[October 2022] KMA YDN NEWSLETTER_01

YDN ZINE

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KMA Young Doctors Network ydn@kma.co.ke

Kenya Medical Association

Table of Contents

KMA President's Remarks

KMA YDN Convenor's Remarks

Inaugural Pre Internship Conference

Opinions & Articles

KMA Young Doctor's Networks Webinars World Medical Association

Dr. Simon Kigondu

Dr Simon Kigondu Obstetrician Gynaecologist President Kenya Medical Association

Internship is the period after completion of medical school and the beginning of working as a licenced doctor It is not only mandatory for licencing but is an important period of sharpening the application of the medical knowledge learnt over at least six years and applying it for direct patient care with the support of colleagues who have been in the field before. Medical internship is the time of learning by applying theory directly into work.

During internship and thereafter, it is important that you as a medical intern are guided by the International Code of Medical Ethics of the World Medical Association. I will highlight some of the important principles that you need to follow as you perform your trade

Promotion of the health and well being of patients is your primary duty This is done by ensuring that you are competent, provide timely and compassionate care and that you demonstrate professionalism while providing care In internship these characteristics count a lot in your internship assessment

The care you give to patients should be fair and just and non discriminatory and based on the patient’s health needs and devoid of bias.

Patients should be treated optimally even where resources may be scarce. This does not mean you practice ‘ poor medicine for poor people’ It means that you provide the highest quality of care even if resources are limited. Remember, referral is also a form of management.

Practice with conscience, honesty and integrity and accountability. Develop independent professional judgement but always consult when in doubt Maintain the highest standard of professional conduct.

Do not allow your professional judgement to be influenced by the possibility of benefit to yourself of your institution. Strive to identify and avoid conflict of interest. If such conflicts are unavoidable, declare them in advance and manage them

Take responsibility of your individual medical decisions Do not alter your sound professional medical judgment based on instructions contrary to medical considerations.

Collaborate with other physicians and health professionals who are involved in the care of patients.

Respect patient confidentiality even when communicating to colleagues about patients.Confine your communication to necessary information only.

Provide professional certification only for what you have personally verified Provide help in medical emergencies while considering your own safety and competence and availability of other viable options for care

Never participate or facilitate acts of torture or other cruel inhuman or degrading practices and punishments.

Maintain and develop professional knowledge and skills by engaging in continuous learning throughout your professional life.

Practice medicine in ways that are environmentally sustainable to minimize environmental health risks to current and future generations

In a nutshell, as medical interns you have duty of care to patients, duty to other physicians, health professionals, students and other personnel, duties to society, duty as a member of the medical profession and over and above all duty to take care of self. You cannot serve from an empty cup

Ensure that you do self care regularly even as you give yourself to the duty as a medical intern.

Finally, I would like to pick 5 lessons from the TIME project that I found useful that may guide your path during internship and thereafter: Compared to the scale of history, a human lifespan is relatively brief Focus on the things that matter Savor life’s best moments Human progress is the result of an ongoing relay race among generations It’s critical that we protect our institutions Over the short term policy matters Over the long term science matters

As you start your internship, to quote Steve Covey’s principles, BEGIN WITH THE END IN MIND.

This applies not only for internship, but for everything you do in life. I thank you and wish you all the best in this very exciting medical journey.

REFERENCES

1. World Medical Association Declaration of Geneva. May 2006. Accessed September 1, 2022. https://www.wma.net/policies post/wmadeclaration of geneva/ 2. World Medical Association. World Medical

2. https://blog.thetimeproject.org/

Dr. Marie Claire Wangari

KMA Young Doctors Network (YDN) Convener

The current state of the economy has left the Kenyan job market very volatile. This has led to job insecurity, with the practice of medicine also being affected, especially amongst the young doctor demographic who are struggling with everything; from seeking the ever elusive P&P contracts to trying to raise fees for postgraduate studies and still going through the general hustle and bustle of life This comes at a time when we only have 1 57 medical doctors per 10,000 population according to WHO (2018)

Whilst we appreciate the slow and gradual efforts to increase the number of medical schools in the country, a number currently standing at 11 medical schools distributed among 8 counties; we must appreciate that more needs to be done so as to align with WHO Global strategy on human resources for health: Workforce 2030 which amongst its recommendations states that "countries should invest in the education and training, recruitment, deployment and retention of health workers to meet national and subnational needs through domestically trained health workers"

As part of KMA YDN's career development efforts, we decided to host the inaugural pre internship conference; an event that has been planned and executed by the pre interns in our steering committee as we would look to empower the intern with skills to make you not only an all rounded doctor who is an avenue for positive health reforms our country Hence the theme "Positioning the intern for opportunities and impact in healthcare."

Furthermore, we appreciate the increasing number of young doctors who are using social media to advocate for change, with the recent #SomebodyTellHealthCS and the various stories of bullying, harassment and overworking of young doctors on multiple platforms Coincidentally, The World Medical Association highlighted both these issues, amplifying the global challenge of junior doctor burnout & highlighting the Physician's role to society through social media in their International Code of Medical Ethics (no. 35)

As we launch the YDN Newsletter, YDN Zine today, we have dedicated this inaugural edition towards highlighting the fundamental role interns play in our health system. We hope this newsletter will pave the way for more collaborations amongst the young doctors fratenity as we not only build the network but also continuously develop young doctors who make a positive difference in our society

In conclusion, as KMA YDN turns five next year, we look forward to hosting the WMA Junior Doctors Network Spring Meeting in Nairobi as a prelude to the April 2023 WMA Council Meeting (you can read more about this on page 32 of this newsletter).

Editorial Note

Greetings! Welcome to the special edition of the KMA Young Doctor's Network newsletter This edition will focus on addressing various issues pertaining to internship. The current landscape of medicine in Kenya is changing at an alarming rate From the newly introduced balloting system to the looming threat of reduced remuneration for medical officer interns.

