OPINION: The voice of a Kenyan doctor abroad on internship posting crisis

By Dr. Ruguru Kimani

The posting of medical interns has become a perennial challenge in Kenya. Each year, medical students graduate from school but must complete a one-year internship in order to obtain a valid practicing license. Currently, more than 1,000 interns have been waiting for almost a year for posting. The Kenyan Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has lobbied to make the process seamless but that has been unsuccessful.

The delayed posting of interns made national news on Thursday, when Dr. Davji Bhimji Atellah, the Secretary General of KMPDU, sustained a head injury during a peaceful protest about the delays that he led, joined by physicians, dentists, and pharmacists. Dr. Atellah was reportedly struck by a teargas canister fired by a senior police officer, causing him a severe head injury, and is presently hospitalized after undergoing a surgery.

This violent incident should serve as a wake-up call.

I am a Kenyan medical doctor, currently undertaking my Master’s in Global Health at Duke University. I completed my internship last year. Our graduating class had to wait 8 months after school before posting. We had meetings and protests at the Ministry of Health (MoH), but nothing hastened our appointments, a time that caused us a lot of frustration.

The World Health Organization (WHO) notes that, in 2021, there were just 2.6 medical doctors per 10,000 people in Kenya. This ratio is far below the WHO’s recommendation that every country should have at least 1 doctor to 1,000 people. Kenya is understaffed, with patients waiting in line for hours and the employed healthcare professionals working long hours. Yet the nation has over 4,000 qualified unemployed doctors, and now more than 1,000 unposted interns. With the understaffing, it becomes impossible to achieve universal health coverage with the shortage of human resource.

So, how can this perennial problem of delayed posting of interns be tackled?

First, this is an opportune moment to strengthen the KMPDU, the body tasked with delivering the grievances of its members for fulfillment. The union needs to hold more press conferences and air out the challenges that come with understaffed hospitals. Stories of doctors need to be shared to garner support from the public, who are the taxpayers and who deserve proper treatment from the hospitals. Encounters need to be told of how some doctors must work more than 36-hour shifts while their colleagues have no jobs. Access to media services and airing stories from the health workers will put a human face to the grievances.

Secondly, the Ministry of Health needs to be engaged. KMPDU has had various meetings in the presence of the interns awaiting posting, but the delays persist. Engagement will involve proper financial planning to have salaries ready to pay the interns, as this has been one of the main reasons given for the delays. Also, the balloting process for internship slots should be done immediately after graduation, so that the hospitals begin preparing rotas on rotations. Interns should be posted within the first month of graduation to create continuity in the learning life cycle, as a delay of close to a year interferes with the progression of learning. The structure created should take into consideration all students enrolled in medical schools each year, as enrollment leads to the inevitable need for an internship 6 years later.

The recent injury to Dr. Atellah has shaken the national health landscape. Policies need to be formed now, agreements need to be signed, to pivot the fate of doctors in Kenya for the better.