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Wednesday–how Kenyan doctors are trained

March 24, 2011

Today, I learned about snake bites, compartment syndrome of the upper extremity and management of depressed skull fractures. What was more interesting to me was talking to the interns and medical officers about their training.

In Kenya, there are two medical schools Eldoret and Nairobi. Approximately 800 medical students graduate each year from these two medical schools. These 800 students do not include those Kenyans that leave the country to go to medical school somewhere else (eg, there is only medical officer here that went to Russia for medical school). These 800 students are the ones who scored the highest on the national exams and qualified to enter the two Kenyan medical schools. To give you some perspective on this number, the state of Michigan alone probably graduates that many medical students each year and that’s only one state.

The Kenyan medical students go straight into a 6 year curriculum after finishing high school. The students only rotate on a surgical service for 6-8 weeks in their fourth year and their sixth year. In that short period of time they have two week rotations (way too short of rotation) on various surgical services. So my current group of students will be on service for two weeks, then go to another general surgery service, where the teaching is less, then spend a few days on ortho, neurosurgery etc. That will be the extent of their surgery exposure. But yet when they become interns (the first year of training after medical school), they will be required to manage everything in the surgery specialities as well as obstetrics, medicine and pediatrics. Then once they finish internship, most will serve two years at “district” hospital as a medical officer (MO). In most places, they will be the only doctor. So now they may actually have to do those surgeries, be the hospital administrator and the medical doctor. No small feat for a 26 year old Kenyan.

Interns who become MOs have no choice as to where they can be assigned. Some end up way “up country” where there is nothing but them. Others end up in more cushy places where they have tons of back-up and may be restricted to a something like reproductive health. So needless to say when these MOs come back for what we in the US call residency (Masters of Medicine in Surgery, ortho or whatever specialty here in Kenya), the level of experience can be drastically different. And I can see it in the OR. Some of them don’t even know how to use the most basic of our surgical instruments.

What’s also amazing to me is how poorly this year’s class of interns is being treated. The interns set in their mind that they only have to survive 12 months and then they get their posting as an MO. This class has been waiting an additional three months. I am sure this is mentally tough for these young Kenyans who have sacrificed a lot to get where they are already. I can only hope the government will get them their postings soon. April 1 would be the next time they could leave for their postings. We’ll see what happens.

Because I felt guilty about not having any pictures. I’m posting some gratuitous pictures of the weekly basketball games played at the IU compound.

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