THE CRUMBLING STATE OF HEALTH IN DEVELOPING COUNTRIES

I HELD MY BREATH AS I LISTENED TO THE GOV SPOKESMAN
On the early hours of Thursday morning on the 6th April 2012, I received a distress call from a respected friend anesthetist at the Kamuzu Central Hospital in Lilongwe.He was asking if by any chance as a visiting WE TRIBE I had some adrenaline in my traveling goody bag. I had non. 30 minutes later, he called again and in confidence told me that the head of state had passed on, he was frustrated because he couldn't get a vial of adrenaline at the countries government's premier referral facility to restart the Head of states cardiac activity after he arrested early that morning, there was no specialist either to guide the resuscitative efforts.The defibrillator at the hospital was a defunct donation that failed at the hour of need. For publicity, the stiff body was flown to SA to give room for transition and sipping of the tragic news to the nation.The rest is in public domain. A year earlier, I had joined a high powered delegation to the Lilongwe state house to plead a case for the need to rebuild the broken health systems in Malawi. Statehouse categorically informed our delegation that there were more pressing budget items that needed support, and I particularly remember a senior Government health official stating to the forum that they have bilateral understanding with India and South Africa to treat the citizens who need specialized care beyond the nations borders. So yesterday,as I saw the government spokesman trivialize an issue of life and death on National Media houses, I held my breath as history was fast replaying on the screen.Only time will tell if it will replay full circle.

LETTER TO THE PRESIDENT

Hello Mr. President

 

I won’t say shame on you because in my thick savannah-toughened blood runs decorum and respect for the elders, even when you don’t agree with them. Just like any other doctor, i am on strike and not amused about how you handling the matter. My million-dollar wish is to see the day where any Kenyan can write to you on; accountability, governance, corruption, national health, national security, unemployment to mention but a few. But that will call for a high literacy level record of the hoi polloi and change of the social class in terms of poverty eradication.

This is what the French call ‘cri de couer’ for the millions of Kenyans like me, who are tired of how healthcare has literally become a forgone rights and how the devil took control of paradise on earth and fed on the blood of people it was supposed to protect.

Sir, your government is not exceptional if not special when it comes to regimes that bank on the illiteracy and poverty status of its electorates. That is the very reason you will go on a political rally, not coincidentally, on a day the low class Kenyans are dying as the doctors are on strike. It only happens in states like Kenya.

Sir, in the real world, where citizens know their rights, you will be impeached and your record track of good governance will plummet in a record synonymous to Wall-street’s numbers, in times like the great depression. Chew on that.

You are charged with the herculean task of delivering affordable healthcare to each and every Kenyan and it beats me how you can sleep at night. You very well know the importance of healthcare to citizens. The very sleepless night a mother goes through when her child is sick or nursing a condition only treatable in some fancy hospitals abroad.

Kenya has embarked on millennium development goals including eradication of poverty and hunger, primary education for all, gender equality and reduced infant and maternal mortality rate. It’s unfortunate that the projected goals are far from realization and healthcare specifically is for the chosen few and the ever-growing middle class of Kenya. In fact, it’s safe to say the current impasse of healthcare only affects the majority who pay taxes, only to be enjoyed by minority over the very basic rights of access to better healthcare.

Health economics dictates the effectiveness of a country’s health scheme to be pecked on three yardsticks; accessibility, cost and quality. Am afraid, the entire access factor is emasculated by the quality factor in terms of facilities and workforce in our healthcare system.

Kenyans are crippled by preventable diseases. The statistics are shocking. The so-called referral hospitals, which are only three for the 40million Kenyans have ramshackle facilities and painful bureaucracy of service delivery. We are very far from achieving WHO standards for specifically low requirement sub-Sahara Africa.The very strike by doctors and nurses camouflaged the very pictures of the shocking revelations in both Kenya and the mother continent. Africa bears a quarter of the world’s disease burden, 65% of which are communicable diseases. It has only 2% of world’s doctors and contributes 1% of the global health expenditure.

Politicians neither have the incentives nor the information for doctors. It’s sad that with all the advisers from different portfolios you enjoy, one would advise you to stay mum about the country’s healthcare crisis and make a mere parting shot about how doctors can’t bring back the lives of Kenyans who regretfully died as a result of the strike. These are issues that require you to urgently convene a crisis meeting and make an official state address under the glaring of state press. That gives the commoner a value for his vote.

