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Access to health seen through our neglected elderly

CHRONIC DISEASES Health Policy

Access to health seen through our neglected elderly

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Access to health seen through our neglected elderly

She struggled to walk through the door. I could tell she had had a stroke, perhaps repeatedly. Her right leg had been paralyzed so that her weight shifted precariously from her left leg to the walking cane. The act of walking seemed painful, each time the cane hitting the floor hard, struggling to stay put as she worked to reposition herself for the step forward. It’s as gut-wrenching as first impressions can be. Such a stroke would affect her ability to talk, and I expected there would be someone accompanying her.
But she was alone. I rose to help her sit down, expecting that would be an exhausting and potentially hazardous activity. Then I greeted her, testing, hoping she could talk.
She could, though she didn’t seem eager to do so. Depression nearly always accompanies a stroke in anyone, and an elderly lady seemingly alone in this world was sure to be severely affected. She held out a paper where her vitals had been recorded. Her blood pressure was well above 200! I was horrified. Such is dangerous for anyone, but for one who had already suffered a stroke, it was simply, well, deathly. Such high levels usually indicate non-adherence to medication, not infrequently because one cannot afford. That seemed to be the likely scenario here.
“Did you take your medication in the morning?” I asked. The answer wasn’t coming as fast as I wanted it. I reminded myself to be calm; for while I knew the dangers from a medical perspective, I had to understand that social and economic circumstances were the root of the matter.
“No. Today I did not.” Even she didn’t seem convinced about the ‘today’ part.
“Only today?” I asked. She was silent again. I reminded her how dangerously high her blood pressure readings were, that I suspected she hadn’t been taking medicines for a while and that, that another stroke was imminent and it would likely be fatal.
“I didn’t have money to buy medicines.” She said. I felt guilty that I had pushed her too hard. Didn’t I already know that would be the answer?
Her medical file was voluminous. I could tell she had had a protracted battle with chronic diseases, had had multiple hospital admissions, and had missed her last three follow-up appointments. I realized there was no benefit in interrogating her; the reason for her worsening health was beyond doubt.
This was a classic case of living dangerously at the intersection of abject poverty and non-communicable diseases; the former dictating everything about the latter, the latter pushing one deeper into the abyss of the former.
In many conferences and workshops I had attended, the increase in non-communicable diseases was discussed with an academic detachment which every successive patient I saw made me see as callousness. Now here with me was an elderly lady living this tragedy, the personification of what seemed a purely academic subject, one which was merely mentioned, for there seemed as if no policy had been made to shield those living with chronic diseases and too poor to afford the medication they need to remain alive. She was one of many, many I had seen in this very clinic.
This was an emergency. I had to leave everything else to expedite the lowering of her blood pressure. But that meant I had to leave the clinic and rush her to the A&E to start an intravenous infusion of antihypertensive medication. It was already afternoon. Tens of patients were still waiting on the queue, understandably impatient, for most had arrived at dawn from far and wide for their quarterly appointment. How could a doctor walk out on them? But then again, how couldn’t I?
As she was receiving the medication, I discussed her case with the social worker, insisting he write a letter to waive her hospital fees and the cost of medication for three months. He took it seriously too but had to deal with the resistance of the system. Not for the first time, I had to deal with the fact that not even in our public hospitals could Kenya’s impoverished tax-payers find respite from all the forces working against their lives. I had chosen to intern in this hospital both to learn to be a doctor as well as witness what it means to be poor, to be elderly (this region has the highest life-expectancy in the country), and ill. I wasn’t merely a witness, but an active participant in life’s tragic drama. I had found that you could be poor (what choice had most people?), you could grow old (thank your genes) but to be sick was a bad mistake.
The system is rigged against the citizen. During your productive years, it siphons everything through taxes – income, VAT, et cetera – and all manner of levies. You retire into misery. As diseases come one after the other, you encounter a healthcare system that still wants to feed off your ailing self through unreasonable hospital charges and high cost of medicines. Medicines you now need just as much as oxygen and more than water! This was the healthcare system I had joined. This was a nation most ungrateful, an economy that knows only to take and take and never give back.
To witness the suffering of the elderly cannot be encouraging to a young entrant into the nation’s workforce, or can it?
When her blood pressure was lowered to a safe level, and her condition was stable, I took the social worker to see her. It was then she revealed that she lived alone, had only one grown son who had disappeared years ago, that she survived her circumstances through well-wishers, mostly churches, that everyone was getting exhausted with it.
