Kenyan Doctor Strike: A Refreshing Perspective

Friday, another week of hectic oscillation between panic and satisfying labor draws to a close, a full 8 weeks now of the strike.  Our maternity unit over the last two weeks since we returned, when things picked up speed, is averaging 16 deliveries a day.  That's nearly a 500/month pace.  Meaning one day this week Scott did 5 C-sections in a row, back to back, morning to evening.  Post call.  Including two cord prolapses, where the baby would have been dead within half an hour for sure.  Instead with a little resuscitation, both thrived.  (One pictured, we just couldn't get over his normality after the weakly pulsating cord, no oxygen in the theatre so the anesthetist had to take time to do a spinal, we thought he was gone for sure).  And including a mom who drove TO NAIVASHA FROM NAIROBI, a 2-3 hour trip in the reverse-referral direction, because she needed a C-section and heard that this place was functioning.

And a 500/month pace on maternity means a hopping Newborn Unit, with preemies spilling out left and right.  Some can't breathe well, some are jaundiced, some are infected.  Some can't feed.  Moms keep cycling in, every three hours.  I juggle blood draws and IV's and notes and teaching, making calculations and talking in my halting limited Swahili to moms.  Some evenings I'm called back.  The hardest part is never really handing over the responsibility.  There's no other doctors involved in Paeds.

But there are nurses and clinical officers, ward clerks and cleaners, lab personnel and secretaries.  There are dedicated people working to keep the doors open for emergencies, for the sickest, for the poorest.  And yesterday I had a refreshing conversation with a senior physician-assistant level woman, a working mom, a decade-long or more employee of the government system.  I asked her, what do you think the government should do?  What would improve health care for Kenyans?  Do you need higher salaries?  Here is a paraphrase of her answer:

The government could afford to pay the doctors more; they have so much money they are hiding or using for themselves.  But that wouldn't really help.  You could halve my salary and it would still be plenty, I mean it's almost embarrassing that I make that much more than my neighbors.  More money won't make people happy.  Don't pay me more and make me still see 70 patients a day, when I can't really do a good job on that many.  HIRE MORE people and let me see 20 or 30 patients, so I can actually help them.  Don't pay me more to prescribe medicines for people that they can't afford, and won't buy.  Buy medicine for the children, so when I see a child and write a prescription I know they will get it and get better.  Buy more equipment, hire more workers.  That's what will make our lives better, and health care better.  

Wow.  Voice of wisdom.  

Meanwhile no one is listening.  The government gave the doctors five more days.  Now they are supposed to return the 31rst.  Not likely.  The Clinical Officers have a case in court to unionize as well, so they can agitate for more secure and better paying jobs.  That will be heard on Monday.  For-profit schools churn out minimally competent health care professionals, who need experience and supervision, a clear job track to progress, a knowledge that certain hours will lead to certain opportunities.  Instead there is a murky opacity, people are hired on short-term contracts, payments are delayed, everyone feels insecure, and the nation suffers.

Like the early believers, we say, come Lord Jesus.  Come in power and renew the world, or come quietly and change hearts one by one to let your Kingdom seep justice and life into Kenya.  Amen.