Sunday, December 11, 2011

Doctors chose the lesser evil by downing tools

Sunday Nation 11 December 2011

Last Monday doctors in the public service went on strike. Among the issues raised by the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) were inadequate staffing, absence of a scheme of service, stoppage of training sponsorships, poor working conditions and inadequate remuneration.

At the onset of the strike, fears were expressed that it would result in needless loss of lives, and it was suggested that it would be unethical for medical personnel to go on strike and leave patients to die. The Hippocratic Oath, which exhorts doctors to put their patients’ needs above all considerations, was cited as a good reason for doctors to call off their strike.

An objective observer would actually be horrified that doctors downed their tools and left their patients to their own devices. However, in order to understand why this happened, it is necessary to examine the events leading up to this strike.

Firstly, it must be appreciated that this is not the first time doctors are going on strike in Kenya or elsewhere.
This is the fourth doctors’ strike in Kenya, and the last one happened in the 1990s, resulting in a massive exodus of doctors to Europe, the United States and southern Africa. The reason for the exodus was that the government totally ignored the doctors’ demands, and instead opted to intimidate those that participated in the strike.

Everything possible

Secondly, one needs to understand the working conditions that the doctors are asking to be improved. When a doctor tells a patient or their relative that everything possible is being done to help them, it is often an intricate public relations exercise meant to hide the deficiencies in the system.

The health system in our country is rotten. Over the years, government expenditure on health as a proportion of total expenditure has progressively fallen, despite a commitment to the Abuja Declaration decreeing that 15 per cent of the budget must be spent on healthcare. The result of this neglect is self evident.

Health facilities are still few and far between, and many people have difficulty gaining access to quality healthcare within a few kilometres of their residence. Those that are available are grossly undermanned, and there are health facilities where one person performs the work of all cadres of healthcare workers. This person is often the only one available to diagnose illnesses, to dispense the treatment, to perform nursing duties and to keep the facility clean and habitable.

Supplies to health facilities have remained erratic and often do not meet the needs of the served population.
Health workers in these facilities are poorly remunerated, and it is often viewed as a punishment to be posted to remote areas of the republic because, among other difficulties, one’s housing allowance is reduced significantly outside the capital city.

In many hospitals, including the national referral facilities, needless loss of lives has been going on for a long time, and doctors are often bystanders who know what needs to be done but have no tools with which to deal with the problem.

The ethical dilemma that faced many doctors at the beginning of the strike was really a no-brainer. What is more ethical: to acquiesce to the continued loss of lives in an underfunded system or to walk away from it all and let everyone know that all is not well?

The striking doctors chose the latter.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association, and lecturer, Moi University School of Medicine.

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