Anger over young medics taking their own lives

A sombre mood engulfed a village in Kenya’s Rift Valley last week as dozens of medical interns joined other mourners at the burial of their colleague who had taken his own life.

Speaker after speaker lamented the loss of Francis Njuki, a 29-year-old trainee pharmacist, whose family told the BBC about his feelings of exhaustion and frustration over the non-payment of his salary by the government since he started working as an intern in August.

He is the fifth medic to kill themselves in Kenya in the last two months because of “work-stress hardships and lack of responsive insurance cover”, according to Dr Davji Atellah, the secretary of the Kenya Medical Practitioners and Dentists Union (KMPDU) – adding it was not something the union had ever recorded before.

There had also been five attempted suicides by KMPDU members this year, the medical body said.

No figures are yet available on the number of suicides nationwide in Kenya this year.

Njuki was doing his internship at a public hospital in Thika town near the capital, Nairobi, when he took his life last month.

He had reported hallucinations and depression due to sleep deprivation, his uncle Tirus Njuki told BBC.

“In his suicide note he mentioned that the four-month salary delay was among issues that aggravated his mental illness, pushing him to end his life,” the uncle added.

The first-born in his family, the intern had been battling depression and had been receiving treatment, according to a police report.

Njuki was among hundreds of interns who were posted to health facilities in August to do their mandatory one-year training to qualify.

But the interns say they had not received their salaries for the first four months, with the government citing financial constraints.

This is despite the fact that interns are a crucial part of the workforce in public hospitals – used by many Kenyans who cannot afford private medical insurance.

Trainees make up about 30% of doctors in the state health sector.

They do most of the work in public hospitals, but under close supervision. They are on call, sometimes for 36 hours, and provide most of the health services that patients need.

“Like many of his colleagues, Dr Njuki faced insurmountable challenges in meeting basic needs such as rent and utility bills,” KMPDU said in a statement.

The government has been in a long-running dispute with unions over the pay and working conditions of interns.

The government has proposed cutting the monthly salary of interns to $540 (£430).

The union wants it to remain at $1,600 as had been agreed with the government in 2017.

But President William Ruto has said that the government cannot afford to pay such an amount, and “we must live within our means”.

“We cannot continue to spend money we don’t have,” Ruto said in early April.

Following mounting pressure and strike threats, the government last month released $7.4m to pay more than 1,200 interns who had not received their salaries since August.

Some of the interns say they are being paid “peanuts”.

“After spending six to seven years of study, we had to wait for several months to get internship. And then with all the long working hours, the government decided to pay us peanuts. We are really suffering,” Dr Abdi Adow, an intern at Mbagathi hospital in Nairobi, told the BBC.

Dr Adow is among hundreds of young medics who are torn between leaving the country to seek jobs overseas or abandoning their profession for better-paid careers.

Another intern, who spoke to the BBC on condition of anonymity for fear of reprisals, said: “I have sworn to save life, at the very least, and restore health, at the very best, but the government is doing everything to kill my zeal and undermine my oath of service.”

Experts point to the death last month of Dr Timothy Riungu as an example of how stressful working conditions are for medics.

He was a paediatrician at Kenyatta National Hospital in Nairobi, who collapsed and died at home after a round-the-clock shift; he had repeatedly complained of exhaustion to his supervisor that day, local media reported.

The 35-year-old was diabetic and had not taken leave for the two years, according to his family.

A post-mortem revealed Dr Riungu had died of hypoglycaemia, caused by the blood sugar level dropping below normal. It also showed he had not eaten anything for more than 48 hours prior to his death.

In May, Kenya’s government reached a deal with one medical union to end a 56-day strike, but the key issue of the salaries of interns remained unresolved.

The strike had halted operations in public hospitals, with dozens of patients reportedly losing their lives.

Several rounds of talks have collapsed over the pay and working conditions of interns.

Last week, the KMPDU ordered all intern doctors to stay home as it issued a fresh 21-day nationwide strike notice, accusing the government of reneging on the agreement reached in May.

In September, a 27-year-old medical intern at the Gatundu Level 5 Hospital in central Kiambu county took her own life.

Dr Desree Moraa Obwogi had just finished a gruelling 36-hour shift that had taken a toll on her mental-health status, according to her workmates.

They said she too struggled to pay her rent and utility bills.

Dr Muinde Nthusi, the chair of KMPDU’s Internship Liaison Committee, blamed financial hardships and a “toxic” work environment for her death.

During the burial, Obwogi’s family asked the government to take responsibility and account for the life lost, local media reported.

The other recent suicide cases noted by the KMPDU include Vincent Bosire Nyambunde, an intern at Kisii Teaching and Referral Hospital; Collins Kiprop Kosgei, a fifth-year medical student at the University of Nairobi and Keith Makori, a 30-year-old medic in central Kiambu county.

Young doctors have been mobilising on X under the hashtag #PayMedicalInterns to push for better pay and working conditions. They marched to the offices of the Ministry of Health last week to vent their frustrations.

“Our doctors and nurses shoulder the weight of a broken system, yet their cries are drowned by the greed of those in power,” Dr Kipkoech Cheruiyot posted on X platform.

Health officials did not respond to a BBC request for comment.

But reacting to the increasing suicide cases in September, Health Minister Deborah Barasa said it was “a stark reminder of the silent struggles that many, including those in the healthcare profession, often endure”.

The minister announced plans to introduce “robust workplace mental wellness” programmes for healthcare workers nationwide to “ensure that support systems are strengthened and that those facing challenges don’t feel alone”.

Medical experts said many young doctors also experience “moral injury”, or psychological trauma as they feel guilty for not doing enough to treat patients, even though they tried their best under difficult conditions.

“The thought that you could have done something to save a patient’s life but you couldn’t, can lead to feelings of guilt, shame, and helplessness, contributing to mental health issues,” Dr Chibanzi Mwachonda, a psychiatrist, told Kenya’s Standard newspaper.

Trainee doctors told the BBC that most medical schools do not adequately address the topic of suicide, leaving new and fatigued physicians poorly equipped to deal with traumatic ordeals – and this is compounded by poor pay.

“A healthy doctor builds a healthy nation. When I am stressed or depressed as a doctor, I might even forget how to perform resuscitation on a patient, which could lead to loss of life,” said one intern doctor.

“A demotivated doctor is a dangerous person to serve you. It’s becoming a thankless job.”

About 1,400 Kenyans die by suicide each year, according to the Kenya National Bureau of Statistics. But some analysts believe that the actual numbers might be higher.

Suicide remains criminalised in Kenya, where those found guilty of attempted suicide can face up to two years imprisonment, a fine, or both.

This law has been widely criticised, with some rights groups calling for its repeal, arguing that it further stigmatises mental-health issues and prevents people from seeking help.

“How many doctors are we going to bury for the government to act?” asked Dr Adow.

If you’re affected by any of the issues in this article you can find details of organisations who can help via the BBC Action Line.

In the UK you can call for free, at any time, to hear recorded information on 0800 066 066. Elsewhere in the world, you can get help here.