A sombre, six-sentence paragraph was the final communication that Dr Fred Muoki penned before he died.
It was not a will, but a suicide note addressed to his sister. He was sorry that the pressures of life had knocked him down.
He was a rising star that many expected to shine bright; a hardworking young man whose hopes for a better life were dimmed by a society and government that neglected him, and many like him.
“I’m sorry sister. I have a lot of pressure. Debts and loans from my friends. I am sorry to disappoint you. I don't have money in my account so don't bother checking. I am deeply sorry sister,” he signed off, before taking his own life.
Muoki is said to have struggled for months to get a job after graduating from medical school, but all attempts hit a snag.
A dark cloud hung over him. The pressure from society sent him to the pits, where he had no strength left to fight.
He needed to provide for his loved ones, but with what income? He needed to live his dream of restoring people’s lives, but who was to give him that chance? He needed to earn his doctor title, but it remained just a name, his skills underutilised.
Muoki, unfortunately, is just one among an increasing number of Kenyan doctors who are taking the dark route to the abyss, after seeing their hopes for saving lives, and a rewarding career, dashed.
According to data by the Kenya Medical Practitioners and Dentists Council, about seven medical doctors in the country have died by suicide in the past seven years after they failed to get an opportunity to practise medicine.
After a grueling six years in medical school, doctors usually look forward to saving lives –but those coming out of school these days wait longer than usual.
About 4,000 trained doctors in the country are jobless, despite both public and private hospitals being overwhelmed by few staff dealing with thousands of patients who turn up for treatment on a daily basis.
In whose hands are the patients safe, one would wonder, for those at work are burnt out, compromising the quality of their output, while others stay at home in frustration, on the verge of slipping into depression?
More than 5,000 doctors have graduated in the past five years, registered and licensed to practise by the Kenya Medical Practitioners and Dentists Council.
Of these, about 3,800 are medical officers, 272 dentists and 1,280 pharmacists.
Last year had the most doctors getting registered; 1,330. The year 2020 had 1,321 doctors joining the market, 2018 (979), 2021 (955) and 767 joined the profession in 2019.
Out of those 5,352 registered in that period, only 1,000 doctors have been employed, with the rest joining the growing list of unemployed graduates in the country.
Nairobi County employed the highest number of medical practitioners in the last five years, having absorbed 134 followed by Kisumu and Kitui employing 58 medical practitioners each.
Mombasa (45), Murang’a (44), Lamu (36), Machakos (34), with Kiambu, Mandera and Laikipia employing 33 medical practitioners each.
Also read: 5,500 doctors needed
The KMPDU data shows that in the past five years, Uasin Gishu County has employed only two medical doctors, while Kajiado, Samburu and Elgeyo Marakwet have hired three each.
Baringo has four, Narok five, Bungoma six, Kisii seven, with Nyamira employing eight doctors in the past five years.
The Union Secretary General, Dr Davji Atellah, told Saturday Nation that only about 20 per cent of the medical practitioners that have graduated have been employed since 2018.
Despite health being a devolved function, counties do not employ doctors on a yearly basis as the national government would do before advent of devolution, deepening the doctor joblessness crisis.
“This is why we have many hospitals in the country with minimal doctors hence not many can give quality healthcare to Kenyans,” Dr Atellah said.
Before 2017, every doctor being churned out of university post-internship got employed, as the Health ministry at the time would post them to different hospitals across the country.
“This stopped and employment stopped as well. That’s why there is a long waiting-list of Kenyans waiting for procedures to be done. Even specialists are left out. For instance, there are many cases of cancer that go undiagnosed because of the shortage of specialists,” he said.
“If we have the doctors employed then the burden will be reduced. The only way we can have functional and access to healthcare as described in the Universal Health Coverage is to have doctors employed,” he added.
In Africa, according to Dr Atellah, Kenya is the only country that has a surplus of unemployed doctors and a biting shortage in the hospitals.
“I really feel for my colleagues who, after spending six to seven years doing a course, they still have to toil for years looking for employment or work under precarious contracts that don’t offer them similar benefits as their older colleagues,” Dr Atellah said.
“For those lucky to be employed, they work long hours, with no leave days, no medical cover, no study leaves and inferior pay with illegal clauses in their contracts barring them from joining the union or participating in union activities. When these inhuman contracts run out, they don’t get renewed and neither do they get their gratuities paid,” he added.
The Union has since called upon the counties to close the gap between the number of graduates and the shortage being recorded in the facilities so that skills are not wasted and hospitals hire as many fresh recruits as they can to help tackle the widespread shortage of medics.
With many waiting to be hired, the few employed ones are struggling to attend to millions of Kenyans crowding the functional facilities.
