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Health Policy

Of Kenya’s “Extremely Overcrowded and grim” Hospitals

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Of Kenya’s “Extremely Overcrowded and grim” Hospitals
Story Highlights

  • Hospital overcrowding is a defining feature of Kenya’s healthcare system. For most Kenyans, it’s impossible to imagine an experience more debasing than what they endure in their hospitals wards.

  • Instead of improving this essential social service, our permissive society allows this delicate sector to be the playground for the cut-throats of commerce. We may, as a country, encourage this at the begining, but it will not be in our power to change anything when things go too far.

We define life based on some natural certainties; the sun, taxes, death. But there is a much more compelling force that defines the human narrative, providing the context within which everything else is experience.
Illness.
It is a fact of life. It is an implicit quality of being human. It doesn’t just come and go. It is a constant in life’s unfolding narrative. It is not just a part of life’s journey, but in many ways, the journey itself. It hovers over birth, it is is the cause of death, and predominates everything in between. That word, illness, summarizes the innate flaws of the human body. It speaks of its susceptibility to external forces, like bugs or poison, or radiation. This affects us often, and even if they didn’t, our bodies are bound to break down from within.
This is why we have a health care system. We must develop a system to address illness. We must have it ready, well-equipped, and focused on nothing but the restoration of what illness takes away from us. The vulnerabilities of the human form and the tendency for us, humans, to exploit these flaws is the foundation of all the ethical, regulatory, and human rights charters created to safeguard the primacy of life and human dignity in health care provision.
Service to humanity has always been the guiding principle in all aspects of health care. Everything else is meant to be secondary. Yet increasing evidence shows that this ideal has been lost. The driving force is now profit-more and more of it. 
For a young doctor still holding on to the Hippocratic ideal, this is a saddening development. It has to be deeply troubling watching an essential social service and a fundamental human right being taken over by the cut-throats of commerce. And this take-over is celebrated in some of the most influential publications in the world.
Take the instance of one article I read as a medical intern in one of the busiest county referral hospital. It helps to state that “busiest”, in this context, implies long, endless queues in outpatient, overcrowded wards with patients sharing beds, an empty pharmacy, and an overwhelmed health workforce. To work there means to witness health care at its worse, and, worst of all, to participate in the shameless pretense that this futile exercise constitutes health care provision. And as I ponder this sad reality, I come across something that indicates we aren’t looking to improve health care as a social service but are giving it up to commercial interests-the most callously profit-oriented of them. 
I read it during a break on a brutal night shift. I was sitting in the on-call room waiting for an emergency call, sipping hot, toxic coffee, trying not to look at the bed. I couldn’t read medical stuff; my brain couldn’t take any more. I decided to check for news on the New York Times online. I came upon an article published that day about “Transplanting private healthcare in Africa”. Now, that was bound to draw my attention.
In it, Kenya was praised for being a lucrative healthcare market.
The main afflictions are malaria, meningitis and road accidents,…there is the rapid rise of unfamiliar ailments—diabetes, heart disease, and obesity.[1]
Now, someone from far away understood the reality I witness daily. Someone was writing about it, in the most prestigious newspaper in the world. But why I tried to understand. I reread the article and found the reason.
You could squeeze another 50 beds in here, easy. That will really improve profits.”1
I was astounded.
My erstwhile worn-out, wandering mind focused. My red, sore eyes could read again, even read between the lines in the terrible lighting.
The coffee went cold, the pull to the bed weakened, sleep disappeared, the emergency call never came. I read it over and over, pondering every word, digesting every fact, deciphering its implications. The places mentioned were familiar, the facts indisputable, the truth repulsive.
“Government-run hospitals offer cheap or even free care, but they can be extremely overcrowded and grim.”1
Now, that was too real.
I was reading this article within one of those “extremely overcrowded and grim hospitals”. That much was a fact I experienced daily. What wasn’t a fact was “the cheap, free care” point. I would have been glad to find a place with that. Here, patients were in “extremely overcrowded and grim wards”, sharing beds, sleeping on the floor, waiting for months to get a surgical operation, wasting away in a slow, painful death. And they had to pay for it. In the end, be they dead or barely alive, they couldn’t leave until they paid bills. Bills they could never afford. Relatives whose loved one had died after an extended stay in the grim wards and incurred huge bills came to me crying, pained by the death, overcome by the bitterness of the reality they had been dealt, weighed by their poverty. Patients were held hostage in the wards until they could pay bills, bodies were held in the mortuaries as families called for fundraisers to pay the bills.
And all this, in a public hospital. I had struggled with the meaning of this since entering this hospital.
Now I understood.
I saw suffering and degradation. Someone from the east saw an opportunity for profits. Such an incredible opportunity that he was thrilled enough to send the story to the most famous paper in the world.
In a country with innumerable problems and an obsession for imported solutions, a reporter in New York exported the meaning I sought. He had ‘transplanted’ into me the meaning I struggled with daily.
I thanked him for it.
I began to wonder about the basis of the “overcrowding and grimness” that defined our healthcare. Everything has a basis. Everything can be broken down to the smallest element. So is healthcare.
