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Health Policy

After The Strike

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The longest doctors' strike left many Kenyan families and individuals with 
wounds that will never heal. The numerous unresolved legal and professional 
issues will likely undermine meaningful healthcare reform.

After the strike, after the tension dissipates and relations normalize, 
there should be sincere efforts to find solutions to the fundamental 
problems within the health care system.

The strike was long. It’s been three weeks since it ended. In the male medical ward, the effects of the strike are all too apparent. Men in dire in dire condition arrive one after the other. Am trying to admit one, then running to resuscitate another, working on completing an urgent procedure on another then moving on to certify the death of one who has arrived too late.
Many of them have waited all of the one hundred days to get treatment. They couldn’t afford the existing alternatives and had to wait until the strike ended. The aftermath wasn’t pretty. Work lessens late in the after but before I think of going off to relax, someone calls my name.
It is Janet, the mother of a boy I had treated on several occasions months before the strike. She arrived this morning, she said, but finding me too preoccupied had waited for hours. She needs to talk. Did I have time to listen? Yes, I say. We sit. I am hoping it will be quick. There’s a pause. She seems deep in thought, somber even.
“There was hope,” she says.
I have been hoping for a respite from the non-ending tragedy that these three weeks have been. From the way she starts the story, all hope of good news evaporates. I wonder what became of her boy.
“We were fighting the battle real hard….” She chokes back the tears. “And then…then…then it happened. Hope turned to numb grief”. She’s sobbing now.
It takes time for her to compose herself. And then, silence. That deafening silence burdened with mourning, bitterness, and regret.
“I don’t want to tell you straight in the eye that you killed him. My child, my everything. He shouldn’t have died; there was so much hope, especially after you took so much pain to educate us on how to take care of him. He was growing into a wonderful man, that boy. And he looked up to you, wanted to be a doctor, to save lives like you had saved his. But that’ll never be. He’s gone, lost to time, an unfulfilled life.”
I look on, seeing nothing, hearing nothing, feeling nothing, numbed by everything. I should feel the pain, tell her I feel her pain, console her. But she doesn’t need that. She didn’t come for that. She isn’t looking for sympathy.
“What exactly did you gain from it?”
“You mean the strike? Nothing”. I say.
“So much suffering, so many deaths. All for nothing.”
I was quiet. What could I say? What could anyone say?
“I know, doc, that you are a caring person — someone with a conscious. We had been to many doctors throughout his short sickly life, but none showed as much concern as you did. For that reason, I never intended to burden you with my tragedy. But for the same reason, I have to, because no one else would understand. No one else would get it as you would. Still, I feel remorse in having to tell you that I carry with me the greatest pain a mother can; to bury your child. And to do so feeling, knowing, that it shouldn’t have happened, that you should have done more. It is the ultimate failure. And I will carry that with me all my life.”
“I…I know…I mean, I understand….”
Silence again. I let it fester. It is not the usual scenario where the doctor controls the conversation. I watch as the erstwhile sobbing, and bereaved mother mutates into a force of confidence glaring at me from across the table. I am aware that the effects of the strike have destroyed any sympathies towards doctors. She’s a victim, this grieving mother, and I may not like what she has to say.
“I watched for a hundred days as our humanity was debated, trivialized, haggled over like a throwaway item at an auction. It is as if we weren’t human. We were categories. We were either doctors, or politicians, or bureaucrats attacking each other, blaming each other, giving ultimatums, mocking each other, looking at humanity from the outside, untouched by it, unmoved by the ravages of diseases, undaunted by the permanence of death. And then after it was all over, we went back to business as usual. We returned to the ministry headquarters and big offices. We went back to the unequipped hospitals, to the dysfunctional operating theaters and to the wards that are health hazards—crowded and devoid of basic public health measures. We went back, especially, to the campaign trail to lie to Kenyans about how their lives lay in their votes. We went back to indifference .”
“But not everyone could so easily emerge from it. The doctors could go back to their practice. The politicians could go back to their lofty positions in society and to their motorcades and to campaigns and to treatment in foreign hospitals and especially to their indifference and dereliction of duty. Their appointed officials could go back to their big offices and big allowances.
“But for us the ordinary Kenyans, we couldn’t go back someplace. I, like thousands of Kenyans, can never shake off the effects of the strike. It was life-altering. To lose a son is like to have a part of you violently cut off. You can never recover from it. I will miss the joy of carefully selecting his dinner. I cannot look forward to seeing him outgrow his clothes and celebrating his milestones. That’s a golden experience of motherhood snatched from me. And for my son, he can’t go back to being alive. He was denied a chance to grow up knowing he is a fighter, the survivor of a bad chronic disease. He will never know if he could have been, in spite of the odds, what he wished to be.”
“I wish there was a way to articulate the loss. We cannot fully measure the implications of all those missed doctors’ appointments, the unfilled prescriptions, the missed chemotherapy doses, the dead children, the dead mothers, the dead fathers, the dead sisters, and brothers; losses we shall never recover from? Think of the loss of trust between the professionals and the population they serve. Think of the loss of goodwill between those in government and the’ nation’s most committed workers. Think of the desecration of dignity for so many millions.
“Now, let’s say that all these were terrible things that happened during the strike. It is impossible for people to find common ground amid all the tension, the grandstanding, and the political noise which pervaded those horrible one hundred days. But now, after the strike, it is time to recollect ourselves and find what really can be done.”
As I watched her leave, I knew she was right. This was the time to go into a deeper and more sincere examination of the health care system. It is not during, but after the strike that we should thoughtfully examine the fundamental problems that caused the strike and all those deaths.

He has led a remarkable campaign, defying the traditional mainstream parties courtesy of his En Marche! movement. For many, however, the campaign has become less about backing Macron and instead about voting against Le Pen, the National Front candidate.

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He has led a remarkable campaign, defying the traditional mainstream parties courtesy of his En Marche! movement. For many, however, the campaign has become less about backing Macron and instead about voting against Le Pen, the National Front candidate.

Capitalize on low hanging fruit to identify a ballpark value added activity to beta test. Override the digital divide with additional clickthroughs from DevOps. Nanotechnology immersion along the information highway will close the loop on focusing solely on.

“Youth is happy because it has the ability to see beauty. Anyone who keeps the ability to see beauty never grows old.”

John Ruth

Le Pen has spent the past few weeks battling to extend her appeal beyond her traditional base of supporters, while Macron has been attempting to convince voters that he is not part of the political elite they rejected in the first round.

The Conclusion

The country is still under a state of emergency following those attacks and several others. Some 12,000 extra police and soldiers are on duty in the capital for election day to secure polling stations and the candidates’ headquarters, Paris police said.

Capitalize on low hanging fruit to identify a ballpark value added activity to beta test. Override the digital divide with additional clickthroughs from DevOps. Nanotechnology immersion along the information highway will close the loop on focusing solely on the bottom line.

 Kara Fox and Barbara Arvanitidis reported from Paris and Bryony Jones reported from Bordeaux. James Masters and Angela Dewan wrote from London. Sebastian Shukla and Karen Smith contributed to this report.

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