For three weeks, The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), have been on strike, protesting in the streets demanding payment of their salary arrears and the immediate posting of medical interns for internship. Furthermore, calling for the implementation of a collective bargaining agreement that was signed in 2017 after a 100-day strike.

The doctors also cited the government’s failure to employ doctors despite nationwide shortage, failure to provide a training budget for eligible postgraduate medical officers. Failure by county governments to release doctors eligible for postgraduate training, failure to remit allowances ,recurrent salary delays among others.

As yet, the medics have firmly rejected the National Treasury’s Sh2.4 billion allocation to deploy medical interns. The Union says that the government’s slashing of interns salaries by 91 per cent is contemptuous, and insisted that the strike would go on until all elements of the Collective Bargaining Agreement signed by the Union and the Health Ministry are implemented fully.

This standoff between the government and KMPDU which represents more than 7,000 members has since left thousands of Kenyans without much-needed public health services.

However, since the onset of the protests, there have been attacks. A peaceful protest of the medics resulted in police brutality which left the KMPDU boss Davji Atellah injured after he was hit by a teargas canister as he led a protest in Nairobi on March 1.

“This is one of the documented physical attacks on the unionist. But that’s not all: they are always targets. Their phones are tapped and they have learned to live by it,” Dr. Dennis Miskella, the KMPDU secretary general, told the Nation.

However, these attacks have gone beyond physical and verbal. We have established that they’ve been taken online too.

The Nation investigations and Code For Africa analysed three hashtags: #FireTheDoctors, #GreedyDoctors, and #KMPDUexposed and observed behavior suggesting an attempt to exploit trending topics on Twitter to spread disinformation amid the doctors’ protests.

Nation questioned KMPDU’s Deputy Secretary General, Dr Dennis Miskellah, on whether he was aware about the online war.

He remarked, "We are well aware of the online attacks, and they do not surprise us. When engaging with an adversary who fights unfairly, one can expect them to use all means possible. In the context of conflict, such tactics are expected. Our opponents will employ any tactic to hinder our progress. Propaganda is a typical part of such conflict. We do not take it as a personal affront to anyone; instead, we disregard it with the disdain it deserves, as it does not merit our response."

An X network that appears to be anti - doctors' has amplified hashtags, in a bid to discredit the protests and resulted in the hashtags trending in Kenya. The network includes a significant number of active X accounts, several of which have large user bases, including 30 accounts, each having more than 32,800 followers at the time of writing.

Some accounts exhibited bot-like characteristics due to their highly suspicious posting rates including producing more than 10 tweets in a day, having numbers in their usernames instead of actual names, and using profile pictures belonging to other persons.

We further observed that the main accounts that triggered this campaign appear to be digital marketers on X (formerly Twitter) suggesting they are paid influencers to market content on social media, as we noticed their frequent engagement in promotional hashtags during overlapping timespans.

The creation and amplification of hashtags.

We observed that the popularity of the hashtags was short-lived, according to an analysis conducted using the monitoring tool Meltwater Explore, indicating that the networks may have been activated to specifically respond to the medics’ protests.

Our analysis established the lifespan of the three hashtags on the period from 21 to 27, March 2024.

Attempts to make anti-doctors hashtags trend

Soon after the nationwide protests of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) on March 21, there were a barrage of X posts specifically addressing the doctors.

The hashtag #FireTheDoctors, seems to have been prompted by three accounts @richiestorn, @iam_nyakoi, and @mrokerosi respectively.

#FireTheDoctors, the hashtag used against the protesting doctors, was launched by @RICHIESTORN on March 21, the same time it was reported that the doctors' protest entered the second week. The post which came at 7 am on March 22nd had a reach of 10,000. However, we identified three other accounts who initiated posts using the same hashtag; @mumbi001m, @africmumke_ and @iammithamo.

Mutahi Ngunyi, a renowned political scientist, also joined the hashtag, with a post at 8 pm, on March 22. He criticised both doctors and the media, likening them to "harlots" who have power but lack responsibility.

His post became the most engaged and was ensued by a peak in the number of mentions of the hashtag which eventually reached Kenya's trending list on this day.

While there were a total of 1362 observed original posts bearing the hashtag. We observed that 352 users that posted more than twice using the hashtag in an attempt to make this hashtag gain traction. A review of the hashtags, also revealed that the majority of the hashtag’s activity came from original posts followed by reposts.

The significant traction of these hashtags was compounded by the fact that its top 30 authors have more than 32,800 followers.

These accounts slammed the medics for protesting, ignoring their real concerns while also diverting the strike to a political and online battle, coupled with high posting rates.

