PERSONAL OPINION ON MMED PRE-ENROLMENT PROFESSIONAL INDEMNTIY COVER

The now entrenched demand that those who apply for masters straining in clinical subjects obtain indemnity cover had generated more heat than light. Many an applicant would like to know why this is paramount before one is even considered for interviews.

From the onset, my personal opinion about this requirement is a big nay. Professional indemnity takes over in cases one, practicing on their own is involved in a legal suit arising from acts of omission or commission while discharging duties of their profession.

For started, persons applying and joining teaching hospitals do so to be taught and are not in any way entitled (whatever they do in these facilities cannot be termed as private practice) do private practice.

It is therefore expected that these apprentices who act and discharge their duties at the behest of their tutors are at all times guided and whatever they do is at all times interrogated. Thus the teachers must indemnify the trainees by bearing overall responsibility. Moreover, the teachers in medical school do not in any way participate in deciding who presents for treatment, procurement of supplies and support services and overall quality of care. Thus, to indemnify trainees on the assumption that the working and/or training environment is in a way that favors best practices is sheer naivety.

So who should take responsibility in indemnifying against unwanted treatment outcomes? My considered opinion is that the training facilities ultimately should bear overall responsibility. They are the custodians of quality and all attributes of quality, processes, staffing and procurement processes. In addition, they define the nature of patients who patronize their facility. Hence it cannot be that having envisaged possible shortcomings in their quality assurance, the training institutions would rush to demand legally unfounded indemnity

That said, the training facilities act with absolute discretion to determine what to demand and what not to demand for. Furthermore such single handed decisions are passed to training institutions who are arm twisted to pass it to trainees without raising queries due to loosely crafted memorandum of understanding. The same MOUs allow universities turn a blind eye when hospitals mistreat, discriminate and intimidate their students due to fear of unspecified consequences

Finally, there is one entity that should define this ranging debate on PIs as prerequisite for application and short listing for post graduate training. This is the courts! The regulatory bodies such as Medical Board and Poisons Board lack locus standi to dictate to other state agencies and training schools and hospitals on what to list as minimum requirements for application. At best these interested regulators can provide an opinion what may be adopted on ignored by the universities/training hospitals. And that is my opinion

Why Dont We Appreciate Our Doctors?

Sociologists world over have argued on the critical role played by praising anything good done. Conversely, reprimanding wrongful deeds have their own role(s). These two mirror images constitute what is called positive and negative reinforcement respectively. Positive reinforcement encourages and motivates repetition of actions that are good and generally accepted while negative reinforcement acts are a deterrent to repetition of such undesired habits. This forms the core of socialization process.

It is human nature to expect that one is acknowledged and appreciated after they put emotional and mental effort to achieve a certain desired good. Moreover, some professions deal with key fundamental services that determine the overall well being of the society.

Such sector is health sector. Any time there is a catastrophe, every one, all and sundry look upon doctors to alleviate human suffering; to treat and heal the afflicted. It ends there whenever all is well until another disaster happens. This cycle of ‘recognition’ at the height of stress and suffering and aloofness at good times should concern many consumers of health care services, both preventive and curative.

It thus shows why the lack of positive reinforcement has adversely affected the morale and commitment among medical practitioners. This unfortunate phenomenon is not a Kenyan or African one. The glaring lack of recognition spans across the borders even to the most developed nations

In Africa, this couple with poor direct and indirect remuneration of doctors has contributed to immense proportions of brain drain. The continent loses its most qualified health workers every day. And sadly, all the health indicators keep point southwards.

Why has there been no initiative to identify the trail blazers in health sector and recognize them? Why doesn’t the public systems and recognition awards ever isolate a doctor who has spent decades toiling with a sole purpose to improve health of the masses? How comes every day we inherit the look warm attitude towards doctors who literally superintend over our individual and collective well being?

Is it possible just to say thank you to our doctors even without solicitation more so at times when things are still? Who exactly is supposed to introduce this revolutionary culture of “saying thank you”? We stand accused as a population, as professionals, at middle class. And as decision makers

A time comes where the public and the players in the sector comes up with a scheme to “say thank you” to our iconic ladies and gentlemen, the ever hard working doctors, the literal custodians of health and wellness.

It shall be done… in the near future.

And during our times.

THE KENYA MEDICAL PRACTITIONERS AND DENTISTS BOARD ELECTIONS 2014; SYNOPSIS

We have given detailed analysis of the going-on at the medical board and point on a number of areas where it was evident that the entity was anti-doctor. There has been too much focus on appeasing other players and we are at cross roads as a profession.

My interaction with the board dates back to the year 2004 when there was rampant delays in registration and unprecedented carelessness that led to loss of internship assessment forms. The board whose the secretary then was the DMS would proceed to post doctors and dentist and fail to remit forms to Afya house for appropriate promotion and adjustment of salaries.

