Mission No Slavery: The Plight of Registrars

It’s an early Thursday morning, 6.50am to be precise. The mid June weather is unforgivingly cold. I am out already, to meet my colleagues for group discussion. Mid year exams are fast approaching. I find a sheltered spot in the Com-care restaurant of KNH and huddle to my notes waiting for my friends to arrive. As I pour on the myriad of drugs and their pharmacological properties, my attention momentarily delves into an approaching trio- two gentlemen and a lady, all dressed in scrubs, golden badges and lab coats, clinging to the latter for warmth. I steal glances at them watching as they select yet another sheltered corner, sit down and order breakfast.

They looked thoroughly spent. Once the coffee and other accompaniments were delivered, they dug in- almost ravenously, the pride that comes with being a doctor was perhaps their only restraint. They refrained from making any exchanges amongst themselves for a while. I became more curious.

As soon as the caffeine and glucose kicked in however, they started conversing in low tones. It is from eavesdropping their exchanges where I would learn that they had been up since mid night in theater. I did not hear the intricate details but whatever procedure it was that they had been doing must have been complicated. What seemed to bother them more was not their obvious fatigue, rather a task they were supposed to accomplish: a major write up to some department that, according to them, took so much time and effort to compile yet was only worth a mere percentage of course work. As they wrapped up their brief breakfast and headed out, I slowly fathomed just how complicated a doctors and more specifically a registrar’s morning can be.

Later on in the day (and in many other days before and after that) I brushed shoulders with similar doctors- registrars. From the minor theater of the casualty in KNH to the dissecting table of the morgue’s autopsy room. These older sisters and brothers in the profession conduct clinics and offer medical services to the larger Kenyan citizenry, majority of whom are poor, on behalf of the hospital. They man the wards, run the Operating Rooms, ensure the smooth running of the entire hospital and also mentor medical students: all this, unfortunately, without any returns.

All work and no pay

Being a doctor has never been simple. Serving in a ‘noble profession’ puts one in an awkward position as far as bargaining for rights is concerned. Being a registrar is something else. A majority have to raise their own fees in the background of an unpaid study leave. As aforementioned, they offer medical services around the clock to the hospital and teaching to medics for no enumeration. Most have families to care and be there for, a hard feat to pull since they also has to lo-cam to make ends meet. All this happens under the umbrella of a bureaucratic education system and to top it all off- one has to excel so as to graduate. In essence, being a registrar is an insurmountable affair. It therefore follows that sentiments by the government in view of their demands for payment as ‘unnecessary’ and ‘unusual’ are complete crass.

A government that cares for its people should have in mind the imperative nature of a proper healthcare system. The backbone of the latter is a country’s doctors. It is rather disturbing that the government would choose to dump mud and dirt on the on going quagmire with medical registrars instead of encouraging positive negotiation. In the light that a well funded health care system and motivated doctors directly culminates to Kenyans benefiting immensely from better health care, the way the government has been handling the frequent fall outs with its doctors is a big shame. After all, most of those who run the government seek healthcare from outside the country. Indeed, by literally enslaving its doctors, the government is showing blatant lack of concern to the needs of its people.

Keep keeping on

As a medical student, I support the stand that the registrars and KMPDU have taken. While fighting for their own rights, the rights of a majority of Kenyans and paving way for the younger medics, it goes further to show that the seemingly feeble voice of reason shall in the end be heard and heard out loud. I hope other doctors and Kenyans at large will join in in solidarity with you, surfing bravely on that long awaited wave of change. Finally, the far we have come should serve to fuel your current efforts. For as long as the stream of doctors’ power runs persistently, the rock of slavery and exploitation will gradually but surely wear out. The struggle continues.


The Student versus The Exam: That epic Face-off

In all honesty, I am not a great fan of education. Having spent more than eighty percent of my life so far in school with nothing tangible to show for it explains why. Worse still is the fact that examinations are the main modality used to assess whether learning has transpired or not. While this is not a bad idea, I think it is quite unfortunate that they test for memory and rarely ever check for thinking or understanding. That said, it should follow that I am not a great fan of exams either. The truth is, I am… not, but whatever happens during examinations sure does give me the kicks. It all rolls down to this.

