NEGLECTED SPECIALTIES IN MEDICINE

Recently a friend asked me to recommend a paediatric neurologist in Nairobi. The one who was attending to them was so busy that it took at least three months to get an appointment. Clinic visits with the specialist was even more frustrating. The appointments were so many, patients waited to be seen up to as late as 11.00 o’clock in the night. I could not imagine a waiting room full of babies with cerebral palsy, epilepsy, attention deficit hyperactivity disorder, stroke and autism, having to sit patiently for hours.

 I was stuck. The only one I knew right off the top of my head was the very same one they were opting out of. I had to call a friend who is a paediatrician, to give me recommendations. She fully understood my predicament. I was not the one who was unfamiliar with paediatric neurologists. They are just that few. She gave me only two more options.

The Medical Practitioners and Dentists Board website currently has only six (6)! Dr. Osman Miyanji, Dr. Richard Kimani, Dr. Stephen Munyi, Dr. Donald Oyatsi, Dr. Douglas Makewa and Dr. Pauline Samia are the only paediatric neurology specialists in Kenya serving a general population of over 20 million minors when it comes to neurological disorders.

These six doctors must serve the total surface area of 580,367 km² that makes up this country. It is no wonder then, that they would generally only be domiciled in the capital and its environs and all of Kenya’s children in need of their services, must travel to them. I cannot even begin to imagine what this means when we speak to access to healthcare.

When I asked my friend whether as a paediatrician, she would be interested in pursuing paediatric neurology in view of the glaring specialist gap, she was very categorical that she would not venture into such a field. Her reason was very simple. Paediatric neurology is a very depressing field. Waking up every morning to deal with difficult diagnosis, frustrated parents who do not know what else to do and babies teetering on the edge in the intensive care unit is not how she envisioned spending her days. It would drive her over the edge.

My short stint as a medical officer intern in the paediatric unit of the National Referral Hospital confirms this in every way. We had babies who spent half their lives in the wards. There were babies with cerebral palsy who were admitted to the wards every other week, with different complications. Or the little ones who would convulse non-stop while we pleaded and bargained with the intensive care unit to miraculously find them a bed so that they could at least be paralysed on cardiorespiratory support and stop the madness. Then there were the delicate newborns with meningitis who would leave us biting our fingers about the whether they would survive the infection and what mayhem it would inflict on their future as a result of the complications.

I have met parents with babies with autism who will do anything to relieve their little ones of the burden of the diagnosis. They will fly to all parts of the world to seek care. They will enroll for all clinical trials with hope of improvement. They will spend millions to pay for experimental treatments that may not have demonstrated much by way of results yet!

Paediatric neurological conditions are not easy. Caring for babies with such difficult conditions is heavily taxing for the family, physically, emotionally and financially. The stress of it all has broken families and caused untold pain. To add insult to injury, most medical insurance covers will not cater for these conditions and when they do, the cap on expenditure is not adequate.

These babies then face the double tragedy of not having access to care due to inadequate specialists in the country. A doctor cannot be forced to take up a certain specialty just because there is a gap. However, the government can mitigate this by making it attractive for young doctors to consider studying in such deficient areas. The Ministry of Health has successfully done so in the past by providing conditional scholarships in areas such as anesthesia and ophthalmology and this has seen the numbers of specialists increase markedly.

It was thought that sourcing for doctors from outside Kenya would cure such deficiencies while buying time to train our own. However, there is need to review the real gaps and plan accordingly. Kenya has come of age where it can train its own super-specialists. We have enough patients, adequate technology and a myriad of medical schools and residency colleges accredited to train medicine. The challenge is to these schools to grow their capacity to train the very highly specialized skills that we are still seeking abroad.

It is also a challenge to the existing super-specialists to mentor the young doctors, help them to get scholarships and train wherever in the world they can, and get back home to help our own. It is not right that the country has only one emergency medicine specialist in a country overrun by boda boda accidents, or one dental radiologist after all these years of training dentistry in Kenya. It is a sign of poor planning for human resources for health!