It appeared that the Board was a military arm of the government to intimidate and harass doctors never to ask questions. And with a stroke of a pen one would get stopped from practicing medicine in the republic until one begs the main guy there.

Fast forward to the year 2011 when there was an outbreak of strikes in the health sector. The board was ambivalent and equivocal when all these transpired. At some point, there was strong attempt to use to board to coerce staff members of a private Hospital to resume duty. That the licensing body could overlook very pertinent concerns raised by the profession whom they are mandated to oversee, that was outrageous.

During the strike to relieve registrars from chronic oppression, we sought guidance from the same board. That the board could remain aloof while person whom they have certified to practice medicine were being abused, this still remains un-understood. The current chair is on the record sending very intimidating adverts to registrars clearly boldened by his position in the board.

In the strike of 2013, the board became the missing link. By standing on the side while quacks and impersonators hoodwinked the public they failed to rise to occasion. The crazy adverts calling for retired interns, medical students, herbalists to come forward and get locums, was the lowest point in my view. The regulator should always speak out whether it is convenient or not.

My big question remains: Do the members of the medical board identify with, or agree that there are issues in the sector that they regulate?

In the last few years, there have been a number of reviews of fees paid by doctors to obtain services from the medical board. The retention fees have more than doubled, the annual cost of licensing has sky rocketed. The most ridiculous is introduction of very high fees to obtain Certificate of good professional standing. What explanation does one give why Kenya Police with all its flaws would charge Ksh 1000 while the Board charges Ksh 20,000? We have sought this answer severally prompted by the pain this causes to users of these good conduct certificates. The last answer was laughable: that the board needed to make money to serve doctors and dentist! If this is a statutory body created by an act of Parliament, this should attract funding from the government. It shall never be allowed that every time these fees are increased at will with absolutely no participation from members.

In the year 2013 we participated in review of the Medical Practitioners Board Act. While the revised version offers some progress, there must be good will to safeguard the interest of members by the regulator. The board is structure to strictly advantage the older members of the profession while ‘giving no damn’ about the younger members. A quick interrogation shows a unit devoid of new ideas. Any person who minds about the profession must strictly consider voting progressive members into the medical board. If this does not happen, CHOICES HAVE CONSEQUENCES.

It is not imperative that every doctor, dentist alive today must participate in the upcoming elections. The board must get people with new ideas, sensitive to the plight of the professions they regulate. In the absence of this paradigm shift, health sector shall remain in the ICU where it is currently.

Let the discussion proceed. And let the discussion culminate into action (Voting)

OH YE HYPOCRITES, KALONZO WAS RIGHT AFTER ALL

Over the weekend the Kenyan media was abuzz with condemnations meted towards the former Kenya vice president over an utterance he made towards a certain journalist. I have had time to reflect on this rather double unfortunate incident and here below is my well considered opinion

Its double unfortunate in this sense; first coming from the person of Kalonzo’s stature, everyone was shocked. And secondly the reaction by the opponents there their thinly veiled political capital leaves a lot of disgust.

It must be remembered from the onset that the CORD quartet of Raila, Nyong’o, Kalonzo and Wetangula were in the ‘half-carpet’ government. This is the government that shall be remembered from entrenching corruption and negative ethnicity to the core of its citizenry. |The argument that the ODM side was sidelined by the coalition government is literally white lies. Having noticed the disorder that was brought into the otherwise stable health sector, the neglect and wanton looting presided by one of the quartette, it spell betrayal to Kenyans and simply assuming that the populace have memory derangements. One of the persons paraded in the press conference to condemn jubilee government was not less than the VP in the previous regime. Surprisingly when asked what he has ever achieved, he is always keen to recite that he was not the CIC.

Moreover, the third principal still harbors a stone tied around his neck having been mentioned in a myriad of scandals. While he may eventually be set free, it must be remembered the saying that those who live in glass houses must not throw stones at their neighbors. As far at the CORD principal, HE Raila is concerned, one can read that he has genuine concern to deliver genuine reforms. In contrast to his intentions, he has chosen to surround himself with a lot of political baggage and persons long past their expiry date. Someone should be candid and tell him so.

Matters of security must never be politicized. As one condemns the law enforcers, they are the only entity entrusted with ensuring that the citizens are safe and secure.  Like any organization, there may be few rotten eggs and this does not imply that all officers are bad persons. We have witnessed police being detonated by gangs who reside amongst us. Yet we assume a don’t-care attitude and the moment anything is done, there are clowns who will shout themselves hoarse. This is an attempt the remain politically afloat and relevant

Now back to the subject matter.

While we all vilify the former VP, let’s not be the proverbial crowd that caught a woman in bed with a man committing fornication. And enthusiastically they brought her before Jesus. It’s documented that He told them if indeed the prescribed penalty was by stoning, “LET HE WHO HAS NO SIN CAST THE FIRST STONE”. The crowd one by one dispersed having searched their hearts.

