Life is a good thing.
Make the most of it while it lasts. Well this is easily one of the strongest philosophical impressions that many of us are left with any time that a friend, kin, colleague, partner, patient or acquaintance passes on to the other side.
You can not with certainty design when this happens. In most cases it remains the greatest mystery; this business of going away. Then sometimes it crawls upon us like an unshakable leech! But even when it happens there is always a bad taste in our mouths.
We often hear these things being said on the regular: take plenty of clean water, eat right, exercise frequently, sleep enough, cut out tobacco, do regular checks etc etc. But do we heed a thing? This however is not the object of this post..
The morning was a typical August morning. Sunny, bright, cheery and with a tonne of promise in the air. But later it would perhaps rain. I busied myself in the ward doing an early morning review. I was in no particular rush and so took my time going over the admissions; this to the consternation of my colleagues who wanted to get it done with so they could go take their tea and engage in chit chat! But slowly we had gone on.
In the general female ward as we proceeded it became apparent that some process of putrefaction was going on somewhere. I had been briefed about the case and so was partly aware about what to expect.
Forty two years old, she had been a house help in Nairobi for the better part of her adult life. She had been married briefly at some point but had separated with the husband. This had been over ten years back. She however had an eighteen year old son. She thus led a sort of solitary life, just given to her occupation. Then she had developed this lump in her left breast. She could not even recall with certainty when it first started. All she remembers was that the left breast became progressively big and that's when she went to a neighborhood facility for attention. There she was examined and told something to the effect that some advanced tests needed to be done and for this reason she was sent to Kenyatta National Hospital.
Kenyatta National Hospital she says turned out a real torment on patience. Eventually the test results came out and it was confirmed she had malignant breast cancer. It had spread beyond her left breast and even the other one was now developing the lumps. Already there were nodular swellings in her axilla (armpits) She had to start treatment immediately.
All this time she had not even disclosed to her boss what she was dealing with, bravely going about her duties in a quiet contemplation and resignation. But it became increasingly clear that her health was dipping. Her appointments became more frequent; what with all the systematic setbacks and disappointments. It's how her employer got wind of the situation. Quite understanding and supportive at first, the situation became untenable some months down the line. The time commitment and financial aspects must have seemed overwhelming and this in view of the bleakness of the condition had led to the parties amicably parting ways.
Life in Nairobi became unbearable. All that she had saved was rapidly diminishing and this coupled with the erratic and unreliable KNH system had necessitated her leaving the city. On the advice of a relative she had relocated to Eldoret where she began therapy all over again at The Moi Teaching and Referral Hospital. She had an appointment for January but had not kept it. Now it was August.
We had all listened to her tale with sympathetic patience. It was very clear the condition was terminal. One half of her left breast was literally eaten away. She was in pain and kept appealing for any assistance she could get.
"And just where have you been all this while?" I had asked her a bit hard though.
"I have gone to many places that I can't even tell you." She had answered with a crushing frankness. We had all deduced what she meant by that.
"But why did you not keep the MTRH appointment?"
"Daktari I could not raise the money, I have an outstanding bill of eight thousands from my last admission there, so you can understand why I kept away."
"But this is a serious issue, every day you kept away the cancer grew some more."
"That I know and I regret it highly, now how do you help me?"
"Let me see, as it is there is so little we can do for you here, I would suggest you go back to MTRH..."
"No doctor, what will they tell me now?"
"Remember we need to get you all the meaningful help that we can now."
"But where do I get the money for all that?"
"Keeping off because of an uncleared bill is the worser evil if you asked me."
"Okay, but kindly do something for this pain, ever since I came here nothing much has been done, I have requested for just two tablets of augmentin but no one even cares."
"Augmentin is not a pain medication!"
"For me it greatly works, kindly get me two tablets of augmentin, please I beg..."
"Okay I will do something about it, I want to talk to your relatives when they come to see you."
"Thank you daktari, God bless you so much."
It was three days before her brother came to see her. In the meantime she had been on cover for infection, the wound was also regularly cleansed and we had found for her a stronger narcotic based anaelgesic. The brother had just reiterated her earlier position; the family was totally out of means, they had even approached the M.P and other well-wishers but no much help had been forthcoming and so they had let things take their course.
For six days she had stayed in the ward, alternating between talkertiveness and prolonged periods of pensive silence. We had recommended hospice care and this from the hopelessness of the situation.
"But what difference is a hospice going to make?"
"They are better suited, equipped and focused on these sort of conditions."
