Saturday 23 March 2013

I KILLED A PATIENT AND SMILED.


Today was just one of those days. And this is not fiction. I ‘killed’ a patient and smiled. ‘Smiled at it’ or ‘smiled about it’ I am not  so sure. I smiled.

You see, as it usually is supposed to happen in this part of the world, I had to weigh between two competing emergencies. I had to make the choice of who lives and so the other dies. Dies like a dry leaf in the firm grip of man. Into ashes and blown away by the wind.  To nowhere in particular.


My country allocates less than 6% of its total budget to healthcare. As a result, most hospitals do lack the equipment meant to save lives.  Doctors and nurses remain largely unmotivated.  A larger budgetary portion is allocated for road construction and an even larger chunk towards paying of our leaders salaries (entertainment allowances and other important similar allowances)

Would you mind knowing that while our leaders would never sit down to discuss increment in allocation of funds to the Healthcare sector, they frequently do emergency late night meetings to increase their pay. Cool?. That’s why we think they are the most hardworking people on the planet. Imagine meeting upto as late as midnight. They deserve it. And even if they don’t, my fellow countrymen approve of it. They call it sovereignty. With a quick rejoinder you will hear, not murmurs but yells of  twitterati #someonetellthewest … followed by you-know –what.  We are cool though. It’s called the price of democracy.

Back to my office, I look at my tray. The emergency drugs have expired , at least we do have those expired ones. Other categories are out of stock. What do you mean you are surprised? When you do come with your relative requiring emergency management like acute asthmatic attack, come with your own drugs. Better still we will send you to buy them 21 kilometers away. That makes us very religious people.  Deity takes charge as you take the 21 kilometer run to save the life of your beloved. Some make it. Some don’t. Darwinian natural selection. I bet it’s a very natural way of ridding the world of asthmatics.

My leaders are also awesome. All of them. They promise big things at the glare of international media gallery so that the world would think we are doing just fine. Everything is about perception, they retort. Even as families bury able bodied young men and surviving infant mortality is categorized as a developmental  milestone.  Pregnancy is a 9 month (or less) time bomb, literally- if it ‘detonates’ and you get a ruptured uterus, pray dear, pray.

I hope we are on the same page.

My people are cool about it though. In no near future do I see the government allocating 15% of its budget to keep us alive. There are more important obligations. Like building roads and making the country look beautiful and developed. For the outside world to see. Never mind it was ranked as one of the most dangerous places to be born. Not even Syria or post genocide Rwanda. Kenya. The country that is also a hub of peace in the horn of Africa. People die rather peacefully here. Who wouldn’t smile.
Today I did kill a patient and smiled. I had two who needed the oxygen cylinder. Both critical. Both terminal if they do not get the life cylinder. I tossed a coin to chose. There was only one oxygen cylinder. The relatives agreed that I was fair. One lived. And so the other died. I smiled.

 I had saved 50% of my patients.

34 comments:

  1. I don't know what to say, we all know the solution to these issues but we are not willing to act.

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  2. Hang in there brother, keep smiling, and don't let guilt destroy you. You are doing good for humanity. What you are saying is the common leadership struggle and health care in Africa.

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    1. Hang on we must Tebora. While the branches still have grip we must hang on :)

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  3. Healthcare needs to be made a priority in the is country The current NHSSP III that is meant to guide us to 2017 does not have any indicators that the country is aspiring too, it is just a nice and fluffy document and does not resemble a strategic plan in any way. In the latest reports indiactors for MDG 5 are regressing and we have an increasing maternal Mortality compared to before! Until Kenyans demand from their leaders that healthcare is made a priority the current condition is unnlikely to change... until the healthcare community exposes the current realities and expalins that the current realities are unacceptable they are unnlikely to make these demands to the leaders and we will continue to build roads while ignoring healthcare! Thanks for exposing the unacceptable realities!

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    1. Thank you Waruguru, let's preach it together

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  4. This comment has been removed by the author.

