Our wrong choices have left us contending with leaders who steal money meant for medical supplies.
This past weekend, doctors and nurses in public hospitals began sharing their experiences online. The stories were consistent across counties: shortages, delays, improvisation, and, in some cases, avoidable deaths.
As I went through those accounts, one thing stood out clearly: we have become used to hearing that billions of shillings are lost yet rarely stop to understand what that actually means in practice.
A doctor is on call somewhere in a Level 4, Level 5 or Level 6 hospital. The call comes through: arrested labour, and therefore an emergency caesarean section is required. There are no sutures or the sterilisation unit has not been working because the sluice broke down days ago or electricity has not been paid.
As time stretches, the baby’s heart rate drops, and the mother has laboured to exhaustion. A clinician decides that the mother is better off at the national hospital. The ambulance has no fuel, and the relatives are asked to fuel it.
In another hospital, in the labour ward, other mothers are being monitored. But there are no gloves. One pair is used, then washed, then used again. The clinicians must, at the required time, carry out examinations to assess how far dilation has occurred.
This is important for charting the partograph (a graphical record used by clinicians to monitor the progress of labour). Because of the scarcity of gloves, reusing gloves on the same patient is not uncommon. However, the clinician knows there is a risk of infection, which can complicate the post labour period, but their hands are tied.
In yet another hospital, a mother who delivered via C-section is wheeled out of the theatre and made to share a bed with another patient. This is yet another risk for the spread of infection, but again, the clinician’s hands are tied. The pain medication that would be appropriate is out of stock, so either the relatives buy it from nearby pharmacies or the patient makes do with what is available in the hospital.
In the newborn unit, a doctor diagnoses jaundice, that is, yellowing of the eyes and skin. The clinician knows well that phototherapy and treatment of infection can reduce bilirubin levels, which can lead to a condition called kernicterus.
Kernicterus is a form of brain damage that occurs when excess bilirubin deposits in the brain, leading to long-term neurological deficits such as hearing loss, difficulty with movement, abnormal muscle tone, and in severe cases, lifelong disability. The phototherapy machine stopped working months ago and the bulb has not been replaced. That child develops kernicterus.
In paediatrics, another clinician is on call. A child is brought in with severe pneumonia. The oxygen saturation is dropping. The clinician prescribes intravenous antibiotics, fluids, and oxygen, specifically high flow oxygen, which requires appropriate delivery systems such as masks or high flow devices. The nurse informs the doctor that only nasal prongs (tubes fitted into a patient’s nostrils to deliver supplemental oxygen) are available, which cannot deliver the level of oxygen required in severe cases. They decide to refer the child. The team assumes the ambulance is equipped, but it is not. There is no oxygen cylinder, no ambu bag (an artificial manual breathing unit). Staff explain that it has been like that for months. The child dies on the way.
Another child comes in, severely dehydrated from diarrhoea. Intravenous access cannot be established because the veins have collapsed. The clinician considers an intraosseous line, a method of delivering fluids directly into the bone in emergencies but there is no intraosseous needle. Some clinicians have never seen one, never used one, and have never had the opportunity to learn. The clinician is left knowing what would work, but having nothing to make it work.
In the medical ward, there is only one manual blood pressure machine because the automatic one does not have batteries. The clinician buys batteries for the BP machine. A diabetic patient needs their fasting and random blood sugar measured regularly, but the nurse tells the doctor that the glucometer strips have not been replaced since the last procurement. The clinician makes a quiet note that healthcare in Kenya is sustained by prayer and our ancestors.
In oncology units, masks are reused, out of necessity. Clinicians are required to wear protective gowns because of the toxicity of the drugs, but due to shortages, they end up reusing them. This poses a risk to cancer patients, who often have low immunity and can easily contract hospital acquired infections. It also places clinicians at risk, as they are repeatedly exposed without adequate protection. This is how both patient safety and provider safety are compromised in the same space.
There are also kidney patients who require dialysis and regular monitoring. The laboratory reports that there are no reagents, and the patients need to be referred to another lab.
Our voter apathy has led to the wrong people being voted into Parliament and the Senate. Our wrong choices have left us contending with leaders who steal money meant for medical supplies.
The question, therefore, is what can we do? Get a voter’s card, and vote right.
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Dr Bosire is a medical doctor and lawyer. [email protected]