We as the KMA Young Doctors Network feel that contributing to these conversations is key in highlighting the stories that matter to the Young Doctors and the Medical fraternity at large. Dr Marie Claire, the Convener of the KMA Young Doctor's Network, came up with the idea of this edition that presents the narrative through different perspectives from several members of the network

In this short and concise publication, you will get to learn more about different issues affecting interns such as the dynamics, merits and demerits of the new intern balloting system. In addition, there is an article highlighting the current policy surrounding maternity leave during internship

Despite all the challenges arising, we are fully convinced that our voices can be amplified better when we band together. This newsletter is one avenue which we intend to use for advocacy on matters arising in medicine, for a lasting impact. We wish you all the best in your journey of navigating this amazing profession that we know, love and intend to safeguard. Happy reading!

Dr. Lynette Kiriga & Ruby Oswere Communications Leads, KMA YDN

Editorial Committee

Dr. Marie Claire Wangari

Dr Kevin Bartay

Dr Lynette Kiriga

Ruby Oswere

KMA Young Doctors

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The Pre-Internship Conference

By: Dr Christine Mutonyi

Why not? That is the question I asked someone who a having the inaugural Pre internship conference Why no have as we await posting by the Ministry of Health? W from students to young doctors in a wonderful event networking? Why not get those who have gone ahead we are better equipped for the momentous year ahead

The Kenya Medical Association through the Young leadership in taking up the vision for this conferenc conference will be hybrid and will be held on 11th Nove feature panel discussions, fireside chats, keynote networking opportunities Topics covered will include: Mental health, Health systems, Doctor preneurship among others. It will bring together various stake holders including: policy makers, innovators, entrepreneurs, researchers and other leaders who will all impart their wealth of wisdom to young doctors.

Healthcare is changing. The path for a doctor was simple and certain. Medical school internship work as an M.O Masters and finally practice as a consultant. The beginning may have been difficult but it sets one on a future that was filled with promise, repaying all the toil of the past. Today, internship is delayed, job opportunities for medical officers are few and specialisation is very expensive in Kenya with very few slots available This means that we as young doctors who want to be agents of change must look to new opportunities. We must maximise our potential in order to stand out This conference seeks to do just that, help the intern chart a path to suit him/herself as he/she pursues a life of fulfilment and success in medicine. Internship is the first step and we have to be ready.

I am of the opinion that the key to solving healthcare problems in this country is to invest in two things: primary healthcare and the people involved in the system (the clients and the healthcare workforce). The latter is particularly important because at the end of the day healthcare is a service. It is not something you buy in the supermarket. Its quality and quantity is inherently tied to those providing it. As such, my team and I are working hard to ensure we have a successful event that goes on to help optimise every attendee’s practice in future Come one, come all and when asked why, simply ask, why not?

Dr. Mutonyi is awaiting to commence her internship (pre-intern) and is the organizing committee chair of the inaugural KMA YDN pre-internship conference

THE DAWN OF A NEW BALLOTING SYSTEM FOR MEDICAL INTERNS

By Dr. Andrew Githiria

Introduction

Training of healthcare professionals in Kenya was initiated in the pre independence era. Since then, more formal internship programs for different cadres have been developed. Internship is a prescribed period of compulsory hands on training in approved institutions for all healthcare professionals. This is a legal requirement before practice after graduation. The Ministry of Health internship policy acknowledges internship as an opportunity to build upon previously acquired knowledge and experiences This is done by working in healthcare facilities approved and accredited by the relevant regulatory bodies and the Ministry of Health as fitting training centers.

To place medical officer interns, KMPDC is tasked with identifying available slots in authorized Internship Training Centers and then conducting a fair balloting process. Over the years, the council has been trying to improve the process of balloting in retort to complaints of irregularities and undue bias. Another prompt for a different balloting system was the fact that the number of institutions and graduates had increased significantly and become visibly disproportionate to the placement positions available.

This led to long waiting periods, undue competition for centers believed to be

Balloting Process

Traditionally, balloting exercise was a physical event. This method, although vulnerable to abuse, was applauded for considering medical graduates' choices and preferences The Board would send a list of available slots in each approved center to medical schools, where deans would facilitate students to choose their preferred centers. If the number of interns exceeded the allocated slots, the dean or the representative would conduct a simple balloting exercise by allowing students to randomly pick pieces of paper with numbers The students who miss a paper on each exercise would then be allowed to participate in another round of balloting for the remaining centers until all of them had been placed.

In 2021, KMPDC presented a surprise to medical students when they decided to renounce this traditional balloting process. They introduced an online approach that involved a medical graduate spinning a virtual wheel on the council portal and randomly getting placement to one of the available internship facilities

better or shunning away from centers believed to be unfriendly to interns

Spinning the wheel

My class was the second cohort to participate in this new system. This move to leverage technology to solve a perennial issue was welcome but not without challenges. My experience with spinning the wheel was surprisingly seamless The first group to spin the wheel had many complaints and I was initially skeptical When it came down to it, compared to the experience of our predecessors, I hold the opinion that this year ' s process was very well organized. We were invited through our class representatives and a personalized SMS to a scheduled virtual meeting.

On that fateful Thursday, the meeting started at 10 am, with pre interns from all universities eligible for balloting in attendance. The institutions present included the University of Nairobi, Kenyatta University, Maseno University and a few international graduates from Kampala International University KMPDC was represented by several officers among them Mr. Emmanuel from the ICT department. He explained the whole balloting process and gave a few clarifications as needed. Many questions were raised by the students ranging from issues with comprehending the whole process to needing technical support on a few hitches such as email delays. The other questions raised were in protest of the introduced method of balloting. A group of students were utterly displeased with this virtual process. They even reminded the council officers in attendance that they had written a protest letter to the council and were yet to receive an official response. The council officers responded to this complaint by offering reassurance and a promise of official communication As I write this, I am not sure whether this has happened

An email containing a balloting link was then sent to everyone You were to create an account and then upload a profile picture before you could access the wheel Only one chance was available for spinning and your center would pop on your screen in less than a minute

Challenges.

There was a big concern with delays with emails. Some pre interns received their emails 30 to 45 minutes after the commencement of the balloting process. In response to this concern, the officer in charge created a Google form to compile the email addresses of those who had missed the link. Of note is that he acted on this issue promptly in real time. Only a few graduates did not get the email by the end of the day and had to present themselves physically at the council office the following day.

