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.

THE FUNNY STORY OF HOW I KILL PEOPLE EVERY DAY

When I was fresh new in the profession, I thought I would employ my go-getter, type A personality to get things going. To get things done. To prevent that mother from going home childless after nine heavy months. To save that leg from amputation. To stop cancer cells from growing. I pretty much believed, like many class 8 kids would after KCPE results, that I am the change I was looking for.

I do not know anymore.

In my first year, I was thrown into the deep end of things, without a floater and expected to be seen alive at the shore. In between my failed attempts to save lives and certify the ones I had lost, I was in utter confusion.

I could no longer tell whether the wetness down my face was sweat from my brow or tears of exasperation. I remember keenly my seniors warn me not to die with every dying patient, not to be too attached. That would affect my service-rendering. I was supposed to move on swiftly like batman from one death to another potential one. Struggling amidst limited or no resources to work. And work we did.

As an intern at the largest referral south of Kenya, I happened to rotate alone for 2 months in obstetrics and gynecology and surgery departments. It was my mandates to do all the night calls, find sleep at the25th hour of the day, and return early morning to memorize my patients’ menstrual cycles. Accurately. More like an illicit lover would need to do to prevent unwanted…well you know what. My routine life had changed without realizing it. In a quick spark, I had begun dying with every dying person, witnessing and officiating needless deaths. I would develop a deep sense of guilt.

The dewy mornings to work would more or less be like an eternal walk to a funeral. Funerals. Sending patients to buy essentials and hiding my guilt with a straight face. A face that masked the inner me, the deep personality that would ever so often, almost always be crying out for change. I would, and still do, work an an average of 10 straight hours. In risky ambiance. Expose my throat to that TB patient who had defaulted treatment and only God knows if he now has Multi drug resistant TB. Happy and eager to help him too nonetheless, after all I get paid for it; the government makes sure that I have a medical allowance of $7 in case it gets me as well. I would hug the infected air, I still do, knowing pretty well I would come back home and my loved ones would run to hug my dirty self. Isn’t that what they see the neighborhood do, why would I deny them this.

A patient would cough straight into my lungs as I struggle to fix the improvised chest tube, my motto; this man must live, the ink to certify a death is too expensive.

I would be left to explain to that woman with fibroids why she would have to do with blood on her bed sheets for a further month or two, the autoclave machine had broken down. To the child with cancer, I would pray and hope that the donors would show up again, like they did 3 months ago, if they didn’t I would sit and pray that the cancer cells would stand still like Joshua’s sun, invariably, this was a useless prayer. I often choked up tears, to maintain a strong face, as I saw them steadily walk towards death. I wondered whether they were scared to die. Were they like me?

Sometimes it got me too angry, and I would run to my room listen to gothic beats and promise myself never to go back to that place again. That place-the hospital. This would only last as long as the anger. Pent up emotions.

Some patients would shout, scream at me, I saw one slap a lady doctor colleague. They just cannot understand how you would stand and do nothing as they lose a loved one. Aren’t you a doctor? Isn’t your work to save lives? What they did not notice were the empty shelves. They also wouldn’t remember when I had to take antiretrovirals for an entire month that time I had an unimpressive contact with blood from a HIV patient. That I bore alone. Not even the people I live with knew why I would rush to the sink to vomit my intestines out  ever so often  thanks to the side effects the drugs had on me. My heroism had handed me a near death deal. Like a bolt.

Sometimes our health administrators would do their rounds, we all know who Dr.Kimani is. The man with his own ideas of how doctors’ lives should be. Some say he is a sadist. How else would you describe a man who made sure hell was always so near. Autocratic and clueless.

I became angry. Every time I would run around, get blood sample, rush up the the stairs that were built by the Chinese to the lab and back to get my seniors to teach me the art of this science, I would break down when all that was in vain. When my pen would be needed in the death certification book; this happens very many times. In just a year, I had witnessed a ‘genocide’ of sorts and  certified it. While the entire nation of Rwanda had to go through mass counseling for their genocide, I was left alone and in the dark. I had to deal with it myself and wake up the next day fit as a fiddle. I had to fit in society too.perfectly.

I was not particularly waiting or hoping to develop a thick skin. A kind of skin that makes me indifferent to deaths. I thank God I am not even close to that.

While this was happening, our country was up in political flames. When I tried to say I need someone who has gone through the experiences that I have to manage the system, I was quickly shut down. Remember how my female collegue was slapped, it felt like that. A million times. When our hopes were sky high with the new government, they cut down spending on health. That to me means, more hazardous working conditions. More empty shelves. More resignation letters from collegues who simply choose to save their own lives.

Today I was at work, even now if I am called I will be there in a split second. Tomorrow too. But I am not sure whether I will be of any help. It is not well with my soul. Maybe we need to go on strike again. It is said, that sometimes to move forward we have to take few steps back. But who will we do it for?  With Kenyans, at least the vocal ones, it is well with their souls.

SYSTEMATIC GENOCIDE IN KENYA

With 34 billion shillings out of the expected total budget of 1.65 trillion Kenya Shillings, our government has yet again relegated your health and mine to a forgotten corner. The above figure translates to 2.01% of our total budget and about 2.8 % of the National GDP.

This represents budget ‘cutting’ of close to 60% from what was allocated last financial year. With the dwindling resources, come additional responsibilities for the Kenyan doctor, the promise of free maternal care in all government hospitals and free health care in all health centers and dispensaries. This free healthcare, for your kind information, would be approximated to cost about 20 billion shillings.