The preparation phase:

Most students prefer to wait till the very last minute when they can jam everything into their short term memory. The books that had been dumped on the shelves and covered with mounds of web and dust are re-opened at last. It is no surprise that so many of us get colds during this time. Social life also changes drastically. The usual gossip and bumming cliques stop and discussion groups become vogue. There are hardly any warm exchanges. You regard those around you either as ‘wasters’ or potential sources of much needed help.

Once in the exam room, it is all panic galore. One may have a blank mind, that weird song that just won’t stop playing in their head or, if they are lucky, a mind that is processing all the data that they are about to regurgitate. After all, it is almost always a Garbage In Garbage Out affair. I normally have a weird song playing in my head. Sometimes I try to go on a music dry spell prior to discourage this from happening but, seemingly, my mind knows better. Anyway once the exam papers are dished out: it is time for the next phase.

The question number one phase:

Whoever has sat an exam can bear witness- the first question is usualy almost seemingly impossible to handle. I am yet to find an explanation for this, but for now I will postulate several working theories. The first one is the ‘examiner is showing off’ theory. I suppose examiners have a wry sense of humor. Perhaps they derive satisfaction from seeing that ‘golden’ expression that those being examined bear when they first flip their papers. That should explain my ‘Up yours!’ mentality after answering this elusive question. The second one is the ‘mental block’ theory. Having being panic stricken for all your adrenal gland’s worth of adrenaline, even the simplest of tasks  will seemingly appear insurmountable. Apparently, you end up cock-blocking yourself. Go google that. The last theory is the ‘question one is just a hard nut to crack’ theory. I believe it speaks for itself.

The self realization phase:

After tackling or skipping several questions a third-way or so into the exam, one slowly starts to appreciate and accept their current predicament. It sinks in that there is no turning back. That is when you commit yourself to regurgitating expected answers on the answer sheet, rarely pausing to think about what you are writing. GIGO is at work here. Some in this phase, prefer to sit and reason out with the examiner. Unfortunately, grammar does not always suffice for a meaningful negotiation for marks. That is why I wish that phrases like ‘You see…’, ‘What I’m trying to say is…’ or ‘Check this out…’ could be used in formal writing because they can make any gibberish sound convincing. From here onwards, things should roll smoothly unless one finds themselves in this next phase.

The Provocative Phase:

This is when everything goes haywire. Its duration is directly proportional to (among other minor factors) your psychological state and who you are sitting next to in the examination room, in that particular order. If you woke up with an empire state of mind, had your facts right and your mojo tagging close by, you are unlikely to experience this. However when self doubt kicks in, things start going south. The latter can be exacerbated when one sits next to a panicky lot, fellows who ask for extra sheets of paper or people who just won’t help a brother in need. This phase, if anything, may provoke you to walk out of the exam room either hands up in protest or just plain upbeat.

Summarily, examinations just reemphasize how education is a relentless uphill task. If it were up to me, tests should also be based on creativity and not just protocol and memory. While those gifted with memory will keep scaling the heights of education, it is my belief that creative minds continue to inherit the world. In the end: examinations group people into- those who deserve to pass; those who will pass by any means; and the lot who will always awe the examiner with just how much ‘crass’ a (normal) human mind can generate in [insert hypothetical exam duration here]. And now if you’ll excuse me, I have a paper to go study for.

When Health Insurance gets tricky

The phone rings and the lady of the house picks and answers, “Hello.”

“Mrs. Sanders please”


“Mrs. Sanders, this is Doctor Jones calling for Mr. Sanders. You see, your husband’s doctor sent his biopsy to our lab last week and at the same time, a biopsy from another Mr. Sanders arrived as well. We are now uncertain which one belongs to your husband. Frankly, either way the results are not too good.”

“What do you mean?” Mrs. Sanders asks nervously.