I received my email 3 minutes after they were sent, followed the instructions, spun the wheel and immediately got my allocated slot I even managed to download a placement slip all in one sitting. All factors considered, I was fully satisfied with both the process and outcome. It is important to note that except for a few graduates who had delays with emails, many who expressed displeasure were only uncomfortable with the outcome (the centers they got) and not any stage of the process The majority of the expressed concerns were related to allocated centers being far flung and unfamiliar, a valid concern given the uncertainty in posting and delays in payments experienced by previous groups

Another concern was the disparity in the hospitals Although many hospitals were available, there was an unequal distribution of numbers to national referrals, county

referrals and sub county hospitals. The ICT officer explained that the algorithm was designed such that slots couldn't be filled by graduates from the same institution because they had a ring fenced quota for each school. Eg. Kenyatta National Hospital would have a graduate from Kenyatta University, University of Nairobi, Maseno University etc

Internship Center Variation/Transfer. KMPDC policy allows that if an Intern is not satisfied with the center they balloted, they can apply for a variation if they haven't reported or apply for a transfer if the intern has already reported In line with this policy, Medical Graduates with valid and compelling reasons that would hinder them from accessing or comfortably serving in the centers they were placed in had an opportunity to appeal They would fill out the Change of Internship Form to be downloaded on the KMPDC portal and attach supporting documents where applicable. A report by one graduate who went to file for variation estimated that over one hundred and fifty graduates had appealed This forms about one third of the total pre intern population. The majority were basing their appeals on family responsibilities, health conditions, pregnancy and safety concerns. KMPDC mentioned that variations would have to be objectively reviewed by a committee before they are approved A few individuals have reported that they have successfully managed to change their centers I am not able to independently confirm this fact, considering the final list is yet to be published Way forward

My opinion is that the system has addressed underlying concerns that have

dodged the traditional method although not without its unique challenges The biggest criticism is based on the fact that the new system fails to incorporate the preference of medical graduates. It is indisputable that public participation is a central principle in any intervention To address this, there should be a provision for medical graduates to select 3 centers in order of preference before they can spin the wheel. Further, medical graduates with compelling reasons to vary their centers to a preferred location should be accounted for in the balloting process A good example is expectant graduates. Currently, no policies have been put in place guaranteeing medical interns paid maternity leaves. Consultations are therefore necessary to develop a policy that will guarantee this right to female interns who may deliver during the training period. The delay in absorption and payment of medical officer interns at the start of the program is a systemic failure that seriously affects the quality of training of MOI This issue needs to be addressed by the Ministry of Health, which carries the mandate for training healthcare workers. Medical Officers interns should be deployed within 3 months of completing Medical School. Their salaries should be paid per standard and international labour laws, without experiencing any previously noted delays. In agreement with recommendation 13 of the task force report on medical specialist training, registrars/Senior House Officers should be managed centrally by the Ministry of Health. The officers' payroll data will be transferred to the national government for management thus freeing up their positions to enable the absorption of the post intern Medical Officers by the counties

This would act as an incentive for medical officer graduates to prefer far flung or rural internship centers as they would be prioritized for retention in these largely understaffed facilities.

Conclusion

The virtual balloting system is a welcome improvement to leverage the power of technology to enhance accountability, efficiency and guarantee fairness in the placement process. Feedback channels need to be created to integrate recommendations from medical graduates

A key suggestion is the incorporation of medical graduates' choices and preferences before progressing to spin the wheel. This will drastically reduce the number of appeals received by the council and increase satisfaction levels among the interns

The virtual balloting system is a welcome improvement to leverage the power of technology to enhance accountability, efficiency and guarantee fairness in the placement process

Dr. Andrew Githiria

Dr Githiria is a Global Health enthusiast & a Youth leader advocating for access to quality and affordable healthcare in underserved communities.

Motherhood During medical internship and postgraduate training? Need for Policy reform in Kenya

By Dr. Bosibori Ondari

Becoming a new parent during medical school training and internship is challenging and may adversely affect attainment of professional goals or even guide career specialty choice based on perceived work life balance The increase of female medical students in Kenyan medical schools to approximately 50% of graduates parallels the increase in pregnancies among females during undergraduate, internship and postgraduate training

Balancing the competing demands of parenthood and a career in medicine is a challenge that many doctors in training experience Medical training often coincides with the optimal biological age for doctors to have children Women especially face difficult decisions as to whether they will have children, when, and how many, while still pursuing their medical career goals. As a profession, we need to think more ambitiously about how we can support doctors who wish to have children at any career stage Some of the challenges encountered include Long or night call work hours, “Punishment” for maternity leave (going on unpaid maternity leave with the obligation to makeup missed calls), no support for breastfeeding or pumping at the workplace, Lack of alternative work arrangements to allow working doctor mothers to obtain improved work/life balance

The provision of longer paid parental leave

and increased support, flexible schedules including shift work, parameters for overnight call during pregnancy and lactation for interns and postgraduate trainees, and practical accommodations such as ensuring availability of lactation rooms or creches within hospitals should be some of the institution level interventions to help female doctors cope well in the workplace.

As medical training programs become more diverse and continue to change old rules, we need to consider the changing dynamics and human right issues that keep arising.

The Government of Kenya through the Ministry of Health needs to make policy reforms and institutional changes to give provision for adequately compensated maternity leave for female medical interns and students in postgraduate training as often the interns and residents cannot afford flexible childcare options. It’s crucial to push for systemic changes as medical programs continue to attract more women. The old notion of motherhood and training being incompatible is completely wrong and women need to be allowed to progress in their careers without motherhood deterring that. As we strive to build more equitable workplaces a lot is needed to be done in policy reform in order to mitigate the impacts of maternal discrimination in medicine.

Dr. Bosibori Ondari is a Resident in Radiation Oncology at the University of Nairobi and the leader of the KMA-YDN Career Development Working Group.