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    1. ...often awed by how easily people vote against their own interest... :) that's a master piece

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    2. Thanks. Had to delete the comment and re-post it below under my real name. Haven't used the Blogger in years and had no idea That Kenyan Loser was my handle. I blog here http://africatalksback.com/. Can I get permission to republish your entry there? If yes, please register and I will give you author privileges. Thanks again for the work you are doing, and your courage.

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    3. sure Edwin. will register right away :)

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  5. This is heartbreaking, but it gives me optimism to know that there are people like you, Doc, who are not afraid to show us how ridiculous we look. I'm often awed by how easily people can be fooled into voting against their own interests. My heart cries when the people of my rural birthplace in the highlands of southwestern tell me that the the thing they are most proud of is the Thika superhighway. Most Kenyans may never get a chance to use these highways. They may never see a skyscraper, but, hey, it makes us look like America, and that's something to be proud of. Who needs healthcare when prayers cost nothing? Who needs wealth, when the Kingdom of Heaven is awaiting the poor? Pray, may people, pray!

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  6. I just cant help thinking of a Y-connector!!

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    1. i like. would also love to do Y connector from the paediatric ward to the medicine general ward. probably make it a W connector to cover surgical and outpatient as well. while our budget is at less than 6% we would need so many Y's. the argument woud be won, but the problem would remain largely unsolved.

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  7. I agree with the Blogger Marcus... why not use a Y-connector and share the oxygen?? maybe be a part of the change we want to see... think outside the box?? 100% patient survival??

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    1. Maybe i do agree too. Then I would move the cylinder to the male general ward and do another Y, then the female general ward and do another Y. Then the paediatric ward and so on, and use that system of DYI to save 100% of our patients?? They said sometimes back, in order to move forward, you might need to take a few steps back. And I agree with this too :)

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    2. Saruni, that sounds good doesn't it? Unfortunately, I consider that to be part of our collective problem. We easily buy into nice sounding words and sayings but rarely bother to invest at least some thought into what we are hearing or, surprisingly often, saying. A Y connector sounds very good, but how practical is it to make such a connection reliably to two patients 50m and 1 floor apart? Actually, should one succeed in doing so, it would cease to be a Y connector and immediately transform into piped oxygen: every doctor's dream! Then of course there is that small question of whether the oxygen in the cylinder would be enough for both patients. How tragic it would be if that would mean less oxygen than any one puff them needs and they both die. Actually, there are a few more considerations to be made but my Key point is, let's think people! Outside, inside, or even under the box takes us a lot further than just buying into things that sound nice. We could begin by imagining that the oxygen cylinder could be, here the author tells us it is not, a metaphor for the numerous life and death decisions, occasioned by needless shortages in the health sector, that doctors in this country have had to make and continue to make on a daily basis and that families of patients have had to contend with and for which reason have lost and continue to lose so many loved ones.

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  8. Some serious discussions about method need to take place, and they need to result in action. These are the types of stories told daily, but they are answered unsystemically (e.g. find oxygen cylinder donations). Well, you may be fortunate to receive additional supplies from a kind donor, or maybe a donor who could care less, and you may save more lives - but how long must you continue begging for the supplies while the oligarchy profits off of death, or making decisions about person A and person B? So what is the method for achieving systemic change? We all know greed and power is behind the system. How do we change it?

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  9. Thanks Suzan for seeing the situation through my eyes. For a people deeply in love with quick fixes and aversion of the truth, collective amnesia becomes a panacea. While we break the sweat to get solutions anchored on quick sand, the larger problem remains unsolved. proper activism on healthcare is rarely done, we do not implore hard enough to the higher offices to keep us alive. All this lies at the policy making/ implementation level. We need to agree, Healthcare is too important to be left to politicians alone.

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  10. The black hole that is the Kenyan Public Healthcare. Sucking the life out of the very people it is meant to restore life upon. Tragic.

