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She had only eleven weeks to go in the surgery department but the consultant added an extra five.

That’s more than a trimester. The organs of a baby would have already formed. The mother would have had her bouts of morning sickness. From the first scan, she would already have known her expected date of delivery. Meanwhile, an intern in a Level 5 hospital would still be stuck in a department.

Completion of the 16 weeks is no guarantee of absolution. The consultant can still add extra weeks to your internship. The scalpel they hold over your life cuts deeper than any blade. Worse, it leaves unseen wounds. Left to fester, these wounds tend to turn septic.

The advice she received from her dear ones was to push through and finish it all. Chin up. Dust herself. Muster courage. It would be over in no time. After all, it would only last a year. She was no longer getting paid by the government; our Kenya Kwanza government sent her to the frontline to bear the brunt of a profession many mistake for a calling.

Her face shows no sign of motivation. Her pockets continue to run dry. No motivation from that end either. No satisfaction from the work she does. Her life is a dark cloud full of emptiness that follows her everywhere.

She would have had better luck in information technology, IT. She’s alive but I’m not sure she’s well. Internship teaches you to hide your scars. A pulsating scar is evidence of life.

Life.

Dr Desree Moraa had a different fate. She was as old as I was when I began my internship. She responded and covered the shift call after call. After 36 hours of saving others, she took her life.

Becoming a doctor is not a calling.

Locked up

I’m locked up

They won’t let me out

They won’t let me out

It starts in medical school. By the time you’re in your clinical years, you can’t bail out. Chicken out is a better phrase. Unless your parents and guardians can afford that luxury, you have to soldier on to the very end. Consultants get known by their traits at this point.

We all like the tall one from Ward 5A, although sometimes he can get mad when no one shows up at his clinic. His opposite, with the Asiatic accent, is a live wire. Another one in Ward 7A will ask you the simplest question but you will never have an answer. You will feel stupid in front of your peers. This blade cuts across all levels of seniority.

Because of these same consultants, registrars – senior health officers undertaking their graduate studies – soothe their scars more than the rest. A consultant can shout at you in front of your colleagues – young doctors, interns, undergraduate students – and patients. Belittle you. Rip open the wounds you thought were sealed and healed after internship.

Fresh blood. Some consultants are out for fresh blood. Vampires of the wards but not afraid of the sunlight. They kill your motivation without aiming a stake at your chest. Days before I started my end-of-year examinations at the University of Nairobi, one of the registrars took her life inside her car. She couldn’t any more.

Becoming a doctor is not a calling.

Licking their wounds, registrars find the easiest staff to pick on – the young doctors. Interns, need I remind you, are doctors. The graduation list recognises them as such. They can’t pick on nurses. Experience has taught them better. The low-hanging fruit, the interns, are the juicier picks.

Hurt by the wails of the consultant, they will leave the intern in the ward to do what they should be doing. Since the intern needs to know all the patients, they toe the line. Along with this baggage of responsibility is the unspoken rule: interns should never call the consultant or the registrar.

Only call me when the patient is dying, they bark.

Call for any other reason and you’ll be the dead one. You might get assigned more weeks of internship. Fail to manage the patient and you might get more weeks. Fail to update the consultant through that call you were told not to make and you might get still more weeks.

Don’t make that call. Let them call you. Know your place.

Becoming a doctor is not a calling.

The tragedy of the commons, rule beating and drifting towards low performance

It’s a tragedy.

The setting breeds grounds for three systemic archetypes. The first is the tragedy of the commons. A good example can be found in a communal toilet. If everybody is supposed to clean the toilet, then nobody will. The toilet becomes dirtier by the day. The feedback about its filthy state slowly registers with the users.

A graffiti streak of poop left on the wall for days becomes the signal. When the sh*t hits the fan. Who’s to blame? You can’t blame anyone. Because nobody takes the blame, nobody acts.

The consultant knows the registrar is in the ward. He or she will not show up except for the ward round and some procedures. The wiser registrar knows better – that registrars hardly spend time in the wards. The registrar knows there are doctors in the wards. And if they are not there, then maybe some other colleague. Or the medical officer intern.

The infectious sneeze of irresponsibility might also have contaminated the interns. If Joy the intern is not there, then Caleb will do it. If not the medical officer intern, then maybe the clinical officer. If not the clinical officer, then the clinical officer intern. In a rush to ensure they know every patient, they will show up a little early the following day in preparation for the ward round. A consultant’s bark can echo for days and haunt your dreams if you don’t know your patients before the ward round.

Now, everything looks good, but it isn’t. The spirit is lacking, but the activities give the impression that everyone is doing their job. Classic rule beating. In this system archetype, the letter of the law is upheld but the spirit is not. Rule beating is when your typical public service vehicle speeds in the absence of the traffic police but shows obeisance in their presence.

The system drifts to low performance.

We have survived before. We’re not badly off.

They say.

Efforts to self-correct on this slippery road decrease steadily. The perceived state influences the actual state, worsening the actual state. All the while, a new system is in the offing. The National Health Insurance Fund is virtually phased out. More money will be pumped into this system where responsibility is pushed to whoever gives a damn – if they exist in the first place.

A calling?

I don’t think so.

The beeping of the hospital monitors reminds the nurses of the need to check the batteries of the pumps. Sometimes they alert the workers of the need to act fast. Not just towards their patients, but also towards their own individual lives.

Nurses, doctors, clinical officers. The entire clique has prepared their papers ready for opportunities abroad. One moment you bump into a nurse on your way home and the next he’s video-calling you from Texas.

Can’t wait to get out
And move forward with my life (Ooh no, with my life)
Got a family that loves me
And wants me to do right
But instead, I’m here locked up

Akon

The ones still working are locked up. Temporarily. They’re doing time. Like prisoners, they have been sentenced. Good behaviour grants them parole. Then they flood the streets seeking jobs.

The system slowly degrades. How can they be absorbed by a system that barely recognises that it is sick? Solutions lurk within but the senses are malfunctional. The channels are sclerosed. As they await approval to hop aboard that plane, they try to avoid that call. That call from the hospital when one is on call.

You know the number off head. You can try to avoid it when you see it. In a club drowning the pain as someone massages your chest where that scar inflicted by the consultant pulsates in its freshness, one of the ladies might decide to save you the trouble and take the call.

Wacha kusumbua daktari!

Becoming a doctor is not a calling.

What I’m trying to say is…

The loss of a young doctor barely done with internship is like the loud siren of an ambulance in Nairobi City on a Friday evening during rush hour.

Cars try to make way, but progress is slowed. Stalled.

When you’re trapped by a system tasked with the duty of giving life, taking yours is a serious call for adjustment. Not by pointing out the perpetrators. The tragedy of the commons shows how many people can be blamed for such an outcome. Detective Hercule Poirot knew as much. And so he blamed everyone for the murder on the Orient Express.

Then again, not everyone can be blamed. I’m lucky to be surrounded by amazing doctors. Amazing consultants. I am evidence that the healthcare system can thrive if the actors are sensitive to its shortcomings and are bent on bringing improvements.

Suicide should be the last thing a medical doctor should contemplate in a healthy system.

The song Locked Up by Akon inspired some of the lines used in this article. Source – YouTube