The Government of Kenya through the Ministry of Health needs to make policy reforms and institutional changes to give provision for adequately compensated maternity leave for female medical interns and students in postgraduate training as often the interns and residents cannot afford flexible childcare options

-Dr. Bosibori Ondari

We Are a Canary in a Coalmine

By Dr. Nicholas Mutuku

My lengthy undergraduate training and brief internship in medicine were a sound education in “You’re going too hard. You’re at your limit. Stop ” When the gas was there and my body was feeling good, I sprinted along as if riding the wind It was spectacular too when I tripped, fought to stay upright, fell flat on my belly in a big flop Once, during my B.Sc. training I upped and disappeared for a day or two, my mind reeling from the pressure. I went to Namanga, where I had never visited before, just to be away from it all And all the while, some parties in my mind were clamouring for me to cross the border and be lost in Tanzania.

I should have read something in the casualness with which my teachers received me when I came back. We didn’t say much to each other We relaxed a few deadlines and I gathered steam and completed my course of study. I even turned in good work.

It was challenging training, but I look back to that year with so much pride. I got to meet something formidable in myself as all doctors no doubt meet during our training, when, thinking we have reached the edge of our strength, some reserve in us comes alive and carries us across a chasm that had quenched our will to continue. Still, after that triumph, I attempted at various times to quit med school, deferred med school, nearly quit internship and having finished that mandatory bit of my service, took flight from practice to teach

No sooner have I nurtured an audacious dream than I am reminded that my aspirations will be hard won So, every day I’m changing myself, always inspecting and reinforcing my weak places to prepare myself for the day I go back to work in a hospital. Then my mind wanders to consider all the doctors who still treat, my peers particularly, and I think about the courage it must take to face a tough day.

Now, every day I flirt with a future life in practice. And every day, just as the sweet taste of how much fun practice can be starts to warm my tongue, somewhere from a tight gap between two teeth which two is always new the bitter tang of the strain practice can put on the soul begins its slow march to conquer my mouth and I am tempted to curse medicine and die.

Understand, though, that my experience is certainly not the modal one among doctors. Medical life is not doom and gloom mine wasn’t. Many days are good. So good A medical life can be thrilling. I know what a pleasure those good days can be It is the other kind of day, however… I know the thought of even one such day has chilled your bones, reader A stretch of such dog days can leave many of us burnt out, depleted, nigh broken, wanting to go away and never come back.

Medicine is a trickster deity, giving with one hand and taking with the other. Alongside all its boons, it offers an assortment of banes. We are always taking hits on this journey and sometimes those hits are big.

Unexpected changes of pace and direction stoppages in play, even, are more commonplace in our world than we are willing to formally admit. We repeat years in school, we defer our studies, we change our programs of study; we strain to bear witness to the vastness of human suffering and cower because it makes us feel so small; we refuse to go into practice, we look for more hospitable places to practice, we change our style of practice; we leave the country, we pick friendly specialties that won’t drag us to the terrible country that is our physical, emotional, spiritual limits; we try something outside clinical work, research or teaching; we take breaks; we quit; we go to therapy, we go on holiday, we take leave extended leave, we get prescriptions, we get hospitalised, we commit to rehab; we wonder if we will ever be good enough; we struggle, we flounder, we fail… Patients die. Doctors die These banes are a companion we meet early on in our journeys I wonder if our elder colleagues still walk with them. I wonder too if this shadowy companion is now a friend or if the walk together remains tenuous Worldwide, in all cultures,

many doctors struggle to be well in their minds Our mental ills start early, too. In medical school, we report poorer mental health than our age matched peers. We are consistent in this through internship, postgraduate training, and into our early years as consultants. And often, our poor mental health makes a bed fellow of some soothing habit or other so that our addictions are many. Still, for all that weight of psychic suffering, no claim can be made that we lack insight. We know that general mental health is poor in our profession. Don’t we all crack jokes about how hard we drink because we ’ re so stressed? Do you recall the casualness I mentioned in the first paragraph? We know this thing called medicine eats its people. It can seem, though, that we are ashamed to admit we serve an ogre king Else we would talk about it more, and loudly even. Perhaps it eats goats too, or fowl, and not just doctors. We may be a delicacy and not our fearsome lord’s staple. Perhaps if we talked more about our ogre king we would know. Every time a doctor or medical student dies of the complications of mental illness our collective breath

catches in our throat and we are dumbstruck We weep or wish to weep. We linger in a long moment frozen in terror We speak few difficult but necessary words of condolence and hope In our hearts we acknowledge how hard it can be We skirt any accusatory language. We get how it can all come to such an end… Even the toughest of us admit to the difficulty of this thing we do Then, after a while, some weeks or months, the terror thaws and we put the crisis behind us and forget that the threat still lingers. We go back to cracking jokes and resume our uneasy peace with what can happen sometimes Until there is another death from mental illness.

If it is true what they say, that we fight disease, then healthcare is war, and the battlefield is littered with our fallen. And woe to us because there are more youth among the dead than there are elders. A tree is being chopped at its trunk

In the early days of industrial mining, before electricity brought safe light and technology provided sensors for air quality, silent death and explosions in mines were common. As miners moled on through a seam of coal,

sometimes a pocket of carbon monoxide would be opened, and the gas would suffocate entire mining crews before anyone knew to sound the alarm. At the advice of a physician, mining crews started taking canaries into the dark with them. Whatever poisons lingered in the air underground were more toxic to these canaries than to people As long as the birds sang, all was well. If the birds stopped singing, trouble was coming and miners knew to seek safety.

A doctor dead from suicide, or immobilised with depression or wasted away because of a too costly addiction is just like a canary in a coal mine. Doctors, and healthcare workers generally, arrive at their privileged place of training and service after a journey of many triumphs and vast investments of attention and resources. We are all a living testament to mental toughness, good fortune and being cared for by our teachers, families and communities I dare say that there are more golden children in medicine that in any other profession We pride ourselves in being the cream of the crop What comes of the crop then if the cream is ravaged by

sourness? When we falter under the weight of our chosen lives it is important that we wonder what the journey is like for those having rougher fates than ours If doctors are struggling to feel well in their minds, what is the experience of everyone else?