"I know that people go to hospices to die." She seemed to be distantly distracted.
"Not necessarily true, it's a recuperative environment sort of."
"Do you believe what you are saying?", she had asked me, intently scrutinizing my face and apparently reviving back to the moment.
"You give it consideration and let me know what you decide by the end of the day."
That day had passed and so had the next. Then she had called for me on the third day after the above conversation.
"Daktari, I want to go home."
"Is that what you have decided?", I had inquired.
"Yes, and I believe it's the best course of action in the circumstances, I do not want to burden anyone any more, let the will of God be done." Then a contemplative silence had ensued, she had come to terms with the eventuality and I found myself regarding the moment with an unexplainable sanctitude..
The next day she went home. We had to find for her a course of augmentin but she declined it. We however pressed and she left us with many thanks. Two weeks later her soul departed this earth.
Life is a good thing while it lasts..
Thursday, 29 October 2015
Sunday, 20 September 2015
Medicine Meets Something Mediocre.
Loliondo!
Most people with a care for recent history will recall that flash-in-a-pan phenomenon of 2011. For a short while this name took the world by storm. Who will easily forget the long winding lines of caravans from across East and Central Africa making their way to that till-then obscure locality in Northern Tanzania. Who will forget the same masses faithfully gulping down cups upon cups of the cherished cure that went for Tsh 500? Kikombe Cha Babu as it was aptly called was this magical elixir that cured all ailments. So you can only imagine what a sensation it was expected to cause. From the incurable HIV to the very troublesome diabetes and erratic hypertension, Kikombe Cha Babu spared none (sounds familiar?) Not just this but even the apparently well people just had to insure themselves from future incidences of sickness. Heck even Tanzanian MPs were not to be left out on this seemingly once-in-a-lifetime-chance at a cheap remedy gravy train! A Health cabinet minister (a doctor herself) sanctioned it..
And so it happened that a remote outpost till then known for some other reasons took the centre stage with the world media shining its full glare on it and thousands upon thousands of hopeful visitors thronging it. At the centre of it was a respectable retired church Minister who claimed to have received a vision about the cure. The substance in question happened to be a local shrub which had other uses before then. Its derivative was actually a lethal poison used to kill lions in the inevitable human wildlife conflict, the area happening to neighbour a national park. And so Reverend Mwasapile aka Babu had gone to work and the world had come to him.
Hospital beds had rapidly been emptied of their occupants and so had many chronic disease and HIV treatment programs.
I was working at Bondo District Hospital then. Before we had grasped the magnitude of the issue so many patients in our care had already made the all important expedition and were already waiting among the frenzied throngs in Loliondo. Then we had made it a point to do a routine talk on the baselessness of the claims. But alas!
A friend of mine who was on follow up had confided to me about his intentions of making the journey. He had quietly listened as I tore through the inaccuracies and laid bare 'facts' surrounding the said concoction (but what did I know about it really?) Alas, poor me! Who was I to stand in the way of a brother who only desired the best for himself? For gone he had, his mind having certainly been made up about the entire business.
Then like all bubbles this one too had burst. It had come in the most tragic but expected of ways. Patients who most likely had been pulled off important lifesaving medicines and secure environments had died awaiting their turn at the cup. Not one, not two, not three but fifty plus two according to the official figures released. Only then had the concerned authorities acted.
But even before this it was easy to see that a disaster in one form or the other was looming large over the village. What was hard to fathom is why authorities looked the other way as matters slowly but surely came to a head. The evident humanitarian crisis alone should have been an indicator to an impending implosion. But such is the way that authorities this side of the world manage important public affairs.
The aftermath of this debacle remains untold but if consideration is taken about the toll of these happenings on the public health system then it becomes clear why healthcare remains one of our biggest challenges.
The drug changes, the worsening morbidities and even mortalities (all of these easily preventable). Name them.
My form two definition of faith remains very clear, "hope for unseen things". Is it what we now have all over the place? Is faith wholesomely dispensable like a prescription? Is the production of a token equal to the manifestation of faith? Many Men of Cloth will have you believe so. For what ends? But only if they went about it with less pomp and more humility. And so it happens that one of the silent thorns in the side of conventional medicine are characters of dubious distinctions who for one reason or the other have been left to operate with unwarranted abandon. Scorning miracle healing is far from my objective but preying on a desperate and thus gullible public to sell their 'wares'? But truth be told, the conundrum that is the public healthcare delivery system is not helping matters either.
