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Tuesday, February 14, 2017

Dear Dr. Oluga: I stand against your arrest, but I stand by the patients

On Monday, the seven leaders of the Kenya Medical Practitioners Union who are leading the strike into its 11th week were arrested and taken to jail.  Today the Kenya Medical Association, in conjunction with many other professional associations for Paediatrics, Surgery, etc., announced that as of midnight no doctors in any facility, even private or mission, should offer any service for 48 hours.  Where is justice, and how should we respond?

Dear Dr. Oluga-
I saw your photo yesterday in the paper, standing strong and confident in your cause as you were led to jail.  You look just as I remember you in your internship, late nights standing in the halls of the Kijabe Hospital operating theatres, waiting to teach you to resuscitate a baby being born by cesarean and in the meantime talking about life.  You were ambitious and passionate then, and clearly not much has changed.

While I admire your tenacity and agree with much of what you fight for, particularly in regards to holding the government accountable to promises and seeking better facilities, equipment, medicines, supplies for serving the public, I will still be going to the hospital tomorrow.

Mass action of a strike, a protest, a slow-down, a refusal can be legitimate ways for the disempowered to collectively find enough power to get the attention of those who control their lives. This is particularly effective if a work force shuts down profits in such a way that their rights become a matter of importance, for instance miners walking out of a mine until safety issues are addressed.  The mine starts losing money, and the bosses come to the table, both sides compromise and life moves forward.  This is most certainly NOT effective for public doctors in Kenya, as you've shown over the last 11 weeks.

Mostly, because of the gap between who you want to punish and who you actually are punishing.  The strike of doctors in public hospitals hurts the poorest segment of society.  Pregnant women.  Premature babies.  HIV-affected families.  Injured pedestrians.  The elderly.  The rural and resourceless.  These people have no power to supply your demands.  Yesterday I found myself kneeling on the gurney to desperately perform CPR on a woman who delivered her baby at home, and bled to death.  Today I took care of her orphaned infant girl.  And a baby whose mother was turned away from a private hospital because she could not pay for a cesarean, even though her cord prolapse was a matter of immediate life or death.  These people are the ones suffering, and their suffering has increased exponentially over the course of this strike.  They don't blame you.  Even though they scrape by on less than 10% of the current lowest intern salary, they do not begrudge you your double or even triple target. But as paradoxically sympathetic as they are,  they can't increase your salary or supply the hospitals with gloves.

In some political systems, you might hope that the more the people suffered, the more political pressure would come to bear upon the government.  In Kenya, this does not seem to be happening.  About 36 hours before your arrest, after 2 1/2 months of the chronic humanitarian emergency this strike has sparked, a politician of the highest rank pulled into our town with his retinue, to campaign and register voters.  The suffering throngs lined the roads cheering.  NO MENTION of the crisis was made in the speeches; no questioning or accountability from the masses.  They will vote for him again, because they are ethnically loyal, and hopeful of benefit.  The politicians will not suffer.  When they get sick, they take public money to fly to South Africa or India.  They don't depend on your services, so they are unharmed both politically (because they still get their votes) and physically (because their medical care comes from outside this system).

Fred, I think we both know that a large part of the problem here is the devolution of health care from the central government to the counties.  In fact it is quite confusing, if the central government can't fulfill the CBA because the power has devolved to counties, isn't your strike against county governments?  Shouldn't they be the ones at the table?  Or the ones deciding on your arrest?  Something is very wrong with this picture.  I am guessing that somewhere far from Africa, someone with money and power dreamed up decentralization as the answer to corruption.  If Uganda, or Kenya, or who knows how many other places wanted aid and investment, they had to shift responsibility downward, closer to the ground.  What sounded good on paper backfired.  It turns out that under devolution, corruption has flourished.  The local pressure for favoritism and profit has been stronger, and scrutiny more difficult.  The counties and the ministry have swallowed health sector money like there's no tomorrow.  We need people of integrity to trace the money flows, people with a commitment to the common good to work at fair but not extravagant salaries, people with technical expertise to upgrade the infrastructure.

Striking is not making that happen.  Throwing you in jail is not making the problem go away either.  Everyone is losing right now.

But while you battle it out, there are lives that can't wait for your solutions.  I have critically ill children whose lives depend upon the substandard but sometimes-adequate care we can provide.  And I can't morally walk out on them, not even to show solidarity with you.

I hope you'll understand, and look for some alternatives.  Focus on standing up for the poor.  Talk about justice.  Pray and consider what Jesus would do. He turned over the money-changer tables and shook up the powers that be.  But he also refused to be crowned king, and laid down his life for others.  I can't tell you how to solve this, but I know God can lead you to hold onto your ideals with humility and to re-evaluate a road that will lead to true and lasting change.  No government can stand indefinitely against truth, fairness, and care for its people.

Believe me, working at the pace of a combined intern, MO, and consultant for this long has been draining.  I truly hope that you are released immediately, and that you and the government settle on terms that bring the doctors back to work.  We miss you.  And that when you do come back, your zeal will lead to a prioritization of good care for those who need it most.  There's no salary or promotion that will lead to a more satisfying life than simply being the healing hands of Jesus in the hardest places in Kenya.

Thanks for listening,
Dr. JM


Anonymous said...

Dr JM, Thank you so much for your comments and your insight and most of all for all the babies and children you are saving at FONWC by being there during this strike to care for these innocent patients who will suffer and die without your attention and professional care. Your appraisal of the situation is so accurate. You are in my prayers and may God guide you through this journey.