“Well, one of the specimen tested positive for Alzheimer’s and the other tested positive for HIV. We can’t tell which is which.”

“That’s dreadful! Can you do the test again?” queried Mrs. Sanders.

“Normally we can, but health insurance only pays for such tests once.”

“Well, what am I supposed to do now?”

“The health insurance advisory recommends that you drop your husband off somewhere in the middle of town. If he finds his way home, don’t sleep with him.”

Second Opinion

A doctor and his wife were having a big argument at breakfast.

“You aren’t so good in bed either!” he shouted as he stormed off to work.

By mid morning, he decided he’d better make amends and phoned home. After many rings, his wife finally picked up the phone.

“What took you so long to answer?”

“I was still in bed”

“In bed? What are you doing in bed this late?”

“Getting a second opinion,” she answered.

Hail unto the Man who dug his own Grave


The previous weekend from this one is nostalgic. It was one of the few moments when I am free from the pandemonium that is medical school, hence at home and relaxing. I particularly enjoyed being with the ‘guys’ relaxing. By the guys here I am referring to my younger brother and my dad- and yes, an introvert plus medical school equals to a not so glossy social life. Lest I digress further, that is the topic of another discussion. Anyhow, we were doing what guys do when they hang out- eating galore, watching sports and, later, news.

Unfortunately, very few Kenyan programs are mentally stimulating. The news is top of the list. In fact, most stories are usually stale which begs the question of why media houses even bother to call them ‘news’. The majority of the content is either banal or, stories of how the country is being ripped off by its ‘leaders’ and how some political big wig is trying to gain voter leverage over another by talking balderdash. Sadly, many a Kenyan offers a ready audience to such. Our political scene is ideally a soap opera which is run by severely myopic directors and an unappealing, obnoxious and, at the most, retarded cast. I will waste no more time on the same. What caught my attention on this particular day however was one Stanley Muriuki Njuki. This here is my perspective of his story.

According to the Gikuyu customs and traditions, Muriuki is a name given to a son who was born after the death of a close relative. It is symbolic of a second chance at life, a reincarnation- a rebirth. Now, Stanley Muriuki is an old but extraordinary Kenyan who hails from Nyeri in the central part of Kenya. The report spoke of him as a retired teacher who is now into small scale farming. He spoke in polished English, a rare feat from a man born, raised and settled in the village. Unlike his seemingly mediocre neighbors, he also came out as more liberal and open minded. This, and his long teaching practice, had fondly earned him the handle ‘Lawyer’. It is perhaps his open mindedness that led him to commit an act regarded as heinous and taboo by African standards. He dug his own grave- literally.

This, he did about thirty years ago. Why? He did not want to leave insurmountable funeral costs to his children once the inevitable had happened. That is pretty reasonable, but still, not an adequate explanation for why a man would proceed to do what is blatantly contraindicated by the larger African society. He added however, that he wanted to be buried like a hero just like the pharaohs of Egypt and their ethereal tombs that were fashioned as pyramids. That is what Muriuki had in mind. As expected though, many around him did not fancy the idea.

His beloved wife for instance would have none of it. While she later came to terms with his actions, she did not want him to prepare a similar grave for her. In Muriuki’s words, “She preferred to die and be buried like ordinary people.” For him however, he wanted to live extraordinarily. For him, his joy is in waking up and seeing his cold concrete grave lying patiently in wait for his remains. He gets his kicks by dutifully tending to his final resting place every morning. Unlike those bewildered around him, he is different.

This old man made my weekend. In my opinion, he was a man who had come to terms with his own mortality. This uniquely profound (yet rare) realization is what makes his days full- it makes his life complete. Old as he was, his heart was young, his soul seemed eager. In a desolate peasant surrounding, he oozed with life, vibrant happiness and an almost tangible sense of inner joy. Indeed, he reaffirmed this by his last sentiments, “I am Lawyer Muriuki.” Then he added, “And I am rich.”

I concur, don’t you?