Along this anti- doctors network, several of the accounts used the hashtag #GreedyMedics, which was initiated by @kingkid__ , In attempts to spread a narrative against doctors, the first account used a fabricated social media card, purported to come from Nation.Africa. The card alleged that Kenyan doctors are the second best paid doctors in Africa. It has since been debunked as fake.

Posts spreading the #GreedyMedics hashtag seemed to typically downplay the protests and support the grievances of the doctors. When the hashtag emerged on March 22 at 8:40 AM, it peaked on the same day with more than 300 mentions and trended in Kenya for the next four days, as it was amplified by accounts with more than 3,000 followers.

However, we observed the impact of this hashtag wasn't as enormous as compared to the rest, partly attributed to the fact that the actors were attempting to counter the narratives driven by #FireTheDoctors and #KMPDUexposed.

Further attempts to drive a vile narrative against the protesting doctors were observed in the hashtag #KMPDUexposed. The hashtag emerged on March 22 and received more than 9,000 mentions. It trended in Kenya between March 22 and 27. The account @MrOkerosi, which initiated the hashtag openly downplayed the medics’ protests claiming it was being staged by university students and not the real doctors.

High posting rates

Another indication of suspicious activity from the network was the high posting rate from some of the accounts. For example, five accounts @itskiprotich1 (43 posts), @jebetke_ (32 posts), @mrokerosi (22 posts), and @cityfrans47_ (5 posts) were among the most prolific, using the hashtag supportive of #KMPDUexposed, mostly in the form of posts and reposts.

On March 24, the account @kababaake1 quoted ten times to different posts using this hashtag. Additionally, the hashtag was initiated by 1899 X accounts, while 458 accounts posted more than twice using the hashtag in attempts to trigger the virality of the campaign.

Similarly, we observed a total of 1362 original posts bearing the hashtag #FireTheDoctors and 352 users posting more than twice using the hashtag. For instance, twenty X accounts each bearing over 30 posts bore this hashtag.

@mkevin____ and @jabalandke were the most prolific with 51 and 50 posts respectively.

Influencer analysis

The Nation identified two X accounts @kusienyakelvin and @davidjesse_ taking part in all the three campaigns using the hashtags #FireTheDoctors, #GreedyMedics and #KMPDUexposed.

Kelvin Kusienya’s account is verified, with his bio stating that he is a medical doctor, a content creator and mentor, with Kakamega as his tagged location.

Similarly 882 X accounts launched #FireTheDoctors and #KMPDUexposed campaigns.

An analysis of X posts, creation times, and mentions reveals that the accounts within these networks — surf noise, info defense, and node of time — are connected, with info defense and node of time being closely associated with one another and surf noise existing on the periphery. The cross-amplification efforts between the accounts were most evident.

As Kenyan doctors continue to protest over poor working conditions, poor pay among other raft of issues, the Nation and Code For Africa observed online coordinated attempts to control narratives can further restrict the information environment. Various accounts in the identified network appear to be taking part in coordinated amplification efforts against the doctors and KMPDU. Our investigation shows an analysis of three hashtags the network amplified and managed to push to X’s trending list, thus creating a false perception of Kenyan doctors and discrediting their concerns.

This network identified by The Nation also, in the recent past, launched hashtags and applied similar amplification activities against Kenya’s media houses.

KMPDU’s Dr Miskellah explains that the attacks have not only been online and physical (involving the injuries meted on the Union’s Secretary General, but that they extend to tapping of their mobile phones. “We have learnt to live by it,” Dr Miskellah told the Nation.

“The first propaganda that came out was when some people from the Ministry of Health and some MPs started trying to sell the propaganda that I am the one who organised for my team members, including my boss Dr Atellah, to be attacked. Through this, they were trying to push the issue of “a power struggle” within the union.

“They were also trying to advance the narrative that we’re being financed by politicians. But if we were to have any political sponsorship, they would be able to know. For us, we consider such things as propaganda. We don’t take it personally. We believe that it is part of the fight. When people cannot raise their points, they raise their voices. They just want to muddy the waters and cause confusion. But of course, our members are smart,” said Dr Miskellah.

“We pride ourselves with smart members who question every side of the coin before coming to a conclusion. Such things don’t dissuade us from pursuing what is rightfully ours. The ratio of doctors to patients in Kenya is 1:17,000, yet the World Health Organisation recommends that a doctor should handle 1000 patients.”

“We are not greedy doctors,” commented Dr Miskellah on the #GreedyDoctors. “Being a doctor is a career. We ask for what is rightfully ours. We must stop imagining that, for a second, we will stop asking for what is ours.” he explains.