 

The ministry of health has been plagued by cases of all sorts. From alleged corruption cases, misplaced priorities in terms of its budget and above all not implementing the Collective bargaining agreement (CBA) that it signed with the doctors three years ago. The credibility of its occupants has gone so low and we are very disappointed.

Kenyans have short memory! Mandarins and cold-heart good-for-nothing degenerates squander money every day in your government and you are shocked of the demand by doctors’ pay rise? That’s because we first see doctors’ fault before the government. We vote them in perennially while we know their morality stain. Tribalism literally trumps every virtue in this country. Jobs are no longer given on merits, appointment to offices are not based on competency.

Even with the current pay rise of doctors, the attention will never shift to how the government has failed to provide for a good healthcare for Kenyans.

Dockets like National Health, Security and Infrastructure are not low budget portfolios and rightly so deserves proper funding.
Sir, Implementing the CBA will turn around healthcare in this country. Think of the incentive and the will of work a doctor or a nurse will have in executing his or her duties. Think of the over 3000 Kenyan doctors working abroad as a result of brain-drain after losing hope. Think of the realization of the dream of that high school kid who says, “I want to be a neurosurgeon “and realizes his dream. Think of the incentive related medical research think-tanks and an end to communicable diseases as a result. Above all, think of an end to the politicians including you who brand Kenya as a country with no proper health facilities when they have to fly abroad for minor procedures like hernias not to mention change of Elastoplast by our governor!

Pay the doctors their Money. It’s a bitter truth that its only money that tests the fabrics of ones’ faith in relation to the description of a doctor’s work as a ‘calling’ Kenyans have bought that single story tragedy hook, line and sinker. Doctors too need to eke a living. George Bernard Shaw said: “We have not lost faith, but we have transferred it from God to the medical profession”.

Adopt a watertight healthcare and health workers’ program. Provide an affordable, accessible and quality healthcare such as health insurance scheme for every citizen that can be enjoyed at the grass root level. Equip our hospitals, and not only in the final year of your term. Tarmac our road networks and let there be a sense of equality and belonging to this country. Secure our borders and beef up our security even if it takes you to build a wall at our border entry points.

 

SONG OF THE FREE

SONG OF THE FREE
We walked in darkness now seeing great light
Out of the shadows into your sunshine
Joy has began great celebrations
Joining one-voice worshiping nation

Chains I was bound now have been broken
Doors that were shut have been flung wide open
Joy has began great celebration
Joining one-voice worshiping nation

Chorus
This is a song a song of free
We sing hosanna
We’ve been redeemed cause our humble king…
has shown us compassion

Chains I was bound now have been broken
Doors that were shut have been flung wide open
Joy has began great celebration
Joining one-voice worshiping nation
Chorus
This is a song a song of free
We sing hosanna
We’ve been redeemed cause our humble king….
has shown us compassion

So we fall to our knees…..
Throw up our hands…….
Cry to the lamb that was slain
We say

You are worthy of all the praise you are, you are (repeat 4 times)

STATE OF HEALTH IN KENYA

INTRODUCTION

#STATEOFHEALTH has been a popular and trending topic on Kenyan social media platforms recently. Being a healthcare worker I know a thing or two about what is ailing the health sector in the country. Indulge me as I share some few thoughts with you.

THE POLITICS OF IGNORANCE AND SELF INTEREST

A few years ago, Kenyan healthcare workers took to the street to protest the poor state of the health sector. They warned that a darkness had been slowly gathering. Decades of under investment in health had finally caught up with the nation and threatened to undermine our collective resolve towards development. 

The issues at stake were deplorable working conditions, under staffing, poor pay, specialist training and broken down health infrastructure. We were then treated to the poor spectacle of strikes and unnecessary patient suffering. All along the political class promised they have prioritized healthcare and soon things would be better.

In the most recent of industrial action, doctors and nurses said that they were opposed to the hurried devolution of health services. They said they want structures and policies in place that would ensure the smooth transition from national to county level. I remember my troubles when explaining to some interested Kenyans how the strike is not about money but about principles.

