OVER-COMMERCIALIZATION OF HEALTH CARE THE SCOURGE OF OUR TIME
From the advent of the 8–4–4 education system, each and every year Kenya has developed a tradition of lionizing and proffering a copious outpouring of publicity upon the best performers in the K.C.P.E and K.C.S.E examinations. For the former prepubescent teenagers and for the latter young men and women are hauled shoulder-high by their definitely well- fed progenitors in pomp and pageantry for exemplary performance. Drum-beats and ululations rend the air in a manner likely to dissuade any inebriated villager who is not in the loop of the foregoing from the impression that celebrations are not in any doubt a foot. If you are one of these unfortunate characters sleeping in the culvert, you could be forgiven for thinking in the polemics of the great African linguistic legionary and wordsmith; Chinua Achebe, “a great titan and wrestling champion of all the seven villages has crossed the seven rivers, hills and the evil forest, gone to the land of the gods, conquered them including his personal Chi and returned unscathed with a tooth of one of deities; his spirit intact.” Back to the celebrations, of course members of the fourth estate and bloggers like yours truly are in attendance with high powered cameras, notepads, pens, outside broadcast equipment and all the requisite paraphernalia of the trade to cover this seemingly inimitable fete. For the primary school graduands, each and every one of the omni-potent students has more or less similar ambition. They seem cut from the same cloth. “I aspire to be a Doctor.” Another, “I feel the predilection to be a Neurosurgeon.” Why we still have only 8 neurosurgeons countrywide after nearly 30 years of the 8–4–4 is a matter I will leave to conjecture! But why is it so attractive to be a medic in Kenya? That is the question I am going to tackle in the subsequent paragraphs of this post.
Many will accuse me of being green with envy for the practitioners of the noble profession. Far from it! All the same, I must aver with unquestionable conviction and unerring contrition that I have never had any aspirations to be a doctor and as such I habour nothing but awe, appreciation and adoration for the practitioners of this trade. For me a spattering of blooded cotton wool is sufficient cause for institutionalization for trauma let alone witnessing a squirting of the life-sustaining body fluid from a severed limb! You may have realized I used the word ‘trade’ instead of ‘calling’ as it should be. It is not a misnomer but a pointer to the great value that should be accorded to the medical profession but is not. As a player in this field, you are no less second to only the Almighty in the words of the saying, ‘Doctors treat but God heals.’ You carry our lives in your hands at the moment we are most vulnerable and have the propensity to either nurse us back to health or at the drop of the surgical cap consign us to the morgue and ultimately the 6 Sq. Ft confines of the nether real-estate! This is vital more so in a developing nation where human capital is the principal factor of production and progression of enterprise. We need men and women in good health to drive the often poorly-lubricated cogs of our economic gear. However in Kenya, mostly in private hospitals this is treated as more of a trade than a calling which is objectionable.
Let me go through the chronology of qualifying as a doctor in Kenya. As stated before you have to be one of the bright intellectual outliers of your generation able to score an ‘A’ in Mathematics, the two national Languages, the three sciences and almost any other course you will take to hold up your aggregate mean. Then you are admitted to a registered and chartered University to slug it out for 6 years through courses like Physiology, Anatomy, Pathology and Parasitology. (There are others intentionally omitted with a view to provide you an abridged insight instead of an encyclopaedia for a blog!) In short you have to be adroit at internal medicine and what the French call ‘Chirurgie’ — Surgery to make it through. Afterwards, you graduate with a Bachelor of Medicine and Surgery Degree (MB. ChB). During your graduation ceremony, there is a session specifically to recite and promise to ascribe to the ‘Hippocratic Oath’ for the preservation of Human life no matter the myriad distractions that may attempt to lay an incursion on your path. This is just the preliminary stage! You then must serve a compulsory residency as an Intern under consultants for a period not less than a year. Following that, one works as a General Practitioner (GP) for some time, gauging their strengths, weaknesses, passion, opportunities and threats before deciding to master and specialize in one of the fields he best desires or is apt in performing. Then, one may decide to go for a sub-specialization on the field. Afterwards, you take an exam to ascertain your suitability to serve under the ambit of your professional licensing body, the Kenya Medical Practitioners & Dentists Board. This entire process may take as long as 12–14 years from the time one is admitted to University to when you are finally licensed to do all that pertains to nursing humanity back to health.
Noble as it may seem, there are others who will look at the period they spent in school as one of lost opportunity for the age-old ‘primitive accumulation of wealth’. They will cast their eyes far and wide and espy the jet-set lawyers, the Engineering braggadocios, the architectural aficionados, pilots and commerce practitioners seemingly reveling in corpulence and vain symbols of status. Riding in Toyota V8s or Range rovers, they will suffer the ignominy of seeing beside their contemporaries a beautiful bride; two healthy and rambunctious children admitted to the local versions of Ivy-league schools, pilots traversing the world enjoying life while getting paid by the truck-load. Their age-mates own land, real-estate, businesses and property almost to the moon! They find themselves muttering under their own breath, the quintessential Jomo-Kenyatta query, “woe is me, what have I done for myself by the ripe old age of 33?”
