — on the streets this year, some of their colleagues spent it remembering the first Kenyan registered nurse, Winfred Wairimu Nyoike.
Wairimu, born in Tetu, Nyeri in 1936, became a registered nurse in 1958 at the young age of 22. She fell sick in April this year and died a week later. Her husband is former Nyandarua South MP Kimani Wa Nyoike.
Her life was one of many firsts: other than the nursing feat in 1958, in 1964 she became the first African matron of PCEA Kikuyu Hospital. Two years later, in 1966, she became Kenyatta National Hospital’s director of nursing, a post she held for 27 years. She was also among the first chairs of the Nursing Council of Kenya.
Her father, who valued education, considered Tetu too far from the school where his girls would study, so he moved the family to Muruguru to allow Wairimu and her six siblings to attend school at the mission facility in Tumu Tumu.
In 1951, Wairimu joined African Girls High School, the current Alliance Girls High School. She then studied nursing before leaving for Britain to specialise in midwifery, and then to America in 1960 to study microbiology.
Her travels and areas of interest marked the initial stages of the evolution of the nursing career in Kenya, which used to be a one-track affair. Now there are 10 specialisations for local nurses — in, among others, midwifery, critical care, psychiatry, paediatry, and renal care.
Of the 31,896 active nurses and midwives in the country, 5.4 per cent (1,736) have specialised skills. Midwives take about 52 per cent (903) of the lot.