I was very young in my practice. Just fresh from internship and very eager to exercise that hard won independence. It is thus to be expected that I saw the world of patient care in only two dimensions; my way and my way. This arose from two weaknesses on my part; the inability to well harmonize theory and actual practice and secondly a shaky grasp of that trifling thing called human nature and conduct. Every new lad in the field goes through the same. So I had seen this middle aged lady with very non specific complaints. My work up had of course included HIV and it turned out positive. Applying tonnes of counselling to the point that I nearly forgot to treat her for the more pressing problems. We had enrolled her in our care unit and I took particular self imposed responsibility for her, she being my first patient to fully deal with right from start. It delighted me that I was now digging my teeth in the otherwise confounding world of HIV care. Scheduled her for sample collection, I gave this business the very best shot and my especial personal touch. Alas!
She did not disappoint at first, dutifully keeping her appointments and seemingly keen on her care. Well till tragedy struck! She met this pastor. And away flew my bird. She defaulted and made it clear that she had found the path to her healing and would keep at it and no other else. I expressed my utter incredulity but nothing could change her mind. Later at the instigation of the very same pastor she had even claimed that we had lumped a wrong status on her; she had never been infected in the first place. The scoundrel. Off she had disappeared in intercessionary schedules and because of many other related reasons we had given up on her.
For some months matters had gone well with her. Well just for some months before she began on a quiet downhill slide. Then the prayer sessions had increased (we maintained a discreet interest in her affairs!) Till it was very late. Then she had died. Case one.
A much beloved high school principal in one of the schools near our facility and whom we had been seeing left us a bitter sad pill. Diabetic and hypertensive it however alarmed us when he started skipping his appointments and going for weeks without his medicines. At first he gave vague reasons for his conduct. That he had seen another physician who had recommended other pills and such like stuff. Of course we trusted that a high school principal must know better so we bothered him no more. It was not before long that word lazily floated on the air that he was actually seeking the intervention of a famed Woman of God not so far from the facility community. Damn!
We have all heard what a deadly combo diabetes and hypertension can make. So here was a man at his prime who had been under good control but who nevertheless thought he had had enough of the daily pills. But for what? He stood no chance. He could for days remain holed up in the lady's premises under her ministrations and word spread that he was on a steady decline. Aloof to the advice of his colleagues it was now in the open that for him it was just a matter of time. He had developed a stroke and one can only imagine what havoc the uncontrolled sugars were playing on his fickle systems. But adamant he remained. He succumbed in this setting and only rushed to hospital when it became apparent he was no more. Prophetess had lost such a high profile and well paying client but you think he would be the last? Case two.
A cup, just one cup will cure it. The rich and poor, elite and unlearned alike all put their faith in a cup of something from one Babu. Any health professional who believes he has seen the last of these miracles cures is deluded. Every day on national TV, radio are these adverts for all sorts of unfounded healing claims. Newer, fancier pastors, herbalists, waganga et al promising heaven only to dispense hell. (Both physical, spiritual and financial). I bet that's how the world operates..
Most people with a care for recent history will recall that flash-in-a-pan phenomenon of 2011. For a short while this name took the world by storm. Who will easily forget the long winding lines of caravans from across East and Central Africa making their way to that till-then obscure locality in Northern Tanzania. Who will forget the same masses faithfully gulping down cups upon cups of the cherished cure that went for Tsh 500? Kikombe Cha Babu as it was aptly called was this magical elixir that cured all ailments. So you can only imagine what a sensation it was expected to cause. From the incurable HIV to the very troublesome diabetes and erratic hypertension, Kikombe Cha Babu spared none (sounds familiar?) Not just this but even the apparently well people just had to insure themselves from future incidences of sickness. Heck even Tanzanian MPs were not to be left out on this seemingly once-in-a-lifetime-chance at a cheap remedy gravy train! A Health cabinet minister (a doctor herself) sanctioned it..
 |
| A Public Security Agent Drinks From 'The Cup'! |
Hospital beds had rapidly been emptied of their occupants and so had many chronic disease and HIV treatment programs.
I was working at Bondo District Hospital then. Before we had grasped the magnitude of the issue so many patients in our care had already made the all important expedition and were already waiting among the frenzied throngs in Loliondo. Then we had made it a point to do a routine talk on the baselessness of the claims. But alas!
A friend of mine who was on follow up had confided to me about his intentions of making the journey. He had quietly listened as I tore through the inaccuracies and laid bare 'facts' surrounding the said concoction (but what did I know about it really?) Alas, poor me! Who was I to stand in the way of a brother who only desired the best for himself? For gone he had, his mind having certainly been made up about the entire business.