The amount allocated gives you just 850 shillings as the per capita allocation for health, meaning your government will only spend that much for your health, in all these programs that not only focus on treatment but prevention of maladies.

WHY is this? I know why. Simply because death and disease-disability are usually very much private affairs. You die alone, away from the glare of the public. Unlike roads which remain beautiful and soaring and therefore a very ‘real’ benchmark for seeking re-election.  To our leaders, it’s all about the next elections, I suspect.

I am still waiting, no abated breath though, for Kenyans to learn and act, probably react, like they did in social media a few days ago. As a doctor, I can only give the services I am facilitated to give. Demand for this right, it is your responsibility.

Study of a peculiar society, that loves pain- Kenya

"Oh ye foolish Galatians, who has bewitched you?" a voice cries from the desert. The annointed one remarked at the thought of the stupidity of his people.

Applies to all of us just right about now. The hue and cry about our politicians literary fists-on-the collars of the salaries team is a scene to adore. I mean it. We, the people so fondly in love with quick fixes and aversion of the truth. A people embalmed in the romance of collective amnesia which recurs every five years is a comedy of  sorts. Get a jar of popcorn and watch it replay in an exact same manner.

Here is the reality your eyes will see once you become honest with yourselves, foolish Galatians (oops..Kenyans)...

We get the leaders we deserve. Our leadership is a reflection of our society. The rot in our leadership is a direct mirror image of the rot in the most basic unit of society- the family.

How many of us are honest at our workplaces? How many make sure they work for the last coin paid even when nobody is watching? How many of you still yell at the top of your voices how you are underpaid yet you spend significant amount of time paid for, mostly by taxpayers for the civil servants, sipping lattes and catching up on bogus stories while serving the public an enhanced menu of impunity?

The difference between our leaders and us is that they are in the glee of the media. The reel always rolls at their actions.

Speaking of the same leaders, an alien in Kenya would be forgiven to think that our leaders are manufactured from some exclusive depot and fed on us without our say. False. We elect them. Given many choices, we make the wrong ones. Again and again.

Our leaders remain better than us. At their point of need, like salary increment, they speak in one voice. At our point of need,like  the elections, we disintegrate into un-useful tribal shadows.

We get the leaders we deserve. Change comes from us. From within us. The only thing that changes from top down is food as it evolves into you know what. Our change must be from bottom up. You know how.

As a society that always votes against its own interests every other 5 years, who would sympathize with us.

WHO IS 'KILLING' OUR LEADERS...HERE

It is not debatable, at the age of 32 Alexander the Great had almost literally conquered the world. Every conquest seemed to go his way or no way. Fast and furious. Just as fast as success had come his side of the divide so did death.

A ten day history of a mysterious illness left him lifeless, again literally. The ‘great’ had been conquered and vanquished by the muscles of his own body. In the 10 days he could not breath leave alone unsheathe the sword.

Nobody has ever explained to our conviction what killed Alexander the great, some say it was due to malaria. Others speculate that it was typhoid, typhoid would make its victim vomit and also has central nervous system manifestations.

For the world’s love of drama and intrigue, poisoning was the most plausible explanation. For Alexander’s  symptoms of vomiting, tremors and seizures, a plant in the genre of alkaloids known as belladonna was accepted as the most likely instrument used to stop this seemingly unstoppable man.

George H. W. Bush, in 1992 had an incident almost similar to what the Late Mutula Kilonzo had. After a tennis match, which he participated while in Japan, it is documented that the former US president vomited until he was unconscious. His was more dramatic as it was captured live by ABC news, a head of state vomiting to unconscious would definitely be attributed to poisoning, what else could it be? He later confessed having suffered from a typical flu which was confirmed.

A joke is made in Japanese that if they say they will make you ‘Bushu suru’they mean they will make you vomit and pass out like Bush.

There are several causes of sudden death. Here are some of them;

1.       Cardiac death; usually sudden and would occur within an hour or so. Vomiting may be involved together with frothing of the mouth.

2.       Respiratory; where vomiting may precede it and aspiration of the vomitus leaves you as dead as a dodo

3.       Herbal medication and some herbs we use as spices may actually be poisons. I recently experienced a case where 3 children from Giriama died suddenly after feeding on some cassava species. Their parents remained well and alive.

4.       Poisoning, accidental or intentional, may require a high index of suspicion in order to collect and process the appropriate toxicology specimens, particularly if a volatile substance is suspected. Some poisonous agents, such as cyanide, can only be smelled by genetically-able individuals (the classic burnt almond smell) and thus may go unnoticed

The onus task lies in the hands of the pathologist to interpret whatever findings they get astutely. Sensationalism must be avoided. A negative autopsy is an expected outcome, similarly a positive finding does not necessarily point towards the cause of death. It is said, a person can live with a disease which won’t necessarily be the cause of his death.

To that end, I ask, who killed Alexander the great?

#RIP Hon Mutula Kilonzo and the 3 Giriama boys 

THE SAD DAY WHEN 'ANYONE' BECAME A SPECIALIST IN HEALTH MATTERS

“ If the frog came out of the water and told you that the crocodile is sick, would you not believe him?”

Chinua Achebe

WHY THE HEALTH DOCKET CANNOT BE MANAGED WITH A PEN BUT A STETHOSCOPE

Mr. President got it awfully wrong. If health was a direction West, he looked East and walked on whistling.