Keynote Speech by Professor Nimrod Bwibo

“THE MANY CHALLENGES AHEAD” A KEYNOTE SPEECH AT THE KENYA ASSOCIATION OF PHYSICIANS 15th ANNUAL SCIENTIFIC CONFERENCE KISUMU 23/5/2011 BY PROFESSOR NIMROD BWIBO

Distinguished Professional Colleagues, Ladies and Gentlemen.

I am delighted and privileged to have this opportunity to participate in this Annual scientific conference of the Kenya Association of Physicians which is holding its first ever meeting in western region of Kenya here in the city of Kisumu. I sincerely thank the organizers for having honored me by entrusting me to give the Keynote Speech. I take this opportunity to welcome you to Kisumu and the region.

I am a familiar person here having been the Chairman of Maseno University Council for a period of ten years. I held many meetings of that council here in Kisumu, which I consider my third home. I consider your meeting a good omen for Maseno University Medical School which opens its gates for the first batch of students within the next six months, in August this year [2011]. Your being here brings to our medical school and students great blessings as I now see the graduates will turn out be great scholars like you. The Maseno Medical School will focus heavily on communicable and non-communicable diseases in the region. I know this as I had the opportunity to do the drafting of the syllabus which was later completed by my other colleagues.

The subject chosen for this year’s conference is very apt. Kenyans are increasingly being afflicted heavily by communicable and noncommunicable diseases that you are embarking on to review their management in our resource constrained country. Of the communicable diseases; even jiggers have come back to raven our people left, right and center. HIV/AIDS, Tuberculosis and Malaria continue to be major causes of morbidity and mortality. Of the non-communicable diseases diabetes mellitus, hypertension, stroke, mental illness and cancer are on rapid increase being a burden to our limited health resources. Your concern about these diseases is therefore very timely.

The late Professor Thomas Ogada, an eminent Physician of the past had this to say in the Forward of the first Edition of the Textbook of Medicine on non-communicable diseases; (AMREF series of books) and I quote “Non Communicable diseases are still rampant in the developing countries and remain a major cause of morbidity and mortality. They are often chronic and very debilitating and are therefore a great financial drain on individual patients, their families and governments”. And he goes on; the incident of non-communicable disease such as hypertension, stroke, diabetes mellitus, peptic ulceration, depression, anxiety neurosis and some tumors such as cancer of esophagus and cervix, have reached epidemics proportions. This is a world-wide trend. Early diagnosis of these diseases, when they are still amenable to treatment, is the main thrust of proper management. Majority of our people live in rural areas; and are therefore unable to benefit from the bulk of clinics which are based in the urban areas.

This leads me to pose several questions regarding the rural folk: Are they reachable? Are their diseases manageable? Are the limited resources stretched to reach them? Are Physician numbers stretchable to serve them? Or are they left to die one by one? The Ministry of Health, in its second National Health Sector Strategic Plan 2005 – 2010 had this to say “Achieving international Millennium Development Goals, as well as the targets set in Kenya’s Economic Recovery Strategy, is among the strongest commitments of the Ministry of Health as a way of realizing our national vision of providing accessible and affordable and quality health care for all Kenyans, in particular the poor.

It is therefore imperative to revitalize the health sector – improve service delivery, ensure community participation, and with multi-faceted actors having a stake in the health sector”. The ambition raised in your theme for this year’s conference challenges heavily in this regard. Are you committed to fully playing your role as Physicians and being one of the actors having a stake in the health sector? Are you prepared to discuss your topic and come up with tangible solutions to reach all Kenyans? Are you able to use your conclusions in the national vision of providing accessible quality medical treatment to all Kenyans? How can you join other health actors in Kenya to do that? May I now turn to six areas of Challenges: Conflict with Traditional Medicine: A large proportion of Kenyans still think that certain diseases many of which are in the non-communicable group are not treatable by conventional medicine. They are therefore treated by traditional medicine. S

hadrack Moimet of Koibatek is reported to have boasted that his herbs cured his grandmother’s cancer related eye problem and gave her long life. He boasts that he has treated many skin diseases, varied tumors, febrile illnesses, malaria, high blood pressure, fungal infection, infertility, impotence, ulcers and even HIV/AIDS. How would you continue or collaborate with these herbalists? Is this conflict real or exaggerated? World Health Organization estimates that Kenya’s conventional health system provides for only 30% of the population, thus the implication is that the remaining 70% must be relying on traditional forms of health care (Fact File on page 23 Standard on Saturday, March 19, 2011).