Then like all bubbles this one too had burst. It had come in the most tragic but expected of ways. Patients who most likely had been pulled off important lifesaving medicines and secure environments had died awaiting their turn at the cup. Not one, not two, not three but fifty plus two according to the official figures released. Only then had the concerned authorities acted.
But even before this it was easy to see that a disaster in one form or the other was looming large over the village. What was hard to fathom is why authorities looked the other way as matters slowly but surely came to a head. The evident humanitarian crisis alone should have been an indicator to an impending implosion. But such is the way that authorities this side of the world manage important public affairs.
 |
| Winding Lines on Their way To Loliondo. |
The aftermath of this debacle remains untold but if consideration is taken about the toll of these happenings on the public health system then it becomes clear why healthcare remains one of our biggest challenges.
The drug changes, the worsening morbidities and even mortalities (all of these easily preventable). Name them.
My form two definition of faith remains very clear, "hope for unseen things". Is it what we now have all over the place? Is faith wholesomely dispensable like a prescription? Is the production of a token equal to the manifestation of faith? Many Men of Cloth will have you believe so. For what ends? But only if they went about it with less pomp and more humility. And so it happens that one of the silent thorns in the side of conventional medicine are characters of dubious distinctions who for one reason or the other have been left to operate with unwarranted abandon. Scorning miracle healing is far from my objective but preying on a desperate and thus gullible public to sell their 'wares'? But truth be told, the conundrum that is the public healthcare delivery system is not helping matters either.
I was very young in my practice. Just fresh from internship and very eager to exercise that hard won independence. It is thus to be expected that I saw the world of patient care in only two dimensions; my way and my way. This arose from two weaknesses on my part; the inability to well harmonize theory and actual practice and secondly a shaky grasp of that trifling thing called human nature and conduct. Every new lad in the field goes through the same. So I had seen this middle aged lady with very non specific complaints. My work up had of course included HIV and it turned out positive. Applying tonnes of counselling to the point that I nearly forgot to treat her for the more pressing problems. We had enrolled her in our care unit and I took particular self imposed responsibility for her, she being my first patient to fully deal with right from start. It delighted me that I was now digging my teeth in the otherwise confounding world of HIV care. Scheduled her for sample collection, I gave this business the very best shot and my especial personal touch. Alas!
She did not disappoint at first, dutifully keeping her appointments and seemingly keen on her care. Well till tragedy struck! She met this pastor. And away flew my bird. She defaulted and made it clear that she had found the path to her healing and would keep at it and no other else. I expressed my utter incredulity but nothing could change her mind. Later at the instigation of the very same pastor she had even claimed that we had lumped a wrong status on her; she had never been infected in the first place. The scoundrel. Off she had disappeared in intercessionary schedules and because of many other related reasons we had given up on her.
For some months matters had gone well with her. Well just for some months before she began on a quiet downhill slide. Then the prayer sessions had increased (we maintained a discreet interest in her affairs!) Till it was very late. Then she had died. Case one.
A much beloved high school principal in one of the schools near our facility and whom we had been seeing left us a bitter sad pill. Diabetic and hypertensive it however alarmed us when he started skipping his appointments and going for weeks without his medicines. At first he gave vague reasons for his conduct. That he had seen another physician who had recommended other pills and such like stuff. Of course we trusted that a high school principal must know better so we bothered him no more. It was not before long that word lazily floated on the air that he was actually seeking the intervention of a famed Woman of God not so far from the facility community. Damn!
We have all heard what a deadly combo diabetes and hypertension can make. So here was a man at his prime who had been under good control but who nevertheless thought he had had enough of the daily pills. But for what? He stood no chance. He could for days remain holed up in the lady's premises under her ministrations and word spread that he was on a steady decline. Aloof to the advice of his colleagues it was now in the open that for him it was just a matter of time. He had developed a stroke and one can only imagine what havoc the uncontrolled sugars were playing on his fickle systems. But adamant he remained. He succumbed in this setting and only rushed to hospital when it became apparent he was no more. Prophetess had lost such a high profile and well paying client but you think he would be the last? Case two.
A cup, just one cup will cure it. The rich and poor, elite and unlearned alike all put their faith in a cup of something from one Babu. Any health professional who believes he has seen the last of these miracles cures is deluded. Every day on national TV, radio are these adverts for all sorts of unfounded healing claims. Newer, fancier pastors, herbalists, waganga et al promising heaven only to dispense hell. (Both physical, spiritual and financial). I bet that's how the world operates..