Multiple interviews by the Sunday Nation has revealed that most of the unemployed doctors have now ventured into business, some unrelated to their profession, while others are doing part-time shifts in private facilities, earning their pay for the hours that they render their services.
Dr Atellah said that doctors who stay for too long without finding employment usually contend with low-paying jobs at private hospitals to fend for themselves and their families.
It takes seven years to train as a medical doctor, including a year of compulsory internship. The cost of training one medical doctor ranges between Sh4 million to Sh5 million.
“It's sad that a nation would spend so much on training its greatest brains in one of the noblest professions and fail to utilize them to save the lives of Kenyans who continue to die from treatable illnesses,” said Dr Atellah.
There are more than nine universities in Kenya currently offering medical training.
Others obtain medical education from international universities and return home to contribute to the country's healthcare system.
“It is sad to note that for past six years, Kenya seems to have adopted a policy of train and dump,” he said.
They now want the government to put in place measures to have annual recruitment of doctors, just like it is done for the military, police officers and teachers; until the country achieves the World Health Organisation (WHO) recommended doctor to patients ratio of 1:1,000.
We are currently at 1:17,000. “This is unacceptable,” he said.
According to WHO, the prescribed health worker to patient ratio is determined as 23 doctors, nurses and midwives for every 10,000 people.
However, data shows that the health workforce ratio in Kenya currently stands at 13 doctors, nurses, and midwives for every 10,000 people.
They also want the management of human resources for healthcare to be centralised and standardised to reduce the many industrial actions that are occasioned by disputes with the county governments.
“The Health ministry announced that the plan to hire 20,000 healthcare workers to bridge the doctor, nurse and midwife ratio recommended by WHO is in the pipeline, but how long is this pipeline?”
Health Cabinet Secretary Susan Nakhumicha in an interview with Nation said that health workers will be recruited over a three-year period subject to the availability of the Sh21 billion that is required by the ministry to bring them on board.
Sunday Nation spoke to doctors who have shared their frustration in being unemployed years after graduation:
Dr Esther Mwinzi, 28, MBChB UoN class of 2021
I had always been a smart kid, and aced my grades in school. Growing up, people would tell me that I was so smart, and so I should become a doctor.
Every time someone told me that, the idea of being a doctor was ingrained in my mind and so I worked to become one.
In 2014, I joined UoN medical school and was prepared for the study pressure that awaited me. Back then, doctors used to be posted directly to public facilities after internship.
What I wasn’t prepared for was life after school post 2017, where doctors were no longer to posted after internship.
It all started during my internship when I was posted at a level five county hospital and started off in the paediatric unit.
I was happy to work in that department because children have a special place in my heart and had dreams to be a paediatrician.
As an intern, I knew that I was to work under a medical officer. I didn’t find one in the paediatric unit and so I was on my own, with no one to learn from except a consultant who used to come once in a while.
Some nurses even bullied me but I had enough grit to shake that off. I’d stay days without a proper meal, or not eating at all, but I had to press on.
As an intern, not even being sick is supposed to make you miss a day of work otherwise you would be labeled lazy or penalised.
Some areas were better than others and passion was re-ignited. With a positive outlook and 52 weeks later, I successfully completed and was licenced.
Since then I have not secured a job. The society then starts judging you by the course you did, expecting that money is not a problem.
As a first child also, there are expectations from my family but I am glad I have understanding parents.
There are days that I have been called for locums to work the whole night for Sh1,000. I accept it sometimes, but other times I let it go.
Most of my colleagues wish to travel abroad, but it is not easy either. It takes money to travel abroad, which we don’t have.
I have changed my attitude in healthcare, despite it being so fulfilling because I have to know someone to get a job or pay hefty bribes.
Sometimes I wish I could’ve been a businessperson and saved my family all the investment in university fees but I am also not one to give up.
There is intrinsic pressure because my peers who did other courses are doing well. I have told my family to be patient. One day, the sun will rise again.
A doctor from Nairobi, MBChB Moi University class of 2020
I request anonymity because even revealing my name brings jitters. The society will be quick to judge me.
It is difficult to be a doctor in Kenya. After the government spent about Sh3 million to educate one doctor, it seemingly does not care what happens afterwards. Our internships are tasking because it is intern doctors that do most of the work.
As an intern, you’re paid some money. No one gives us financial literacy. After the internship, with no source of income, reality starts to sink in.
I have applied for countless jobs, I have walked door-to-door, and I have contacted HR managers to no avail.
Dr Marvin Ochieng, 30, University of Nairobi Bachelor of Pharmacy 2017
When I went to pursue my course, I wanted to serve the community at the hospital level since this is where my passion was. I still long for such days, and I can only hope.