An Encounter with a Silent Killer

For most people, the word tumor is synonymous to cancer: the diagnosis of which is likened to a ‘gift’ delivered from the grim reaper himself, with not-so-much love. Medical truth however suggests otherwise. From it, we know that benign and malignant tumors exist. It is the malignant ones that most doctors dread: and the doctors who (as it seems) don’t are called oncologists. I wouldn’t wish a malignant tumor on my worst enemy, nor advise them to pursue oncology. The latter is indeed (and infamously) the most depressing specialty in medicine, reasons behind this being rather obvious. Some encounters with malignancies however, are worth recounting.

Now, for many a student there are those moments when your conscience tells you that you would rather sit out a class than attend and let yourself down. This happens to me sometimes: after all, some classes can be quite a task! On this particular day, I was with a close friend of mine. We made our way to the hospital’s casualty where after entering the consultation area, a familiar voice caught our attention. It was one of my good doctor friends who I am tempted to describe as follows. He is an ample guy; indeed, an aspiring epitome of the consequences of unhealthy eating. He is a jolly one too; often punctuating his sentiments with billows of chesty, heartfelt laughter. He even lightly comments how the KNH Trauma department is a refuge center for thugs whenever we assist him in the minor theater. In essence, he has a contagious personality- an infrequent thing from a doctor working in this particular hospital.

He beckoned us into his consultation room.

There, we found a half dressed sexagenarian lady on the examination table. Many similar scenarios had trained us to put professionalism and deep respect for the patient before shyness or lad-ish mischief. Our host immediately got to work on our now eager minds. He pointed at a swelling on the lady’s right loin, asked us to examine her and make a diagnosis. My friend and I asked for consent then got to work- inspecting keenly for color changes, deformities, scars or swelling then palpating for tenderness, lymph nodes, edema and any other notable things as per protocol. All we detected were the inguinal lymph node swellings the doctor had earlier pointed, a mildly edematous right leg and a dark, irregular patch on the heel of her foot on the same leg. The patient was not in pain. This, in our naïve minds was puzzling.

We got to thinking and mumbling guesses that sometimes screamed loudly of our ‘ignorance.’ The doctor however exuded a fatherly sense of patience. He guided and probed us further, merely asking us to dig deep into what I would consider our ‘shallow lakes’ of knowledge. In a last and almost desperate attempt, I uttered- ‘Melanoma.’ He smiled at me, a gesture which he complemented with a solid affirmative ‘YES’. At last I had gotten it. He then produced a chest X-ray of the same patient. Her lungs’ morphology was uneven with rounded zones of what the doctor told us were metastases. I then turned to the patient, curious for a brief history.

Her foot had started hurting five months earlier as she was working on her farm- a pain which receded after a short while. It was only after she had experienced repeated episodes of coughing that she sought treatment from a local healthcare centre; a journey which ended at our teaching and referral hospital. She was not in pain. However, her body was now an unwilling host to a fast spreading, inconspicuous yet lethal tumor- a malignancy called Melanoma. We let her dress as I exchanged ideas with my classmate. And when she rose to receive her documentation and advice from the doctor, I trained my eyes on her yet again.

She was a simple country woman. Her headscarf had slipped further back now perhaps from her prolonged recumbent position on the examination table. Her hair was jet-black, plain and kinky, few streaks of grey standing out augmenting the subtle creases on her face. Her eyes were sunken, whether because of worry or the disease creeping upon her- I couldn’t quite tell. There was a slight aura of hope on her demeanor though. This hope, I thought, was founded on ignorance. Her lack of knowledge about her current predicament was her shield; a weak one, but a shield nonetheless. As expected, her body looked fairly healthy: save for the X-ray images we had just seen. Our conclusion; she was sitting on a ticking time bomb. Prognosis is guarded.

I pitied her. Deep down, I wanted to give her the benefit of doubt. But I knew a tad better. If not by the disease, chemo-radiation and depression would take its toll on her. There was little chance that she would live through it. The outcome however is always in the hands of a Higher power. Having learnt something new though, we left hoping that whatever her fate was, she would dig deep into her soul and find the courage to face it all.

