Thursday, 19 December 2013

#sickat50 - Health crisis escalated by unreasonable government stand!

The healthcare workers strike has been on for 10 days now and still there is no progress in terms of reaching a mutually satisfactory arrangement. This is despite the unions approaching the government several times in the past 6 months and in turn issuing a strike notice 6 weeks ago that requests a stay of human resource devolution to the county level and implementation of the Collective Bargaining Agreement struck in July 2012. 

The nationwide strike has resulted in thousands of healthcare workers downing their tools and a complete paralysis of public health facilities at the county level. The recent high court ruling against the unions further escalated the stalemate. Sadly, President Kenyatta’s statement soon after this ruling did nothing to reconcile the situation.

The county governors now have permission to hire other healthcare workers to replace the striking force. This sort of directive just shows the level to which this government completely lacks coherence of the issues at hand. There are no other healthcare workers (HCWS) to hire; in fact Kenya is dismally short of HCWs by a massive shortfall of at least 50,000 doctors and hundreds of thousands of nurses and other cadres.

So this plan to hire other workers is just ridiculous and of course will not work. The main thing that such directives do is place the blame for patient suffering squarely where it rightly belongs, at the feet of insensitive and incompetent government officials. 

One of the recurring accusations from the government towards the unions is that the HCWs are causing patient deaths and should go back to work for the sake of their patients. But this argument is just a baseless guilt trip that has no bearing in reality. Does the government care about patients ONLY when HCWs are striking? As one medic states “You cannot chronically under invest in health and at the same time talk about how you care about Kenyans, the two are incompatible. While the government has the luxury of pretending to care about patients, we (HCWs) who have to care for the patients “all the time” do not have the luxury to fail patients in future. We know this irregular devolution will hurt the patient in future, why should we go back to serve the patient today and forever fail the patient due to poor staffing?”

We voted in a new constitution with the hope that the transition and devolution of services would be done in a structured and systematic manner. This means that even in the devolution of health services, proper policies and legislation must be in place such that the process is implemented across the country in a manner that will genuinely deliver healthcare services to all citizens and for the foreseeable future. 

Instead, this government chooses a hard line position that completely ignores the concerns of the healthcare unions and harasses and intimidates the HCWs with no regard whatsoever for the public.
Healthcare is one of the most sensitive institutions and services that this government is obliged to provide. It is just criminal negligence on the part of government officials to reject a call to follow the law and order the devolution process in a responsible and considered manner.

While the governors choose to sack and hire HCWs through the media, the propaganda machinery is hard at work to blind the public from the grave realities being presented by this situation. Firstly, the governors did not hire the HCWs thus they cannot fire them, they cannot evict them from government housing and there is no pool of unemployed HCWs from which to source HCWs. 

Politicians should not be allowed to interfere with healthcare in such a manner, their utter ignorance of how sufficient and effective healthcare systems are established ultimately creates collapsed facilities. The best example of a devolved hospital that has been graphically mismanaged due to incompetent political leadership is Pumwani Maternity hospital, the country’s largest maternal care facility. Pumwani is currently in a consistent state of collapse, barely able to cater to the thousands of women who attend this facility each year and the maternal and infant mortality rate is unfortunately very high because of this.

While political leaders claim that the HCWs strike and in particular the doctors contravenes the Hippocratic oath, its best to remember that such claims are rooted in clear ignorance of the doctors’ creed. Kenya’s medical fraternity does NOT administer the Hippocratic Oath which incidentally is an outdated oath to the god Apollo and other goddesses. Rather, they administer the Geneva Declaration also known as the Physician’s Oath which was developed by the World Medical Association in 1948 and was revised as recently as 2006. Moreover, medicine is a PROFESSION and not a CALLING, so to claim that doctors should treat patients without consideration of their own needs by the government is absurd. 

In fact it is the words of the Physician’s Oath that absolutely justifies this HCWs Strike, as it clearly states that : “I will not permit considerations of age, disease or disability, creed, ethnic origin, gender nationality political affiliation or any other factor to intervene between my duty and patient; I will maintain the utmost respect for human life; I will not use my medical knowledge to violate human rights and civil liberties even under threat, I make these promises solemnly freely and upon my honor.”

The refusal by this government to structurally and properly implement the devolution of health services to the nation is a violation of citizens’ human rights and a complete disregard for human life. Were the doctors to resume duty in decrepit, mismanaged, underfunded and under resourced institutions that are in a constant state of collapse, it would be a violation of human rights and a continuation of needless deaths of patients who have consistently been denied proper medical care by a callous leadership. 

Moreover, the decision by the national government to pass on new payroll to the county level that includes a slashing of gross salaries by up to 45% is not only illegal it is a further abuse of HCWs civil rights. With all the propaganda flying around driven at turning the public against their own medics, it is a shame that these truths concerning the health sector are ignored. It is for our own sake that these doctors are insisting on the formation of a Health Service Commission and the implementation of the Collective Bargaining Agreement which would inherently establish the exact structures that ensure consistent and effective medical services for all Kenyans. It’s time for the public to wise up to the lies being propagated that seek to deny them what is rightfully theirs!

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