Both the politicians and the public criticized the action, reminding us that we took an oath to protect lives. Nobody cared to listen to the numerous union officials explain the logic and rationale behind the strike. Some said 'We would understand if you downed tools for salaries like teachers of this country.... 'The governors promise to handle heath better than the national government ever did....'the structures you desire will be legislated by the real experts of the constitution and the law.  And so  the government moved quickly to devolve health. Perhaps central government wanted to wash its hands of the burden of negotiating with a unified doctors union( kmpdu). They must have reckoned that it would be harder for devolved workers to unionize and strike whenever calls for dialogue were ignored.

THE DARKNESS FINALLY ARRIVES

After two years of the health devolution experiment, it is safe to say that the country's healthcare system has been turned into a complete mess. We all know what the problems are, and how they they can be solved, but in typical Kenyan style, we are too distracted with politically rooted headlines to notice.

A quick glance at the news making stories in healthcare makes me weep. GOVERNORS OPPOSED TO 38BILLION MEDICAL EQUIPMENT LEASING!! BEYOND ZERO!!! FIRST LADIES FIGHTING CANCER!! DEADLY INJECTION LEAVES CHILDREN LIMPING!!! ARVS IN DUMP SITE!!! YOUNG MEN DIE OF ALCOHOL WITHDRAWAL etc.

The real issues facing ordinary Kenyans are never brought to the fore. Not the many children who die of easily treatable diarrhea and vomiting, nor the many whose kidneys are failing because of the thriving unregulated quacks and herbal medicine men who claim to cure chronic illnesses like AIDS, diabetes and cancer.

What irks me the most is though, is how the counties have handled health. For obvious reasons, County governments were quick to take over the budgeting and procurement roles. The immediately bought pick up trucks and painted the word AMBULANCE' on them. This they said, would ensure the people with various health emergencies were promptly rushed to the hospital.

A closer look at this noble idea reveals the folly of letting  Governors and MCAs control health budgets.

First the vehicles do not have basic life saving equipment required in an ambulance. No emergency lifesaving drugs, no oxygen, no staff. Secondly, in my county at least, the vehicles don't even have fuel and maintenance budgets. Did they purchase easily serviceable vehicles like Toyota? Nope. Counties have style. They do American Ford rangers....Vehicles with no easily available after sale services. When they break down, repairing them is expensive and time consuming since you have to wait for spares from dealerships. All this added cost to taxpayers, for no value whatsoever!

These ambulances are regularly seen in funeral ceremonies, usually aiding in transport logistics. Usually the local MCA is in attendance to point out how helpful he has been. Eti..hii ambulance no yenu! Free!' Interesting to see how the shepherd always try to persuade the sheep that their interest and their own are the same.

The counties also took up the purchasing of medical drugs. All good, but as we all know, they don't consult health care workers on the ground. The result has been delayed supply, wastage due to stocking drugs with complete disregard for demand and consumption data. Indeed, many hospital pharmacies regularly overstock on drugs they don't need, and quickly run out of essential drugs.

EQUATING DEVELOPMENT WITH CONCRETE

In my county, there are over 90 government run health facilities. Majority of these are dispensaries and health centers manned (or more appropriately, womaned) by few nurses. This situation is replicated throughout the country; in some cases, a single nurse runs the facility. With no clinicians or medical laboratory technicians available, the nurses usually have a short list of diagnoses to choose from. The most popular is malaria of course.

Recently a story of limping children in Teso hit national headlines. The nurse had wrongly administered quinine and injured the sciatic nerves of over 30 children. Images of children dragging their feet with foot drop were broadcast allover. Kenyans were outraged.....How could she? Where was the nurse trained?.. She should be suspended pending disciplinary action.

A media house even interviews the director of medical services, who had nothing but tough speak about how he would demand answers from the nursing council. I guess by now somebody is out of a job that ideally shouldn't have been theirs in the first place.

Does a government that has commissions nurses to play doctors, lab techs and pharmacists.....(heck even accountants and hospital administrators)....have the moral authority to prescribe punishment to same nurses when they err? Kenyans would rather see that nurse fired than wonder why government has posted her without any support to offer services that meet standard of care.

Its shameful for a politician and county executive to stand and criticize a single individual, to walk away with cheap political capital while at the same time do nothing to address the real issues. County governments it would seem, are happy to have health money devolved, but when questions about service delivery are asked, of course it is the health workers at fault. After all, remember the expensive ambulances we have procured?

