Tell us about yourself
I am a medical doctor, a pathologist to be exact. Founding CEO of an internationally accredited multinational laboratory, while trying to be a healthy middle-aged man, a good father and a loving husband. I was born in Pumwani Maternity Hospital, raised in Kibra where I grew up. Kibra still remains my home.
From early childhood, my mum and grandmother always motivated me to set my goals higher than what I could achieve. I guess that is what made me thrive in Kibra.
Your education background?
I attended Joseph Kangethe Nursery School in Woodley then Shadrack Kimalel Primary School in Kibra, after which I joined Jamhuri High School where I was the first student to get an A in 8-4-4. It is actually a very good school by all standards and one of the best places I’ve been in my life. I did my undergraduate medical education in the University of Nairobi during which time I was also a tutor in human anatomy at University of Nairobi's Chiromo campus. I qualified as a medical doctor in 2001.
How is your professional and career journey so far?
On becoming a doctor I served internship at the Coast General Provincial Hospital in Mombasa, then returned back to the University of Nairobi for my postgraduate in Pathology after which I worked as a Provincial Government Pathologist in Garissa, later proceeded to South Africa for a Fellowship sub-specialty training in pathology at the University of the Witwatersand.
What made you go into pathology?
Strangely enough, my career aspiration was to become a surgeon especially when I joined medical school and tutored in human anatomy. I however, got interested in pathology while doing some part-time assignments for the former chief government pathologist Dr Kirasi Olumbe. While in my pre-final year at medical school, I got a scholarship to do elective (placement undertaken as part of a medical degree) in KwaZulu Natal where I got exposed to a different world of pathology.
How did that happen?
I had an epiphany moment in South Africa during my elective when I literally saw the light down the microscope. Basically, one day, while visiting a friend Prof Mohamed Dada, a professor of pathology at the King Edwards Hospital, during a lunch break, I found him discussing a particular case with some students and fellow colleagues in the pathology department. It was about a patient I knew of in the ward whose diagnosis was a mystery yet here they were, pathologists, unravelling it. I was asked to peep to see what was going on and was told it is a Merkel cell tumor – a rare form of cancer which can only be diagnosed through pathological examination. I realised at that very moment that pathology is what I wanted to do. As the cliché goes, “I saw the light down the microscope" and turned away from the blinding lights of surgical theatre.
What is pathology and why is it important?
Pathology is a branch of medical science and a speciality in medicine that is concerned with the understanding of diseases and the scientific diagnosis of disease. So it encompasses laboratory investigation of samples to determine whether there is disease and the type of disease, as well as forensic pathology that relates to application of the knowledge to legal cases. I did a general human pathology in University of Nairobi, then further specialised in anatomical pathology, which deals with processing, examination and diagnosis of tissue specimens in the lab for microscopic diagnosis of disease like cancer and infections.
The slogan for the Royal College of Pathologists in the United Kingdom states that "Pathology is the science behind the cure". That sums it all up. Pathology enables the medical community to establish diagnosis and provides the basis for evidence-based treatment. Pathologists are also called “the doctors’ doctor” because we help the other doctors make conclusive diagnosis through the report we generate from our laboratories.
You also conduct postmoterms. How does that affect you?
I must clarify that post-mortems and forensic pathology are a just tiny fraction of pathology as a whole. For pathologists like me who are mainly in clinical work, the interaction with post-mortems comprise less than one per cent of our engagement. So pathology is not all about dead bodies, but the dead are one of the specimen types we deal with. We do come across all scary stuff though from cancers to deadly infections that only be determined scientifically, just like determining cause of death from post-mortems. For the pathologists who enjoy their career, it is a calling and the gory details fade away. We dissect bodies and study them, we cut specimens, we never get to even think about them.
What is of your vision for Pathologist Lancet Kenya?
When I was in South Africa on my fellowship training, I was very impressed by the advanced level of pathology service in public hospitals there. I wanted to set-up something similar here at home. I started to make some inquiries on what is needed to start an advanced lab. I approached the Ministry of Health but resources were constrained. I got also the red tape because I was completing my training. Somewhat word got to the chairman of Lancet Laboratories in South Africa, Dr Gangaram Hariparsad. He heard of this guy who wanted to set-up a lab in Kenya but had no funds from his employer in government. He approached me discuss partnership with them in setting up a lab in Kenya. By then, they had already ventured into Zambia and Ghana, so my vision to set-up a lab fitted in perfectly with their vision for expansion into East Africa. They put in the resources and I ran with it. I must say, it was a bit challenging because I had no experience outside the public and academic sectors. I was very enthusiastic and passionate about doing something new. We would work up to 22 hours a day. It has been an amazingly thrilling journey. We have now grown to be a brand that is part of the health ecosystem in four East African countries. We have the largest independent laboratory network and biggest laboratory infrastructure in the region. Our headquarters in Nairobi has a collective 30,000 sq meters of space in Upper Hill and Mombasa Road for the service and administrative units respectively.
How do you rate the pathology sector in Kenya, in both the public and private sector?
Unfortunately, pathology as a discipline does not get the share of resources and attention that it deserves. This is true from policy levels to the general public who would be more captivated by specialities like public health, cardiology and oncology but forget that pathology exists – simply because pathology is condemned behind the scenes in basements, mortuaries and hind sections of the hospitals. Even in the private medical facilities, pathology is often hidden from view. To make matters worse, pathologists are in short supply worldwide because many medical students and young doctors shy away from pathology because it is a difficult subject and seen to be unglamorous. Many associate it with the dead. That is a worldwide problem but more acute in Kenya. But we have made great strides. I’m grateful to be part of the drive to change the face of pathology and perception towards pathologists. We have more than 70 pathologists in the country now. Some countries in Africa have hardly two.
