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Wednesday, May 17, 2017

Post-strike, pre-strike, the status mid-week

Today we were remarking with a fellow physician:  the sheer uncertainty of this year wears one down.

The Nakuru county government signed an agreement last Friday to pay all the doctors in our county according to their strike demands:  the 50% increase in base salary, various allowances, the arrears for the months they were on strike.  On Monday the docs started trickling back in to work.  Some have been supplementing their income in private venues, but others feel the crunch of months of missing salaries.  No interns returned, because that group decided their much-interrupted training year was OVER and the new year's group are not scheduled to begin until June 1. Today we had our (except interns) full team of 2 consultants and 2 Medical Officers (finished internship and working for a few years before applying for master's or residency degrees), and 6 clinical officer interns who have learned a great deal by being forced to work without much of any help but me.  Scott's team is a bit less intact, with his consultant partner out of town for the week and some personal issues/sickness with his Medical Officers.  Still, we both felt the relief of working in partnership today. It's just more fun to have people to discuss cases with, to lend a hand, to know you're not alone, to even converse with in a more friendly way, to plan for teaching conferences and improvements.  Sometimes Scott comes out of surgery and says, this is what I was made to do.  Today, he called me in as a woman whose baby had severe distress was being prepared for a C-section, but as I walked into the theatre the mom was pushing her baby out naturally, on the operating table, into Scott's hands as he scrambled to be ready.  The baby was blue and covered in muck, but those lungs filled with air as he cried lustily.  He was big and strong and mad.  We all rejoiced.  A great outcome.  Enough doctors, enough nurses, good care.

Sounds good, except for one detail.  The signed agreement between the county government and the doctors still hasn't translated into actual cash.  So we heard today that if the doctors don't see a change on their computer-generated pay-slips (which isn't quite money, but enough to make them believe the money is coming) by 5 pm Friday, the strike resumes.

Maternity (and therefore newborn unit too) has been consistently fairly busy, but the Paeds ward is still less than half full.  It seems the public and the outpatient screeners still don't really believe that the week's resumption of duties will last more than a few days.  In fact everyone is pretty skeptical.  Will this government, focused solely on re-election, spend money on health?  Money that could be spent on influencing votes?  Votes that would keep them in power, accessing more money?

We shall see.

Which brings us back to the exhaustion of uncertainty.  Without interns the evening and night coverage is still sketchy.  With no docs at all it becomes much worse.  The lower patient volume makes it a bit more manageable.  But many of those who come are the most poor and the most desperate.  Some severe malnutrition, some kids who are breathless or in pain or convulsing.  And we know that empty beds most likely do not represent healing; instead they represent confusion and barriers to accessing care.

Today's Bible reading came from the pruning the vine passage from John 15.  Perhaps that is the strike effect.  Cutting away expectations, cutting away comforts, cutting away extraneous uses of time, cutting away entanglements.  Making space for light, for growth, for fruit.  Praying.

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