Take the example of Embu county. Its one of the geographically smaller ones, with slightly over 500,000 residents. It has over 133 health facilities, about 90 of which are government run. The various ward MCAs have taken to building maternity wards in even the smallest centers near each other. Was this based on need or catchment population needs? Of course not. Such lofty details that concern the professionals pale in comparison with the political mileage one stands to gain by erecting an empty concrete structure.  Some now record less than one delivery a week. Midwives there are bored to death. So instead of waiting for the rare delivery, they would rather leave clear instructions about how they can get the ambulance to rush the laboring mothers to the main hospital, for free of course. Thanks Mr governor... Mr MCA. This is not a frivolous referral either, because the maternities were built but not equipped.

This is how to play tennis without the net. Simple Kenyans voters are happy with the  politicians for their hard work. The politicians are happy too because any further failures in this arrangement can be blamed on a poor nurse who just can't seem to do her job right. 

Meanwhile, middle class Kenyans who can spare a few coins aren't bothered. If they want health services, they just go to private hospitals.....where the more they pay, the better they think their health gets.

The man eat man situation

Every time I walk out the door of my house I cannot help but take note of the number of people out there grinding. The shoe shiner in front of the little M-Pesa shop making sure our shoes are clean; The newspaper vendor up with the early birds to ensure we get the news of the day; The Matatu tout shouting his voice hoarse before even the sun is up for commuters to get to their destinations early; The lady in that small mabati establishment ‘’hotel’’ serving tea and mandazis for the bachelors and other Kenyans unable to take breakfast at home; The thousands and thousands of pedestrians walking miles and miles to reach their work place every day; Truly there are many people working hard in this great Nation to make ends meet.
Kenya is a country of hardworking individuals, all with hopes of better tomorrow. It saddens me therefore to see the sweat, blood and tears go down the drain. The hope for a better life is being looted at an alarming rate by people who call themselves hustlers but do not have the slightest of clue what that word means. The cycle of poverty is the single most difficult obstacle to navigate because the rich want to maintain their status quo. This is evidenced by the way our ‘’leaders’’ take seconds to increase their salaries but ages and eons to add teachers and other ‘’low’’ cadre civil servants peanuts.
As a small boy growing up in the village attending a school without doors or windows, bare feet and with torn shorts, I was always encouraged by my teachers to not think about my situation then but to do something about it. The slogan was’ Hard work pays’. I bought it, worked hard and became a Doctor. I cannot help but feel cheated. I know I am not alone; the newspaper vendor, the shoe shiner, the Matatu tout among others must feel cheated too
We talk about living the American dream; we celebrate when people go abroad for greener pastures; Can we create and live our own Kenyan dream? Yes WE can. Can we develop greener pastures in our own backyard? Yes WE can. The solution is simple; let’s all embrace our responsibility and responsibilities to our neighbors. Let us make hard work pay again. Start by reminding the government WE are the taxpayers, the heavy lifters and as such are entitled to better education, quality health and lifestyle
The good book says Love thy neighbor as you do yourself; the greatest commandment of all. Our neighbors are dying because they are poor and unable to join the elite in flying abroad or attending private hospitals for treatment. Let our voices be heard, stand up and be counted. Join the Kenyan Doctors in wanting the Kenyan dream. Let hard work pay again.
# LipaKamaTender .
# ImplementCBA.
# IstandWithDoctors

DEVIL DEVOLUTION

COPIED

MISPLACED PRIORITIES
In my workplace, a level 4 hosp, there is a C-Arm xray machine, purchased by govt in the recent flury of tenders by the MOH. A C-arm xray is used by highly skilled Orthopaedic surgeons to minimise "cutting" of patients during operations & ensure proper alignment of bones. The truth is orthopaedic surgeons can still work pretty well without this machine, its just supposed to make work easier, faster & more accurate.
The county, which has two level 4 hospitals(hence 2 machines) has only 1 physician, 1 general surgeon, 1 gynecologist, no paediatrician & no orthopaedic specialist. As things stand, there is no hope of having these specialists soon.
We have the very latest digital xray & ultrasound scan machines but no radiographer to operate them. In this same hosp I sometimes have to shamefully refer patients due to some basic reasons like the theatre has no oxygen, no electricity & hosp generator has no fuel, or lack of normal saline, etc. Yes we launched these machines in front of cameras but mama mboga is still suffering. She will applaud u and blame the the doctor thinking they are lazy on their jobs.

