I SIT HERE WRITING

His liquid petite eyes told a story. Delicately emblazoned on his seemingly decrepit face would tell you of the tales in his short life. His nose sticking out and letting out a camber like a whip. His temporals sunk to an almost meeting distance. The skin on his brow and cheeks established thin creases as he changed from one facial expression to another. While his neck struggled to hold up the weight of his head, you could see monstrous veins threatening to let way occasionally distracted as he swallowed saliva.

Cupping his left hand to support his cheek, he looked at the floor as if reading it. You could easily tell how deeply in thought he was but never guess the filling. He momentarily shifted his eyes from the floor to the empty ceiling and back to the floor again. Avoiding as much as he could our eyes being caught in the snare of the silent tête-à-tête.

When I just thought he would open up and mumble, he ended up calmly swaying his right hand and noisily scratch the dorsum of his left. Letting out white skin marks. He would then look underneath his nails as if he expected something different.

I sat there pensively. Wondering what in his one decade of experience in life had disturbed him to this extent.

“Mmmmmmhh…” he finally started.

I leaned forward to encourage him on. Our skulls almost touching. I could smell the sweat of his once white T-shirt.

“I wish she could love us as much as my mother did,” looking from his left side then to his right side he continued. This time creases formed on my forehead as I tried to read his opaque minds. His disturbingly slow let-out sending out an avalanche of thoughts and conclusions.

He continued to narrate the ordeal of his life. His spongy penetrating voiceand  girlish fidgeting informing me of a distressed mind.

So he narrated.

He had lost his mother two years back while she was giving birth to his sister Shida. She had bled to death, doctors told his father. He was eight years old then when his father came home carrying a noisy shrilly bundle of a baby and some clothes in a paper-bag. He ran out of the house to see if his mother was taking her shoes off to get into the house, but no one was there. Then his father broke it to him.

 His father, a man who used to labor in the rich neighborhoods, would shortly get married and bestow them to his new wife. He would then be ‘lucky’ as he got a job as a truck driver in the United Arab Emirates. Time to time, he would send them money for food and clothes. He can only bare witness for the food bit as he never saw any for the clothing. I could tell. Perhaps you too could tell.

Earlier that week, he said, Shida’s body was increasingly becoming hot. She would sweat in the middle of the night. Cold water did her no good. She would now get seemingly strong thrusts in her chest and let out everything she ate. She couldn’t sleep at night. Not that she could but also because he wouldn’t let her. What if she slept and never woke up.

Little Maneno had come to ask for dawa for his sister. The hospital was half a day’s trek in good weather. He couldn’t have come with her because thin as she was, she was still too heavy for him.

It was at this point that I sat back. My pen subconsciously tipped at the edge of my mouth.

I remembered our empty shelves. The circumstances. We would have to get this girl and have her checked up. The machines that were donated by the Chinese government had broken down just around the time Shida’s mother died. So we would have to send them away to get the investigations done elsewhere. Then come back for a prescription.  Then send them away to go buy the dawa.

It was now, like it had started. When we started he was dumbfounded. Now, I am dumbfounded.

It’s been twelve hours since; you might not be interested in how the situation was sorted out. I chose to sit out in the lawn. Gaze at the endless ocean embrace the sky. A sky so starless and lifeless. A sea so selfish and quiet despite having a lot to itself.  Just as endless as the ocean and its infinite love for touching the sky at the horizon, my thoughts race as to the exact meaning of the word FREE.

From the moment of the evening when grayness replaced the earthly colors. When that same grayness was itself consumed by the dark of nothingness. Throughout the sulky sky and quiet sea. I have had nothing to say but just sit and wonder.

So I sit.I sit here writing.

 

UNDERSTANDING THE PROSPECTS OF FREE MATERNITY SERVICES IN KENYA

The president has finally launched the ambitious free maternity services for all Kenyan women. This is a program that needs to be graduated with caution and intense planning because its effects cut across several sectors and affect our sanctity of life

It is estimated that approximately 1.5 million children are born in Kenya every year. Such a program would see to it an end where it would be intended that all these births be conducted in hospitals. Our economic profile only favors that a small proportion would afford private facilities. The rest will deliver in our public institutions.

To better understand the ramifications of this, let me paint to you a picture of our health system as avidly as I can.

The Kenyan health system operates on the concept of cost sharing. Patients are required to pay a much subsidized fee for these services. On their part, the hospitals through their management boards use these funds to keep them running; paying for consumables and employing casuals who are requisite for the running of our health system.

It therefore would be untenable to scrap off this fee without providing an alternative way for the hospitals to survive, they would simply close shop. As a result therefore, the free maternity policy outlines that for every birth conducted, the hospitals would be entitled to a blanket Ksh 5000. As earlier agreed, a majority of the 1.5 million births conducted in Kenya fall in the lower socio-economic quadrant. This is to say that many of them would be anticipated to take up this form of scheme. We are therefore approximating that we would need approximately 7.5 billion Ksh to start off the project.

It cannot be ordered that the money will be reimbursed after services are rendered; the money will be needed to render these services. Where else would the hospitals get the consumables?

Another important aspect to look at would be how often these reimbursements will be made. Making them an annual event would glue our hospitals to year-long debts and in some way incapacitate them. This is likely to affect the quality of services.

While it would be easy to increase the demand for the services through scrapping of the user fee, efforts must be made in the immediate to address the projected increased demand. We still suffer an acute shortage of both nurses and doctors. Increasing the work capacity without adequately addressing this shortfall will definitely injure the quality of health care provision. At present, it would be prudent to employ more nurses and retain the few who were on contract through the economic stimulus program. It would also be far-sighted to increase capacity of both doctors and clinical officers to address the expected surge in demand for these reproductive health services.

While the government allocated just about 2.8% of its GDP to health sector, it is quite obvious that dedicating more than a third of it to just a single sphere of the country’s health strata would have negative end effects on health provision as a whole. More funds need to be channeled to this ministry to better achieve this noble objective.

We also hope that the government will jump over the legal challenge that is the fourth schedule, which clearly stipulates where the mandate of running the affected facilities lie. It is the absolute mandate of county governments to decide the happenings in all public hospitals in Kenya, save for the two referral hospitals.

In the end, we hope for better statistical and substantive result that would pale the dangers of child delivery in Kenya. If that is done, we will surely be many steps ahead of our peers.