Doctors’ strike lifts lid on ailing health sector

A number of stories told over the last two months starting December 5, have opened the lid on the deplorable state of the public healthcare system with patients languishing on hospital floors in the absence of doctors.

Those who could not afford services at private facilities, which most charge two-fold that of public hospitals, either lost their lives or continue to bear the brunt of the ongoing medical staff strike now in its second month.

As the impasse continues to hold sway, more lives are lost and more Kenyans’ hope continue to fade. The situation is worse particularly for cancer patients who can only afford treatment in public health facilities. Even before the national doctors’ strike many cancer patients were suffering.

Calmela Kagendo, 58, a widow with two children is one of those hard hit with the doctors’ strike.

Ms Kagendo who resides in Chuka was diagnosed with cervical cancer last year.

Upon diagnosis, she was immediately put under radiotherapy treatment at the Kenyatta National Hospital (KNH) and was about to start her chemotherapy sessions when the doctors boycotted work over a collective bargaining agreement (CBA) signed with government in June 2013.

A patient may require up to 25 sessions of radiotherapy. Until September last year, KNH charged Sh500 for each radiotherapy for non-members of the National Hospital Insurance Fund. The fees were increased to Sh1,000 per session and Sh3,600 for those who have subscribed to the national insurer.

Hospital chief executive Lily Koros said in a past interview that the Sh3,600-a-session billed on NHIF patients a day translates to the Sh18,000 a week.

Those who cannot afford out-of-the-pocket services have to struggle to remain on treatment.

The widow depends on subsistence farming for her daily upkeep and to support her family. She had already bought the chemotherapy drugs but would not have it administered to her as the doctors went on strike.

Since last December, Ms Kagendo has not been able to go for treatment at KNH and her meagre earnings cannot afford a private facility. Sometimes, to make it among the approximate 400 cancer patients who seek weekly treatment at the largest referral facility in the region, she had to be supported by family or friends, who would chip in to pay for radiotherapy.

“My only hope is to be able to return to KNH and find doctors to administer chemotherapy since I may be forced to have an increased dose to supplement the lost sessions or start treatment from square one – I cannot afford,” said Ms Kagendo.

According to the executive director of the Kenya Cancer Association (KENCASA) Deborah Modi, a patient residing outside Nairobi, who comes to receive treatment at Kenyatta hospital incurs estimated average costs of over Sh2,500 per day on accommodation and transport besides cost of treatment.

Ms Modi said care givers have often been forced to take time off from work in order to look after patients, leading to income loss in cases where they may not be paid for the days they are away from their jobs.

“The doctors’ strike has had a toll on many cancer patients and families as those who are not able to seek treatment at alternative private institutions are left to suffer,” said Ms Modi.

“Some have been forced to seek treatment in private hospitals but are now grappling with the burden of high medical bills, which they are unable to repay.”

KENCASA and Faraja Cancer Support Trust have been leading some interventions to aid cancer patients not to relapse on treatment by navigating them through various facilities for radiotherapy and chemotherapy services.

Faraja Cancer Support Trust, for instance, has been going heavy on physical activity such as yoga, Zumba, Pilates and breathing exercises, which have significantly been therapeutic to most cancer patients, and aiding their treatment.

“At Faraja, we encourage such activities as they help cancer patients, not only to manage the life-altering side-effects of treatment such as fatigue, depression and heart damage, but also in reducing the risk of the disease worsening or recurring,” said a patient support manager at the trust Philip Odiyo.

In finding a lasting solution to reduce the burden of cancer in the country, KENCASA last week submitted representations for the Cancer Prevention and Control (Amendment) Bill, 2016 that is currently in Parliament.

The Bill seeks to amend the Cancer Prevention and Control Act, 2012 to make provision for training of health cadres in specialised medical field of oncology.

It also seeks to include cancer treatment as part of the provision of primary healthcare and to incorporate the use of e-health and telemedicine to ease diagnosis.

Part of what the defiant doctors are fighting for in the June 2013 CBA is the training of medical officers into specialised fields and the recruitment of at least 2,500 doctors in the system annually.

“The June 2013 CBA looks at the number of doctors spread across all specialties. All doctors in Kenya should possess at least one or two specialisation; whether in administration or in a clinical area to close the gap – it is not just about the salaries,” said the Kenya Medical Practitioners, Pharmacists and Dentists Union, Secretary-General Ouma Oluga.

According to a statement from the Clerk of the National Assembly, The Cancer Prevention and Control (Amendment Bill, 2016) has since undergone the first reading and is now committed to the Departmental Committee on Health for consideration and thereafter report to the House.