Death of intern doctor points out unresolved health sector issues

The medical community has been shaken by the tragic death of 26-year-old Dr Desree Moraa Obwogi, a medical intern at Gatundu Level 5 Hospital, in what is suspected to be a case of suicide.

This tragic event casts a harsh light on a crisis that has been brewing silently within Kenya’s healthcare system - the alarming unsparing nature of suicide, with medical professionals adding to the long list of the affected.

Dr Obwogi’s death highlights the extreme pressures faced by medical interns in Kenya.

Reports indicate that interns often work shifts exceeding 36 hours without adequate rest or meals, contributing to physical exhaustion and mental strain. Financial struggles, including delayed salaries, add to their burden, with many unable to meet basic needs such as rent and utilities.

Dr Elisha Harry Otieno, Secretary General of the Internship Liaison Committee, sums it all.

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“Medical interns contribute approximately 30 per cent of the labour in public health facilities, often under inhumane conditions. The mental health implications cannot be overstated,” he said in a statement.

Dr Kipkoech Cheruiyot points out a troubling dynamic within the medical hierarchy. “The hard truth is that often, the greatest challenge for a junior doctor is not the oppressive system, but senior doctors themselves,” he explains.

On May 8 this year, The Kenya Medical, Pharmacists and Dentists Union (KMPDU) ended its 56-day, after signing a Collective Bargaining Agreement with the Ministry of Health. As the two parties celebrated this fit, intern doctors, whose issues had rankled the union into the industrial action, felt betrayed. As these voices fizzled out, issues that they were raising stayed, and possibly escalated.

With the current cash crisis facing county governments, reports that Dr Obwogi had struggled with making ends meet while working her days off, are not surprising. The crisis extends beyond interns.Recently, a senior lecturer at the University of Nairobi, Dr Samwel Owino Mwanda, died by suspected suicide in Homa Bay County, underscoring that even those in established positions are not immune to mental health struggles.

Dr Chibanzi Mwachonda, a Senior Psychiatry Registrar at the University of Nairobi and Mathari National Teaching and Referral Hospital, sheds light on the psychological challenges faced by medical professionals.

“The medical environment has its challenges that can impact mental health. It’s a very highly stressful environment. It’s also traumatic in its own way because of what you deal with every day,” he explains.

Dr Mwachonda introduces the concept of “moral injury,” a psychological trauma that occurs when healthcare workers are unable to provide the care they know is necessary due to constraints beyond their control. This can lead to feelings of guilt, shame, and helplessness, contributing to mental health issues.

The financial aspect of the crisis cannot be overlooked.

“Lack of payment results in financial distress. When you’re unable to pay your bills, when you’re unable to have a meal, when you have responsibilities that require finances to sort, then that becomes a stressor,” he says.

Dr Davji Bhimji Atellah, Secretary General of the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU), calls for urgent action: “We need a comprehensive approach to address the root causes of suicide in our society, particularly within the medical community. This includes improving working conditions, providing mental health support, and destigmatizsng mental health issues.”

The Ministry of Health, led by Cabinet Secretary Dr Debra Mlongo Barasa, has acknowledged the crisis and pledged to implement measures to support healthcare workers’ mental health.