Why Kenyan doctors are ill at ease with Cuban training

The death of a Kenyan doctor, who was sponsored by the government to study family medicine in a deal with Cuba, has exposed the soft underbelly of the programme.

The training deal, signed between the two governments during President Uhuru Kenyatta's visit to Havana in March last year, was meant to develop a pool of much-needed skills in the ailing Kenyan healthcare sector.

The deal would see 100 Cuban doctors come to Kenya, of which 47 work as specialists while 53 family physicians were deployed to the counties.

Kenya in turn secured space for its 50 doctors to study in Cuba, famed for its world-class healthcare system. But now questions are likely to emerge about the deal after Dr Hamisi Ali Juma committed suicide in Cuba in what is attributed to frustration from training conditions there.

Details emerged Tuesday of how all the 50 doctors, including Dr Juma, sent an urgent appeal to the government, saying that it was no longer tenable to continue with the programme given the logistical challenges they endure. It is not clear whether the complaints were addressed.

On Monday the Kenya Medical Association (KMA) demanded that their colleagues who want to come back be allowed to do so and be placed in local institutions that offer family medicine training at government’s cost.

The medics say they were enrolled on the programme without complete information on the course, accommodation, welfare, and allowances. They cite threats from the government as reasons for their having boarded the flight to Cuba and their continued stay on the programme.

“We were then made to board the plane with threats that whoever does not do this should write his/her name on a list that was provided and would face undisclosed tough disciplinary actions by his/her county,” says a letter that was signed by the doctors.

The doctors, who are employees of the county governments, say that they have had no choice but to stay on despite the fact that life is expensive and they hardly communicate with their families.

Late last year, one of the doctors, who sought anonymity, said that after completion of their 15-week language proficiency course they again requested for a delay in moving to the School of Medicine in Havana where they were to begin their Master's degree in Family Medicine course.

“On September 20 we wrote to the Ministry of Health asking that the travel dates to Cuba be postponed to allow for some issues to be addressed but this was ignored and so this time we would rather come back home than find ourselves in the same conditions we have experienced here in Cojimar,” he said.

Stipend

Early this year the medics wrote to the ministry to complain about delays in payment of the quarterly stipend, something which the Chief Administrative Secretary Rashid Aman, acknowledged.

“We pay an advance which was delayed because of the holiday season, it is a slight delay but there is no need for concern,” Dr Aman said.

The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPPDU), through secretary-general Ouma Oluga, said that the doctors were given a raw deal.

“The arrangement has left Kenyan doctors vulnerable, frustrated and in deplorable conditions. This follows failure by the Kenyan government to secure proper housing, pay promised allowances and allow the doctors to reconnect with their families," Dr Oluga said.

Dr Thuranira Kaugiria, the KMPPDU secretary-general for Nairobi County, said the doctors had raised concerns about allowances and reconnection with families on several occasions.

“I think it is time we called for an audit of the Cuban deal because the doctors who travelled there have formally lodged a complaint with the ministry, stating that the cost of living was high and that they would like their allowances raised to an agreed upon amount of Sh144,000 a month and yet they were only paid Sh36,000 a month,” he said.

Enhance payment

The ministry said that the reason the doctors are paid 25 per cent of the initial Sh144,000 is because it caters for food and accommodation for the medics. It, however, made an attempt to address the issue in a letter to the doctors stating that it would enhance the payment for the months of January, February and March 2019 from Sh36,000 to Sh50,000 a month.

“Going forward the ministry will commence payment of stipends as provided for in the circular number OP/CAB.2/12A dated November 4, 2001 on rates of allowances payable to government-sponsored trainees once the addendum to the agreement is finalised and signed,” says the letter.

The doctors, who had also requested for return tickets, every year as is the case with the Cuban medics in the country, were informed that they were not entitled to air tickets during their mid-term.

“The Memorandum of Understanding (MoU) did not factor in the provision of air tickets during the mid-term break and therefore the ministry is unable to provide for the same,” says the letter.

On Monday, Dr Aman said that there was still room for negotiations and that they would try and figure out a way to make the doctors' stay in Cuba bearable.

“We are talking with the counties to see a way forward because it has been six months only and it is still possible to come up with an agreement on this [air tickets] and other issues that have come up,” he said.

As the ministry sends its team to Cuba to investigate the reason behind the death of Dr Juma the team is also expected to chart a way forward with the 49 doctors who have declared they would rather come back than continue with the programme as it is.