Nurses worldwide may well be the unsung heroes of the medical field — they not only provide care for those hospitalised, but also execute tasks few others are willing to do under the immense pressure of the profession.
From giving injections, handling doctors’ prescriptions, dealing with psychotic patients, bed-bathing some, to soothing irate patients’ kin, their tasks are numerous and indispensable.
Despite this important role, many nurses take home a measly pay.
From 2008, nurses in Kenya -- who are now more than 26,000 but still short of the World Health Organisation (WHO) recommended ratio of numbers relative to the population -- have been fighting for better terms.
This fight for increased pay and better working conditions has driven them to down their tools.
As many of their counterparts in the first world look forward to waking up to serving yet another patient, Kenyan nurses have been on strike for months.
“If I was a little wiser earlier in my 30s I would not have continued with nursing,” Ms Agnes Munderu, 52, told the Business Daily in an interview.
“I cannot continue sacrificing my wellbeing for a government that has no respect for its workers.”
Ms Munderu quit her job in August last year and later retired in March to fight for the nurses’ rights away from the systems for “fear of intimidation by the government.”
She is the treasurer of the Kenya National Union of Nurses (Knun) and has practised since 1993, when she started with a salary of Sh2,700.
The mother of two, and who has three grandchildren, took an early retirement saying the pressure was too much and frustrations were taking a toll on her.
When she decided to call it quits, her salary for the 23 years in practice in Job Group K had risen to Sh40,000.
All these years, she has been at the forefront fighting for a better life for nurses.
“I have been at the forefront fighting for nurses’ rights since 1993. I have been suspended, interdicted, jailed because of that and never for once because of failing to report to work,” she said.
Until her resignation, she was a senior nurse at the Mathari National Teaching and Referral Hospital, the only public psychiatric facility in the country.
The facility, according to Ms Munderu, is highly understaffed with wanting working conditions.
This is confirmed by the then hospital head Dr Julius Ogato, who told the last National Assembly’s Health Committee before the August 8 General Election that the facility is overstretched as it cannot turn away patients referred there for psychiatric evaluation and treatment by government departments.
Dr Ogato said the hospital had a bed capacity of 250 and an average occupancy rate of 200 per cent, meaning it was operating with double the number of patients it should have.
“By the time I left the hospital one year ago, a ward with a 50 bed capacity could hold more than 100 patients under the care of one nurse,” said Ms Munderu.
Beaten by patients
“Imagine one nurse dealing with 150 psychotic patients most of who are male, murderers and brought in under maximum security in police cuffs…”
“Patients would sometime turn to nurses and beat them and do nasty things… I was once beaten by my patients. We reported but nothing happens. Very little is done. This is what it means when nurses are fighting for good working conditions.”
In a psychiatric facility, the recommended nurses to patient ratio should be 1:10 but in Mathari Hospital it’s 1:150 patients, according to Ms Munderu.
Nurses have been neglected, she laments.
It is now more than 120 days since the nationwide nurses’ strike started, but she says “nobody seems to understand what nurses do.”
The Kenya Healthcare Workforce Report shows the current ratio of practicing nurses to the population is at 8.3 per 10,000, way below WHO recommended limit of 25 nurses per 10,000.
Official records further show Kenya has 51,649 registered nurses below 60 years of age but only 31,896 are active in hospitals.
The data shows that a Kenyan nurse is exposed to working overtime and at least three times more than a nurse in South Africa or America.
Ms Munderu, a Nakuru Medical Training College alumni, says her salary could not meet her needs.
Therefore, instead of going home after a day’s work at the government facility, she would do locum — fees paid to a health worker hired on a temporary basis — in other hospitals in order to meet her household’s expenditures.
“We could stay even for a week before seeing our children as we were running from one hospital to another to earn a decent living.”
Nurses in the same Job Group who resided in Nairobi, Kiambu received a house allowance of Sh10,000, risk allowance of Sh3,850, commuter allowance of Sh4,000, uniform allowance of Sh10,000 annually and leave allowance of Sh6,000 once a year.
The current CBA proposes the lowest house allowance of Sh12,000 and the highest of Sh72,000.
On July 23, 2013 Knun signed a deal with the Health ministry where the government was to follow up the implementation of a scheme of service and the collective bargaining agreement (CBA) for nurses.
The two would later in the same month start talks and agreed to complete the exercise within 30 days.
Concluded in 2014
Negotiations were concluded in April, 2014 but are yet to be implemented.
Knun general-secretary, Seth Panyako said the Office of the Attorney-General advised against implementing the CBA in the form it was as it would only be legally applicable to employees of the national government.
“The AG said it would disadvantage nurses in the county governments who employ majority of nurses beside the unnecessary litigation but it could have been reworded,” Mr Panyako told the Business Daily in an interview at his Uchumi House office.
This, he said, followed a strike notice on September 1, 2014 after government’s refusal to sign and facilitate registration of the nurses CBA in court.
The continuous CBA negotiations led to new proposed harmonised salaries across all job groups, with the highest paid nurse asking for Sh874,500 net salary inclusive of 40 per cent remunerative allowances.
The lowest nurse in the proposal is to get Sh29,800 inclusive of allowances.
“Nurses’ demands sum up to Sh7.8 billion per year for the 25,000 union members against the Sh8.2 billion that doctors were given to cater for the roughly 4,000 of them,” said Panyako.
As the crisis in the public health sector deepens even after clinical officers resumed their strike last week over delayed salaries, unpaid internship and “unfair” job evaluation by the Salaries and Remunerations Commission (SRC), the county governments are still unyielding on the nurses’ demands.
The Council of Governors (CoG) chairman Josphat Nanok has said some of the nurses’ demands cannot be met due to budgetary constraints.
“As a matter of fact the nurses’ strike is illegal. It is notable that the nurses went on strike while the negotiations on their CBA were taking place.
This was an act in bad faith,” said Mr Nanok.
Mr Nanok, who is also the Turkana County governor, went ahead to ask counties to advertise the positions of nurses who will have not returned to work and their salaries stopped.
A week before the August 8 polls, the nurses rejected the last offer by the governors to end their strike against another offer to release their July salaries and allowances.
This is even after an August 28 meeting to review the CBA by CoG and Knun officials, which reached new agreements.
“As at August 30, the union had reduced her demands to the lowest minimums just to allow for a final agreement with government register the CBA and have nurses resume work,” said Mr Panyako.
“During the last meeting the union dropped two previously agreed allowances; call allowance of Sh10,000 per month and a monthly responsibility allowance of Sh5,000.”
Mr Panyako added: “The union also dropped the extraneous allowance of Sh5,000 and has settled to a bare minimum of proper grading structure, health risk structure and uniform allowance.”
Other allowances reduced include; health risk allowance of Sh15,400, Uniform allowance of Sh50,000 per year, which they agreed could be paid out in phases.
Ms Munderu says that nurses are still facing historical injustices basically because doctors are seen to be more superior.
“Is it because these government officials interact more with doctors in their private clinics and nurses take care of the weak who cannot come to our rescue?” she pondered.
“When we went on strike in 2013, I was among those who were arrested and locked in Kilimani Police Station for a night and when my girls got the news they celebrated – they hoped I would finally stop fighting for the nurses’ rights… but, aluta continua.”