It is true that mental distress is more common among doctors Yet, I believe, it continues to become more common among doctors because the mental health of the whole society is in dire straits. If we are struggling to remain resilient, it is because our collective resilience as a people is undermined. If we are struggling because we have no people in whom to seek comfort during our times of trouble, it is because loneliness is rampant If we are suffering from the harms of toxic unrelenting stress, it is because toxic stress is more prevalent. If diagnosis and care of mental illness among doctors is delayed, it is because these services are sorely lacking everywhere else We must see our profession’s burden of mental illness as a symptom of a larger trend in society, not simply as a unique misfortune we must bear because we patrol the borderlands between life

and death. If we take such a stance, we will see too that finding solutions to our profession’s ailments is a vital step in easing the nation’s burden.

At the 49th Annual KMA Conference this year, physician wellbeing and mental health took centre stage and we worked towards collective acclamation that doctors indeed work under a shadow The momentum built during those few days in Eldoret is already at work and there is a push within KMA and KMA’s Young Doctors Network as well as among other players to improve our collective mental fates. We must explore and arrive at solutions to the assault on our resilience as health workers. Else, we will be incompetent to build and protect the mental health of others Else, we will fail in our role as leaders in the national effort to foster resilience in the face of mental hardship. If we thrive, we can lead others to thriving, be bolder in our assertion that mental wellbeing for all is a right, and be more palatable because we will be preaching truths we exemplify in our daily lives If we thrive, we will be more

effective proponents of abundant mental health So, we must purpose to thrive.

I talk a lot about the coming surge of African babies: 1 billion before 2050, 50 million of them Kenyan. I can think of no bigger gift we can offer them than brain friendly environments in which to grow up. A healthy human brain pitted against a problem is a wonder to watch for its determination and innovativeness Thus, we must prioritise the making of healthy brains to accelerate the flourishing of dignity for every African. This is a lens I wish we can use to view our efforts to create a mentally healthier profession Like nearly all our professional work, there is more in this for others than ourselves The true fruit of our labour is the abundance of mental wellness for our nation and continent First the doctor, then the society. We must see that now, as 2022 draws to a close, we are a pivot upon which the tide of history can turn Let us not be afraid to surrender ourselves to the greater purpose that has been revealed. There is no prosperity without health, and there is no health without mental health.

Remain kind to yourself and to your colleagues Consider

showing your honour to those we have lost to suicide by committing to end such losses Committing: as you are, in your own way, to account to your own conscience And when KMA makes a rallying call, answer with your whole heart

Dr. Nicholas Mutuku is a Tutorial Fellow in Human Anatomy at Kisii University, a Master of Science student at the Department of Human Anatomy and Physiology at the University of Nairobi, and the leader of the KMA-YDN Mental Health Working Group.

At the 49th Annual KMA Conference this year, physician wellbeing and mental health took centre stage and we worked towards collective acclamation that doctors indeed work under a shadow.

-Dr. Nicholas Mutuku

CLIMATE CHANGE ACTION

By Dr. Dave Arunga & Dr. Ruby Oswere

A lot is discussed about the noble initiative that is Climate Change

it presents us

The Science Of Climate Change

In the advent of extreme climate events; more common and severe droughts, hurricanes, typhoons, heat waves, wild fires are witnessed as harbingers of devastation. Comprehension of these and the rise in average global temperatures is in determinants such as Intensity of solar radiation. Composition of earths Atmosphere. Albedo ( reflectivity of earths surface). The green house gas effect where CO2 , CH4, H2O vapour trap irradiated heat from the earth surface consequently warming our planet is at the centre of this cascade of life threatening events. Has the atmosphere been changing in a way to explain increase in temperature ?? Is an inquest bringing CO2 to focus Through multiple studies with mathematical and graphical representations plotting CO2 alongside Temperature increase we learn of the direct proportionality of the two variables Definitively implicating burning of fossil fuels as an accelerant and so is destruction of natural carbon sinks.

National Climate Change Action Plan (NCCAP)

To bring the conversation closer to home where all the charity should commence Kenya has in place The National Climate Change Action Plan (NCCAP), 2018 2022, is a five year plan that helps Kenya adapt to climate change and reduce greenhouse gas emissions. Mainstreaming Climate Action into sector functions by GoK A 7 pillar guiding policy touching on:

Disaster Risk Management

Background: With the 2022 United Nations Climate Change Conference, more commonly referred to as Conference of the Parties of the UNFCCC, or COP27 taking place from the 06 18 November 2022, we highlight why this topic is important to consider even whilst undertaking your internship

Action But what is the science long before we delve into the much needed solutions and the new opportunities that

Food and Nutrition Security Water and Blue Economy

Forestry Wildlife and Tourism Health Sanitation and Human settlements

Manufacturing Energy and Transport

Nonetheless, problem solving whatever the magnitude always starts with the individual Therefore what is our inherent role as Inheritors of our Mother Planet in making her green and sustainable again

The Role Of Young Health Care Workers

As youth skilled in different professions our work is cut out for us but it all starts with a bold step forward in the right direction. Doing what you can. With what you have. Where you are. Be it planting trees and leveraging on our biodiversity as a carbon sink Advocacy of Green action . Innovation and research to pioneer ground breaking solutions. Or even inculcating a green and sustainable consumer mindset As well as being cognizant of our environment by leveraging the promise of a circular economy.

Climate Change And Health

As a young doctor in the Kenyan Space . The health of our population is our foremost concern Medicine has long been preferred preventive than curative In the same breath under the auspices of Public and Community Health. Environmental Health to be specific the modern day health practitioner has their fair share of responsibility as Climate Change create new inumerable Health risks of higher temperatures and devastating climate effects. Climate change has a direct impact on health such that rising temperates are increasing the prevalence of harmful vectors such as mosquitoes whose distribution, life cycle and feeding habits is largely dependent on weather conditions. Rising global temperatures can contribute towards the increase disease burden of tropical diseases in areas that were previously considered vector free. Hence, it is imperative for young healthcare workers to take their place in the global mandate towards combating climate change The ills that we are currently experiencing are as a result of poor decision making from previous generations. Now, we have an opportunity to make sure that future generations will benefit from the better decisions that we can start making today to address the issue to climate change.

