06 Mar Case Study: Kenya’s Health Crisis

Above, we have the 13 stitches removed by our volunteer nurse.

Clavicle Conundrums

Here is a little Facebook post we put up last month about one of our kids.

One of our 11 year old boys was running away from a friend in a harmless game of tag, when he ran clavicle-first into a tree. This little guy didn’t cry, but he did complain of severe shoulder pain. In his words, “…the tree bit me!” Those darn Acacias. The x-ray showed a broken clavicle, and as luck would have it, the clavicle was fractured in the only spot that wouldn’t heal on its own: the dreaded ‘distal third’. It even sounds scary. And surgery is necessary for him to regain use of his arm.

Public doctors in Kenya are currently on strike, and have been for the past 2 months. Which leaves only certain private clinics available. So after two days of carting this poor guy to different clinics for assessments, he was offered a surgical spot for $1500-2000 USD. With the admission forms ready, we planned on going to the hospital only to discover that today, February 15, the private sector doctors have been forced to join the public sector doctors on strike. This means that nearly all services are halted for the time being. When they do open (and hopefully soon) he will be facing a large bill to receive care. Like we mentioned, without surgery, he will have severely limited use of his arm for the rest of his life. He wont be able to throw sweet gangsta signs like in this photo (taken back at Christmas). If you would like to help, please send your suitcases full of money to Simama Project! Head to www.simamaproject.org to see just how you can help. Check out the blog while you are there!

By that time we got the surgery, his shoulder has been broken for 20 days. Our volunteer nurse Rachel had taken him to 5 doctors, 4 clinics, and spent 9 days calling around and taking him to these appointments. Public doctors here have been on strike since the beginning of December, protesting wages and the general dilapidation of the Kenyan healthcare system, so the remaining options are private docs. The sad reality is, if this little guy didn’t have a team of people doing the work, figuring out a solution and funding it, his shoulder would have probably remained untreated. Which is the reality for most Kenyans right now. We have a friend who told us of a child in his community who has had a compound fracture femur (broken thigh bone with the bone protruding from his skin), for over a month. His parents cant afford to continually take him to clinics, just to be refused treatment. Its been hard for us trying to get results while the doctors are on strike, and my first response has been anger at the doctors for going on strike in the first place. But after some digging, the story is a bit more nuanced.

So a deal was signed between the Kenya Medical Practitioners’ Union and the government in 2013 that covered wages, working conditions, etc. The government still hasn’t honoured the requirements from that agreement, so the wages and working conditions are still where they were before. In reality, lots of the public doctors are making about $1200 a month. Reading the news here, the government is trying to paint the doctors as “greedy” by saying doctors are seeking huge pay increases. But the union is only seeking that the government honour the agreement that they signed 4 years ago. Two weeks ago the government arrested doctors involved in the strike, sentencing them to one month in jail. Private doctors, who were to this point not involved in the strike, were forced to join the strike in solidarity to their imprisoned co-workers.

The doctors’ union also says it wants more medics hired to reduce the doctor-patient ratio, currently one doctor for more than 16,000 Kenyans. America by comparison, is 1 doc to 500 Americans. So lets do some more digging.

Here is a pretty amazing quote from Al Jazeera news.

Kenya boasts one of world’s fastest growing economies and a national budget of about $16 billion.

In 2015 more than a quarter of that budget went missing entirely and only 1 percent was spent legally, according to a comprehensive audit by the independent auditor general. Of the $4.4 billion that disappeared, $53m came from Kenya’s health ministry. Doctors say if officials can swindle that much money, they can come up with the funds to implement the 2013 agreement.

Critics of the government point out that during the same years in which the government was deliberating over whether to raise doctors’ salaries, Kenyan politicians voted repeatedly to raise their own. Parliamentarians now earn about $5,000 per month and thousands of dollars more in annual perks. They are the second most highly paid politicians in the world.

Second most highly paid politicians in the world, even though Kenya’s GDP per capita, (lets adjust for relative purchasing power) places it at number 150, or the 39th poorest in the world.

Check out the full article here http://www.aljazeera.com/indepth/features/2017/02/kenya-doctors-strike-leaves-nation-ailing-170209104743865.html

Finding real news articles about this stuff is VERY difficult. BBC or Al Jazeera have been good, but most of the articles you read by the in-country papers are heavily influenced. So, with the information we have, shall we side with the doctors in this fight? Its not that simple either. This is a complicated situation.

Kenya is a fast growing economy, but still a very poor economy. Kenya’s economic backbone is its agricultural sector, which is of course weathering a huge drought right now. Unemployment in Kenya is still around 50%. So lets look at this doctors strike with the local economy in mind. If the agreement the doctors and government signed  in 2013 had been fully honoured, the government would have had to hire a huge amount of medical professionals, and pay them substantially more. Lets say we start by paying an average of $50 000 a year to each doc (pretty cheap by western standards), and hire 2x the doctors (bringing the doc/patient ratio to a still very frugal 1 doc/8000 Kenyans) Just the salaries for those docs would be $700 million. That is more than the entire health budget from last year. Leaving no salaries for the 30,000 nurses, not to mention the extra nurses the agreement says they need to hire, not to mention the badly needed infrastructure updates and maintenance, not to mention lets say… MEDICINE. We can compare that to other countries with free healthcare, such as Canada who by contrast spends roughly 10% of its budget paying its doctors. This is a big problem. Kenya is a fast developing country, and experiencing some serious growing pains, made obvious recently in this health sector problem. Doctors receive educations comparable to their western counterparts, and should have a right to expect comparable wages, right? But it seems the economy cannot support it right now. If we look at their wages compared to the national average, we see some interesting numbers. Sorry, but this is gonna get a bit nerdy. Ok, the national average Kenyan salary is $912. Thats $2.45 a day. Paying a doc $50 000 a year would mean they would be making 55 times the national average salary. If we compare to Canada’s public health system again, the average wage in Canada is $49 504 a year, and the average Canadian doc makes $161 000, only 3.2 times the average Canadian. Even if we compare to Americas private system, which is known for being pricey, doctors make an average of $230 000, thats only 4.8 times the average wage of $48 099. (These numbers are from forbes.com.)

In conclusion, this is a very complicated time for Kenya. The doctors here are being paid very poorly, working in very rough conditions. But the economy cannot realistically support the agreement that they signed with the government 4 yrs ago. It’s probably going to be a long strike. This is the world in which Simama operates in. What all this means for us, is the hospitals are closed. Private clinics are overrun. The short-term outlook is pretty bleak.

Simama continues to work towards long term change, starting here, in Nanyuki, Kenya.IMG_2308 (1)