Dr. Ouma Oluga. The activities of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) from December 2016 through to March 2017 will live long in the memories of Kenyan doctors. The names of a number of young doctors in the country were frequently mentioned in the 100-day long doctors’ strike. However, the name Dr. Ouma Oluga stands out tall. Then a young doctor employed by the Vihiga county government and perusing his Mmed at UON, Oluga brought the health sector and with it the mighty government of Kenya to its knees. His eloquence, bravado, knowledge and fearlessness were unmatched. The only terms on the lips of doctors countrywide were ‘CBA’ and ‘lipa kama tender’. It was simply heroic. “The shoes Dr. Ouma Oluga left are big, but I have faith that with the current generation of doctors, we are going to not only fill them but achieve even bigger things.” Said Dr. Harvey Mulei as I sat down to listen to the tales of the doctors’ union.
“In 2016, I was serving as the Chairperson of the lower Eastern branch of KMPDU when a fracas occurred in Machakos county under governor Alfred Mutua. The governor, publicly insulted a doctor and incited the public against her, saying that she was earning too much money. He then dismissed her from her job without notice. She filed her complain to the union leadership and this really got to our nerves. We had been working in deplorable states; doctors’ salaries were being delayed, none of them had been released to go for further studies, and promotions had never been implemented since the governor had taken office. He was adding salt to the wound by insulting one of our very own. We would have none of it.
We issued a 21-day strike notice. The county government, like all governments do thought we were bluffing. They did not act only any of our complaints and on the 22nd day, I led all the doctors in Machakos county to a strike. It was my first time doing such a thing. I barely believed in myself, yet here I was supposed to lead professors and senior doctors against a very clever and sly and well experienced politician. It wasn’t easy.
After having to convinced my colleagues that this was the only way (you know how hard it is to lead smart people), I had to lead negotiations against the governor’s team. They tried all sorts of tactics to knock us off our feet; they intimidated, they threatened and they belittled us for being young. It was my first time but out of nowhere I managed to sermon a courage that even I did not know I had and after more than a month of paralyzed health systems in Machakos county, the governor surrendered. We walked away with a massive win. Two months later, after bench marking in Machakos, Dr. Ouma Oluga and his team at the national office decided to replicate the win at Machakos to the whole country and as they say, the rest is history”
The Era of the stethoscope
“We need to take medicine back to where it was in the ‘70s!”: Prof. Stephene Ogendo (dean, school of medicine, Maseno University and council member KMPDC).
When I first heard these words, I thought them barbaric and backwards. Aren’t we supposed to be going forward without looking back? We are in an era of technology and evidence-based medicine. Why would someone want to take us back to the dark ages? We are lucky to be doctors at such an amazing time. Can you imagine having to make a diagnosis of mitral valve stenosis just from clinical examination then deciding to replace the valve without any evidence to back you up? In whose OR? Medicine has come a long way since the 1970s.
So how come such a renown, respected and equally feared scholar of medicine can utter such a statement? He has been there through the journey medicine has made from the 70s when the first medical school was established to date when we have so many medical schools across the entire country. Even the number of hospitals, leave alone doctors must have been much less. But somehow, prof believes that the profession was better back then than it is now.
Dr. Harvey Mulei Mbithi, chairperson of the KMPDU lower Eastern Branch has been on the forefront fighting for doctors’ rights throughout his career as a doctor. According to Dr. Mbithi, in the 1970s, a doctor and a member of parliament at the time had nothing to separate them; the salaries were the same and the respect and honor given to a political MP was the same as that given to a doctor if not less. Provincial administrators would stand and salute at doctors as they did to political leaders; and up to date the retired D.Os and D.Cs will stand as a show of respect if you introduced yourself as a doctor.
Doctors were glorified and respected. The practice of medicine was and still is the most noble of professions. With all the comfort of free housing and chauffeured government vehicles, doctors of the time got comfortable. Too comfortable to the extend that they forgot how fast the world around them was moving. They focused on the stethoscope. Their equals, on the other hand, made up of selfish, crafty and corrupt individuals in bunge amended the laws to their satisfaction and comfort. They raised their salaries with each financial year. As inflation caught up their salaries kept up to speed and before doctors rose their heads from the open abdomen in theatre, their equals were miles away. Today the basic salary of a member of parliament can pay up to 10 doctors.