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  11. I am humbled.''People die rather peacefuly here.'' I wish we do away with institutional bureaucracy and increase our budgetary allocation to heathcare.
    Well said !
    Ombado

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  12. You did not kill the patient. Otherwise the article is very thought provoking.

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  13. OMG! So sad and so touching at the same time. But I cant judge you. You did all you could to bail one patient rather than complicating matters and losing both at the same time....

    How I wish those concerned with the health ministry would subscribe to your blog. A lot to be learnt and admired.

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  14. Well, a referral hospital still operates the same way, choosing between a ruptured ectopic pregnancy and a child with a foreign body in one of the major airways, and it is a referral hospital. Kenya has what it takes to take care of its people, what we have are greedy leaders who pocket everything.

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  15. I waz 2 yrs your junior @ sunshine elgon house dorm number 7!!any way I feel u I am working in a parastatal n see 1st hand the levels of impunity and corruption...my md attended a 5 day conference in mombasa together with his driver, on coming back he claimed 65000 as his stipend n his driver claimed 6000..his claim was payed within 3 hrs of him making it yet the driver 3 wks down th line is being harrased by th finance dptmnt to bring reciepts 2 prove his claim!!our leadership is all wrong n soonest we open our eyes n realise it the better or else kenya is doomed!!hang in thea God remembers his people eventually!!

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  16. With you Doctor, we do not need Ngugi Wa Thiongo to come back and write about these things. Really touching story.Yes we need local engineers to develop cheaper but effective solutions. But they are busy learning complicated things. Yes, the Thika road, but not small technology to make affordable bridges across dangerous streams. I lived in a rural area of Uganda and would cross a river with a basket of 20 big cabbages on a slippery tree. I did not know how to swim! When I would get malaria fever- and it was quite often, I would leave school, go to the local dispensary. With no medical worker in sight; I would lie on the grass under a tree, get various insects to bite me as I sweated out. The insect bites seemed to cure me... I would then go back home feeling better. That was in Bunyole in Uganda. My sister, the Late Dr. Mary Nagudi Hanyerere M'Marete who later worked at Kerugoya and Nairobi hospitals would marvel at my stories. I am now writing from London where I am studying; I do not remember when I last visited the GP.Ironical! Talk about the role of geography in our problems! Henry Nampandu. hnampandu@yahoo.com

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  17. For a life to be saved, we need; passable roads, well equipped hospitals (emergency kits, ambulances, professional drivers), motivated human resource (medical practitioners), cooperation from the relatives to the patients (paying hospital bills and moral support) and the patients themselves (being positive about healing and faithfully following doctors advise). Well, let’s not be unappreciative about Thika Super Highway. But, let’s think of strategies to use to make health care a priority for 11th parliament. That they build a fully fledged referral hospital in every County together with Palliative Care Units that are operational as well as offer scholarships to doctors to specialize on diseases like cancer which is now pandemic among other life threatening diseases.

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  18. Mwachi we wait for the day where healthcare shall be a priority in our dear country

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  19. nice article, well said or rather well done? u've done ua part Abidan. Only hope keeps us going, hope, hope and hope alone........

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  20. An excellent post; thank you for your cogent analysis. You do what you think is right and thats what matters.
    Check this out too:
    Medisoft Program

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  21. Well I must first say you are a good writer. Skills that befit your title Doc. Its however the seriousness of your blog thats more captivating. One feels like exploding to the Government on reading the blog. I happen to married to a doctor, thus more close to similar stories. We need a revolution. Its urgent and important that our leadership focuses on its most precious resource; The People. For who will ran on the SGR when the last Kenyan is dead????

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  22. Love the satire. It brings the message Home. Will email it to our President

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  23. Sad really sad,but then again who is votting for this egocentric individuals who only think of their stomachs? People who don't value the effort of our doctors and nurses yet we have the best of the best in the world. So called leaders who will fly out for medication even for a common cold.its simple doctors and nurses should demand for more we will suffer for now but fighting without seizing will yield positive results we surely want.

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