The Doctor’s Hand: A Healing Touch

The human hand is a remarkable fragment of anatomy. It is perfectly crafted: neatly assembled phalanges and wrist bones, ample joints supplemented with tendinous pulleys from dozens of muscles for motility. All this is strongly woven together by supporting ligaments. In the chaos of muscle agonist-antagonist activity, fine movements of the hand result. The skin covering this framework is equipped with a battery of sensors- for temperature, touch and joint position. All these components working in synchrony make a mechanism for manipulating objects, a sensory device, a mode of defense, a craftsman most valuable tool but most importantly- a means of social, spiritual and emotional interaction. So where am I going with this- you may ask.

Thanks to technology, there is a plethora of information out there that only the truly curious and eager to learn can access and imbibe. Fortunately I was curious enough today to listen to an eye opening talk by Abraham Verghese M.D, a physician cum writer and lecturer at Sanford University. He was talking about technology but, unlike me, in a not so complementary tongue. His focus: an observation he had made after his many years of medical practice with cutting edge technology. He was talking about the iPatient.

According to Verghese, the iPatient is an icon in the modern doctor’s computer. While the traditional practice of medicine mostly revolved around the patient, the modern doctor will have none of that. He is surrounded by numerous gadgetry, some hand-held and some colossal- all processing data obtained from the patient; all tools that help him analyze the patient’s ailment. The information galore around the modern practice of medicine has improved its efficiency by leaps and bounds. But as the modern doctor revels in his hubris, a crucial component is continually slipping off the patient-doctor relationship. This, Verghese says, is the ‘physician’s hand’.

He then proceeds to passionately describe a standard patient examination- its cathartic essence to the doctor, and the feeling of care it evokes in the patient. He delves into the intricacies of this process, choosing his wording with the prowess of a linguist and delicately balancing this with years of physician practice. He elaborates the history of percussion, the sounds of diseased lungs in auscultation and the thoroughness of palpation. In expounding his argument, he tells some poignant but relevant cases that blend well with the importance of the now fading practice of patient examination. The following anecdote is particularly worth mentioning.

A friend of his had been diagnosed with breast cancer and gone for tumor removal. Later, she went on to look for the best cancer center in order to receive cutting edge screening and care. She found a center in a different city, got registered there as a patient there and proceeded to receive the care she needed. Soon however, she was back at her local hospital under the care of her private oncologist. When he probed her into explaining the drastic change of events, she talked of the superb facilities she had at her disposal at the centre but then, with utmost concern, added this- ‘They did not touch my breasts.’

These sentiments sank in deep. I recall the times I skipped going to the wards for the fear of contracting a resistant infection or out of sheer laziness. I am reminded of my efforts in struggling to interpret radiological findings in a chest X-ray where a chest examination could help express my sense of empathy to the patient, possibly contributing to a credible diagnosis. It dawns on me that I could do better as a medical student. I suppress the shame welling up within with my innocence. For a moment, I am lost in thought…

I ponder deeply. I reflect on the tempest my supposed brilliance is constantly subjected to, the immense detail that I ought to process, the human suffering for which I am and will everyday be a first-hand witness to and whose torment I am destined to relieve. I gently caress the books which the profession I pursue has bequeathed upon me. The zeal to learn once again bathes my conscience and an even greater curiosity throttles through my veins.

In the end, I come to register this- it is not my understanding of disease or my knowledge of technology that will make me the healer I seek to become. Neither is knowing the secrets of therapy going to make me any better a doctor. In comprehending the power of my hands however, I have the key. For in touching whoever has or wherever there is distress, in knowing how much my touch is needed and indeed submitting to my hands trained and true sensation- only then can I fathom the covert details of my patient’s illness. Only then can I perform a transforming ritual in reverence to the founding fathers of medicine. Only then can my touch lead to true healing. Only and only then, can I touch a life and change it.