Dr. Arunga Dave Sustainable Development Consultant and Policy Advisor

Over 250 health journals urge world leaders to deliver climate justice for Africa

Background: Over 250 health journals urge world leaders to deliver climate justice for Africa Africa has suffered disproportionately although it has done little to cause the crisis.The damage to Africa should be of supreme concern to all nations, warn editors Over 250 health journals across the world have come together to simultaneously publish an editorial urging world leaders to deliver climate justice for Africa ahead of the UN Climate Change Conference (COP27) taking place in Cairo, Egypt in November

Africa has suffered disproportionately although it has done little to cause the crisis The damage to Africa should be of supreme concern to all nations, warn editors

Over 250 health journals across the world have come together to simultaneously publish an editorial urging world leaders to deliver climate justice for Africa ahead of the UN Climate Change Conference (COP27) taking place in Cairo, Egypt in November

The editorial, which is authored by 16 editors of leading biomedical journals across Africa, including African Health Sciences, the African Journal of Primary Health Care & Family Medicine, and the East African Medical Journal, is simultaneously being published in 50 African journals and other leading international medical journals such as The BMJ, The Lancet, the New England Journal of Medicine, the National Medical Journal of India, and the Medical Journal of Australia

Never have so many journals come together to make the same call, reflecting the severity of the climate change emergency now facing the world

The authors say Africa has suffered disproportionately although it has done little to cause the crisis, and urges wealthy nations to step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change The climate crisis has had an impact on the environmental and social determinants of health across Africa, leading to devastating health effects, explain the authors.

In West and Central Africa, for example, severe flooding resulted in mortality and forced migration from loss of shelter, cultivated land, and livestock, while extreme weather damages water and food supply, increasing food insecurity and malnutrition, which causes 1 7 million deaths annually in Africa

The damage to Africa should be of supreme concern to all nations, they write, because in an interconnected world, leaving countries to the mercy of environmental shocks creates instability that has severe consequences for all nations.

They argue that achieving the $100bn a year climate finance target is now “globally critical if we are to forestall the systemic risks of leaving societies in crisis,” and say additional resources for loss and damage must now also be introduced.

They acknowledge that some progress has already been made, including early warning systems and infrastructure to defend against extremes, but point out that frontline nations are not compensated for impacts from a crisis they did not cause.

This is not only unfair, but also drives the spiral of global destabilisation, as nations pour money into responding to disasters, but can no longer afford to pay for greater resilience or to reduce the root problem through emissions reductions, they warn.

“The climate crisis is a product of global inaction, and comes at great cost not only to disproportionately impacted African countries, but to the whole world,” they write. “Africa is united with other frontline regions in urging wealthy nations to finally step up, if for no other reason than that the crises in Africa will sooner rather than later spread and engulf all corners of the globe, by which time it may be too late to effectively respond.

“If so far they have failed to be persuaded by moral arguments, then hopefully their self interest will now prevail,” they conclude

Lukoye Atwoli, Professor and Dean of Medical College East Africa and Associate Director of Brain and Mind Institute said: “It is time the global community acknowledges that the climate crisis, while disproportionately affecting the continent, is a global crisis. Action must begin now, and begin where it is hurting most, in Africa Failure to act will make the crisis everyone ’ s problem very soon. ”

Bob Mash, Editor of the African Journal of Primary Health Care and Family Medicine and President of the South African Academy of Family Physicians said: “In Africa we are already seeing the devastating effects of climate change on people’s health and the need to strengthen community oriented primary health care is now more than ever ” [Ends]

References

1. 2. 3.

COP27 Climate Change Conference: urgent action needed for Africa and the world doi: 10 1136/bmj o2459

Embargoed link to editorial: http://press.psprings.co.uk/bmj/october/climatecop27.pdf Public link once embargo lifts: https://www bmj com/content/379/bmj o2459 The editorial is being published simultaneously in 259 international journals. A full list of participating journals can be found here

What is KMA YDN WEBINAR

By Ruby Oswere

On 24th September 2022, the KMA Young Doctor’s Network (YDN) committee held an introductory webinar from 6pm to 7pm on “What is KMA YDN”. This was aimed at raising awareness about YDN and answering some of the basic questions about the mission, goals, and various working arms. The program for the session was as follows:

Opening Remarks by Dr. Amos Otara, KMA Vice President Welcoming Speakers by the moderator Dr Andrew Githira (KMA YDN Member)

Presentation about WMA JDN by Dr. Wenzhen Zuo (2021 JDN Membership Director) and Dr. Wunna Tun (2021 JDN Secretary)

Panel Discussion by Dr, Marie Clarie (Current Convener YDN), Dr. Lyndah Kemunto (Immediate past convener YDN and current Treasuer General KMA) and Dr. Elizabeth Gitau (Inaugural Convener YDN, Current KMA Assistant Secretary General).

Vote of thanks and closing remarks by Dr. Diana Marion (Current SG KMA) and Dr Simon Kigondu, KMA President

Here are some of the main highlights from the session

Definition

Young Doctors Network is a committee under the Kenya Medical Association, launched at the KMA@50 AGM in April 2018. The committee was formed to increase the participation of the younger professionals in the association while offering networking opportunities, mentorship in leadership, and professional development.

What is the mission of KMA Young Doctors Network?

To connect, develop and support Young Doctors by providing opportunities to explore and develop personal and professional growth.

What are some of the goals that YDN seeks to achieve?

Promote the health and well being of young doctors, including mental health Provide a forum for young doctors to share experiences, challenges, and solutions in the medical profession. Provide young doctors with a platform to engage in advocacy and policy making, including participating in boards

Ensure young doctors have fair and adequate representation in Kenya Medical Association.

Promote Continuous Medical Education and career progression among young doctors.

Provide an avenue for young doctors to collaborate with other like minded professionals

What is the organizational structure of YDN?