The Kenyan healthcare system is a 55-year-old super complex, multilayered giant with problems seemingly impossible for the 47 million of us to fathom, let alone solve. It is an incredibly complicated and expansive maze no one seems able to get around. The management is a nightmare; the workforce is inadequate, and on the run to greener pastures, the hospitals are few and “extremely overcrowded and grim”, large areas and millions of people are devoid of basic healthcare, medicines remain expensive and inaccessible to most, efforts by different stakeholders are fragmentary and result in little solid utility.
From the view of this article, one element stood out. It stood tall, announcing its significance, shouting its importance in the grand scheme of an “extremely overcrowded and grim” healthcare system. I had found a name for it.
The profit motive.
We are not afraid to cash in on the suffering of fellow humankind. We worship profit with such bravado that people from the east had discovered and wanted to join our religion, to tap the endless flow of tithes from suffering, dying population. They, the converts from the east, had found it so amazing that they sent the report of their finding all the way to the distant west where it found a perch so conspicuous, even a worn out intern with sore eyes in the middle of the night couldn’t miss it.
Back home, the priests of the profit god were at the altar, standing tall, beseeching the “crowd” of “grim” Kenyans to give more tithe. And Kenyans are paying up. We always do, poor us. 
Money paid by poor sick people in the name of cost-sharing quickly disappears. Big money from the ministry vanishes. The money pooled by poor, hardworking Kenyans to the hospital insurance fund is gnawed at. A doctor employed to work at the public hospital prefers to cash in at a private clinic. A nurse sets up a clinic and charges poor people while giving them pain killers and cough syrup for any and all illnesses. Someone sets up a big private hospital and demands huge fees, even deposits before ICU admissions for critical, dying patients. From the proceeds, a person buys big cars and rides in them without a care in the world. Another, or the same one, buys a big house, and walks in its expansive rooms, wonders at its high ceiling, and enjoys its wonderful view without scruples. We know it’s happening. We hear about it and read about it. And still, we go to bed and sleep at night. We sleep soundly, dreaming big and scheming more. The poor be damned
As we try to survive, to free ourselves the wrath of the god of profit, we worsen our circumstances. Running from the “extremely overcrowded and grim” hospitals, we land into the private hospitals built not to treat, but to profit. Frustrated by the hospital insurance fund, we pay private insurance that will never pay up. Running out of money, we resort to magicians and herbalists. Even then, we cannot escape overcrowding, exploitation, and death. We soon find ourselves “extremely overcrowded and grim” in Loliondo, drawn by the promise of some magician that can heal all sicknesses. The journey is long and dreary, the wait worse than in the hospitals, the concoction expensive and as bitter as it is useless. We drink it. We die soon after; in pain and penniless, the final, nasty end. 
For us, poor Kenyans reduced to “extremely overcrowded and grim” circumstances, there is no respite. Wherever we go, whatever we resort to, we profit someone, and then we die; sometimes quickly, most often slowly, but always painfully-robbed both of our money and dignity. 
I had entered the system just as innocently as interns do. I had visions of saving humanity from its maladies. I had not allowed the warnings of older, jaded doctors to contaminate me. Now, as the sun rose from the east (where profiteers came from) to lighten and warm the patients in “extremely crowded and grim” wards, as I prepared to go to those wards and start my futile routine: prescribing drugs they couldn’t afford; watching them wither away; witnessing and confirming their deaths; condoling distraught relatives. I knew I wasn’t here to save anyone. I was just a cog in a powerful profit machine.
As the warm rays hit my head, I realized I faced a dilemma. What was I to do after internship was over? Should I stay in this “extremely overcrowded and grim” system signing out the dead? Should I join the efficient private system where “more beds would easily be squeezed to improve profits”?
I pondered my problem as the months wore on.
Everyone knows that our healthcare system is not as it should be. We have known this for more than half a century. Instead of solving the dysfunction, instead of dealing with problems as they arose, we allowed them to accumulate to the point where it is impossible to set priorities on what to solve first and which later. The confusion and difficulty implicit in such a situation drive the need for alternatives. We allowed the private system to provide an easy way out. It was, after all, smaller, efficient, and expertly managed. Then it grew, predictably, to a significant and indispensable force that sets the healthcare agenda. Just as the mythical elephant which asked to shelter its trunk from rain and finally took over the house, the profit system took over, over healthcare, over our doctors and nurses, over our conscious.
As long as health is no more than an opportunity to profit, as long as those profits flow, as long as people from the east and the west can find sacred altars for the god of profit in our hospitals, millions shall be sacrificed on those altars.
Isn’t there anything, for our society, that is too sacred to desecrate? Isn’t there just one aspect of our changing society we value too much to sell it out? Health care, as a social service and a fundamental right, as an answer to the human body’s inescapable flaws, ought to be safeguarded from the profit motive at all costs. It is about life and human dignity. And if this isn’t sacred for us, nothing else can hold our society together against multiple forces of disintegration.

[1]Landon Thomas Jr. (2016, October 8). An Investor’s Plan to Transplant Private Health Care in Africa. New York Times. Retrieved from http://www.nytimes.com

 The author is a medical doctor and writer

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