Medicine is noble and doctors shouldn’t do it for the money. Other professions like teachers caught on early and formed unions in good time to lobby for their people. KNUT has been in existence for decades while KMPDU is still in its infancy. Maybe it was because of the small number of doctors in the country who were too buys taking care of the sick to have time to engage in running battles with the government over something as trivial as salaries. So, they worked. Life became harder, the profession remained noble but the pay remained mediocre.
Doctors never complained. How could they? They had no union; they had never learned how to lead. As students at the university of Nairobi were engaging in running battles with the police on the streets of Nairobi fighting barbaric government policies, corruption and dictatorship, medical students were spending this precious time in the library memorizing Grays Anatomy and Davidsons textbook of Medicine. It is those rioting students that ended up being Kenya’s top leaders taking care of their people. The end result was a serious lack of leadership or even representation in government for doctors. The health sector suffered, infrastructure remained as was left by the colonial masters and doctors lived in misery.
Nonetheless, doctors cannot be blamed for this. The moment you set foot into that first class in medical school, all else becomes a luxury and a waste of time. A lot of emphasis is put on grasping the concepts and memorizing huge books to be the best doctor you can be. Passing exams was and still is a strenuous activity. One second’s laps in concentration and you have a year added to your studies. Politics was reserved for the “lesser students,” the ones who had time to waste. Up to this date, there are conservative medical schools that still strongly discourage their doctoblasts from perusing passions in student leadership positions. True as it may be, the course is grueling and it requires undivided attention. Activities that are a norm among other university students like having a girlfriend can easily distract you from the main goal. That was the era of the stethoscope!
KMPDU, a home for all doctor
Doctors for a very long time, lacked leadership. It was not until August 2011 that a newer brand of doctors decided enough was enough. They formed the KMPDU. This group of young newly graduated doctors had soon realized that the private sector where most of their predecessors had escaped to soon after finishing their internship was unable to absorb any more of them, they had to try and fix the public sector.
With zero experience in leadership or negotiation skills, they managed to take doctors to their 1st ever unified strike in 2011. By the end of the strike, the salary of every doctor in the county had risen by almost 60%. From a salary of 36,000 for medical officers to 70,000; it was a major achievement. Our savior had come. KMPDU had shown its powers and there was no turning back.
Over the years since its establishment, KMPDU under the able leadership of various young doctors has done wonders. Doctors pay has increased significantly, not even close to where it should be when compared to the international outlook, but somewhere and significantly so compared to the crisis doctors were in before the establishment of KMPDU.
Salaries are not the only problem doctors have been having. Before the formation of the Kenya Medical Practitioners, pharmacists and Dentists Union, promotions for doctors were a pipe dream. Doctors would practice in the same job group for years without any promotions. “When it comes to promotions, we do not bargain. Since the registration of the first ever doctors CBA in 2017, the thorny issue of promotions has significantly improved. The entry Job group for Doctors, for instance, has changed from JG L to JG M. Despite not being fully implemented, the CBA seeks to ensure that all doctors are in their rightful job groups. ” Dr. Mulei says.
“This has been tough to implement especially in the counties,” he continues “since for some senior consultants, promoting them to their deserved job groups would mean they go to job groups higher than those of their bosses at the county headquarters, who sadly are not doctors. It is a pity that doctors are not leading themselves. A county chief of health who is an accountant, for example, will never be the right person to lead doctors. The era of the stethoscope is over. Doctors need to learn management; doctors must be their own managers and not mere worker bees, whose job description is determined by people who have no idea what the job actually entails.”
The future of KMPDU
The union has done a lot for the Kenyan doctor but there is still a lot to be done. The biggest of which is to once and for all exit the counties. We had initially thought that devolution was the answer to our problems but it was a mistake. We were wrong and we must take the blame for it as a union and look for the perfect exit strategy. Health human resource should have never been devolved. Doctors obviously do not fit in the regular civil service scheme, we must find a scheme of our own, a centralized one, that will seamlessly manage our HR for even better service.
We also have plans to expand the union, have our own building which we can even rent out to generate revenue for KMPDU. We hope to have as many doctors as possible, if not all, join the union because the benefits are innumerable. We are working on having a standby law firm that can represent our doctors especially when they get into wrangles with their employers as they often do in the current arrangements. I can assure all doctors especially young doctors that the future is bright as long as we all come together and look at the bigger picture. Our biggest problem at the moment is employment and it is very frustrating to our young doctors, but this too we shall overcome. We will bring back honor to the profession and make the Kenyan doctor great again.
BY Dr. Nyadimu