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My teacher of English, Mr Oula, would stress this advice whenever he got the chance: Never become a teacher. Never. You will be the most frustrated human being on this planet. 

I felt like he was always addressing me because once I joined his class, he did not see a student. He saw a son. Many times he would pull me to the side and offer his advice. I heeded it. By the time I got to high school, becoming a teacher was out of the question.

Medicine, however, was not my first choice. I wanted to become an electrical engineer. Physics was my first love. Engineering looked like the best world for me at the time; until, that is, my biology teacher brought a full set of bones to class. Then I considered the possibility of doing medicine. I speak for others too when I say maybe I shouldn’t have. But times were hard. Conversations with my mother opened me to the well-laid-out path to becoming a doctor and the security it assured. I had to make the lemonade rather than letting the lemons rot.

KCSE came, we passed, and I decided to do the course that was guaranteed to take away all our empty-pocket problems. The plan was to explore how the body worked and imagine being the bioengineer and diagnosis connoisseur, even though I am not a fan of the doctor title.

So, I decided to pursue the course — Bachelor in Medicine and Bachelor in Surgery (MBChB). The future looked bright. It was the beginning of a fruitful marriage

Married to the game, but she broke her vows

I was lucky to pursue another course mid-way through medical school. It changed my thinking; my supervisors enabled me — I could now think critically.

I spent more years on campus than most. An undergraduate course usually takes four years if all goes well. An MBChB takes six years. Adding another course midway would stretch it to seven years. If all goes well. It doesn’t always go well at UoN.

I was in third year for three years. Not because I failed my exams. Not because I did a retake. But because of forces outside my control.

First came the doctors’ strike. They were demanding a collective bargaining agreement – a CBA. Led by the firm Dr Oluga, hospitals had a critical-mass strike for close to a hundred days. We stayed at home. No zoom meetings. That came and passed.

But just as we were about to continue, there was a university strike. Lecturers had not been paid. Classes were moot. That continued for a while, but somehow, it was resolved. Somehow.

A few months – or maybe weeks – after this, we were sent home for the general elections. We thought it would be smooth sailing since we had learnt our lesson in 2007. It wasn’t. The first round was contested. So we went back home because of the re-run.

Somewhere in between there was a university strike. The student leadership felt the comrades’ grievances were not being addressed.

As a result, we started the third year in September 2016, lasted through 2017, and had the results out on the 3rd of January, 2018. Three years in third year. It was worse for me because, allegedly, I wasn’t on the list of people proceeding to the next year.

We were married to the game, but it was not through the good times and the bad. It was just plain bad.

The game broke her vows.

It seems like the odd years had it in for us because as we were getting into our final rotation in our fifth year, COVID-19 hit. We were sent home. This time round, adjustments were made to consider online learning.

It contrasted with the age-old principle of see one, do one, teach one. You could only see if you had a good internet connection. I never had a complete Obstetrics and Gynecology clinical rotation. I had to learn it afresh, practically during my internship year.

We found ways of handling this poor marriage we were trapped in. Add the fact that we were in the leading institution in the region; they just don’t like releasing their students into the world. Most of my twenties were spent on campus, at the University of Nairobi.

It was a relief to graduate, but that was not the end. It seemed like we had been tossed from one cruel spouse to another. Enter internship.

Throw dirt on me, and grow a wildflower

Internship is the most demanding year for a young doctor.

You have very few practical skills. You have been attending classes about a single medical condition but diseases present as they wish on any patient that walks to the clinic – not the way the lecturer taught them. You have no money despite people having witnessed or attended your graduation. You’re now a doctor but with a steep learning gradient ahead of you.

You either learn to swim fast or drown. Some people drown in the high tide of expectations relative to the little moral and psychological support they get. But for a good number of us, we hold on. We held on.

Patients’ conditions don’t understand the “sanitized” classes we took. I remember getting a referral patient whose eyes were popping out, suggesting a thyroid disease, which I later confirmed to be the case. The patient also had swollen legs and face, elevated blood pressure, difficulty breathing and, to top it all, she was in her third trimester of pregnancy. All these are different classes in medical school. The lecturers who taught us these conditions probably don’t even know each other. But as a doctor, you have to know what to prioritize, the stepwise actions to take, and most importantly, when not to intervene.

The intern, a doctor just so we’re clear, is the first line of defense. They will receive all the patients being admitted and follow up with their care. The hours are back-breaking. But nobody cares. If you don’t have fellow sufferers to pour out your frustrations on, you sink into your abysmal pit. It’s why a good number drown.

I remember once attending a mortality and morbidity meeting, the kind where discussions about near misses, deaths, and interesting cases that the hospital has admitted take place. I held a summary of the month’s work that I presented in front of a bright-faced audience of health workers. I was from a mind-numbing night shift, but couldn’t leave because we had to discuss these cases. Furthermore, it was supposed to be a learning session. 

It wasn’t. It was a blame-game morning tea party. 

Why didn’t you?

You were there, why did you…

If you had done this…

I had only taken a summary from the file. I was not the one that had made all those supposed errors they were so keen to point out; the ward is hardly an ideal setting. Inadequate staff, questionable equipment, and rising frustrations hardly match the step-by-step management procedures in textbooks and national guidelines. 

