20 Nov 2011. Letter to the Kenyan patient..(from the Kenyan doctor)
Thank you for taking your time to read this…..
6 months post internship and I still suffer from insomnia. Mine is not a unique case, but one of every Kenyan doctor that has been in the system. I look back at the highlights of my long one year to remind me of how doctors and in general Kenyans must be so angry to do something about the situation.
I can’t quite decide if it is the night I performed 2 caesarian sections with the anesthetist shining the light from his Nokia phone because the generator did not function and the operation had started, or if it is the nights that I had to beg the anesthetist to come to work for life saving operations that brings back the nostalgia. Maybe it is the worse reality of recent events of doctors performing deliveries with no gloves, of young doctors dying of renal failure because they cannot afford dialysis or renal replacement therapy.
I wish to step back from the emotional laments, to look at a typical day for a doctor. The day begins in the morning, way before 7 am to prepare for the rounds, and continues to 5 pm. In general, there are on average 3 interns in properly staffed centers and occasionally 2 interns manning a ward. This means that you get to go on call on every alternate day. On a day you are on call, the day simply does not end. On a good day you may get some minutes to have some food and get back to clear the day’s work before night time. Beyond 5 pm, one is designated to attend to all patients through the night, with a higher burden in the surgical rotations that may require you to go to theatre though the night. The unfortunate thing is that for most of the night it is difficult to get the help of specialists in the few facilities that have them, but it is worse in areas where you cannot access the specialists. On the next morning there is no break, and you continue to work the day till 5pm in the evening to complete a 36 hour shift.
Kenyan, did you know when I can get 2 hours of sleep at night I sleep on a bench in the tea room or laundry?
I applaud the medical profession in utilizing social media in communicating our plight especially on the use of twitter and facebook as a tool of advocacy. The social media has been the tool for the Kenyan public too to lash back at the medical profession, notably one from Alice
Such comments do not offend me but make me angrier. For instance, does the Kenyan public know about the several instances this year when nights were raped this year in 2 district hospitals during night duty by some ‘patients’? Does the general Kenyan public know of the humble initiatives to try and offer free service to marginalized areas organized as health camps? I remember my first visit to Turkana as part of a health camp, and a lady with a chronic ulcer had to walk for 2 days so that she could make it to see the doctors. There are several young children with rheumatic heart disease that we took back with use to get more specialized care.
Reaching out to rural Kenyan communities to provide health care
Due to the exposure to the TB cases in the wards, the medics carry a higher incidence of latent Tuberculosis, with several doctors on anti-Tuberculosis drugs. For a profession with no health cover, most of the doctors have at one point taken ARVs as part of post exposure prophylaxis and lack even a basic Hepatitis B immunization.
Did you know the last time you sent relief food I had to line up for some. All shops in my area of work are closed down and my money is worthless here.
Kenyan, the truth is there is no good working environment for medical practitioners. The system fails to provide basic equipment and even minimum staffing needs.
On a different view, we doctors are angry at you, the Kenyan patient. You must remember that we are not God or magicians or miracle workers. When you as a patient makes several visits from one local traditional healer to another and bring your poisoned child and lie about it, I will not work a miracle. I have no access to ICU services and I have not toxicology support to work up what the poison is. When all people in your village go blind and you continue to drink illegal alcohol, if you continue to consume the same brew you will go blind by the time you arrive in the hospital. I appreciate second opinions, but when you keep paying money to a quark that treats you for a “weak heart” and you stop your antihypertensive medications, you will get a stroke, and there is nothing I can do about that. Moreover, if you are pregnant, but decide to stay at home with no antenatal care because the last pregnancy was fine, remember hypertension is a leading killer and if you come with eclampsia you have a high likelihood of dying. Kenyan, when was the last time you had a pap smear or visited a wellness clinic?
Point is, it is time for change. We are not perfect, we are not asking for unreasonable terms. We are human, humbled to be in a nobel profession but with family and other responsibilities. We are asking for equal rights, an overtime that you the general Kenyan get in your work, some protection regarding the higher risk of the work and environment in which we work in.
We are asking you to be responsible for your health, and help us work better. Moreover we are asking for some piece of mind, and better health for us so that we can continue to serve you better.
We are sorry for the time you got less than optimal treatment in the system. I am sorry for the time I had to send you out to look for the IV cannulas for your dehydrated child to get any fluids. You may not believe this but there were none in the hospital. For the days you were frustrated because your anemic child did not get transfused, I called all hospitals and the blood bank. I obtained blood bags to allow several children to share one pint of blood because that’s all I could get. Kenyan, when was the last time you donated blood? Kenyan, I know you preferred that I rub your back through labour which I could not. I had 20 other patients in labour at that time. I know you were in pain; there are no pain medications for use in labour in our hospitals. I couldn’t rub your back, but I ran you to theatre when you had a prolapsed cord, or came in with a ruptured uterus, and saved your life.
Kenyan, please invest in your health. You do not allow my children to attend school with no unpaid fees. At the bank, I do not get free service. Yes, I use the ‘matatu’ and pay the hiked fares during the rainy season. In fact, at your place of work you clearly put up a notice saying “For credit, come tomorrow !”. I am simply extending the same courtesy to you. My services are not for free. Have you paid up for the NHIF insurance or any form of insurance? Do you even save for health costs? Why do you make your lack of planning my emergency? The last time you came to deliver, you did not bring any clothes for the baby. This year you did not bring baby clothes again! Please respect my work area as I respect your own.
The frustrated Kenyan doctor…
November 20th 2011