Kenyan Post Graduate Medical Training and The Church
It is April 2012 on a not-so-busy Thursday afternoon and my colleague and I have just dashed into town to pick some documents from the district medical officer of health’s (DMOH) office. We are both medical interns in a Catholic Mission Hospital in Kenya. As we wait for the DMOH to finish his meeting, we delve into a discussion coveting the level of advancement of medical training in the developed world. Such a talk has been a routine to us; everyone reminiscing on his brief experience abroad as an undergraduate.
As usual when we do these conversations, we embark on critiquing our healthcare. Why can’t we give free healthcare for all? Why can’t we afford automatic progression from undergraduate training into residency? Why is there such a shortage of critical health services such as dialysis and cancer treatment equipment in our public hospitals? Even the few ones in the private hospitals are not adequate. He steals a quick look at the DMOH’s secretary who motions that the meeting is still on. So we nostalgically continue with our chat.
Fast forward to August 2012 and my friend, having got an admission into an American university for a masters’ degree course, has since left for the land of opportunities. I have been redeployed to a district hospital in rural Kenya. I have met more challenges and limitations than I anticipated- skeleton staff, frequently out-of-stock drugs, limited diagnostic capabilities and a significant portion of patients who have to spend an extra two days in the ward after discharge as they struggle to meet the bill. Countless are those who throng the hospital administration office seeking a waiver of their bills. Things are simply tough!
The Mission Triad
This is a remote area and I didn’t expect a private hospital here. But alas I am wrong!
There is a catholic mission hospital. It has good infrastructure but the number of patients is small. Of course it costs several times more than my district hospital. It is then I recall my high school history teacher talking about the early Christian missionary activities in Kenya. Wherever they settled, he used to tell us, these missionary groups would establish a mission centre that comprised of a triad of a church, a hospital (health centre) and a school.
This arrangement is reflected here; there is a school, a church and of course this hospital. All are functional although the buildings have seen better days.
This arrangement reverberates across the country. Even before the birth of the country majority of these were in existence; for it is the missionary society’s arrival to east Africa that preceded the arrival of the British colonialists and settlers. Thence it comes as no surprise that in places where government amenities are a rarity, the odds of finding a mission centre are high. These centres have served Kenyans very well. They provide amenities (schools, churches, health centres, hospitals) and employment. Majority of Kenyans have experienced the influence and contribution of the church in one way or the other.
Scarcity of medical training opportunities
Kenya suffers from an abject shortage of medical doctors. With approximately eight thousand doctors for the population of over 40 million, we are in dire need of over thirty two thousand more doctors to meet the WHO recommended doctor: population ratio of 1:1000. While several Kenyan universities are offering undergraduate training for doctors, post graduate training/residency remains below par. With the current capacity, specialist training is going to remain a challenge further complicating attempts to address the nation’s health needs and achieve the health related millennium development goals.
Opportunity for the Catholic Church
The Catholic Church is a dominant religion in Kenya. It has hospitals across the country. In fact there is at least one catholic hospital in every county. A number of these are fairly well equipped and staffed; some of them are trail blazers in terms of tertiary healthcare. Yet the only catholic university in Kenya- the Catholic University of Eastern Africa (CUEA) does not offer medical training. The church needs to take this earliest chance to exploit their potential and offer this country this valuable service.
There are several factors that favour the rolling out of residency programmes in the catholic hospitals in Kenya.
Firstly, the countrywide distribution of the facilities will ensure infrastructural support for such a programme. Kenyans can imagine the residents doing their tropical medicine rotations in western Kenya, lifestyle diseases in the Mount Kenya region!
Secondly, the global presence that the church enjoys would attract international collaborations involving teacher and resident exchange. Visiting renowned professors would teach some programmes in Kenya.
Lastly, such an arrangement would be cost effective for these hospitals. Instead of hiring doctors who leave after a while to pursue residency elsewhere, they would have these doctors work as they train and possibly retain the best as tutors.
To do the above, the church needs to get professional in the management of these hospitals. Most of these hospitals are run by priests as the administrators. The danger with this is not the ineptitude they may have as administrators (most of them have trained in theology and philosophy); it is the sense of impunity. Each hospital needs to have someone they can fire, or sue. Much as some of the priests make excellent administrators, if some of them go rogue and mismanage the hospital the worst that can happen to them is to be transferred to another catholic facility which they will equally bring down before being transferred to another, with a similar outcome.
The way forward
CUEA should be the university to administer the programme. They need to draft the curriculum and get approval from the Kenyan Commission for Higher Education. They will then assess the situation and determine which programmes can kick off.
The various dioceses that are in charge of these hospitals will also need to relinquish the control of the hospitals to a caucus that should be formed and based at the catholic secretariat at the national level. Such a caucus should co-ordinate all the involved hospitals as a unit.
The next step will be to develop a strategic plan to have all the programmes that are necessary running by a certain appointed time. Hand in hand with this should be the vibrant development of international collaboration.
This is the time. Such an arrangement should have started long time ago, but it’s never too late.
As St. Theresa of Avata used to tell her nuns, ‘you will find God in your pots and pans.’
The Catholic Church has done well providing the Kenyan people with hospitals; they can do better by training health specialist for Kenyans.
About the author: Dr. Aruyaru Stanley Mwenda is a general practitioner working with the Kenyan government. He has graduated from Moi University, Kenya and is interested in surgery and clinical research. The author can be reached at: [email protected]
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