Alarm as local doctors snub cancer training

By Gatonye Gathura

Medical experts are concerned over the few Kenya doctors applying for specialist cancer training being offered in Nairobi.

Currently enrolling the second lot, the fully paid for two-year course was launched in 2016, as a first step to address the massive shortage of cancer specialists in Africa.

However Programme Director Prof Nicholas Achola Abinya of the University of Nairobi (UoN) says uptake especially by Kenyans and East Africans in general has so far been disappointing.

Prof Abinya says while the programme has the capacity to take up to 22 trainees for the two-year period, only five were enrolled for the pioneering group which graduates next month.

The first batch of five trainees is completing the two-year-course in September with the next batch supposed to be applying.

“But too few, especially from Kenya and East Africa are applying for the course,” said Prof Abinya in an interview last week

The programme he explained is open to doctors with post graduate degree in internal medicine from all over Africa. These are basically practicing doctors at the moment.

However the number of applicants from Kenya and East Africa generally has been disappointing.

For example, in the outgoing group more than 100 applications had been received from Nigeria alone but only about 10 from Kenya.

“We finally picked on five, with only two from Kenya,” said Prof Abinya who in 2015 surprised Kenyans in a study which showed wearing of bra could lead to development of breast cancer.

“This is the best time for doctors in the region to take up specialization in cancer care,” said Dr Nazik Kamad of Queens University, Canada and one of the external lecturers to the programme. Others are from South Africa, Egypt and Europe.

One of the reasons for the slow pick up among Kenyans, Prof Abinya hazards is reluctance by county governments to release their scarce medical personnel for training.

While in training, it is a requirement that doctors, who are employees of the county governments, continue receiving their salaries and other benefits.

The trainees should also be assured of re-absorption into the system once they are through with the training with guarantees of all earned promotions.

However, counties have been reluctant to release doctors for the training especially because of already existing shortages.

“Also because most counties lack specialist cancer facilities they may not see the training as a priority,” said Dr Kamad in an interview at Kenyatta National Hospital.

There have also been proposals for all medical specialists to be put in a national pool from where the expertise would be sourced as required.

In such an eventuality the county governments argue then it would be the responsibility of the national government to pick the full training bill including payment of salaries.

The Secretary General of the Kenya Medical Practitioners and Dentists Union Secretary General Ouma Oluga, say in some instances county governments have refused to pay salaries for doctors who go for specialist training or give them release letters.

“When you want to go for further studies, you are required to get a release letter from your employer and salary while on study. This has not been happening. They either refuse to give you the release letter or they stop paying your salary,” says Dr Oluga.

The other problem comes from the national government which also runs a competing specialist training scholarship programme which prefers to train abroad.

Prof Abinya explains that many potential trainees may prefer training abroad for the prestige involved.

The current training, Prof Abinya who was involved in drawing up the National Cancer Management Guidelines in 2013, says is being collaborated with several local and international institutions.

The training based at the University of Nairobi is conducted at Kenyatta National Hospital, Nairobi Hospital, Plaza Imaging and at Lancet Kenya Laboratories through a Private Public Partinership.

While Kenyatta hospital gives the trainees access to a wide range of cancer patients, Prof Abinya says the other institutions have top quality equipment and technologies.

“We have some of the best cancer diagnostic and pathology equipment found anywhere in the world,” says Dr Ahmed Kalebi of Lancet Laboratories Nairobi, an affiliate of the South African Lancet group of Laboratories.

The initiative is an offshoot of the first National Cancer Management Guidelines launched in 2013 by the then Cabinet Secretary for Health James Macharia.

Among promises made by the document was the establishment of four comprehensive cancer centers at the Coast, Nyanza, Nyeri and Eldoret.

“But this may not be realized as yet due to the lack of qualified personnel to run the proposed facilities,” said Macharia

The proposed establishments, the document had tabulated would require 125 cancer specialists broken down as follows: 15 radiation oncologists, 25 medical oncologists, 10 radiation therapy technologists, 50 oncology nurses, 10 medical physicists, eight nuclear medicine physicians, and 12 nuclear medicine technologists.

“The long-term goal will be to establish the training programmes locally,” Macharia had said and hence the current initiative.

Ideally, the university, Prof Abinya says would like to train many more than the five they are doing today. “But this is a significant step.”

Despite the slow uptake, Prof Abinya says the country will in less than a decade have significant cancer specialists to watch over Kenyans.

Last month the Cabinet Secretary for Health Sicily Kariuki said the government is seeking to have basic cancer treatment capability in the 47 counties under the National Cancer Control Strategy 2017 – 2022.

“Our eventual target as government is to have capability in this country and that we not only become the provider for ourselves, but a regional hub,” she said.

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