A sombre, six-sentence paragraph was the final communication Dr Fred Muoki penned. It wasn’t a will, but a suicide note addressed to his sister.
He expressed regret that the pressure of life had knocked him down.
He was a rising star that many expected to shine bright, a hardworking young man whose hopes for a better life were dimmed by a society and government that neglected him.
“I’m sorry sister. I have a lot of pressure. Debts and loans from my friends. I am sorry to disappoint you. I don’t have money in my account so don’t bother checking. I am deeply sorry sister,” he signed off before killing himself.
Dr Muoki is said to have struggled for months to secure employment after graduating from medical school.
Societal pressure gave him tough bouts that robbed off any strength left in him.
He needed to provide for his loved ones. He needed to live his dream of restoring people’s lives, but who was to give him that chance?
He needed to earn his doctor title, but it remained just a name, his skills underutilised.
Muoki, unfortunately, is one among an increasing number of Kenyan doctors who are taking the dark route to the abyss, after seeing their hopes for saving lives, and a rewarding career dashed.
Mourners pay their last respects to Dr Fredrick Muoki Wambua at Ketululu Village in Machakos County on February 3, 2023. Dr Muoki died by suicide at Kangundo Township last week.
According to the Kenya Medical Practitioners and Dentists Board, about seven medical doctors have died by suicide in the last seven years, after failing to get an opportunity to practice.
After a gruelling six years in medical school, doctors always look forward to saving lives, but those coming out of school wait longer than usual these days.
About 4,000 doctors in Kenya are jobless, despite both public and private hospitals being overwhelmed by staff shortages.
In whose hands are the patients safe, one would wonder, for those at work are burnt out, compromising the quality of their output.
Worrying numbers
More than 5,000 doctors have graduated in the last five years, registered and licensed by the Kenya Medical Practitioners and Dentists Council to practice.
Of these, about 3,800 are medical officers, 272 dentists and 1,280 pharmacists.
Last year had the most doctors getting registered – 1,330. The year 2020 had 1,321 doctors join the market, 2018 registered 979 doctors, in 2021 (955) and another 767 joined the profession in 2019.
Out of the 5,352 registered in that period, only 1,000 have been hired, with the rest joining the growing list of unemployed graduates.
Nairobi County recruited the highest number of medical practitioners in the last five years, having absorbed 134.
It is followed by Kisumu and Kitui hiring 58 each.
Mombasa employed 45, Murang’a (44), Lamu (36), Machakos (34) with Kiambu, Mandera and Laikipia employing 33 medical practitioners each.
Read: 5,500 doctors needed
The KMPDU data shows that in the same period, Uasin Gishu County employed only two doctors, while Kajiado, Samburu and Elgeyo Marakwet hired three each.
Baringo recruited four, Narok (five), Bungoma (six), Kisii (seven), with Nyamira employing eight.
Union Secretary General Davji Atellah, told the Sunday Nation that only about 20 per cent of medical practitioners that have graduated have been employed since 2018.
Despite health being a devolved function, counties do not hire doctors every year as the national government would do before the advent of devolution.
“This is many hospitals suffer staff shortages. Not many hospitals can give quality healthcare,” Dr Atellah said.
Before 2017, every doctor being churned out of university post-internship got hired. The Health Ministry would post them to different hospitals across the country.
Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU) Secretary General Dr. Davji Bhimji Atellah. Atellah says that only about 20 per cent of medical practitioners that have graduated have been employed since 2018.
“This stopped and that is why there is a long list of Kenyans waiting for procedures. Even specialists are left out. Many cancer cases go undiagnosed because of the shortage,” he said.
“If doctors were hired, the burden would reduce. The only way to successful universal health coverage is hiring doctors.”
Dr Atellah says Kenya is the only country on the continent that has a surplus of unemployed doctors and a biting shortage in hospitals.
“I feel for my colleagues who, after spending many years on a course, still have to toil for years looking for employment or work under precarious contracts that don’t offer them similar benefits as their older colleagues,” Dr Atellah said.
“Those lucky to be employed work long hours, with no leave days, no medical cover, no study leave and inferior pay with illegal clauses in their contracts barring them from joining the union or participating in union activities. When these inhuman contracts run out, they don’t get renewed and neither do the doctors get their gratuity.”
The union has since urged county governments to close the gap between the number of graduates and the shortage being recorded in hospitals.
It wants hospitals to recruit as many fresh recruits as they can to address the staff shortage.
With many waiting to be hired, the few employed ones are struggling to attend to millions of Kenyans crowding at hospitals.
Business ventures
Multiple interviews by the Sunday Nation revealed that many of the unemployed doctors have ventured into business, some unrelated to their profession.
Others are doing part-time shifts in private hospitals, earning for the hours that they render.
Dr Atellah said doctors who remain unemployed for long opt for low-paying jobs at private hospitals.
It takes seven years to train as a medical doctor, including a year of compulsory internship.
The cost of training one doctor ranges from Sh4million to Sh5 million.