We have focused so much in removing specs in other persons’ eyes and forgotten that indeed ours have large planks of wound. We have become masters of double speak and selective amnesia. We put on sheep skin yet inside we are voracious wolfs. The cancer of negative ethnicity haunts all and sundry. It is preached in churched and other places of worship. Here most emphasize and sugarcoat it as being proud of one’s roots. Negative ethnicity is the most glorified vice across the nation. It is deep rooted and unfortunate. It has been embraced by everyone. How sad.

Why do I say so?

In the recent past, Kenyans have turned a cold should, deaf ear to the suffering of many a Kenyan whose only fault is to bear certain names or having been born in certain geographical regions. Every day we witness systematic disenfranchisement of millions. We see generalized neglect. How else should one explained kids learning in the cold under a tree on empty stomachs, in rugs and jigger infested in a nation that that remained an exporter of peace? Does it bother our conscience that in certain regions becoming pregnant is almost equivalent to signing up for death sentence? How about the high prevalence of malnutrition, anguish and chronic hunger suffered by residents of upper rift valley and North Eastern Kenya? Such regions are only remembered during elections often through their leaders who constantly auction them.

When appointment for plum jobs are skewed, and smaller groups are marginalized what can be worse than this? A nation that does ignore the plight of the weak and down trodden and every one pretends that all is well, does it then bother us when people walk around with stress, heavy hearts and resentment?

So was Kalonzo right on his ethnic slur?

This question still remains divisive. Although circumstantially, he may be considered to have been right; the only blunder he committed was to speak out his mind. Most of us are afraid of openly expressing what we openly feel or thinks. Consequently we white wash tombs in order to appear alright. If he honestly perceived that the prodding was motivate by other factors other than knowing the truth on the part of the journalist, he may have acted within reasonable limits. Moreover world over the role of opposition is to poke holes in the actions of the ruling class. It have never been the work of opposition to provide strategy to the ruling class

On the other hand if he lumped the entire community and presumed that the journalist spoke on their behalf, this is a gross error. He should come out and unreservedly offer and apology. Failure to which he shall remain blacklisted and all his good deeds of the past might as well be erased from one careless utterance.

Finally, I will take the middle class, who have become idlers on social media seriously if they champion for what is right in an unbiased manner. Selective noise making has never served to build any nation. On the contrary this will segregate communities and groups and further drive a wedge along ethnopolitical cleavage.

I stand to be corrected.

F. Kairithia

SHOULD YOU SPEAK OR KEEP QUIET?

One Friday afternoon on the eve of a national holiday you arrive at the matatu terminus at 4.30pm. You have been held up at the office preparing for this long weekend. The process took longer than anticipated and you must travel.

On checking at the terminus, there is one vehicle and you are the fifth passenger. You need seven more passengers to embark on the safari. At 5.45pm you only need one person. The driver strolls and ignites the vehicle in anticipation that as soon as the last person boards, the vehicle takes off.

The driver appears obviously nervous and a bit confused. He is actually nervous. He fumbles his pockets and finally appears to have remembers something. He opens the small cabinet at the vehicle dashboard and retrieves two small paper bags and a bottle of water. He does this as he engages you in conversation. You discuss the happenings of the day, politics and other matters.

As he proceeds, you notice he has some prescription medicines. Curiously you look. One set is written Tegretol 200mg and another is Panadol. He blames his headaches on the extreme temperatures of the day. He looks drunk but there is no alcoholic smell. After brief thought, it hits you! The guy is actually epileptic for 4yrs now.  The driver explained after an accident he started having the ‘problem’ but of late due to increased workload he has been forgetting to take his drugs regularly. As such he had fainted twice in the last 3months.

Immediately you appreciate that there is a problem. You may get an accident along the way should the driver develop the ‘problem’. The first attempt is to talk to him that it would be better to look for another driver and for him to get and get some rest. He vehemently refuses and turns very irate accusing you of trying to dictate him at his place of work. You get too polite but to no avail. The other passengers notice you are in argument.

As a conscientious person you decide to postpone you journey and alight. Wait a minute. You decide to inform other passengers about your fears. They retort that the driver has been on the road the whole day and nothing has happened. In addition they invoke religion and say if God planned for them to have an accident, it will happen anyway. Darkness is fast approaching and as you protest, the other passengers become violent verbally and threaten to fix you if you continued with the wild allegations.

Finally, you make the final decision. Disembark from the vehicle and leave the scene with regret that your passion to assist has brought you so much anguish. Fortunately you get a room at the town and postpone your travel to the following day.

While taking your meals, you notice some breaking news on the TV that a 13seater matatu has veered off the road at a sharp bend and killed all the occupants. They give details and you later realize it is the same vehicle you alighted from.

You are overcome with grief and leave your meals half way to spend a sleepless night tossing and turning in bed not sure whose fault it is…………………………………………………