The plight of medical interns in Kenya

The streets of social media and the rooms of mainstream media in Kenya have blown up with the story of a young doctor who died by suicide over the weekend. She was a medical intern at a hospital I previously worked at when I lived and worked as a nurse in Kenya. It hurt in every possible way. I may not have met Dr. Moraa (her name) but it is baffling that we passed through the same hospital gate, five years after my departure. I mourn her and join her family and friends in telling the world that Dr. Moraa did not just die by suicide, the system killed her.

To understand that last statement, walk with me to when I was still a nurse/midwife in Kenya. It was a beautiful Sunday morning and we had a mum in the labor and delivery unit and we had a mum in obstructed labour. She needed an emergency Caesarean Section lest we lose her or the baby, if not both. We could have lost them anyway had we gone for the Caesarean Section with a visibly tired and hungry doctor. We needed a safe doctor, not just a doctor. We insisted that she ate, and rested. She (the doctor) had done 72hours shift without a break. The outcome of her rest was a live mother and a live baby, both in perfect condition.

This is not abnormal in Kenya. Doctors (medical interns), undertake inhumanly long shifts with little to no pay and are expected to work at their optimum abilities. For context, they are not "students," as the government would want everyone to believe. If they were, then they would always be working under the supervision of consultants. Consultants show up once in the morning for Ward Rounds if we are lucky, then disappear to their thriving private clinics. This is the practice in Kenya and for that reason, if nothing else, medical interns are fully-fledged doctors.

Medical interns treat and perform surgeries without supervision. They are only expected to call the consultant if they are stuck. ?Even then, if a consultant has to leave their private practice and come attend to the patient after being called by the medical intern, that medical intern will hate the day they were born. Many consultants turn up to insult the intern. They degrade them and instead of instructing for educational purposes, they make them feel like they committed murder just by asking them to come help save a patient's life. The interns learn early not to bother their demigods of a consultant. So they refer to the next available facility. A missed opportunity, and a delayed diagnosis wrapped up in ribbons of patient safety concerns.

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?Dr.Moraa did not have to die. Yet her death is a wake-up call to the abusive system that interns find themselves in in Kenya. They are insulted by the consultants under whom they train. During Ward Rounds, they are degraded in front of students and patients in the hospital. They are hit with superlative expletives which make them feel like they know nothing about medicine. They are expected to keep calm and absorb it because they are doctors. Their seniors went through the same, why would they want it any easier?

Which leads me to the crux of the matter. Why do you have to bully someone into something they are already motivated for? Medicine is a tough profession already, anyone reaching the level of an intern is truly committed to the profession. It makes no sense to force-feed it to them. It steals the whole joy of the experience. They do not complain because this brokenness is normal. Wholesome, kind, compassionate training, is abnormal. They keep calm and carry on.

This issue is compounded by delay or denial of salaries. Doctors need money to pay bills on time. The current Ministry of Health is hellbent on calling medical interns ‘students’ to justify not paying them. Furthermore, county (local) governments and individual hospitals have free will to do whatever they want with their interns. There is no binding structure on when and how much a medical intern should be paid. And whatever structure exists is just a suggestion, like our traffic rules in Kenya. Well written, not executed. ?

Allegedly, Dr.Moraa had gone for months without pay. Her bills were insurmountable. Her debt, choking. It is illegal, corrupt, immoral, inhumane, and borderline sadistic.

The medical interns’ traumatic training is compounded by an unspoken culture of silence among doctors. They are taught to take whatever life throws their way and keep on keeping on. They do not speak about their struggles, lest they be seen as weaklings. Weaklings are not good doctors, are they?

May God comfort the family of Dr.Moraa, and may her soul rest in eternal peace.

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I wrote this article to highlight the problems that medical interns in Kenya go through, which have been brought to light by this unfortunate event. Perhaps, somewhere in the darkness, someone will listen.