Apprehension sets in as Medical Practitioners are caught scrambling to catch-up with their peers. They rent a backstreet alley; lo and behold, the Private practice has been set up. To remove any untoward elements from this narration for any aspiring doctor, it is never always like this; however, This is Kenya! (https://www.youtube.com/watch?v=lug6cupwmIw ) and (https://www.youtube.com/watch?v=T7uzheM1nGk ) Warning: I pay credence to the gifted owners of all copyright to the material ensconced within the two URLs above.
Men and women; supposedly the custodians of our public health care systems, find themselves juggling the conundrum that is their calling in Public hospitals vis-à-vis commercial interests. Some even go the extra mile of burning the midnight oil as lecturers. Sooner rather than later also due to economic pressure, commerce triumphs over calling as one realizes that he will mint more money apportioning extra time to his Private clinic as opposed to the well documented and predictably meagre pickings that is the government salary. The hustle is real out here and many are oft vulnerable to break-down under its weight and find themselves in the hallowed waiting room of these private facilities. For salaried and unionizable employees the allure of the fully-catered for medical insurance package is too coercive for a private medical practitioner to resist. Cases of men who bumped their head on the low-lying canopy of a ‘ma-three’, got a gargantuan bruise which had them worried sick so they ran to their ‘family-doctor’ to have a check, had CT and MRI scans recommended to them on top of the consultancy fees, were misdiagnosed with brain damage and had to be wheeled into surgery have not been few and far between. Besides, how callous can one get to recommend unnecessary treatment merely for pecuniary gain! Who does that?
Costs for all medical consumables like bandages, scalpels, splints, band-aids and the requisite medicine are hiked ostensibly to take advantage of that much touted item of good fortune, the NHIF. A deworming tablet sold over the counter at 20–30/- is now extrapolated to the irreverent figure of 150/- . All this in an effort to make hay while the sun-shines! In the week starting Monday 26th November 2018, the social media platform — Twitter was awash with a trending hash tag #JusticeForBentaOpande .
This as told in the grapevine is the harrowing tale of a lady who had incessant back pain that was rife on her to the extent of seeking medical redress. She casually drove herself to hospital, had the requisite tests and scans performed on her including the precursory X-ray just to determine where the problem was. Things were not looking good. She had slipped albeit weakened lumbar vertebrae that required firming and strengthening. After a studious look of the results a neurosurgeon ostensibly recommended the only course of treatment as surgery. To the untrained eye this may or may not be an over-kill. I chose to believe it was all for the best. In an episode as tear-jerking as any, on the appointed day the Civil servant drove herself and her two young daughters to hospital.
As they held vigil for her praying and hoping, she was wheeled into surgery. In the ensuing macabre occurrence that has blurred the frontier between surgery and the handiwork of a butcher man the procedure was botched. A mish-mash of Screws, washers, nuts and bolts were all fastened on her spine callously disdaining her animate state.
The aftermath is all too gruesome to relate but I will try. The pain was amplified and as if this was not enough she started losing sensation on her right-side. Her right leg absolutely paralyzed if not utterly atrophied. Her distraught daughters could not stomach their grief when they were finally allowed to see their mother. Tears streamed down their faces as they surveyed the current convalescent state of dear mum.
For the daughters it was familial concern and empathy while for Mama Opande it was mortal pain and infernal agony. To add insult to injury this exclusive private hospital also withheld her title deed as collateral if she failed to clear the bill! She had to be flown to India for more specialized care. The question I must now pose is this: Was this surgery really required any more than advise on posture, back pillows, proper comportment and popping of calcium tablets that can be opined by an ordinary chiropractor? In the backdrop of the new X-ray footage obtained, was the screw-up job performed by experienced orthopaedic surgeons, interns or a run-of-the-mill wielder of the proverbial meat cleaver?
Could this be categorized as a case of medical negligence? Let the professionals at Kenya Medical Alliance in concert with Dr. Oluga and the Dr. Orokos of this world at KMPDU determine the case instead of opinionated albeit ardent Viu-Sasa medical-drama junkies like yours truly on the court of mere hearsay!