What’s more, the people who were hurling these questions were new faces who wanted to stamp their authority on those in the room. I soon learnt that it was the duty of the intern to take the blame because they were learning and their errors could be excused.

Luckily, I had developed a tough veneer from my time taking the intercalated course where supervisors could be cruel for the sake of it, when they felt like it. 

Lil Wayne said it best:

So you can keep knockin’, 

But won’t knock me down

No love lost, no love found

I was a wildflower. I could take whatever was thrown at me. I could thrive on their criticisms. But not my colleagues. They were putting them in a cage and hoping to get princes and princesses from the experiment.

I had a female colleague who occasionally had weeks when cramps controlled her life. Painfully. On those days and nights, she had to continue with her shifts because supervisors thought she was making excuses. We found ways of making the most of their absence because interns too can get sick.

Having cramps on a night when every hospital is sending referrals because their lift is not working, or they have no gloves, or they have run out of sutures takes a toll on interns the kind our current health cabinet secretary will never understand. These are shifts you continue to do without pausing.

This is how beasts trapped in cages are made. No carrots. Only sticks. 

Okay, you want me up in a cage, then I’ll come out in beast mode.

The standard number of hours one ought to work in a week is usually 40 hours. That’s eight hours, five times a week. An intern could blow through that in two days. You show up early because of a PowerPoint presentation you have to prepare from scouring through the records department, do your 36-hour shift, and then stick around for the ward round thereafter. By the time you hit your bed, you don’t want to pick up any phone call, you hate your ringtone and start asking yourself if this was what you had signed up for.

All the while, remember, you have not been paid for over four months. Debt is the lady in red who dances with you every night. Thank the heavens that you sneak into your house when everybody, including the landlord, is asleep.

Then someone says that these doctors, the first in line in case of any emergencies in our hospitals, should not get paid?

Ah! Ah! I wonder.

I’m not even in my harshest

And I don’t think these stories paint the complete picture. They are merely anecdotes.


There was a time when doctors and MPs earned the same salary

It was the chief government pathologist who revealed this shocking truth to me. When he was an intern, his salary and that of the MP were the same. Both cadres served the country.

Over time, the numbers changed. Firstly, the doctor-to-patient ratio has worsened yet the on-demand standards of care continue to rise. It’s difficult to keep up with international standards and an ever-enlightened populace when there is little that a hospital can offer.

The number of patients we used to see at the Obs/Gyn clinic at Thika Level V Hospital was so large that it took the whole day to clear the lines. Such large numbers also mean that the time it takes to see a patient is so short that it does not guarantee getting quality service.

By the time a doctor has seen over 100 patients without a meal to temper his patience, they don’t care. It’s how beasts are forged. Doctors’ bodies don’t run on jet fuel. Neither do they have infinite stores of patience and empathy. When an ecosystem’s carrying capacity is exceeded, collapse is imminent. The same goes for quality care, empathy, and patience.

But if you go ahead to squash the hopes of anyone pursuing the course by taking away that which makes them forget, namely, the salary they should receive, you are not advocating for health but rather its opposite – sickness.

Secondly, the time value of money, the cost of living, and the salary increments have changed. For the MP, it has kept up with the changing times, but for the doctor, what they currently earn is a fifth of what the MPs earn but barely touch; what they make in side deals, the sleeping allowances – because, honestly, many don’t sit in the parliament, they sleep – could be the only money they use. Their salaries can remain in their banks accumulating fiscal dust for all they care.

Then the Ministry of Health says that the cornerstone of our healthcare, the first-in-line of any public hospital, should not receive any pay or get pity money for their services; it’s worrying.

That is someone who is not ministering to health but to sickness. The title should be changed. Then it would appear that someone is really working in line with their role.

As I close…

When I visited Mama Lucy Hospital to see if we could participate in the Caesarean sections as interns, I was met by a lanky in-charge male consultant. He was as friendly as he was informative. His first question was: Why are you still here? Did you miss your flight? Leave as soon as you can. This country doesn’t value its doctors or nurses.

I would counsel anyone hoping to take this course in the same spirit. They would be better advised to pursue pharmacy which has some degree of promise, although it too has its challenges. But Medicine and Surgery or Dental Surgery? No. They will be one of the most frustrated people in the country because its leaders don’t see their value. Maybe the patients and the relatives do, but as for the leaders… that’s something else.

Mr Oula might have been happy that I took medicine, and that I’m now a doctor. He might be surprised, however, by the fact that I love teaching. It is the very opposite of what he preached. It is fulfilling, not frustrating.

At present, the most frustrated lot are those who were promised heaven on earth by teachers when they were in school. Right now, for those who are in medical school or are yet to start their internship as doctors, it looks like it’s too late.

It’s a little too late

To say that you’re sorry now (uh)

You kicked me when I was down

But what you say just don’t (hurt me)

Yeah, that’s right, it don’t (hurt me)

And I don’t need you (no more)

Don’t wanna see you (no more)

What I ask myself is where these leaders will go when they become sick. We’ll have to wait and see.

This song inspired some of the lines used in this article. Source – YouTube