Friday, 11 September 2015
Absurd Rape Related Tales..
One day, in the not so distant past I was seated in The Hallowed Consultation Room just lost in The Muse. The time was around 2030hrs and I was covering the night. Worn out from my daytime activities I was using the downtime to unwind and unclog my mind. And so as I leisurely reclined in my seat painting fantastic mental pictures I heard a knock on the door but even before I could regroup all my faculties back to reality in peeped the night security guard who took the liberty of inviting the two (actually three) fellows behind him in. Well I had to scramble back from wanderland (yes wanderland) and fast!
I went through the preliminary part of the consultation; just confirming the name, age and so forth. It was a very young couple, the man was eighteen (was able to determine that) while the lady was nineteen. They had with them a three year old girl but from the woman's earlier relationship. Married only for a few months, they were now expecting their first fruit of love together, the lady being about two months heavy with child. I had initially thought it was the child who was sick but the card read the mother. Then I had inquired what the problem was. Silence. Fidgeting. More silence.
We have been taught never to speak for a patient; a patient has to state his case in his or her own words and it's your duty to figure out with precision what they mean. However you may paraphrase or ask with tact to establish what they have said. So here we were. Checking my demeanor I asked again in the gentlest of tones what it was that had brought them to the facility. Furtive glances and some half attempts at speaking up. Then the man had eventually surmounted the difficulty by imploring the wife to state the issue.
Not able to maintain eye contact at first and fidgeting some more she had eventually explained that the previous night somebody had attempted to rape her. Damn! Where? In their house. What time? Around 0200hrs. How? The intruder had told her he wanted to see her husband and so she had believed he was friends with hubby.
Now the problem was this: the husband was not at home at that time and they being new in the place he expected no night visit from any friend of his. He was doing night duty at his place of work that week. Intruder had however insisted on being admitted saying he had a message for the husband. Well on entering he had cut to the chase and threatened her with a dagger. She had not seen his face for he had moved like the devil himself. This is where it gets twisted. He had not been able to manage intercourse due to a defensive manoeuvre she had adopted and so defeated in his evil designs he had quietly slunk away into the dark night. Real Creepy.
No hair touched, no bruise sustained, no blow given, no alarm raised, nothing but a lone shaken woman at a ghostly hour of the night. Believable? The hubby hardly believed a thing and seemed very riled though he appeared one of those meekly indisposed, gentle characters. It's here that he wanted me to come in. To establish if at all there had been penetration; he had heard that it's possible to examine and know if someone has been raped. Damn, Mungu Baba, saidia hapa!
I went over the details slowly and meticulously. The lady now confident and with a reassuring telling was however adamant that nothing happened, no penetration, no intercourse, no sex, no rape. Nothing. In my own assessment her tale had a ring of honesty to it. The husband however persistent with his hows just could not buy it. I understood his cynicism and so tried to reassure him by pointing out that it made no sense for her having even told him a thing if she was a willing accomplice in the business. She had tried calling him after the scary ordeal but he was apparently sound asleep on duty.
He had never doubted her trust before and nothing so far had occurred that made him have doubts on her fidelity. Same to her. I went through the paces of detailing the post rape protocols and everything that had to be done, explained what risks there were to her and the fetus and that if any intervention needed to be made then we still had time but she stuck to her word. Nothing had happened. At that point I chose to fully believe her.
A private session with the husband and I was able to make him understand that though it was hard for any man to come to terms with anything like that we had to believe her all the same. They had however to report the matter to the police because criminals always left an unmistakable scent or two. Trust Sherlock Holmes to unravel a mystery of this nature and nab the ghost-like, faceless, night time prankster. And who knows, he might have wanted to part hubby's neck from his head. It went like one phantom tale, but true it was. I became more afraid of the dark some more and for some days slept with the lights on..
The hilly terrains of Iten and Cherangany and Kapsabet have bequeathed us with generations upon generations of nimble sure footed gifted track athletes, world beaters who have represented us well on the very competitive global stage. It's also true that many of business magnates and captains of industry spent their childhoods braving the morning chill of The Aberdares and Mount Kenya. Now there is in this country one county famed for it's very decent professor-per-village ratio. With many sons of the land well settled in many notable research and academic entities the world over it easily occupies the enviable position as the undisputed hotbed of scholars in the country. It is here that we now go.