That was bound to move even the least sensitive of us. Thankfully, the hospital agreed to give her medication for two months and waive the other fees. As I handed her the medicines, she propped herself on my shoulder and broke down!
True, personal kindness was a rare encounter to her. Could there be a worse indictment on the society to which I belong?
I booked her next clinic to just one month so she would have her prescription refilled, hopefully. But before that could happen, the doctors downed their tools, all operations in public hospitals ground to a halt.
I was sad for her. Sad for everyone like her who wallowed in poverty and was unfortunate enough to have a chronic illness. She was a Wanjiku—a species capable of surviving the appropriation of its sweat and blood to feed a developing economy which is unwilling to give back in social services. I was sad for all those who depended on us (the professionals and the system) but were consistently let down. Let down not in merely getting disappointed, but in having their lives callously used in the tussling of those in high society. For months as the rest of us brawled, hundreds of thousands of patients with chronic conditions—from infectious ones like HIV and TB to the non-communicable like hypertension and diabetes and others—risked serious complications and death as they missed follow-up reviews and went without medications as public pharmacies were closed and they could not afford the inflated prices in private chemists. (For some medicines like for HIV and TB, only the government supplies through pharmacies in public hospitals).
If that is how we regard the lives of fellow humans, as a society, we are an unfolding disaster. What is yet to happen is the catastrophic fragmentation of what little shreds of social sensibility remain. They can’t hold for long.
As in other matters of health and healthcare, access to medicines is primarily an issue of moral and social responsibility. Our healthcare is set as if only economics matter. The pinnacle of the health ministry is populated by economists and accountants and a random sampling of bureaucratic paper pushers with a smattering understanding of the dynamics of health. They set the healthcare policies as if only economics matter, as if human life is of little consequence. This ministry is historically the most neglected (though others have a right to claim this position), least funded and loosely regulated.
Most of all, medicines, which are the medium of treatment and the currency of healthcare operations, are ever in short supply. No one can ever be sure of the quality. A good sign of the government’s impotence in supply and regulation is the proliferation of chemists on every street of every little town and marketplace.
It may be understandable that a developing economy struggling to finance infrastructural development, defense and other such national priorities cannot pay for complex healthcare needs. But such argumentation stands only in a society so degenerate that life is no more than an economic priority. All my articles on this platform derive from real-life stories of people, flesh-and-blood human beings, because only in rediscovering the humanistic ideals of healthcare can we outgrow our dependence on health policies which are far removed from the lived realities of those whose lives they pretend to target.
There may be arguments of things done to Wanjiku, or justifications for why some cannot be done. There may be explanations for why we cannot solve the suffering of everyone; of some Wanjiku living under a tree in some obscure village. Yet society is society because the one is all and all is one. They all should feel the pain of the one, just as each one bears the burden of all in our contribution through work, taxes et cetera. Improving all facets of healthcare, from access to medicines to addressing the evils that ail the healthcare system as a whole—those which cause repeated strikes and an ever-demoralized workforce—isn’t just about those particular issues or just a particular ministry. It is about saving the very soul of our society. Few things can be as representative of a grateful nation than being cared for when you are aged and no longer productive.
For Wanjiku, the probability is that she is still alive, defying the odds just as she had years before our encounter. The certainty is that life for the rest of us goes on, be she alive or not. Am not suggesting the world should stop when one of us suffers or dies, but the fact that those things don’t matter sounds tragic to me. Wanjiku is her singular self, but she is also the rest of us; millions of us who work all our lives and pay taxes and then find ourselves sailing through the sunset years in neglect; cold, isolated, watching the lights go out of our lives, painfully aware that no one will notice when it’s finally dark. Her circumstances are a representation of the dark side of a nation working hard on economic development while hurtling toward social doom. Her fate may be your fate, my fate, the fate of us as a collective.
This may sound like the moral assessment of a naïve, juvenile mind. On that charge, I am guilty. Yet mine isn’t a judgment but rather the highlighting of a matter I believe ought to be important, to be considered as beyond a mere economic priority.
Access to medicines in Kenya is a nightmare; everyone seems to be able to set their own prices and some stock drugs of questionable quality. Part of the proliferation of chemists and clinics on every street and dark alley has to do with virtual lack of regulation or inability of regulatory authorities to keep pace with an industry driven by a growing population and especially by the desperation of millions who find themselves having only two options: death or financial ruin. Usually, the latter comes first followed quickly by the former.

 

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