Koven Cottage. It’s a chilled Saturday evening. The Karen skies are calm and azure. Tall indigenous trees give this place a rather scenic look. It seems so distant from the concrete jungle that is Nairobi, yet it is barely an hour’s drive from city center. I get into this compound and a sign of Mbwa kali greets me at the gate, stirring a little fear in me. I have an innate fear of fierce dogs like Bruno and Pablo, those dogs that bite flesh like cannibals. My dog is called Sibuor and that’s how we end the story of dogs. The place is beautiful. An old rugged house stands in the middle of the compound and chairs are scattered outside. The look is rustic with art all around. What the human body cant say in words, it expresses profoundly in art.
Beyond the stethoscope was holding an event for doctors, dentists, and pharmacists. If you didn’t know, Beyond the stethoscope is a safe space for medical practitioners, dentists, and pharmacists where we learn soft skills that medical school never taught us. Talk of investments, taxes, tech, and everything that we need to catch up with. Opportunities available in both clinical and non-clinical areas are also shared on the platform.
A bright smile welcomes me to this place. It is Dr. Amakove. Amakove Wala – the founder and CEO of Wanderlust Diaries and Beyond The Stethoscope. We are here to talk as doctors. You know those fireside chats that you wished you had while growing up, those are the chats we went to have. We went to validate our existence, to remind each other that we can never be more human than we already are.
We go into medicine without ever getting into terms with the fact that medicine has its unique set of challenges that only we doctors can solve. Nobody told us of the toxic work environment that awaited us upon graduation. While there are a handful of people committed to making the profession better, there are those that move in the opposite direction. They are the ones that hold us back. They are the ones who are sinking this ship.
The issue of Internships for doctors arose. Internship remains a fundamental part of our training. Unfortunately, it’s from here that we learn the worst traits that will haunt us for eternity. Training doesn’t have to be arduous and uninspiring as it stands in most internship centers. A 2015 Kenyan study highlighted lack of adequate supervision, inadequate social support, lack of mentorship, and inadequate clinical resources as the major challenges that the Kenyan medical intern grapples with. There seems to be no intent to tackle these problems. We will not be able to deal with the consequences.
Meet Dr. Joy. Joy is not her real name. She just finished her internship a few months ago. She interned somewhere in Kiambu.
“How was it like to be on call Daktari?” I ask, staring blankly at her beautiful face. She painted her lips red and had a white top and blue jeans that fitted nicely. She belonged to the red carpet!
“It was hell, doc. We did long hours as junior doctors with poor working conditions, something that I don’t wish for even my worst enemies. We had only two beds in our call room. At any given time there were four interns on call, so we literally had to share the beds.”
“What if you were the only girl on call that night?” I ask with an air of shyness.
“It didn’t matter, you just had to find a way around with sleep.’ It was evident that the system was failing to take care of its own.
“What was your worst call?”
“It was on a Sunday. There was a road carnage along Thika Road that had claimed so many lives. The survivors were brought to our hospital for care. I had very sick patients some of whom required emergency surgeries. I decided to contact my seniors to see how we can go about this. I had more than ten injured patients. The second on-call picked his phone and said he is not coming. The consultant was unreachable. That night I lost a boy that could have been saved. I don’t remember the rest. I mean, I don’t want to remember…” she smiled graciously, her eyes rolling sharply away from my gaze. She had been through it all. The worst possible night that you would ever get right after campus. No guidance. No nothing. It’s just you and your inexperienced guts. All these happen despite the fact that research consistently shows that poor communication among health professionals may lead to life-threatening complications.
“How was your relationship with your consultants?”
“Some of my consultants were so good, they taught me well. Then there are those that you never forget of course, because of the agony they put you through. I once forgot to add one more patient to the theatre list, the surgeon told me in a condenscending manner that the only thing I can’t forget is to do my nails. I remember it was his fault that the theatre list was not made in time. He submitted the name last after everyone else had been included. I didn’t like those vibes, you know, when you are all bubbly and then someone shuts you up with those statements, your day is totally ruined.”
People have not yet streamed and so we still have some more time to talk.
We are joined by Dr. Juliana. Again, not her real name.
The wind drifts slowly in our direction carrying along with it the aroma of smoked pork ribs that is slow cooking at the smoker. The smell of the food stimulated my appetite centers making my mouth drip with saliva.
“Wassup Doc!” Joy and I muttered. The beauty of medicine is that sometimes you can get away with not knowing your colleague’s name. You just say Duck. Hi Duck.
Dr. Juliana is tall, so tall that my head literally rests on her shoulder when we stand side to side. She is fair-skinned and bubbly. She came with a glass of water in one hand and her bag in the other. “Hey peeps, let me take my drugs, and then we can chill…” She says excitedly. As she was trying to close her bag, a packet of drugs fell to the ground. She could not easily bend to pick the drugs because the other hand had a glass of water. So I bent to pick the drugs for her. Fludac was the name on the packet. Fludac is a drug used in the treatment of depression.
“What is your internship experience doc?” Joy asks.
” Internship has been the most alienating and isolating period of my life. There is this culture where interns are seen as inanimate objects to get things done without any objection. There is constant pressure, unsupportive seniors, outrageous call hours, and sleep deprivation. Generally, there is no compassion or any form of emotional intelligence when dealing with interns. Everybody yells, ‘Where is the intern?’ instead of , ‘How is the intern?'”
She recounted her harrowing experience tears welling up her eyes.
“How do you cope Daktari?” I asked her.
“Well, I have learnt to be my own advocate. It is crystal clear that nobody gives a damn about interns. So whenever I feel like the center cannot hold, I take a break much to the chagrin of my seniors; which really doesnt move me because I know none of those *** will do more than contribute a measley 2k for my funeral when the work finally kills me. And my epitaph wont read ‘The best intern.'” Her voice is becoming heavy. I lean in to listen to more of what she has to say.
“The mistreatment of interns is often sanitized by statements like, ‘Its just one year, jikaze, umalize na uende. 365 days of agony and abuse hiding under the veil of learning. When you come out at the other end, you are a survivor and now you have the power to perpetuate the never ending cycle of violence, vehemence and abuse. This should not be the norm. A profession tasked with restoring health could contain so much sickness. Tragic.”
She tells us how she tried changing internship centers several times and failed at every attempt. There is a guy in the council who always wanted money from her. He kept her going round and round without anything ever materializing. That has always been the story with the council. There are people there who take advantage of the desperate situation that interns find themselves in. You must pay them to have you sorted. Unfortunate. We shall revisit.
Our chatting is suddenly brought to a stop when a sonorous voice welcomes us for the sumptuous lunch that followed. There was food and pomp and glory. There was no milk or honey, yet this was paradise.
Doctors, we must come to the round table and initiate difficult conversations of change. We must stand up for the profession. Again, we cant approach the problem by saying that there are a few other good people. The culture we have created is that of competition and intimidation. We young doctors are left to wander in murky and muddy waters, with no maps and no guides.
By any means, we are not complaining. We still want to follow the dreams we read in Gifted Hands. Growth, mentorship, and supportive environments are all we ask for. If you can not give these then at least, do no harm. That is our cri de couer.