I did my internship for a year, which ended in May 2019. Reality dawned on me after campus when I had to taste the proverbial bitter lemon despite working so hard to have a ‘sweeter’ life. I am now a pharmacist at someone else’s retail outlet dispensing medication and minor diagnoses of ailments and treatment
I have applied for jobs in vain. I have done many interviews and a number of applications from the counties and private sectors, but so far nothing has been forthcoming.
I am hoping that this year, with the new administration, things will be different and we will be placed somewhere.
I have even worked in a pharmacy outlet being paid less than Sh50,000 because of frustration.
Dr Wycklife Oyugi, MBChBM 2019
I graduated in December 2020. Graduation day was the best in my life.
Little did I know that two years down the line, I would be narrating a story, not in the strides made so far in my career, but of a scourge affecting the majority of junior doctors in the country. I have been unemployed for just under a year.
During this time, I have volunteered in several local health facilities in my neighbourhood to sharpen my skills and reinforce the knowledge I got from school.
Medical professionals, just like any other professionals, will always have pressure from society. I have learnt that the most important thing is not to succumb to the pressure and to never lose hope. That has been my mantra and it has kept me going during this tumultuous period.
Where there is life, there will always be hope, so we keep believing that the future will be bright in the near future.
The government should look into healthcare professionals’ issues because it is a ticking time bomb. It cuts across all cadres of the health care system and not just the medical professionals only.
We know that healthy people are a pillar to the success of any nation. In my waiting period, I have taken a few jobs in between the unemployed periods that are unrelated to my profession because I have bills to pay.
I have tried online writing gigs but, deep down, medicine remains my passion. I hope the government will actualise Universal Health Coverage across the whole country by equipping our public facilities with human resources.
They should also consider the establishment of the Health Service Commission to cater for the needs of Health Care Workers as envisioned in the 2017 Collective Bargaining Agreement with the medics.
Dr Audrey Akinyi Waga, Jkuat 2018 June, Bachelor of Pharmacy
Chemistry was one of my best subjects in high school and I wanted a course that I was passionate about and that’s how I chose pharmacy.
All I knew when I joined was that it being a people-centred course, getting an employment would be easy-peasy.
The six years of training were intense. After that, I did my internship, had another exam and was licenced to practice.
The headache now began, throbbing so hard with internal screams of unemployment. I needed something to keep me busy.
I kept trying, applying everywhere and anywhere. I did this for a year but the lucky-girl syndrome didn’t locate me. I was depressed and anxious and every day, I regretted my choice of course.
After years of frustration, I went back home and volunteered at Kisumu District hospital hoping to get a job.
It is always believed that once you are inside the system, then it is easier to find your way when an opportunity is advertised. For three months without pay, I was not lucky.
The pandemic made it worse. I applied for jobs, but only those who graduated earlier were considered.
I resorted to working in facilities and being paid per day. I would look for opportunities where people have gone on leave, sick or resigned and work the time they are away, when they come back, I go back to my unemployed shell, once in a while looking for employment.
For three months, I worked for an organisation where I was paid Sh1,500 after 12 hours of work.
With all the frustrations and having to ask my parents for support, I went and sat them down and requested to go back to school. I am now in my final year pursuing a Master's in Clinical Pharmacy. Still, I don’t know if I will get a job after graduation.
Dr Aisha Bahmud, 27 years old, University of Nairobi 2014, graduated in 2021
I was born and bred in Saudi Arabia but I came to Kenya because I felt safe to come and study and work in my home country. I now feel frustrated, how I wish I would have done the course in Saudi, I would be working now.
I did my internship at St Francis Community Hospital in Kasarani and finished in November last year.
Throughout my medical training I was always passionate about becoming a doctor. I enjoyed every bit of it.
I have been applying for jobs through emails with no feedback. Currently, I opted to go from hospital to hospital dropping my CV to see whether there is any vacancy.
It is very frustrating, I don’t understand why the country cannot employ us yet there are not enough doctors.
I am considering an alternative career or even venturing into business. It is frustrating staying without employment.
I am thinking about leaving the country, which will be a big loss. The government has spent so much training us.
We have long waiting lines in many facilities yet doctors are just at home.
I don’t regret doing the course, I am ready to put my skills to work but everything is working against me.
Dr Abed Athman, 37 years, Clinical Oncologist, Alexander University, Egypt
I graduated in October 2021. I have approached different counties and institutions, dropped my CV, but none has found me worthy.
I volunteered at Kilifi county referral hospital for three months in early 2022, after which I was told they could not absorb me because they had their own doctors who had gone for further studies and they were waiting to employ them.
I moved to Coast General Hospital and volunteered for another five months since I wanted to continue practising.
All this time, I used my own money for transport. I left when I was informed there was no vacancy.
As a specialist, I can only hope that my skills will be tapped into one day. Life has not been easy, but I am hoping that in the coming years things will change.