Is Kenya really committed to improving health for all? Well…

Last week did not end well. It was mortifying, to say the least, to see a law enforcement officer, who is an essential service officer, intentionally harm a fellow essential service officer, a doctor, during a peaceful demonstration.

It is said that as a country, you know that we have crossed the red line when we willfully attack those expected to put their lives on the line for the health of a nation. Dr Davji Atela, the Kenya Medical Practitioners, Pharmacists and Dentists’ Union (KMPDU) secretary-general, sustained injuries to the head after a police officer hit him with a teargas canister.

This happened during a peaceful demonstration by the KMPDU officials and dozens of recently graduated doctors demanding that these doctors get posted by the Ministry of Health for internship. By law, one cannot be registered to practice as a doctor in Kenya without going through a highly prescriptive internship programme for a period of 12 months. The intern must be placed at an approved internship centre and work under the supervision of not just any doctor, but the specialists.

To many, the idea that an intern is paid during their internship period may seem like an entitlement and many have questioned the reason for it. What many people fail to realise is that for the most part, the frontline health services in public and several faith-based hospitals is actually done by interns. This includes the medical practitioners, dentists, pharmacists, clinical officers, nurses and lab technicians.

Most county referral hospitals literally stay afloat because of interns. A typical accident and emergency department will have one medical officer and three or four clinical officers running it. This team is responsible for handling no less than 200 people who walk through the public hospital doors with various emergencies.

Due to the limitations in most of these facilities, they can only do so much. Patients are quickly stabilised and sent to the respective wards for admission. Once a patient arrives in the ward, the real care begins. The first person they will meet is the medical officer intern or clinical officer intern. This is the person who sit to take a proper history, do a full general examination, order for lab tests and ensure treatment has commenced. This is the person who reviews that mother in labour to know if they are progressing well or whether there is need to pull the medical officer or consultant out of the clinic of theatre for a review by a higher level of expertise. 

This young doctor, nurse or clinical officer is the one on the bedside calculating the total volume of fluids your little one needs to be given to rehydrate them without overdoing it and causing a whole set of new problems. This is the person who monitors the blood sugars of the type one diabetic patient, ensuring the hourly blood sugar level check is done and the insulin prescription observed to a T, to ensure return to normal. This is the person left holding fort, making sure each patient is reviewed every day, even on the weekend, when everyone else takes a break. 

This poor intern, who has not slept for 30 hours, is still the one who cannot go to bed even when it is well past time for any useful bodily function because he is camped out at the lab, begging the lab technician to prioritise his patient and give them blood for transfusion; where the demand for blood from every ward far outweighs the blood units available. This is the person whose night shift long ended but they are in the intensive care unit begging for an ICU bed for their 14-year-old patient in the surgical ward who barely survived a horrendous road accident.

An average medical officer intern works no less than 100 hours a week. A lunch break is a luxury unknown to them. Many will go several days without the taste of a hot meal because they are too tired to cook and the restaurants in town are closed for the night by the time they get out of the wards. Many a times the only shower they get is in the hospital theatre, as they change from one pair of scrubs to another. Many pay rent that they have no luxury of enjoying as they spend most nights snoozing in smelly hospital call rooms due to necessity.

Save for residency, there is no other time an intern doctor is going to work as hard. It is baptism by fire, a once-in-a-lifetime experience that moulds one into a skilled practitioner, with the endurance required of the job. It is the very last time one has an opportunity to have oversight over their decision-making process before they are released to the unsuspecting public as qualified practitioners.

The internship period lasts 12 months. This ensures cyclic continuity. As the period draws to a close and the interns leave the hospitals, the next batch of fresh graduates steps right into their shoes and carries on the hugely important role. Failure to post interns in a timely fashion means that we are creating unnecessary human resource gaps in our facilities, resulting in poor health outcomes for our patients.

As it currently stands, county budgets are not sufficient to support a fully-fledged health workforce in line with the World Health Organization recommendations. Counties heavily rely on the intern workforce to bridge the huge human resource for health gaps experienced in their facilities. Internship training is a national function, hence the cost of having the interns is not on counties. With the demonstration last week, I would have expected to see a number of governors joining the marching doctors, because they are the ones who need their services the most! .

We can pass all these fancy laws regarding health financing but until we realise that the primary care units are not dependent on community health promoters (CHPs) alone, we have lost the plot. The ultimate goal of CHPs is heath service demand creation. Once they have done so, they will refer the patients to health facilities that cannot meet the needs of the populace because the care providers at facility level are not available. The famous wheel and spokes will only get off the ground when the entire team is on board!

Supporting internship training for health workers is not a privilege, it is the correct and responsible thing for any nation that has the interest of its people at heart. This not only applies to doctors, but all health workforce interns, in line with the Internship training policy that this country has in place!

Dr Bosire is an obstetrician/ gynaecologist