I would wish this case was an isolated one but not in the least I have one that hit close to home. In late 2009 my father was involved in a road accident that wrote off his vehicle and saw him fracturing a right humerus. He was more fortuitous than most escaping the ordeal with a slap-on-the-wrist style bruised thigh, clavicle and the aforementioned vertebral tid-bit. Grinning and singing the token, “Hakuna Mungu kama wewe…”(There is no God like you) number he was wheeled into theatre to fix the crocked appendage. He stirred up in some agony but this was to be expected of any surgery. After one and a half weeks he was discharged back to his solicitous kinsmen for some tender loving care. Then after a week instead of the pain abating it ingrained itself. Sleep became a luxury and analgesics became anything more than candy. He was compelled to return to the same private hospital. Prima-facie; the joint looked to be healing, but on close quarters it was clear the titanium plate had not been well secured. Screws had been drilled into the bone but the plate was still mobile and as such a second instance of surgery was required. After surgery #2, problems persisted and a secondary opinion was sought. Incidentally, after the third surgery dad was fixed although he had to suffer the ignominy of learning how to write with the left-hand in middle-age. On aesthetics; post third surgery, the clean-cut incisions of the first surgery were blurred such that his arm looked like tapestry out of a dog’s mouth! This raises another red-flag. Can a GP or let’s say gynaecologist perform orthopaedic surgery with the finesse of an experienced specialist? My Dad is living proof they should not, though he regained functional use of the limb in 9 months’ time. Heavy lifting is proscribed though we proffer orison to the Lord daily for that act of divine providence. But how many Kenyans can count on such in the absence of financial muscle and the uncanny happenstance of finding the right remedy? A drunk and bluntly honest sage once quipped, “The missteps of an engineer are fortified but those of a doctor are buried!” (https://twitter.com/dennis_mukoya/status/1067365514526277632 ) It’s that stark.
In a latter post, I will divulge the 1001 demerits of allowing Health care in Kenya to be a devolved function! That was an ill-advised policy step, megalomaniacal at worst and pandering to popular benightedness at best. Yes, I said it! But today I will delve into characters of the ilk of Mugo wa Wairimu who has gained notoriety by tapping into the gravy train that is Private Medical practice in Kenya. With absolute disregard to any form of licensing, respect for neither the sacrosanctity of human life nor limb, answering to no higher call of the Hippocratic Oath and with stereotypical love for the lucre; he set up shop in Githurai 44, Nairobi. No one would have realized the aberration in this circumstance if the monster within had remained bottled up. Operating a gynaecological practice is not for the faint-hearted and when I say this I mean it with all the fallibilities and perversion that may come with it for the sons of Adam. As men we are physiologically predisposed to be attracted and display manic affection for the most favoured mate. Years of scholarly pursuit logged in the pedagogical development of Medical learning, eon of wisdom thereby inculcated and a new-found appreciation for professionalism are supposed to tame the animal instinct in a man! A Doctor is duty-bound to abide by a higher sense of ideal and morality than the ordinary man but not the aforementioned -wa Wairimu. On the 1st of November 2014, a young woman sauntered into his clinic coaxing within him a fire of the manner he was ill-accustomed to resist. Like a hyena; the faux-medic sized up his prey, the unsuspecting victim eloquently describing her symptoms in abeyance. In the back of his mind he already had a prognosis. A dose of ‘sugarcane’ would do! He sedated the damsel, had her half-dead, licked his lips, pulled down his trousers exposing an appendage that looked like a half-consumed piece of firewood and in typical sociopath-narcissistic fashion proceeded to hit pile-drivers into the woman if you get my drift. The ensuing fiasco is all too graphic for the church-boy in me to countenance! When the lady came back to her senses she had not been treated of her ailment, reeked of the pungent odour of ‘human-seed’ and was absolutely slovenly in dress. What she did not know was that a heinous crime had been perpetrated against her person and she carried within her an impromptu zygote. You all know how it went when the lady discovered this and pressed charges. Lady Justice was hot on his trail. From Makuyu, to Thika and finally to Gachie where the long arm of the law caught up with Mugo. He was nevertheless, in stupefying fashion let go with nothing more than a whimper as retribution and continued his illicit medical practice. In late 2018, the same character has hit the headlines yet again for similar shenanigans! Apparently, the Kenya Medical Practitioners and Dentists Board does not have anyone fitting his profile in their records and as such have no jurisdiction to take any action on him, the allegations and his illegitimate economic venture notwithstanding. What??? Also the limitations of statutes may have lapsed and the legal arm has been decapitated against this predator. Double what?? A case of moving rivers to escape the riparian reserve!
What makes private medical facilities so attractive to everyone? The crucial stricture here is having a doctor who takes seriously to the professional code of ethics, viewing his gift as a calling and not merely a trade. The well-oiled establishments they man have a 24-hr fully functional medical team, an in-patient and out-patient unit, fully furnished medical supplies repositories, well remunerated and fervent staff, a sufficient number of well-spaced beds, no linen reeking of urea, private suites for the contagious, presidential suites for VVIPs, clean hospital wards, a well-articulated and thought out strategy for the assimilation of health insurance, fully-furnished & serviceable ambulances, an onsite morgue and milky-white walls with attractive signage. Accountability is the common denominator. The most important thing is client referrals from those who have enjoyed the ambience of the same and have lived to tell the tale after visiting the facility. Keeping mortality rate low is an added advantage. I reiterate and urge the current Health cabinet secretary to implement a framework that will have Health reclaiming its lustre as a calling and not a cash-cow for the uninitiated yet moneyed investor.