Unknown said...

Dear Tim, thank you for sharing this, and Jennifer- beautifully written. This is poignant, and true, and unsettling. Yet, as a Christian above all, who God in his wisdom chose to place in Kenya, as a doctor, at this point in time, I am left deeply conflicted. I have witnessed the carnage from further off than you have.- in those 'lucky' enough to make it to the private hospitals. For some, it's too late and they have died. And I have asked whether anything ,at all, is worth the life of a human being. Then there are those who run up debts they can't possibly pay, and though they escape with their lives, the economic setback will hound their lives for ages, and they are back into the poverty which they've tried so hard to escape. Again, I wonder if anything is worth the dignity of a human life, made in the image of God. BUT then I turn and look at the system that's in this place. We have been over-run by evil, by leaders who do not care, and by a population that is so ill informed and (almost) hopelessly unsophisticated, that they are bound to put the very same leaders back into power. So the cycle continues. How do you speak to power in a language that it will heed? How do you advocate for a people that don't even recognize they need advocating for? Don't the Kenyans- even the least of these- deserve 'world class care, here and now' ? Why should we be satisfied with overstretched facilities, lack of drugs and equipment? Is a life in Kenya worth the same as that of one in the West? Then why settle for so little? As for the financial aspect of the strike- you have to understand - there's no fallback for those employed by the government. There's no pension worth talking about, there's no insurance scheme if they fall ill, there's no benevolent church to support them- if anything they are the support for family, relatives and the communities around them. And ultimately, if the country utterly fails, there's nowhere to run or be evacuated to. These are the real and very pressing concerns in the minds of the striking doctors. I know there are bad apples and there are undedicated, avaricious and atrocious doctors whose only aim here is to line their pockets. Those are in the minority hopefully (as are to be found in any country). I know that for the vast majority who are participants/supporters in this action (some of whom have been stellar doctors at Kijabe) - their hope is to practice to the top of their licence with dignity for the doctor and the patient. To offer the patients world class care. To have good training. To practice in an environment that enables them to make the most of their skills to the benefit of the patient. I understand this is the third world, we are poor, and maybe in the world's eyes we should just make the best of it. But I desire better -for us, for our children and this country. We would like to stop depending on aid and goodwill, and start using the resources that we have responsibly. This is where the anger and dissatisfaction arises. Finally, what does Jesus require of me, as ultimately, everything we do should be for His glory and fame? I don't have a clear answer. I know it doesn't involve the innocent being collateral damage. Yet I know it doesn't involve silence, inaction or a ho-hum attitude in the face of injustice. As I said, I am conflicted and so I completely agree with your post and your perspective, while inviting you to deeper reflection on where the heart of a Kenyan doctor lies. Much love and appreciation for your tireless work over so many years. May God restore and renew your strength and provide you and your families everything you need to live a life pleasing to Him - Felix.

DrsMyhre said...

@Felix-Thanks for taking the time to so thoughtfully engage. I think we are on the same team, feeling the same way. I want for Kenya and for you all the things you do. That's why we're here. Yes, we all have some colleagues who are in medicine for selfish reasons, or who are so burned out on the system they act in a very self-centered and sloppy way. But I know that you, and the majority of the Kenyan doctors I have met, are wrestling with a very corrupt and unjust system. That's why I say, I don't know the answer, plead with God, talk to each other, try some things, tell us outsiders how to support you. My only point and plea is that the strike only punishes the poorest people and not the decision makers. It's not working, and in fact the overwhelming public support I sensed is now diminishing. People are dying. So forgive us, your friends and colleagues, for not joining. Thanks.

Unknown said...

Jennifer, we just want you to know, without getting into these issues which you present so cogently, that we are in daily prayer for you and for Scott as you expend so much physical and emotional energy in helping these desperate people in need. We prayed for you by name at our church on Sunday, so we want you to know that you have that support.

God bless you and strengthen you as you continue on, hopefully for a short time as this situation is hopefully resolved soon.

Margaret and Gary

Unknown said...

Dear Dr Jennifer and Scott,

I feel you, and congratulations for staying strong and making that difference. Our God who sees all, will certainly reward you coz no earthly man will ever do that.

I like the points you raised and I hope the CBA7 as they are currently branded will re- evaluate the methods of engagement with the Govt and strike a balance that ends the pain and suffering of the poor majority. Am hopeful that the teams will have a desire to evaluate the impact of this long strike in a few years to come and see how painful lives families are living resultant to that. The effects of the last 2 1/2 months are long term. Both parties should be wary of curses resulting for a desire for more earthly wealth.

I join you and others in praying for soberness as they search for a lasting healthy solution to the stalemate.

Lastly, kindly don't tire continue helping and Gods blessings will be upon you and your family.

With love.

James Wattuman
Project manager,
Friends of Naivasha, Kenya.

Nerd Mom said...

It sounds like both sides are so caught up in "winning" that they've lost sight of what their goals should be.

They should all have to face the families of the people who have died because of lack of care and explain to them how making a point was more important than human lives.

Rich Davis said...

The Catholic Bishops of Kenya released a similar statement calling both sides to task, no doubt you saw it. I was disappointed our own organization refused to take a similar stand. I'm praying for you guys and this country. -Rich Davis

DrsMyhre said...

@ Rich, thanks for posting that. Very inspiring and well put from the Catholic Bishops. Agree we need leadership to bring churches together to speak into this issue.