Any clinician or nurse or physician or any of the health professional for that matter will tell you they have met some very confounding cases in the course of their work. But it has to be noted that many of these confine themselves to the medical or scientific aspect of things. Any social dimension taking the centre stage in a case and we beat a hasty retreat into our nauseating doctor or nurse cocoons and refer to the counselors, psychologists, pyschiatrists or even the police and the administrators. This state of affairs is however to be understood and the medics are not to be begrudged, they already have much going for them already and almost all training curricula are so deficient in this aspect.
So in the land of scholars one Saturday morning at the OPD/A&E of one of the county referral hospitals, the outpatient crowd sat patiently and orderly waiting in turn at the waiting area. The departments were still very sluggish, what with some of us preoccupied with the usual silly extra-hospital banter and gossip; but the patients and their relatives waited with unbearable patience all the same. Then waves of guilt hit us like the dry heat of The December. Were we really doing justice to whatever it was that paid the bills albeit belatedly? Was this how we repaid back the government after gifting us a hefty extraneous allowance! So one by one we had trooped to our stations and settled down to work. And work we did for in no time the crowd had been conquered!
When you work in the accident and emergency department of any hospital you are always putting out critical situation fires. Serious injuries, shocks, comas, grave complications of all sorts. You are literally in the firing line of things. Speed, sound judgement, experience, patience are all of utmost importance. Then can you hone your competence. But you also get to meet some of the most baffling real life situations that only highlight how deep a well human nature truly is.
And so as we had gone about our work on this particular Saturday morning, a commotion outside had drawn all our attention. A sobbing lady of about twenty two was hustled into the area. She was disheveled and in such a sorry state emotionally and physically. Hot on her heels was the mother, apparently. Also in tow were several relations most likely siblings to the young lady. Mother was fuming, agitated and in no moods to display any etiquette of following the laid down regulations. She headed straight to the nearest consultation room which happened to be mine! They half pulled, half supported the daughter inside and she slumped into the seat. Then the rest of that no nonsense entourage followed, all evidently ruffled and using some of the choicest not-so-nice English words. I let them vent and ventilate for a minute or two before I cracked the whip demanding order and decency. As a condition for anything to proceed I requested they all leave the room except the young lady. The mother insisted on remaining. I grabbed some writing material and dug into it.
"She has been raped" bursts the mother.
I calmly ask to let the lady speak for herself.
"Can't you see how distraught she is?".
I however insist and kindly request the mother to leave the room. Then she beats me to it, rapidly launching into how the suspect waylaid the daughter the previous night and sexually abused her the whole night. She had only been able to make her escape in the wee hours of the morning after the satiated and worn out beast had slumbered off.
I asked the lady to corroborate the narrative but all I got were sobs and more sobs. I sat back and quietly regarded everything. Then out of idle curiosity asked if they knew the suspect. She told me he had been apprehended by the police. However as if on cue another commotion outside revealed that the suspect had been brought to the hospital. Badly beaten, he was bleeding from many scores.
I requested the lady to lie on the couch so I could examine her. She complied and I completed the assessment noting down my findings. After establishing she had not changed her clothing nor had taken a shower I explained to them that we needed to get some samples for lab investigations. It's like the mother had been waiting for this important piece of information. Urging me with uncommon vigor to speedily get done with it. They needed to lock away the unfortunate, worthless and mannerless mongrel.
Then the daughter snapped.
"Mum, why are you doing this to me, how far will you go to achieve your mean objectives? Denounce me but kindly let Kevin go, he is just a poor innocent boy, please mum, I beg you", young lady had hysterically broken down, inviting some alarmed colleagues and even patients into the room.
"You shut up, disgraceful scoundrel, you are a total embarrassment to my person and the entire family. Messing around with poor, pathetic scumbags, is that what is expected of you?".
I was by that time stupefied by the unfolding drama and remained rooted to my feet, I have seen some melodramatic Nigerian movies but only believed them to be sweetened tales. Now here I was!
"Daktari, can you kindly proceed?". the mother roused me from my incomprehension.
I asked to be told what exactly was going on because it looked to me some stinking fishy bit of business.
"Which part of 'she has been raped' don't you understand?".
I inquired from the lady what had then happened. She tells me Kevin was just her boyfriend and she had willingly spent the previous night with him. She was stopped midway by two well aimed slaps from the mother amidst a torrent of unprintables.
That being the case I tried to explain that there really was nothing much to be done here. In fact nothing at all. Wasting valuable daktari and genuine patient's time in this manner was not so cool. Complicated matters of rejected choices were best handled privately and civilly in chief's courts or behind their palatial residences.
