First Published in http://www.sitrepng.press
In 1972, the pioneer set of Kenya’s locally trained indigenous doctors graduated from the first medical school in Kenya, the School of Medicine, at the University of Nairobi, having been under the tutelage of Dr. Joseph Maina Mungai, the first African to become dean of the faculty.
Kenya having become independent in 1963, after decades of British colonialization, it was nine years after independence, that these first locally trained doctors graduated from the illustrious Dr Mungai’s classes.
Dr. Mungai can best be described as the pioneer medical researcher in East Africa and it is during his neurological studies that he noticed the racist arguments used to justify the application of racial segregation in education in Kenya. In his autobiography “From Simple to Complex” Dr. Mungai describes the underlying policy on education in pre-independent Kenya.
“In the course of my reading, I came across work based on studies which had been done in Kenya. It was the most unbelievable reading that I had ever come across. I read it over and over again, as I tried to understand some of the background to the racially segregated system of Kenyan education for Europeans, Asians and Africans.”
“… it is in trying to justify racial segregation in education in Kenya, that the most erroneous conclusion was made. This was that the stage of development of the average African adult brain was equivalent to that of the average European boy between seven and eight years of age. The false justification for the continuation of a segregated educational system for Europeans, Indians and Africans in Kenya had been given a scholarly veneer.”
The education of African students had thus always been of an inferior quality and nature prior to independence and it was the express hope of the Kenyan people that with the acquisition of self-rule, the Kenyan government would be able to reverse this. This would thus provide education at par with that obtainable in Britain itself to Kenyans.
In 1965 the independence government presented to Parliament the now famous Sessional Paper 10, called “African Socialism And Its Application To Planning In Kenya”.
In its foreword, then President Jomo Kenyatta(the father of current president, Uhuru Kenyatta) stated that, “Our entire approach has been dominated by a desire to ensure Africanisation of the economy and the public service.”
By the time Sessional paper 10 was published, Kenya had been under its own sovereign rule for 18 months.
Within its pages you can see the high optimism of the young government most explicitly stated in the belief that African socialism is a viable approach to running a country, the critical approach being that Kenya can build upon its traditional societies and culture in order to unite as an African nation. A lot of Marxist theory dominated this belief, specifically driving the initiative to recognise and establish trade unions within the country to deal with African workers’ rights within the private sector as well as an employer’s union.
In fact, some industrial unions were assisted by government and thus had obligations towards the government’s objectives as regards co-operatives.
At the time, the notion that civil or public servants would need to be unionised was not mentioned, instead there was a greater emphasis in the rapid training and recruitment of Africans as doctors, surgeons, engineers, surveyors, and other professionals.
The subsequent planning cycles of the Kenya government after 1965 showed a shift in economic ideology principally from African socialism to a mixture of liberalism and capitalism; this translated in the medical sector as adaptation and alteration of the generic health policy in Kenya from one based on the Medical Model between 1965-early 1970’s to one based on the Primary Health Care Model in the late 1970s and the 1980s, and later to a Market (profit based) model in the 1990s.
This shift in public policy meant that ultimately, the medical students graduating from Kenya’s first medical school would find a chronic lack of resources in the hospitals in the areas they are posted to by the government. They would also increasingly find it difficult to be gainfully employed by the government, many resorting to opening private clinics, and doing locums at private hospitals.
By 1983, just as Kenya was finally acknowledging the existence of the HIV virus and AIDS disease, the country was also steadily experiencing a medical brain drain. The more lucrative opportunities offered in Western nations especially contrasted sharply with the sort of conditions to be found in government facilities. At the same time, the 1982 coup attempt introduced a destabilising element to the scene which gave more urgency to the need for medical practitioners to flee abroad.
This brain drain escalated with the introduction in the 1990s of the US diversity visa lottery program, which piggy-backed on the increase in stricter immigration laws in the UK. Needless to say, the 1990s and early 2000s saw the greatest exit of professionals from Kenya to the US, with Kenya being the 5th largest contributor of skilled migrants from sub-Saharan Africa.
Essentially, Kenya was now educating doctors for the West, a complete turnaround from the African socialist ideals of 1965, which were rooted in the concept that we can provide for, govern and sustain ourselves.
The patent disregard by government of the Kenyan healthcare system and its effects on the prospects as well as standards of medical education is seen in the steep deterioration noted between 1985 and 1995; a period during which the Kenyatta National Hospital, Kenya’s premier referral facility went from being a facility that senior civil servants were expected to receive treatment in, to KNH being synonymous with stolen/missing resources such as medicine, bedsheets and also absentee doctors.
The rapid decline of the nation’s facilities was commensurate with the rapid emigration of Kenyan doctors, deterioration and lack of implementation of public policy, and eventually a shift by the public to primary reliance on private health care.
The decades of neglect, oppression and underfunding by a public health sector that is incredibly corrupt, and the frustrations of medical students found a unifying force and outlet in Kenya’s 1990s agitation for multi-party democracy, much of which was driven by the energy of university students.
As soon as, President Moi repealed section 2 (a) of the constitution in 1992, the momentum begun to build in the medical students and practitioners who demanded the right to register the Kenyan Medical Practitioners, Pharmacists and Dentists’ Union.
In 1994, 3000 Kenyan doctors went on strike for 105 days, the longest medical strike ever experienced in post-independent Kenya. The Ministry of Health responded by firing 1000 doctors for striking. 23 years later, Kenya has not recovered from that loss of medical professionals all of whom were either absorbed in private sector or emigrated abroad. Leaving the public sector, where the poor who cannot afford private care, seek treatment, devoid of these doctors.
Among the principal causes of the 1994 strike were the standard and quality of education the doctors were receiving; standards that ensured resources and educators were not only insufficient for the number of students admitted, but that even qualifying as a doctor after being educated was discriminatory. Career success in the public health sector was made dependent on ethno-political affiliation, with the choices postings going to those deemed favourable to the elite. So also was academic success in the medical schools were made dependent on these same factors.
In totality, the sort of medical education that doctors were receiving under public policy were a throwback to the racial discrimination and segregation of educational standards in pre-independence Kenya. The exact problem independence was supposed to correct, was one the post-independence elite perpetuated.
It was presumed that the 1994 strike was a failure, and for the 18 years the medical profession remained without a trade union. In 2011 however, the doctors registered their union and the KMPDU called for the first doctors’ strike under the new Kenya constitution.
Chief among the key points of contention by the KMPDU was of course, the sorry state of medical education in Kenya and the treatment of public sector medical professionals by their employer, which is the Kenyan government. This was only the most recent iteration of a 5 decade long struggle to change the course of the Kenya government being the primary reason that Africans were not only discriminated in their education, but also in accessing healthcare and decent wages.