"Doctors do their best, but there are many challenges"

Dr Alfred Murage is a Consultant Gynaecologist. He chairs the Royal College of Obstetricians and Gynaecologists’ (RCOG) educational and clinical programmes in Kenya, and is the interim secretary of the Kenya Fertility Society.He is heading initiatives regulations for fertility treatment and a fertility register in Kenya.He has been an Assistant Professor, Department of Obstetrics & Gynaecology at the Aga Khan University Hospital.

Q. How long should a gynaecologist take with a patient who has no complications? There are way too many patients seeking services from too few doctors.

Dr Murage: About 10 – 15 minutes. Complex cases can last much longer .
Gynaecologists are unevenly distributed, most are in urban areas and major cities.The rural folk get a raw deal, they don’t have ready access to specialists. Devolution may somehow help address this skewed care, but more is needed to encourage specialists to set up shop in rural areas.

Q. What hinders gynaecologists from giving their patients the best possible care?

I think every gynaecologist tries their best to give the optimal care.There are many obstacles though, ranging from optimal staffing in big gynaecology units, to supplies of essential drugs and equipment.This is more so in poorly resourced public facilities. Private facilities, like ours, tend to clearly define their limits.

Q. What steps can the government do to improve specialised services such as maternal health?

First, improve investment in staffing in terms of adequate numbers, skilled staff and retention.The government also needs to ensure ready availability of all commodities needed to do our jobs satisfactorily – this includes medication and equipment.It is also important to improve and maintain infrastructure in health facilities

Q. How’s your typical working day?

That is a tricky question. A typical day varies with clinical activities booked.I’m an early riser, allowing me to drop my daughters at school before heading to the office, aiming to be there by 7.30 am. The day before, I’d have previewed the next day’s bookings so nothing comes as a surprise.My specialty (fertility) involves lots of consultations, ultrasound scans, fertility-related procedures and day-care surgical procedures.
I priorities surgical procedures early in the morning if we have any booked.I allow mini-breaks in between for coffee and a chat with the rest of the team.I don’t have a set lunch break, though I usually get out for a walk round the block to clear my head or eat a fruit. Our bookings go up to 5 pm, but occasionally, we work longer.I’ll head straight home most days of the week. But I allow some indulgence every now and again to meet friends and colleagues in the evening.
Once home, it’s dinner, catching up with the family, quick update on what’s happening in the world, then bed no later than midnight.I tend not to take any work home, and I am very selective in using my phone whilst at home in the evenings.Once in a while, I get late night emergency phone calls from patients - every gynaecologist does, though it depends on what individual gynaecologists do.When emergencies arise, patients should make a self-judgment and head to nearest A&E centres, which have the capacity to deal with emergency conditions.The particular doctor can then get alerted as the patient is getting stabilised.

Q. On average, how many patients do you see in a day?

This varies day to day. We have an online clinic booking system that allows self-booking every half hour from 9am. A full consultation day will have about 15 patients, aiming to give each couple ample time. Some days will have less, other days will have more.