"Test her for HIV", barked the mother, evidently smarting from her temporary setback.
The daughter saved me the trouble by flatly declining to have anything to do with a forced HIV test. Out went the mother cursing and wailing and making such a scene that you would certainly believe the greatest calamity had struck home.
Compelling the young lady to compose herself I was itching to get to the bottom of this trifling matter. It turned out to be nothing but a rich girl, poor boy antagonistic family story. She was from a very well-off family from the neighborhood. The mother was a college lecturer, the father a university don. She was herself at the university pursuing a degree in fine arts. Her boyfriend who she confessed to love dearly was in another campus pursuing actuarial science. He was however from an underprivileged background and thus her parents would have none of that social tomfoolery. Only that? Yes. They are despicable egotistical maniacs who have gone to very laughable lengths to achieve their objectives. They have bribed the police and the chief to fabricate and backup this rape story. But they will not succeed. I need to see him daktari.
It would be expected that in any community with a significantly big proportion of well read people would also boast of a corresponding social advancement with scant prejudices and full of understanding and that elusive erudite pity. Wrong.
I can't clearly recall how those Nigerian movies ended. I can't say how this one ended either. The family left the hospital in a huff, young lady remained behind with her boyfriend who was still under police custody though undergoing treatment for his injuries. I asked a police friend of mine how they felt being in such farcical and ridiculous situations and being used thus and he just laughed.
I went through the preliminary part of the consultation; just confirming the name, age and so forth. It was a very young couple, the man was eighteen (was able to determine that) while the lady was nineteen. They had with them a three year old girl but from the woman's earlier relationship. Married only for a few months, they were now expecting their first fruit of love together, the lady being about two months heavy with child. I had initially thought it was the child who was sick but the card read the mother. Then I had inquired what the problem was. Silence. Fidgeting. More silence.
We have been taught never to speak for a patient; a patient has to state his case in his or her own words and it's your duty to figure out with precision what they mean. However you may paraphrase or ask with tact to establish what they have said. So here we were. Checking my demeanor I asked again in the gentlest of tones what it was that had brought them to the facility. Furtive glances and some half attempts at speaking up. Then the man had eventually surmounted the difficulty by imploring the wife to state the issue.
Not able to maintain eye contact at first and fidgeting some more she had eventually explained that the previous night somebody had attempted to rape her. Damn! Where? In their house. What time? Around 0200hrs. How? The intruder had told her he wanted to see her husband and so she had believed he was friends with hubby.
Now the problem was this: the husband was not at home at that time and they being new in the place he expected no night visit from any friend of his. He was doing night duty at his place of work that week. Intruder had however insisted on being admitted saying he had a message for the husband. Well on entering he had cut to the chase and threatened her with a dagger. She had not seen his face for he had moved like the devil himself. This is where it gets twisted. He had not been able to manage intercourse due to a defensive manoeuvre she had adopted and so defeated in his evil designs he had quietly slunk away into the dark night. Real Creepy.
No hair touched, no bruise sustained, no blow given, no alarm raised, nothing but a lone shaken woman at a ghostly hour of the night. Believable? The hubby hardly believed a thing and seemed very riled though he appeared one of those meekly indisposed, gentle characters. It's here that he wanted me to come in. To establish if at all there had been penetration; he had heard that it's possible to examine and know if someone has been raped. Damn, Mungu Baba, saidia hapa!
I went over the details slowly and meticulously. The lady now confident and with a reassuring telling was however adamant that nothing happened, no penetration, no intercourse, no sex, no rape. Nothing. In my own assessment her tale had a ring of honesty to it. The husband however persistent with his hows just could not buy it. I understood his cynicism and so tried to reassure him by pointing out that it made no sense for her having even told him a thing if she was a willing accomplice in the business. She had tried calling him after the scary ordeal but he was apparently sound asleep on duty.
He had never doubted her trust before and nothing so far had occurred that made him have doubts on her fidelity. Same to her. I went through the paces of detailing the post rape protocols and everything that had to be done, explained what risks there were to her and the fetus and that if any intervention needed to be made then we still had time but she stuck to her word. Nothing had happened. At that point I chose to fully believe her.
A private session with the husband and I was able to make him understand that though it was hard for any man to come to terms with anything like that we had to believe her all the same. They had however to report the matter to the police because criminals always left an unmistakable scent or two. Trust Sherlock Holmes to unravel a mystery of this nature and nab the ghost-like, faceless, night time prankster. And who knows, he might have wanted to part hubby's neck from his head. It went like one phantom tale, but true it was. I became more afraid of the dark some more and for some days slept with the lights on..
