How Cuban doctors deal was ‘hawked’ to Uhuru

Cuban doctors

Health Cabinet Secretary Mutahi Kagwe addresses some of the 20 Cuban doctors stationed at the Kenyatta University Teaching, Referral and Research Hospital during the launch of the hospital’s Infectious Disease Unit (IDU) and Intensive Care Unit (ICU) on August 5.

Photo credit: Francis Nderitu | Nation Media Group

What you need to know:

  • This broad memorandum also called for collaboration between Cuba and Kenya to explore investment opportunities for the manufacture of vaccines, ARVs, medical gases and antimalarial medicines.
  • Dr Yumbya adds that there are 228 foreign medics, who, when added to this, take the ratio to one doctor per 5,101 people — way below the one doctor per 1,000 that the World Health Organization (WHO) recommends.

In August 2016, Cuban diplomat Raul Rodriguez Ramos drove to State House in Nairobi to bid farewell to President Kenyatta after his tour of duty. 

It was during the talks that the President said he was looking for “broader relationships” with Cuba on health.

Kenya, by then, did not have an embassy in Havana. However, in a month’s time, it had opened a resident mission, which was by March 2018 transformed into an embassy.

It was in the wake of this diplomatic push that, in 2017, former Health Cabinet Secretary (CS) Cleopa Mailu approached the Cuban government for a partnership.

A letter in the Nation’s possession, written in May 2017 by Dr Mailu and posted from Geneva by Ambassador Andrew Kihurani to the Cuban government, was accompanied by a general memorandum of agreement seeking a general “exchange of skills” between Cuba and Kenya. 

This broad memorandum also called for collaboration between Cuba and Kenya to explore investment opportunities for the manufacture of vaccines, ARVs, medical gases and antimalarial medicines.

In the report, there is no mention of bringing in experts for a long-term engagement.

 A year later, however, Ms Sicily Kariuki, the predecessor of Health CS Mutahi Kagwe, signed a deal for $4,000 (about Sh404,000) per month for each of the doctors from Cuba —  way above what Kenyan doctors earned.

Shortage of medics

One of the reasons given for the figure was that the Cuban doctors were coming to solve the chronic shortage of medics. 

Indeed, Kenya Medical Practitioners and Dentists Council CEO Daniel Yumbya admits the country has a problem with numbers.  He says there are 9,096 Kenyan doctors licensed to take care of 47,564,296 Kenyans, translating to one doctor for every 5,229 people.

 Dr Yumbya adds that there are 228 foreign medics, who, when added to this, take the ratio to one doctor per 5,101 people — way below the one doctor per 1,000 that the World Health Organization (WHO) recommends.

The council, which is mandated by the State to license doctors, blames the shortage on brain drain and failure by the national and county governments to provide doctors with incentives to work in the country.

Asked why county governments were unwilling to offer the same incentives to Kenyan doctors as they were offering to the Cubans, Council of Governors’ communications officer Yvonne Ogwang declined to go on record and did not respond to any further texts on who should speak to the media about the matter.

In 2018, then doctors’ union secretary-general Ouma Oluga said the government had failed to “incentivise” doctors to work in “hardship” counties by providing them with housing, security as well as insurance.

Kenya Medical Association (KMA) president Andrew Onyino Were warned that continued disregard of doctors’ welfare would lead to another brain drain at a time the country needs more healthcare workers to fight Covid-19.

 “I don’t know the exact number this year, but l know doctors are leaving. That I can assure you,” Dr Onyino said.

When the Cuban medics landed, the government set up a nine-person secretariat at the Ministry of Health to handle their integration into the country’s healthcare system.

A source in the Health ministry said that, in February, just a month to the end of their contract,  then Health CS Kariuki instructed researchers at the Kenya Medical Research Institute (Kemri) to evaluate the impact of the Cuban doctors’ work in the country.

The Kemri researchers were given a fortnight to come up with a report.

According to our sources, the researchers were strongly persuaded to ensure their report would be in favour of renewing the contract.

However, before Kemri could make a decision, a new Health CS was appointed and the country went into lockdown following diagnosis of the first case of Covid-19.

A fantastic job

In June, Health CS Kagwe described the Cuban doctors’ work thus: “They are doing a fantastic job, especially at this time when we need experienced doctors to deal with Covid-19 as well as our usual cases.”

 The CS, however, did not provide details of the ‘fantastic job’. But how did Kenya enter into such a deal?

The Nation reached out to Dr Mailu, who is now a diplomat in Geneva, and he said: “I did not pursue the matter beyond the memorandum of understanding, really.”

Neither of the Health ministers have explained how they arrived at the amount.

 Medical workers are Cuba’s biggest export, and the country has been using their expertise to earn foreign currency and train even more health workers.

A similar deal was brokered by WHO between Cuba and Brazil, under which 8,000 Cuban doctors were deployed to Brazil, where they would earn $ 3,620 each.

 The Cuban government would receive 75 per cent of this amount and the doctors about US$900 per month.

 The contract was, however, terminated by Brazilian President Jair Bolsonaro when he came to power in 2018.

The Cuban medics in Brazil may not have benefited directly from the deals, but at Sh100,000, the deal was still good for them.

According to an article in Folha De Sao Paulo, a leading Brazilian newspaper, Cuban doctors earn US$ 40 a month (about Sh4,000) back home.

The article revealed that leasing healthcare professionals to foreign governments earns Cuba around $11 billion each year, making it a bigger source of revenue than the tourism industry and remittances from abroad.

In 2017, South American paper El Pais reported that there were around 50,000 Cuban medical workers in 67 countries around the world.

Back home, the answer as to whether the government should continue keeping the Cuban doctors is not a clear-cut “Yes” or “No” for some counties, as the decision was made for them back in pre-colonial times.

For instance, Mandera and Makueni counties had been looking for two specialists — critical care and surgery — for newly constructed hospitals in these “hardship” areas.

Today, Makueni County Referral Hospital has a four-bed intensive care unit that is always full, managed by Cuban medic Dr Thomas Lastres Aviles, a huge relief to the locals who had to come to Nairobi for the services.

A 2006 study by the Society for International Development (SID) dubbed “Readings on Inequality in Kenya: Sectoral Dynamics and Perspectives” confirms that Kenya has never made an attempt to support traditionally marginalised regions.

In a 2018 paper, medical anthropologist Salome Bukachi details how Rift Valley Fever killed cattle and people in the North Eastern area because there was no road network, through which doctors and veterinarians could reach the area.

Some of these factors made the Cuban doctors’ arrival a big relief for residents.

Satisfied with the skills’

In a survey, Kemri talked to doctors who head hospitals in all 47 counties on how the Cuban doctors work with the locals.

 The report from the Kemri study, which is not in the public domain, indicated 83 per cent of the medical superintendents were “very satisfied with the skills of the specialist deployed to their county”.

The 24-page report carried a detailed analysis of the Latin American medics’ skills and ties with their local colleagues.

The biggest challenge (above 80 per cent), the report noted, was communication barriers.

This report was supported by the Africa Women Journalism Project (AWJP) in partnership with the International Center for Journalists (ICFJ).

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