As the coronavirus descends upon Africa, its doctors and nurses are walking off the job. Not because they don’t want to fight the pandemic, but because they feel as though they’re not being properly equipped to do so. On Wednesday, for example, health-care workers at the Kakamega County General Teaching and Referral Hospital in Kenya left the facility after a patient with coronavirus symptoms showed up. They had begged for weeks to get proper training, tests and protective equipment for the impending COVID-19 pandemic — but to no avail.
Likewise, on Tuesday, doctors and nurses at the Chuka County Referral Hospital staged a go-slow, a form of labor protest where work is deliberately delayed, and threatened a full strike if they aren’t equipped with basic protections like sanitizer, gloves, masks and dividers to separate sick patients in isolation while they wait for their test results. The same day, nurses called off their go-slow at the Mbagathi County Hospital in Nairobi, only after the national government agreed to stop selectively providing training and supplies to the Kenyatta National Hospital at the expense of the less-resourced county hospital.
Kenya currently has 15 confirmed cases of coronavirus, but given the circumstances, Kenyans like 28-year-old Prince, a social scientist and activist who’s lived in Nairobi his entire life and who wouldn’t disclose his real name due to concerns of retaliation, anticipate more strikes and diagnoses alike. “So many doctors and nurses in Kenya are underpaid,” Prince tells me. Doctors in the public-health sector make only $400 to $850 per month, whereas nurses take home about $145 to $335. As low as that seems, academics like Herman Manyora, a lecturer at the University of Nairobi who staged similar strikes on behalf of college professors, have noted that salary is just one issue the country’s doctors and nurses have struck over. In fact, what really pushes Kenyan health-care workers to walk off the job are the conditions they’re forced to perform in — e.g., dilapidated facilities, lack of supplies, insufficient training and an extreme shortage of doctors and nurses (approximately one for every 10,000 people).
These problems, which have never been fully resolved in past strikes, are coming to a head once more as coronavirus takes hold.
The precedent set by past outbreaks and a deeply reactive health-care system is extremely poor. In Kenya, 80 percent of citizens rely on the public-health system, yet more than 40 percent of health services are provided by the private sector. Health-care services are also heavily concentrated in cities like Nairobi, while a majority of Kenyans live in rural areas and lack access to care. Not to mention, primary health care, which has been found to significantly reduce mortality rates, receives the least amount of funding. Devastating, decade-long epidemics ranging from cholera to malaria to HIV/AIDS, which claimed the lives of 25,000 Kenyans in 2018 alone, are almost a matter of procedure at this point. Worse yet, a country consisting of 50 million people has only 130 intensive care beds and roughly 200 specialized intensive care nurses. As such, scientists have gone as far as to call COVID-19 “a ticking time bomb” in Africa.
“Most nurses don’t have the necessary expertise to handle coronavirus patients, and this scares them,” Prince says. Moreover, there’s barely any hand sanitizer in the country, and Kenya is facing a severe, underreported mask shortage after many were upsold to China, along with other vital supplies like thermometers, to profit off of the pandemic there. Prince, too, notes that because of the high temperatures in the country, it’s difficult to detect fevers without a thermometer. A significant amount of Kenyans in rural areas also don’t have clean running water to wash their hands, and many families consider soap a luxury.
“People are scared that the test itself is just currently done in Nairobi and no other place. So those in remote areas can’t be tested,” Prince explains. “We have a huge shortage of medics. Even the normal sick people are having a hard time being treated. It’s getting serious.” (This has inspired a sort of vigilante justice — i.e., on Tuesday night, a 35-year-old man in Kwale County was beaten to death in the streets for showing coronavirus symptoms.)
Chinese billionaire Jack Ma’s donation of 1.1 million testing kits, six million masks and 60,000 protective suits and face shields to Africa won’t move the needle for Kenyans either. With a history of corruption in their health-care system, including a scandal where approximately $48.2 million (or about one-fifth of the Kenyan health budget), went missing in 2016, these resources are unlikely to trickle down to hospital workers, let alone patients. The donation was more of a publicity stunt than anything, Prince says, adding that if politicians have access to the supplies first “nobody will even know they came.”
There have been more than two dozen health-care worker strikes in the country since 2013 alone, when health services were decentralized from the federal government and made the responsibility of county governments. This process was rushed and reckless and left many poorly structured, oft-corrupt local governments to fend for themselves with little federal money to pay doctors and nurses, explains Moses Masika, a researcher at the University of Nairobi School of Medicine. “Previous strikes by the Doctors’ Union have been pushing for adequate staffing and tooling of health facilities, but they haven’t been very successful,” he tells me. “It’s therefore not surprising that these issues keep re-emerging.”
