Tackling professionalism challenges in health sector

A nurse tending to a patient. FILE PHOTO | NMG 

By SARAH OOKO

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Summary

• Due to the high cut-off marks (A grade) required to pursue medicine in public universities, most Kenyans regard it as a prestigious course reserved solely for ‘bright’ students.
• In countries such as the United States and Canada, medicine is only available at Master’s level.
• Applicants therefore need to complete a pre-med bachelor’s degree programme, which for most students will entail studying sciences like biology and chemistry for four years.

In 2008, when Jane Wavinya discovered that she was pregnant, she immediately got in touch with a doctor whose advice she followed diligently.

But the two later disagreed when the doctor recommended that she undergo a Caesarean section – two weeks to the delivery date - without a ‘concrete’ reason.

“I was shocked since I had enjoyed a clean bill of health throughout the pregnancy. But when I asked to be given a reason, he got defensive and blamed me for questioning him when he was the expert.”

Ms Wavinya decided to seek a second opinion. The new doctor deemed her fit for natural delivery, which took place without any complications.

“I thank God that everything worked out well in the end. But to date, it still pains me to imagine that a doctor I had trusted with my life had no qualms about misleading me.”

Her story is shared by many Kenyans who due to such nasty experiences, feel like health standards in the medical profession are deteriorating.

“Before, doctors seemed to care. But now it feels like they are only after money. If you’re not careful, some will recommend unnecessary procedures or even put you on expensive medication for selfish gains.”

New research published in ‘‘The Annals of African Surgery’’ journal offers insights into the possible origins of these challenges as well as potential solutions.

The study, titled ‘‘Nurturing Professionalism in the Surgical Community,’’ states that focus must begin at the entry point of the medical profession.

This is aimed at ensuring that students being recruited into various medical schools are committed to the professional principles of morality that view medicine as a ‘call’.

“We need to ensure that those pursuing medicine are in it to serve patients and not to get rich at the expense of the sick,” said Dr Daniel Ojuka, a surgeon at Kenyatta National Hospital (KNH) and lead author of the study.

Due to the high cut-off marks (A grade) required to pursue medicine in public universities, most Kenyans regard it as a prestigious course reserved solely for ‘bright’ students.

“So, top performers in the Kenya Certificate of Secondary Education (KCSE) exam sometimes rush for the course due to its perceived status and not because they have a genuine interest in the profession.”

Aside from offering adequate career guidance to students, Dr Ojuka notes that another way of tackling the problem would be to offer medicine as a graduate course instead of an undergraduate one.

In countries such as the United States and Canada, medicine is only available at Master’s level.

Applicants therefore need to complete a pre-med bachelor’s degree programme, which for most students will entail studying sciences like biology and chemistry for four years.

They then go through a rigorous selection process (encompassing interviews and self-reflection sessions) before being accepted into the Master’s programme.

“By then, you can tell if your heart is in medicine or not.”

Even with the high status attached to the medical profession, Dr Ojuka states that there are students who genuinely embrace the career with the intention of changing lives.

However, he notes that the students’ journey through medical school and early life into the profession sometimes washes away the altruism, slowly replacing it with cynicism. The study found that this predicament is caused largely by the discord between professional ethics taught in class and what students see in reality.

“You teach students that they should value all patients. But then they see you making only technical appearances here at KNH then rushing to spend the whole day in your private clinic.”

“You’re basically teaching them to devalue human life and just care about commercial gains. So by the time they get out, they really won’t care,” said Dr Ojuka, who is also a lecturer at the University of Nairobi School of Medicine.

According to the study, doctors’ professionalism is also hampered by institutional challenges such as ill-equipped or poorly managed hospitals, as well as overcrowded facilities (leading to an overwhelmed workforce).

The researchers pointed out that the ills in public facilities that are linked to medical schools tend to create a bad picture of how hospitals should be run, hence setting a bad example for students.

“Either we transform the way these hospitals run or we get our separate teaching institutions.”

Dr Ouma Oluga, secretary-general of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), states that there is need for strong regulations to protect the profession from the negative effects of commercialisation.

“There is a global shift seeking to view healthcare as a commodity to be sold for profit as opposed to it being a public good. And this is wrong.”

He notes that this commercialisation has led to the insurgence of invisible forces such as insurance companies and pharmaceutical organisations that influence how patients are treated.