Capacity of Health Facilities For you Physicians to manage communicable and non-communicable diseases to your satisfaction, the constraints in health facilities should be minimized. The health facility should be:

  • Well equipped -With functioning laboratories -With x-ray facilities
  • Supplied with required drugs.

This is often not the case and should be stressed in your plans of managing the communicable and non-communicable diseases and be discussed fully by Health facility management. Funding for Medical Care: As you strive to combat the communicable and non-communicable diseases, constraints in funding health services should be addressed. Quite often the health budget is not sufficient for buying equipment and the required drugs. The Quality of Health Care: The quality of health care you can provide based on your knowledge, skills and attitude acquired during training cannot be underestimated. I urge you to keep up with new developments through continuing medical education.

A large proportion of Kenya’s 40 million people live in rural areas. To a large extent your work is based in urban areas thus benefiting only a few of our people. How can your skills benefit the rural poor? These people cannot come to you. The obvious question is: can you go to them? Two options exist. You can in groups arrange outreach clinics or you can regularly visit those low caliber health facilities and provide your expert care to our rural communities. The ball is in your court. Consider the options. Physician numbers We the trainers train many of you with the intention of serving our resource constrained country, Kenya and our communities.

It saddens many of us that many of our physicians leave for greener pastures in developed countries. This Brain Drain takes away our human resources; thus creating a vicious cycle making Kenya a perpetually human resource constrained country. How long do we have to continue training physicians for developed countries?

The Brain Drain leaves you:

  • Overstretched
  • Overloaded with work
  • Frustrated
  • Underperforming

How can you then be expected to have health care accessible to all Kenyans? I am saddened to read somewhere that today there are just 4,500 doctors in the Kenya, which includes you physicians; to serve a population of 40 million. This gives a ratio of approximately one doctor to 9000 inhabitants, the skewed distribution of doctors in the country notwithstanding. This ration is probably worsened by the fact that there is a net emigration of doctors of 51 percent? Cuba has a Doctor: Inhabitant ratio of 1:175; United Kingdom it is 1:600 and in Nigeria it is 1:4400. As you travel world over you meet very brilliant Kenyan doctors settled out there.

Can you put a strong case against this Brain Drain? Medical Tourism It is shocking news that the number of Kenyans preferring to seek treatment abroad is large. This so called Medical Tourism is occasioned by the prohibitive cost and lack of adequate health care facilities. This painful revelation is extensively written on page 10 of March19, 2011 Standard Newspaper, under the heading of “Feature’. Is this prohibitive cost referred to your charges as Physicians or is it the cost of hospitalization, drugs and laboratory or radiological services? We as the medical fraternity in this country seriously need to address these pressing issues.

In conclusion, Mr. Chairman, I wish you a fruitful conference. You have three days ahead of you to ponder and come up with workable solutions to the problems ahead of you. I have indicated some challenges. At the end of your conference, I hope you will come up with a concise report which our parent Ministry can further deliberate on and formulate workable solutions to the patients in this country. Biblically, "The harvest is plentiful, but the workers are few. i.e. there are many patients and the health providers are few.

Being few, commit yourselves to work, organize your time and clinics, use alternative approaches to enable you manage your busy clinics. Focus on the increasing communicable and non-communicable diseases like diabetes, hypertension, stroke, mental illness and cancer and serve your patients efficiently, effectively to your satisfaction.

Thank you.