Stop foreign medical referrals to give local doctors experience

I recently attended a promotion interview for a medic at one of the local institutions of higher learning. After the usual questions, the candidate was then faced with one unusual issue. Would he refer Kenyans for treatment abroad, particularly India and in what circumstances?

Little did I know I would be faced with the same question later that day at my clinic where a patient requested for a letter to have her plates removed in India. I found the request bizarre and turned it down.

Such requests for treatment in India are made on the grounds that there is lack of expertise locally, lack of investigative and treatment equipment, doctors are too expensive and mercenary, and high prices of drugs for certain diseases.

My position was informed by the fact that I was aware of a recent operation by some Indian doctors in a hospital specialising in referrals from Kenya that went wrong.

The patient and parents came to seek referral to the same doctors to repeat the operation in India. This was a routine operation in Kenya.

Another patient with operation fracture pelvis gone wrong consulted me and was advised to have a two-stage surgical procedure. He refused, went to India and accepted the same treatment. He had step one and now is back but things don’t seem to have gone right.

All this is underpinned by the fact that certain Indian doctors run local clinics and refer patients to themselves in India. In fact, some Kenyan doctors refer patients to India on commission and indeed some doctors, including me, have been approached to do so.

Kenyan doctors are not allowed to self-advertise, but it appears Indian doctors are allowed to do so in Kenya. Kenyans also love labels made abroad. For example, the Yana tyres are made in Kenya, but how many fancy them on their cars?

Research and innovation have been lacking in Kenya. Certain individuals and institutions have become conduits sending patients to India.

When a high profile politician goes to India and invites doctors there to run clinics in Kenya who can deny them? The foregoing raises the question on what is the way forward.

The often fronted argument that certain expertise is not available in Kenya is a fallacy. Kenya has a wide spectrum of specialists. The only problem is illegality of self advertisement. Even hospitals make no effort to tell the public what ailments they can treat.

The chief executive of the Kenya Medical Practitioners and Dentists Board (KMPDB) recently announced that they are going to allow medical practitioners to self advertise. Of course, the merits or demerits of this move are another question.

Investigative and treatment equipment are not perfect but in most cases are adequate, where they are lacking the medical practitioners will advise, but such occasions are very few.

There are good laboratories, X-Ray machines, ultrasound, CT, Magnetic Resonance Imaging (MRI) and Isotopic scans which greatly assist in investigations.

A Positron Emission Tomography (PET) scan is still unavailable, but this is only occasionally required and with prodding will soon be available.

The KMPDB have set guidelines on charges and any aggrieved person can refer the case to it and it will be addressed. Going to India for treatment requires a ticket and accommodation for two. Some hospitals have come up with very reasonable packages for certain treatments.

Certain diseases require very expensive drugs for which generics are available. The solution is not to send patients to be treated by these generics, but for the government to identify these drugs and facilitate their importation at a reasonable cost and see to it that pharmacies don’t exploit the patients.

These cheap generics don’t only come from India, but other places like Brazil, the Netherlands and Switzerland. Kenyan doctors wonder who gives Indian doctors licences to run clinics in Kenya when the reverse can never happen.

Certainly the Kenya Medical Practitioners and Dentists Board (KMPDB) has something to explain to local doctors. Certain hospitals top Asian invites for Indian doctors to run clinics and operations with exclusion of local doctors. These are not charity operations.

Speaker of the National Assembly Justin Muturi recently instructed the Health Committee to investigate a certain hospital that is known to run Indian doctors programmes referring most cases to India and the Kenya Medical Practitioners and Dentists Union (KMPDU) was also reported to be investigating cases of referrals to India on commissions. We await the results of this investigation.

Kenyans should stop the adoration of all that is foreign. Once I heard some women talking about hip prostheses among themselves. One had been operated at Nairobi Hospital, another in the United Kingdom and the last in South Africa.

The foreign-operated talked with much pride and some sort of derision of the local one. They had all come for follow up. Follow up after operation is very important as complications do occur.

Many local doctors are seeing these returnees who cannot go back because of cost. These cases are not reported.

Gain experience

Our scholars have gone to sleep in the area of research and innovation. Even if research is done it is never published.

Occasionally one comes across innovations like the one by Dr Hillary Rono who invented a mobile app called the Portable Eye Examination Kit (Peek) for field examinations of the eye using a mobile phone.

Even this simple and practical innovation is coming to light because a Briton was involved. Kenyan medics should do research, publish findings and put them into practice. The government has a duty to avail research funds.

It is not wrong for doctors from other countries to come and work with local doctors to promote transfer of technology. This is often done by doctors from the US, Britain, South Africa, Germany and Sweden.

It is however wrong for doctors to come, set up camp for the sole purpose of making money. It is not bad for Kenyans to seek treatment abroad in areas where there is good reason to do so.

The bottom line, however, is that the more patients are treated abroad the more local doctors lose opportunities to gain experience. Besides, our economy unnecessarily loses valuable foreign exchange in this unwarranted quest for treatment abroad.

Mulimba is a professor of orthopaedics and trauma at the University of Nairobi.