Why we're not using our medical specialists to the optimum

We are almost celebrating a decade since devolution was implemented. It has been a bumpy ride in many sectors, most notably in the health sector. Devolution of health has not been a walk in the park but like everything else, we have had positive growth in many counties while several others have left a lot to be desired.

One of the strongest pillars of healthcare is the human resource for health. The devolution journey did not start well for this pillar. The health workers, in unison, protested being devolved haphazardly to counties and it has taken several years for the dust to settle.

Every county has focused on strengthening different aspects of the health sector depending on what they have perceived as their immediate need. Some counties have heavily invested in infrastructure, building new hospitals or markedly expanding the existing facilities. Others have focused on introduction of previously non-existent services at facility level.

Some counties heavily invested in human resource development. Counties like Mombasa, Kisii and Kakamega have supported the training of their doctors to increase the number of specialists in the county. This is an effort worth applauding. Increasing the number of specialists should pretty much translate to increased quality and scope of services offered in the facilities, with the end outcome of improving the health outcomes of the population.

However, from the look of things, this may not necessarily be the case! Patients still have to queue for long hours to see the specialists, wait in line for long periods before they are scheduled for specialised medical procedures and surgeries and still wait for laboratory and imaging reports for uncomfortably long periods.

In some instances, the presence of these specialists in not felt on the ground, making one wonder whether the training was a worthy investment. So what are some of the obstacles that stand in the way of extracting value from these highly skilled professionals?

The most immediate one has remained the mismatch between the available skillset and the resources required to put it to good use. I once recall visiting an extremely busy level five hospital serving a huge catchment population and lucky to have an ophthalmologist. He bitterly complained how he could not convince management to set up an ophthalmology theatre for him to conduct his surgeries.

He had dozens of patients who would benefit from surgery, yet every other month, they visited the ophthalmology clinic to rebook their theatre appointments. Eventually, frustration drove him to quit his position in search of greener pastures where his skills would be put to use. This has remained the single most demotivating factor among specialists.

The other significant morale-killer is lack of appropriate teams to work with. It is preposterous to have a neonatologist posted to a facility with a newborn unit but no trained neonatal nurses! However well skilled the doctor is, it is not possible to work alone to provide the highly technical care required for the best outcomes for their tiny patients. It remains a constant cycle of dropping the ball.

Provision of adequate consumables is probably the most trivial excuse to fail the patients! When the surgeon walks into the operating room ready to work, yet there are no sterile surgical packs to use in surgery. The whole surgical team of no less than five sits around waiting for the precious sets to be delivered four hours later while the patient is starving in the ward not knowing when they will finally be wheeled to the operating room! What an abomination!

On the flipside, public institutions have remained somewhat archaic in how they utilise their specialists. Public hospitals have a set standard work week that requires the specialists to attend a ward round once a week, conduct scheduled surgery one day a week and attend a specialist clinic one day a week. For the rest of the week, the specialist remains on call to attend to emergencies as required by the general practitioners and interns working under them.

This means that if the junior doctors do not have a technical reason to call for help, the specialist remains grossly underutilised. It means that in the event the junior doctors are overwhelmed by just the sheer numbers of the patients they have to attend to, they are unlikely to call the specialist to come on board as an extra pair of hands.

In the end, for the very patient the specialist went to train hard to come and serve, it is a sheer privilege to see this specialist! What is even worse is that even if the specialists within the facility multiply, the net effect does not translate to the ground. The entire team simply turns up for the three allocated days, with no room to be more available to the patients due to the set hospital schedules.

We need to throw out whatever guidelines created this sad situation! Every patient deserves an opportunity to be seen by the highest available skillset in a hospital within a reasonable time and accorded appropriate care!

Dr Bosire is an obstetrician/gynaecologist