Wht's the point of splashing 40bn on machines if service delivery remains the same? Isn't this defrauding the taxpayer? Are we really addressing the pains of the pple?

In any organization, whenever u want to introduce some form of service, employee training/recruitment is the 1st step, because human resource is the most important factor in its success.
I am a believer tht true success is always abt the pple. If the pple did not embrace facebook, Mark Zuckerberg would not b a great man. China is the strongest economy in the world, why? They have a huge knowledgeable population,  who r all providing their expertise in their economy. The doctor's CBA is aimed at retaining such skilled expertise in our country.
Someone needs to speak for mama mboga. We need direction in this country.
#lipakamatender#
#doctorsontrial#

The daily undertakings of Kenyan doctors

I ESCAPED, BY A WHISKER! Most Kenyans agree on one thing: they can’t stand the smell of a public hospital. The wards have a smell so distinct, so pungent, it might as well be patented as the UltraPublic Hospital 2.0 scent for all ages and sexes. Yet, as a doctor, that smell is part of my daily story. Doctors’ nostrils undergo something akin to mutation, till they longer notice that smell. Does that matter? Doctors endure the stench of sputum, urine, sweat, stale food, rusted beds, and moldy walls to serve the poor masses who can’t afford private hospitals. Doctors have to burrow their way between cracking doors, falling ceilings, rat-infested wards, and ghost-like curtains from the 1958. Even where improvements are being made, it seems the greater good goes to the pockets awarded tenders. So, that night, I almost lost my life. I was on call. That means, I was expected to stay awake, all night, sorting out this and that patient, this and that emergency, with no hope whatsoever of any sleep. All this with no hope of refreshments (the tea served in these hospitals can kill cockroaches and suffocate mosquitoes). No hope for a decent meal (the smell of the food is bad enough to electrocute you before you taste it). No hope of decent nap (the room you are expected to nap in has cracked window-panes, mounted on windows whose hinges shriek louder than Rongai matatu’s emergency breaks, and the cockroaches and bed-bugs have an ongoing collabo in the crevices of the bed). I needed to rest, but I couldn’t sleep in the hospital. This was night three. In other words, I hadn’t slept a wink, for more than 60 hours! That night, I requested a colleague to cover a few hours for me. I went to grab a nap in my bed. I overslept. There was an emergency in the hospital. My colleague was overwhelmed. The hospital called. I was too deep asleep to hear. They called again. Again. And again. They gave up. After hours, I stirred up awake. I saw the million missed calls. I rushed out of the house. Lab-coat at hand. I belted out of the residential compound. I ran up along the road. My head thumping. My heart pounding. My breath heaving with difficulty. My body stiffened from sleep and fatigue… and the sound of footsteps crunching on dry leaves on the opposite side of the road. “Simama!” I heard the curt command. But my brain didn’t register what it meant. I ran on. One thing on my mind. They need me 100 meters further ahead. Two or three bodies leaped with a thud onto the tarmac and started beating a tattoo as they ran behind me. My energy was down to a thread but I struggled on. My feet heavy. In my rush, I had forgotten to put on socks. So the sweat from my feet caused my soles to slide with each step, and my big toe to glide against the tip of the shoe. The harder I strode, the more painful it became. But the rankly footsteps clonking a few meters behind me jolted my body enough to keep edging closer to the hospital gate. Twenty meters to go. Fifteen. I heard a deafening crackle accompanied by a crimson flash. I heard voices shouting, but I didn’t hear what they said. Ten meters. The thumping on the tarmac behind me persisted, even closer now. Five meters. Finally, I slid thro the hospital gate like a gazelle thro a boulder-slit that blocks the lion’s advance. I don’t know how much further in I ran before I collapsed, nothing more remaining to give… except the will to breath on. Therefore Mr President, when I hear the words “Innocent patients”, I am left wondering: What about the innocent doctors? What about the innocent doctors who have lost their lives at night serving patients? What about doctors who sacrifice most of their youth acquiring skills that are the backbone of an under-resourced, under-valued, and under-prioritized health sector? What about the doctors who were civil enough to sign a CBA with the government only for the government to renege on its rightful duty? Yes there’s a stalemate, with three parties involved. On one hand, innocent patients; they need services. On the other, innocent doctors; they only wish to see justice done, their rights upheld. Make no mistake. This is not a strike. This is the culmination into UNSHAKABLE RESOLVE after decades of frustration. The third part, and the one whose actions meets the needs of both the patients and the doctors, is GOVERNMENT. The government is not being asked to pay some fake tender, no. Simply, to honor legal document. Implement the CBA and backdate it to the dates it was signed. Please don’t pay all the way back to 2008, we will not accept that. 2013. That’s it. #LipaKamaTende

