Today, I would share some of my personal thoughts on the state of our health sector in the country and relate to some of my personal experiences both in-country and abroad. I say it’s critical that we as a country think about a better design for our health systems. When COVID started, we had time to prepare for any surges but it hurts when a year later we see reports of misuse of funds, lack of oxygen supply. In my own opinion, the current health system is not people-centered but money-centered. I look around now and every child on the street who can do basic math skills has been sent to sell masks and sanitizers, it is wrong when we see business opportunities on people’s health. My county Kakamega has now reported that the referral facility is full with patience hence the new admissions are directed to Mumias level 4 hospital. As much as some of you will say that it’s the surge in cases but I will still insist that it is the poor planning and approach to health care.
I say this because, in 2019, my daughter had a heart condition (Truncus Arteriosus) that needed corrective open-heart surgery. It took us 6 months from birth to discover she had the condition, thanks to her Pediatric Cardiologist Mrs. Myra Koech. Our Journey was not easy, with frequent cases of lack of oxygen in the hospitals we visited in the country, I remember in the county referral hospital Jolene had to share oxygen with two other patients, so lack of oxygen supply is not a new issue to me, it was expected. Corona is just here to expose the rot in the systems and as I said in my previous articles, God will take this cup of suffering away once He is satisfied that our health system has been improved by the government.
The current healthcare in Kenya is not designed to keep people healthy, it is designed to respond to diseases, as a country we are more into rapid response rather than avoidance. That is why the people tasked with the mandate to make health better are forming partnerships and opening hospitals to offer services that they could offer through those public facilities. We all understand that if you see your doctor in his/her private facility, they will take more time with you, they will provide better services than when you visit them in a public facility. COVID came and we started working on our facilities rather than working on the people, in most of the health Ministry’s statements, they were profiling counties in terms of the facility set up to handle the surge of cases based on trends from other countries. The talk was largely costs of medication, cost of the tests, and how we can ensure most of the people intending to reopen their businesses to be tested.
The idea that most COVID positive cases should be in hospital facilities is proving difficult at the moment since service delivery is an issue. Yes, for COVID cases it’s a challenge but can we then look at the many non-Covid cases. Most private hospitals see admissions as cash-cows, such that they can decide to admit you with mild malaria symptoms just to earn from NHIF or other medical insurance claims. We took Jolene to India and I must say that there is a very big difference in how health is handled between the two countries. For a delicate surgery that I thought would keep us in hospital for weeks, it kept us in hospital for 8 days max, in fact, the 8th day was due to the fact that I had not cleared the bill and we had to be kept in longer. In my brief chat with Dr. Nidhi Rawal, US-trained Expert in Pediatric Gastroenterology at Artemis hospital in Gurgaon India, she was categorical that they only admit if that is the only option. In our case, we were admitted the same day we landed in the country, and the surgery was the following day since it was critical. My daughter underwent a 9-hour surgery, was in ICU for 6 days and was discharged from the hospital after the 7th day. We were however expected to return back for regular check-ups after every 7 days after discharge till the month ended.
The most important part of this health care design is patient management. According to Dr. Nidhi, this is a critical part a caregiver should be keen to avoid longer stay in hospitals. She and her team took us through how to give care, clean, and change the wound to avoid infections that might make us return to the ward. In her own words, “we will empower you to own your daughter’s recovery process”. We were later given a thermometer, pulse oximeter, and other basic medical equipments which to them should be in every household. Their systems unlike Kenya’s is not built to wait for people, it’s built to reach out to people, that’s the difference. It’s now 2 years after our visit, I am still invited to zoom sessions to learn new management skills. The hospital wards are designed to handle critical patients, most of those who visit the facilities are outpatient as the hospitals see no need for admissions unless justification is given. Focusing on people will mean that, they are empowered to handle some cases from home, they will spend less time in hospitals and discharge will be after fewer days. This in turn will lead to less infrastructure than it is currently. The secret to them is empowering people to deal with mild health issues from home.
It’s about time as a country we think HEALTH and build an integrated people-centered system where HEALTHCARE is only a part of it not the ONLY part! We can empower our people with knowledge of basic things. For our healthcare practitioners, we need to invest more in them. I later came to learn that in India,10% of the specialists in the hospitals are from African counties and would not wish to return back home for there are no support systems by their government. A person’s work environment will impact how they work hence there is a need to improve basic requirements at our public hospitals. Advancing our medical practitioners’ skills should also be amongst the government support framework. At least a health care fund for doctors who would want to learn more would be ideal. It still hurts that we have bigger hospitals, superior equipment’s but our medical practitioners have less knowledge to handle some of the complications that report to these facilities.
We are still far in the woods but Food for thought!