The 2022/2024 convener for YDN is Dr. Marie Claire and the interim co convener is Dr. Brenda Obondo. There are 5 working arms namely:

Projects: Dr Ted Omwenga and Dr Caleb Ngari

Mental health and wellness: Dr Ndemange Mutuku

Mentorship and Membership: Membership Joan Kyalo, Mentorship Yaaser Hamza

Communication: Dr Lynette Kiriga and Ruby Oswere

Career Development: Dr Felisters Ondari and Dr. Christine Mutonyi

Meawhile the five focus areas are as follows

Who can join YDN?

To join YDN, you need to be a registered KMA member who is either:

A doctor registered in Kenya and is under the age of 40 years. A medical student registered in Kenya and is within 5 years of completing their undergraduate studies Both criteria (1&2)

Role of KMA YDN in the Global Health Advocacy Space

The KMA YDN actively participate in the World Medical Association Junior Doctor’s Network (WMA JDN) It is through participation at WMA and JDN activities that KMA YDN was conceived in 2018.

JDN hosts two bi annual meetings in that prelude the WMA Council Meeting in April and the WMA General Assembly in October. It is worth noting that the next meeting WMA and JDN meetings are in Nairobi, Kenya in April 2023 (read more in our WMA article) YDN members are encouraged to become members of the global Junior Doctor’s Network to gain more access to various global opportunities for further career development and networking You can learn more about how to sign up for the JDN here: WMA

What are some of the benefits of being part of the YDN?

The various panelists shared their own personal experience of the benefits they have accrued as a result of being part of the JDN. Some of these include:

Opportunities for mentorship which has paved the way for more KMA leaders and national and divisional level. Currently, more young doctors are in current KMA leadership at the National Governing Council and Divisional levels, a first since the network’s inception Provides a platform to influence policy making eg looking into the current state of internship and mental health and well being of young doctors. Amazing avenues to learn more about healthcare leadership on a global scale through interaction with JDN and other international bodies. Engaging interactions with peers leading to lasting networks and connections.

If you are interested to join the YDN, be assured that this is an amazing decision that you will not regret. Simply visit https://kma co ke/membership/about membership to sign up as a member.

The full recording of the introductory webinar session is available on YouTube https://www youtube com/watch? v=qIT4XA9bgmA&t=4715s.

The Future of Healthcare Practice for Young Kenyan Healthcare Workers

By Dr. Bonnke Arunga

On 5th November 2022, the Kenya Medical Association Young Doctors Network (KMA/YDN) held a multidisciplinary twitter space as a prequel to the 11th November Pre Internship Conference.

Invited speakers at the space were:

· Dr Marie Claire Wangari The Convener for The Young Doctor Doctors Network

· D. Muthomi Njagi Associate Dentist Upper Hill Dental Center

· Dr. David Odhiambo Chairperson Pharmaceutical Society of Kenya Young pharmacists group

Ruby Oswere is a fifth year medical student at the University of Nairobi and the Assistant Secretary of the KMA YDN Steering Committee.

·

·

Donald Ngalula Chairperson KESNNUR

Cinammon Nyagaka Chairperson KEHSS

·

Gideon Gachihi Representative from Clinical Medicine

· Dr. Simon Kigondu The President of Kenya Medical Association

Background of the Twitter space

The space was organized in the wake of recent developments in the healthcare space and the spread of misinformation about doctors and medical interns in the country. It also served as a prequel for the much anticipated Pre Internship conference by KMA/YDN.

The Conversation and Key Takeaway Points

The panelists introduced the session with their general perspectives about their internship and post internship experience Dr. David Odhiambo expressed the need for professional bodies in healthcare to expedite the posting of interns after undergraduate studies.

In agreement with the sentiments of Dr. David, Dr Marie Claire also expressed the uncertainty of employment opportunities post internship Ngalula pointed out that these challenges can be solved when the systems run as they should, and the Unions and Associations should consider young professionals not merely as paid subscribers but as future investments in healthcare

All the panelists and the discussants had a consensus that every health worker should perform duties within their scope of practice and level of expertise, setting aside selfish interests, to optimize care delivery to the general population.

Conclusion

Thanks to the stellar moderation by Dr Bonnke Arunga, and Dr. Abigail Hilda, the objectives of Twitter Space were met. It was evident that Young Healthcare Workers can use avenues such as social media to constructively advocate for changes in healthcare through health promotion and advocacy

The twitter space recording can be found here: https://twitter.com/i/spaces/1ZkJzXzdgER Kv?s=20

The president of KMA expressed the need for all cadres of healthcare workers to work together in pushing for healthcare reforms and not to allow their efforts to be marred by persons who may want to pitch each cadre against the other

Bonnke Arunga is a Doctor, MB ChB, and a recent graduate from Maseno University waiting for internship placement. He is a full-time, freelance medical writer helping to dispel medical misinformation and disinformation online.

World Medical Association comes to Nairobi in April 2023!!

By Dr. Amina Guleid & Dr. Marie-Claire Wangari

The Kenya Medical Association will be hosting the World Medical Association (WMA) Council Meeting in April 2023! This event is tentatively slated for 20 22 April 2023 with the WMA Junior Doctors Network (JDN) event preluding it days earlier

As KMA Nairobi Division, we want to demystify what WMA and WMA JDN are, and the importance of this global event in shaping not only global health policy but also our division.

So, what is WMA and WMA JDN?

The World Medical Association (WMA) is an international organization representing physicians.

The World Medical Association Junior Doctors Network (WMA JDN) is an international platform for junior doctors to facilitate an open dialogue of global events and activities that are relevant to junior doctors

History of WMA

The WMA was founded on 17 September 1947, when physicians from 27 different countries met at the First General Assembly of the WMA in Paris.