CBA O'Cklock

CBA O'CLOCK (12th Day)

It is a Friday evening and I hope you for once are having that restful evening you have longed for since you became a doctor.

If you are an employee of the Government of Kenya in a parastatal, county or MoH and you aren't home because you are on locum or sneaking into hospital then your curse is spared specially in Heaven.

We have spent the last 12 days faithfully reciting allegiance to the CBA. We shall do so until that document is implemented.

However, for the first time in 3 and half years, the GoK  acknowledged that the Kenyan doctors through KMPDU have a CBA that is legally binding and yes it was minuted. This was like swallowing back the previous description of 'useless piece of paper'. A position that CoG representing the 47 counties confirmed and noted that as long Treasury allocates funds, the CBA can be implemented.

We are alive to the machinations of the oppressors and we were well prepared to all tactics. We are aware of court cases and possible arrest warrants over our heads. We are aware that the same GoK now acknowledging the CBA appealed the Hon. Justice Monica Mbaru ruling.

Our court case comes for Mention on Monday. Our legal team has advised that we are not required or mandated to attend even as we know the court may order our immediate arrests anytime from Monday. Bring it on! We shall advise when you should attend court.

The journey to the CBA implementation will be the most interesting, most painful and yet most fruitful ever KMPDU and all Kenyan doctors shall ever engage in.

We thank you for staying strong. We are extremely grateful of your support as we walk to freedom as WE. With a determination and resolve not imagined since independence.

We welcome the advices and we note them. But your most important work is to stay at home and keep other doctors out of work until such a time you confirm that the CBA has been implemented. Be your champions.  Get on twitter

Have a good night beloved doctors.

Dr. Ouma Oluga
Secretary General
KMPDU

#lipakamatender

From Prof. Samuel Ayaya
To my former classmate Dr Cleopa Mailu and my student Dr. Muraguri I urge you please to listen to your colleagues my students Drs Ouma Oluga and Daisy Korir. The latter are representing our TRIBE of DOCTORS. I know all of you personally as people capable of solving the problems of our TRIBE. You know what it takes to become a doctor and work as a doctor. You know the hours and risks involved. Do you think your brothers and sisters are well remunerated? We have followed all the procedures in the laws of the land but your Government has reneged on its signatures and declared our only recourse illegal. What's illegal? To refuse to honor your signature or to go on strike as per the law?
I know that you are not the Government and you do not and can't make the necessary decisions. But you can make our case to the Government being one of us. Explain to it as doctors and advice it to listen to our cries. The TRIBE is only asking for the implementation of the signed CBA . We trust in our Government and believe it can't go back on its word. When I was a child we used to hear that once the President ( Jomo Kenyatta) gave his word it could not be changed. We were ecstatic when God gave us Jomo's clone because we thought he was wired in the same way.
When meetings are called to discuss this matter do not allow non members of the TRIBE to belittle our reps. Ensure that the agenda:  CBA is stuck to.
We are aware of the calling and the Hippocratic oath. Neither of these justify our being mistreated, underpaid and belittled. Let the Government understand that these are the creme de la creme of the country and deserve the top dollar.
The strike is not against you. It's for you. You will be happier to look after a well catered for and satisfied team of colleagues. You also need a soft landing.
The strike is about saying NO to IMPUNITY and regaining DIGNITY for our TRIBE.
I believe that you will go down history as those who regained the DIGNITY of the NOBLE profession and not as those who KILLED it.
CHOOSE YOUR PLACE IN HISTORY.
PS: I have used this mode of communication because though we know each other, you live in a different world. My attempts to reach you before failed miserably.