Some months ago, my brother and sister in law who live in Dar es Saalam came to visit. Because of traffic and other delays they arrived few minutes after midnight. As they approached the door to my apartment they came across a young man who was fitting.
When I opened the door, the look on her face told it all, ‘we can’t just leave him there. After all, you are a doctor and your wife is a nurse’, she said. My wife and I stepped out to have a look at the young man. The main priority was to keep his neck well positioned so that he could breathe and to keep him warm since it was quite cold in Nairobi. This we did, while my in-laws tried to get in touch with an ambulance.
I realized then that I did not have any list of public emergency medical service providers and my in-laws went to the internet to try and get a list of service providers in Nairobi. There was no public ambulance service that was functioning. So we quickly turned to private service providers. We called three different providers and all of them asked for a payment first.
After one hour of trying, I decided it was time to call the MSF Ambulance. I called the medical team leader to get a green light because the location where I lived was way out of the catchment area served by the MSF programme. And yet there I was with a helpless young man fitting incessantly because of a drug overdose.
I remember expressing my vision for emergency services in Nairobi and Kenya in general during the first joint steering committee meeting I attended on the Mathare Emergency Programme. I envision that if anyone collapsed with a heart attack, they would get to a well-equipped emergency room in less than 15 minutes and get proper diagnosis and definitive care within the hour. I still hope to see the day when this happens.
My friend once attended a funeral of a middle aged man who was woken up by a sharp pain in his chest. His wife could not drive so he decided it was going to be quicker to drive to hospital himself than to wait for a taxi or an ambulance. They jumped into their family car and he drove himself to one of the leading private hospitals in Nairobi. Luckily, it was late at night and there was no traffic.
He got there still in pain and within the hour his wife had to watch while the ER team tried relentlessly to resuscitate him. He had finally collapsed while in the casualty. Such a classical history of a heart attack in progress and yet the intervention still fell short.
In the past two weeks, the Kenyan nation has been following closely the story of a man who was mortally wounded in a road traffic accident and required immediate intensive care but who was turned away by a private hospital and the national referral hospital; In the first instance, because the private hospital needed a cash deposit of Kenya shillings 200,000 (an equivalent of about 2,000 USD); and in the second instance, because the national hospital did not have an ICU bed available. Eventually, the poor man was admitted at the national hospital 18 hours later and died in the days that followed.
This incident reminded me of an experience I had with one of the leading private hospital in the year 2001. We had travelled from Eldoret to bring my mother who had been referred for care. We travelled by road and arrived at the hospital only to be denied admission until my father’s employer had paid a deposit to the hospital. Because of bureaucratic processes, processing the payment took another three hours.
During those three hours, my mother convulsed several times as the nurse in the ambulance watched helplessly. She had no drugs to control the convulsions. The accident and emergency nurses watched from a distance and did nothing. As soon as they received a green light from their finance department that the deposit had been paid, they came running! I was left in a state beyond dismay.
The incident on the night my sister-in-law arrived and the incident of the man that was widely publicised in the Kenyan media highlight what the MSF emergency medical teams working in Mathare go through on a recurring basis. There are many patients who have experienced a significant delay in accessing care. Some of these have lost their lives because of the gaps in the system.
Part two of the Kenyan Constitution spells out the rights and fundamental freedoms for Kenyans. The first under the section on economic and social rights reads; ‘Every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care’.
The state of healthcare in the country falls short of fulfilling this right to the common citizen. Top government officials, business executives and private sector operatives are all covered by private health insurance companies with generous packs of health benefits. They can be flown out of the country on short notice. It is unlikely that they will fit in an ambulance for hours while nurses watch and wait for a payment; it is unlikely that they will be turned away because there was no ICU bed or a deposit was required.
As a Kenyan Nation, we have to re-evaluate the value we attach to human life. We have to rethink our private health sector including our model of health insurance that covers less than 10% of the population. The government has to commit to investing in emergency medical services if we are going to make an impact on acute mortalities. We have to re-think the quality of health services in public hospitals if access to the ‘highest attainable’ standard of health is going to be a reality.
For our own sakes and the sakes of our children, let us speak up about this and make demands because the dead who have been failed by the system cannot claim their right to emergency medical care.