The organization was created to ensure the independence of physicians and to work for the highest possible standards of ethical behaviour and care by physicians, at all times.WMA provides a forum for its member associations to communicate freely, to co operate actively, to achieve consensus on high standards of medical ethics and professional competence, and to promote the professional freedom of physicians worldwide This unique partnership facilitates high calibre, humane care to patients in a healthy environment, enhancing the quality of life for all people in the world. More information on WMA is availablehere: https://www wma net/who we are/about us/

History of WMA JDN

The Junior Doctors Network (JDN) serves as an international platform for junior doctors to facilitate an open dialogue about global events and activities that are relevant to their postgraduate training and the World Medical Association (WMA) It was approved by the WMA at the 61st WMA General Assembly (October 2010) in Vancouver, Canada. More information on WMA JDN is available here: https://www.wma.net/junior doctors/about us/

How Does WMA & WMA JDN tie into KMA?

WMA is an independent confederation of free professional associations. Funding is from the annual contributions of its members, which has now grown to 115 National Medical Associations The Kenya Medical Association is one of the National Medical Associations that subscribe to the WMA. It is through maintaining their subscription that in October 2019 KMA successfully won the bid to host the April 2023 WMA Council Meeting (hence the article you are reading ��)

At a Young Doctors Level, through our KMA Young Doctors Network, interested doctors can subscribe to be members of the WMA Junior Doctors Network (JDN) which hosts a series of activities online and in person.

With regards to subscription, WMA and WMA JDN operate similarly to KMA membership i.e., it is done at an individual level. However, you must subscribe to each entity individually i e , WMA and WMA JDN

From KMA Nairobi Division, we will be working in conjunction with the KMA National Office, to support the efforts

towards the successful actualization of this landmark event in Kenya More information on KMA can be found here: http://kma co ke/contact us/who we are while further information on KMA YDN can be found here: http://kma.co.ke/contact us/committes and divisions/kma ydn

KMA’s experience in WMA & WMA JDN The Kenya Medical Association is an active member of the World Medical Association. Kenyan Physicians subscribed to the WMA are always open to giving their input in key WMA affairs, especially the policies of the association. In addition, several past and present KMA National Executive Council Members (NEC) and YDN members have served in the various WMA and WMA JDN Committees as follows: 1.

Former WMA Committee Members: Dr Jacqueline Kitulu: Immediate Past KMA President. Previously served on the Communication & Advocacy Panel Prof. Lukoye Atwoli: Former KMA Vice President Previously served on the Ethics Committee Dr Supa Tunje: Former KMA Treasurer General. Previously served on the Finance Committee

2.

WMA JDN

Dr. Marie Claire Wangari: KMA YDN Convener Current JDN Secretary Dr. Mercy Wanjala: KMA Embu Honorary Chair Current Lead, WHO Activities Working Group Dr Lyndah Kemunto: KMA Treasurer General. Former JDN Communications & Membership Director

Dr. Mellany Murgor: KMA Committee Convener Previously WMA JDN Newsletter Publications Team member

At an undergraduate student level, medical students who are current subscribers to the Medical Students’ Associations of Kenya (MSAKE) and the International Federation of Medical Students Associations (IFMSA) are eligible to apply for the WMA internship opportunity offered by the IFMSA In 2019, Ms. Nyambura Muroki from the University of Nairobi was selected for this prestigious internship (reference)

What are the Benefits of joining WMA & WMA JDN?

Benefits Of Being a WMA Member: 1 2. 3. 4 5.

Recognition and acceptance as a member of an international organization such as the WMA lend tremendous credibility to the National Medical Association (NMA). This is particularly true when there is more than one professional association representing physicians in a country The WMA is in official relations with United Nations agencies such as the World Health Organization, which gives NMAs and Associate Members access to these world bodies

By participating in the debate with colleagues from all over the world, NMAs and Associate Members have the opportunity to provide the world with valuable ethical guidance and leadership in health care. Information and knowledge can be sourced from the WMA, which can contribute to the optimal efficacy of NMAs and individual physicians. NMAs and Associate Members can make use of the WMA’s products and services.

JDN Membership & its Benefits:

Junior doctors are physicians, within 10 years after their medical graduation, who are completing postgraduate training in clinical, medical education, policy, public health, or research specialities. They may become Associate Members of the WMA and serve as members of their respective National Medical Associations The JDN provides the natural progression and development of the existing relationship between the IFMSA and the WMA. JDN‘s mission is to empower young physicians to work together towards a healthier world through advocacy, education, and international collaboration.

How can you be part of the WMA Council Meeting in Nairobi in April 2023?

KMA and MSAKE members who have their subscriptions up to date will be eligible to attend the WMA council meeting in Nairobi 2023 at a relatively fairer price than non members Registration details shall be shared on the WMA and KMA websites and channels, so be on the lookout.

At a national and divisional level, as we approach the event, more opportunities may pop up regarding the organization of the event which shall be announced via the KMA Channels

Dr. Amina Guleid is the Secretary for KMA Nairobi Division

Pharmaceutical Society of Kenya (PSK) is the professional association that was established to enable Pharmacists’ to employ their professional expertise in the care of patients by fostering professional development and promoting members’ welfare.

Young Pharmacists Group (YPG) is an ad-hoc committee of the Pharmaceutical Society of Kenya (PSK) National Executive Council (NEC) mandated to offer leadership and guidance in addressing concerns affecting young pharmacists in furtherance of the mandate of the association.

The roles and responsibilities of the YPG will be structured into four key pillars i.e.

-Advocacy and Visibility

-Policy Engagement

-Coalition Building and Partnership Development -Learning, Networking and Mentorship

To learn more or engage in PSK YPG activities reach out to them on youngpharmacistske@gmail.com

The Kenya Healthcare Students Summit (KEHSS) is an umbrella body that brings together healthcare students from all over Kenya. KEHSS aims at building capacity of Kenyan and by extension, African healthcare Students on matters pertaining to Universal Health Coverage as well as equip them with the necessary soft skills that they will need in their future profession as Healthcare Practitioners. KEHSS is one of the leading associations in the country that represents all health sciences students in the country through their respective faculties. We are also one of the official mouthpieces for most Healthcare Students organs on the African and World stage. We aim to not only provide an avenue for students to interact with key policy and decision makers but to also engage them on issues that the normal classroom environment may not touch on in the course of their training.

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