“It is sad that a nation would spend so much on training its greatest brains in one of the noblest professions and fail to utilise them to save lives. Kenyans continue to die from treatable illnesses,” Dr Atellah said.
Almost 10 local universities offer medical training.
Other doctors obtain medical education from international universities and return home to contribute to the country’s healthcare.
“Kenya seems to have adopted a policy of train and dump in the last six years,” he said.
The union and council want the government to recruit doctors every year as is the case with the military, police and teachers. They say that should happen start and go on until the country achieves the World Health Organisation (WHO) recommended doctor to patients ratio of 1:1,000. We are at 1:17,000. This is unacceptable,” Dr Atellah said.
According to the WHO, the prescribed health worker-to-patient ratio is determined as 23 doctors, nurses and midwives for every 10,000 people.
However, data shows that the health workforce ratio in Kenya stands at 13 doctors, nurses and midwives for every 10,000 people.
They also want the management of human resources for healthcare to be centralised and standardised to reduce the many strikes and work boycotts occasioned by disputes with devolved governments.
“The Ministry of Health announced that the plan to hire 20,000 workers to bridge the doctor, nurse and midwife ratio recommended by WHO is in the pipeline but how just long is this pipeline?” he asked.
In an interview with the Sunday Nation, Health Cabinet Secretary Susan Nakhumicha said workers would be recruited over a three-year period subject to the availability of the Sh21 billion that is required to bring them on board.
The Sunday Nation spoke to several unemployed doctors.
Dr Esther Mwinzi, 28, MBChB UoN class of 2021
Dr Esther Mwinzi.
I had always been a smart child and aced my grades in school. When growing up, people would say that I was so smart and that I should become a doctor.
Every time someone told me that, the idea of being a doctor was ingrained in my mind. I worked to be one.
In 2014, I joined the University of Nairobi Medical School and was prepared for the pressure that awaited me. Back then, doctors used to be posted directly to public hospitals after internships.
What I wasn’t prepared for was life after school post-2017, where doctors were no longer to be posted. It started during my internship when I was posted at a level five county hospital and started off in the paediatric unit.
I was happy to work in that department because children have a special place in my heart.
As an intern, I knew that I was to work under a medical officer. I didn’t find one in the paediatric unit and so I was on my own, with no one to learn from except a consultant who used to come once in a while.
Some nurses even bullied me but I had enough grit to shake that off.
I’d stay days without a proper meal, or not eating at all, but I had to press on. As an intern, not even being sick is supposed to make you miss a day of work otherwise you would be labelled lazy or penalised. Some areas were better than others and passion was re-ignited.
With a positive outlook and 52 weeks later, I successfully completed and was licenced. Since then I have not secured a job. Society then starts judging you by the course you did, expecting that money is not a problem. As a first child also, there are expectations from my family but I am glad I have understanding parents.
There are days that I have been called for locums to work the whole night for Sh1,000. I accept it sometimes, but other times I let it go. Most of my colleagues wish to travel abroad, but it is not easy either. It takes money to travel abroad, which we don’t have. I have changed my attitude toward healthcare, despite it being so fulfilling because I have to know someone to get a job or pay hefty bribes. Sometimes I wish I could’ve been a businessperson and saved my family all the investment in university fees but I am also not one to give up. There is intrinsic pressure because my peers who did other courses are doing well. I have told my family to be patient. One day, the sun will rise again.
A doctor from Nairobi, MBChB Moi University class of 2020
I request anonymity because even revealing my name brings jitters. The society will be quick to judge me. It is difficult to be a doctor in Kenya. After the government spent about Sh3 million to educate one doctor, it seemingly does not care what happens afterwards. Our internships are tasking because it is intern doctors that do most of the work. As an intern, you’re paid some money. No one gives us financial literacy. After the internship, with no source of income, reality starts to sink in. I have applied for countless jobs, I have walked door-to-door, and I have contacted HR managers to no avail.
Dr Marvin Ochieng, 30, University of Nairobi Bachelor of Pharmacy 2017
Dr Marvin Ochieng.
When I went to pursue my course, I wanted to serve the community at the hospital level. I did my internship for a year, which ended in May 2019. Reality dawned on me after campus when I had to taste the proverbial bitter lemon despite working so hard to have a sweet life. I am now a pharmacist at someone else’s retail outlet. I have applied for jobs in vain. I have done many interviews and a number of applications from the counties and private sectors, but so far nothing has been forthcoming. I am hoping that this year, with the new administration, things will be different.
Dr Aisha Bahmud, 27 years old, University of Nairobi 2014, graduated in 2021
Dr Asha Bahmud.
I was born and bred in Saudi Arabia but came to Kenya because I felt safe and wanted to work in my country. I feel frustrated. I did my internship at St Francis Community Hospital in Kasarani and finished in November last year. Throughout my medical training, I was always passionate about becoming a doctor. I have been applying for jobs with no feedback. I now move from hospital to hospital dropping my CV. I don’t understand why the country cannot employ us. I am now considering an alternative career or even venturing into business. BY DAILY NATION