There is concern that pathology services in Kenya are too expensive for most people
The notion that pathology is expensive is a myth. People tend to think tests for cancer are expensive. For instance, a patient in a public hospital like Kenyatta National Hospital or Mbagathi County Hospital may be suspected to have, say an ovarian cancer or ovarian TB infection, thus confirmation of diagnosis is required but misconception abounds that doing all the laboratory tests would be expensive thus patient’s diagnosis drags on and on, meanwhile she isn’t on the right treatment. This patient is paying Sh1,000 or Sh2,000 per day in the ward waiting for diagnosis. The relatives are coming to visit him/her everyday spending money. She is away from home and her work/livelihood. By the time the right tests are done and the right diagnosis is made, the patient has wasted loads of time and money. If the right tests were done at the right time all the wastage would be averted, health outcome improved. Testing correctly is cost effective and patients if informed accordingly, would raise the funds to get properly diagnosed and treated.
Many Kenyans dying of cancer everyday. With such medical advancements, why are we not able to arrest that?
According to official records, at least 76 Kenyans die of cancer everyday. This may be an underestimation. Many cancer patients die without knowing their status. Cancer is on the increase for real but also better awareness is making more patients to seek tests for cancer. Diagnosis is often being made far too late. Adequate treatment for the disease is also lacking. Patients lose a lot of time before they get help.
However, despite all the challenges, we have made great strides as a nation. Unfortunately, we are at a stage where more people are dying of cancer than those who get timely and quality treatment. We must realise, even in the best of centres in the best of economies, there are still lot of cancers which nothing can be done about. But as pathologists, ours is to make accurate diagnosis and help the health system handle cancers better. We are slowly winning the war against this disease. Six years ago patients with breast cancer were not being tested for tumour receptors, no hospital or laboratory was doing the test routinely.
But, as human beings, we must remember, at some stage of our lives, we have to die of something and as doctors, it is about helping alleviate the suffering from things that can kill miserably like cancer.
Recently, the Kenya Accreditation Agency (KENAS), the official government accreditation agency, raised concern of incorrect results being produced by some medical laboratories. How can this problem be addressed?
KENAS is doing a great job, given the few years it has been in existence. The Kenya Medical Laboratory Technology and Technologies Board has come a long way to inject discipline and professionalism in the sector. For a long time, our labs were unregulated, no standards, no proper infrastructure, practitioner untrained. This has an obvious impact on the quality of services offered. When Kenas did their survey, they found horrific stories of people giving fake, cooked results. Microscopes in some labs were seen not working.
On the other hand, one may have all the machines, the latest technology can offer but the external assurance, quality control and pathology review may be lacking affecting quality of results. Kenas provides a mark of quality, calling on lab centers to voluntarily come forward for accreditation. Our main lab got accredited within its first year of inception by the South African National Accreditation System (SANAS). We also have several labs accredited by Kenas. Kenya has less than 20 accredited labs. It may as well be a tall order that all labs across the country be accredited, but at least, we must a minimum standards.
Labs must have qualified staff, right equipment before registration. Unfortunately, both KMLTTB and Kenas have limited capacity to police the lab sector in the whole country. Public awareness and demand for accountability will give this country the impetus towards better quality in public and private labs.
What are the main challenges, therefore, in providing routine and advanced medical lab services in the country?
The cost of operations to provide quality services. Equipment are expensive and maintenance not easy. For reagents, for instance, we pay in dollars, costing us a lot given the fluctuating exchange rates. We have to pay taxes and VATs as well. Prices are irrational, too. Lack of appreciation of quality is another challenge. People go to a hospital and believe what any doctor say. No one questions these results.
How do you at Lancet, keep track of the world's ever changing technological advances in pathology?
All the equipment we use are Food and Drugs Administration (FDA)-approved and Conformité Européen- certified. We only buy from reputable manufacturers and evaluation done. We have very robust system for information technology and service delivery that gives us the edge. A doctor, client or patient at our facilities can for example, access results through a secure MobileApp, the first in East Africa. We have a new customer service centre in our headquarters that is bigger than most labs, fully equipped with latest clients relations management systems and exclusively dedicated to operational efficiency for the customer. We have a warehouse dedicated to our supply chain management and an internal courier system with GPS tracking for better coordination of service. Soon we are launching night services in Nairobi for specimen collection.
As a doctor, what are the steps can be taken to improve health-care to Kenyans overall?
It is a tale of two cities. We have the best of the best. We also have the worst of the worst. But much remains to done. If you outside Nairobi, things are bleak. Some areas are completely forsaken. There are no incentives for medical entrepreneurs to enable them invest in health. There are no investments in health, which cause wide disparity and lack of accessibility to health facilities.
Many Kenyans seek treatment outside the country mainly in India. Comment.
People overrate India and South Africa. In these countries, they have areas which are worse than you will ever have here at home. Besides, there are many people of different nationalities that seek treatment in Kenya. They are in-bound medical tourists. Yet, we see Kenyans going to seek treatment outside for things that are available here. Lack of information is an issue. As far as competence of doctors and modern equipment are concerned, we are not very behind. We however need to encourage more investors in the medical world.
Recently, some hospitals are accused for referring patients to Indian hospitals while charging commissions while the same services patients are referred for may be available in the country. As a medic, aren't you concerned?
We also receive emails from Indian hospitals, asking us to refer patients for 15 per cent to 20 per cent commission.This is unfortunate and unacceptable. It unnecessarily increases costs for patients. It destroys local development. In India, they have huge volume and as such cost bases are lower. The key thing is to provide full information that will help patients make the best choices. Referrals should only be done in the best interest of patients. Doctors should strive to be entrepreneurial and earn from their services rather than from commissions.