Back in 2013, the Kenyan government also signed a collective bargaining agreement to increase doctors’ and nurses’ salaries by 300 percent, improve understaffed and under-resourced facilities and close the gap between the highest and lowest paid physicians. The problem is, they never honored it, even after the Kenya Medical Practitioners, Pharmacists and Dentists Union tried to compel them to do so in court in 2015. All of this came to a head in December 2016, when doctors staged a 100-day strike.
But instead of honoring the agreement, the government attempted to coerce workers into submission by further withholding wages and threatening union leaders with jail time. An agreement was reached in March 2017. It didn’t, however, uphold the 2013 terms; it mainly increased benefit allowances and improved some work conditions (such as no longer requiring doctors to be on-call 24/7, seven days a week).
All of this was compounded when nurses entered into a five-month strike not long after the doctor’s strike ended. The cumulative effects of both strikes led to a number of deaths, and an incident where more than 80 psychiatric patients escaped the Mathari Hospital after climbing the walls and running onto one of the country’s busiest highways.
There have been scattered strikes and false promises in individual counties ever since, Masika and Prince both say. The last of these nurse walkouts was just three weeks ago at Pumwani Maternity Hospital over four months of unpaid salaries. One of the organizers, a friend of Prince’s, was arrested. “When he came to the hospital, he was arrested on allegations that he was trying to administer an abortion, which, of course, is a lie,” he tells me.
Meanwhile, another strike has broken out in Nigeria, due to what doctors claim are five months’ worth of unpaid wages. “It’s unfortunate that we’re on strike at this time but we need motivation to enable us to carry out our responsibilities,” says Roland Aigbovo, president of the Association of Resident Doctors. “Doctors with families to care for are owed up to four to five months salary, and they expect us to continue working.” He denies, then, that the strike has anything to do with coronavirus, of which there are 30 confirmed cases in the country. “I can categorically tell you that it’s about our wages,” he continues. “The hardship occasioned by the non-payment of our wages is extreme.”
Still, Nigerians like Nasha (not her real name), a 30-year-old in ecommerce from Lagos, suspect the timing of the strike is more than an inconvenient coincidence. “On the surface level, it’s not connected to COVID-19, but I think they took the actions because of it,” she tells me. In this way, she believes they’re using the pandemic to force the government’s hand, since, throughout the world, power is shifting from politicians to health-care workers. “So maybe it’s a scare tactic to get the government to pay what they owe given the current state of emergency,” Nasha speculates.
Masika is careful to note that what’s happening in Kenya isn’t a formal strike — at least not yet. However, concerns among health-care workers about coronavirus safety and preparedness is resulting in smaller, less formal walkouts and go-slows in individual counties. “Although there haven’t been any strikes in the proper sense of the word, there have been reports of health-care workers refusing to attend to particular patients in fear of getting exposed to COVID-19,” he explains. “The main driver of this fear is lack of adequate preparation of health-care workers and health facilities. Many health-care workers across the country don’t have the requisite training or personal protective equipment required to handle it, and therefore, they don’t feel confident enough to see these patients.”
“We aren’t prepared as a country,” Prince adds. “There are reports that people in quarantine are being treated like they’re already dead. If the cases become many, then we’re done.”
County-level strikes of public-health workers may not affect Kenya’s private hospitals, but they do threaten to overwhelm these facilities with patients who cannot pay their bills. In Kenya, where the poverty rate is 86.5 percent, when people default on hospital payments, these medical facilities frequently forcibly detain them for up to two years as a punishment. If a person dies while imprisoned, their bodies are kept until their families pay up.
Given these conditions, it’s understandable why one woman left the isolation unit at Mbagathi Hospital — among the two facilities the government has tasked with combating COVID-19 — where she was quarantined and awaiting the results of her coronavirus test. By the time hospital officials tracked her down, however, her test had come back positive; in that time, she’d interacted with about 85 people.
On Thursday, Health Cabinet Secretary Mutahi Kagwe formally addressed Kenyans concerns about the coronavirus, warning against “fake news,” including allegations that the country had only tested 32 people. Kagwe claimed that the government has already screened over 600,000 Kenyans and tested 173 (resulting in seven positive tests). He proceeded to threaten with jail time anyone who said otherwise, but especially journalists. “We will proceed to arrest a number of them to prove our point,” he warned. “And of course since they want something to report regarding coronavirus, we will oblige by taking them to Mbagathi where they can report the matter. Because that’s where the issue of coronavirus can be handled.”
Prince, though, argues the real fear stems from a health-care system that cannot take care of its workers or patients in even the best of times. And the fact that, if Kenyans get sick, they can only really rely on their doctors and nurses’ sense of moral obligation to keep them at work. “Nurses aren’t scared of arrests if they strike,” he says. “Most of the time, they just call off the strike because it’s the most humane thing to do in such a situation. But if they want to strike, nothing will stop them.”