The hilly terrains of Iten and Cherangany and Kapsabet have bequeathed us with generations upon generations of nimble sure footed gifted track athletes, world beaters who have represented us well on the very competitive global stage. It's also true that many of business magnates and captains of industry spent their childhoods braving the morning chill of The Aberdares and Mount Kenya. Now there is in this country one county famed for it's very decent professor-per-village ratio. With many sons of the land well settled in many notable research and academic entities the world over it easily occupies the enviable position as the undisputed hotbed of scholars in the country. It is here that we now go.
Any clinician or nurse or physician or any of the health professional for that matter will tell you they have met some very confounding cases in the course of their work. But it has to be noted that many of these confine themselves to the medical or scientific aspect of things. Any social dimension taking the centre stage in a case and we beat a hasty retreat into our nauseating doctor or nurse cocoons and refer to the counselors, psychologists, pyschiatrists or even the police and the administrators. This state of affairs is however to be understood and the medics are not to be begrudged, they already have much going for them already and almost all training curricula are so deficient in this aspect.
So in the land of scholars one Saturday morning at the OPD/A&E of one of the county referral hospitals, the outpatient crowd sat patiently and orderly waiting in turn at the waiting area. The departments were still very sluggish, what with some of us preoccupied with the usual silly extra-hospital banter and gossip; but the patients and their relatives waited with unbearable patience all the same. Then waves of guilt hit us like the dry heat of The December. Were we really doing justice to whatever it was that paid the bills albeit belatedly? Was this how we repaid back the government after gifting us a hefty extraneous allowance! So one by one we had trooped to our stations and settled down to work. And work we did for in no time the crowd had been conquered!
When you work in the accident and emergency department of any hospital you are always putting out critical situation fires. Serious injuries, shocks, comas, grave complications of all sorts. You are literally in the firing line of things. Speed, sound judgement, experience, patience are all of utmost importance. Then can you hone your competence. But you also get to meet some of the most baffling real life situations that only highlight how deep a well human nature truly is.
And so as we had gone about our work on this particular Saturday morning, a commotion outside had drawn all our attention. A sobbing lady of about twenty two was hustled into the area. She was disheveled and in such a sorry state emotionally and physically. Hot on her heels was the mother, apparently. Also in tow were several relations most likely siblings to the young lady. Mother was fuming, agitated and in no moods to display any etiquette of following the laid down regulations. She headed straight to the nearest consultation room which happened to be mine! They half pulled, half supported the daughter inside and she slumped into the seat. Then the rest of that no nonsense entourage followed, all evidently ruffled and using some of the choicest not-so-nice English words. I let them vent and ventilate for a minute or two before I cracked the whip demanding order and decency. As a condition for anything to proceed I requested they all leave the room except the young lady. The mother insisted on remaining. I grabbed some writing material and dug into it.
"She has been raped" bursts the mother.
I calmly ask to let the lady speak for herself.
"Can't you see how distraught she is?".
I however insist and kindly request the mother to leave the room. Then she beats me to it, rapidly launching into how the suspect waylaid the daughter the previous night and sexually abused her the whole night. She had only been able to make her escape in the wee hours of the morning after the satiated and worn out beast had slumbered off.
I asked the lady to corroborate the narrative but all I got were sobs and more sobs. I sat back and quietly regarded everything. Then out of idle curiosity asked if they knew the suspect. She told me he had been apprehended by the police. However as if on cue another commotion outside revealed that the suspect had been brought to the hospital. Badly beaten, he was bleeding from many scores.
I requested the lady to lie on the couch so I could examine her. She complied and I completed the assessment noting down my findings. After establishing she had not changed her clothing nor had taken a shower I explained to them that we needed to get some samples for lab investigations. It's like the mother had been waiting for this important piece of information. Urging me with uncommon vigor to speedily get done with it. They needed to lock away the unfortunate, worthless and mannerless mongrel.
Then the daughter snapped.
"Mum, why are you doing this to me, how far will you go to achieve your mean objectives? Denounce me but kindly let Kevin go, he is just a poor innocent boy, please mum, I beg you", young lady had hysterically broken down, inviting some alarmed colleagues and even patients into the room.
"You shut up, disgraceful scoundrel, you are a total embarrassment to my person and the entire family. Messing around with poor, pathetic scumbags, is that what is expected of you?".
I was by that time stupefied by the unfolding drama and remained rooted to my feet, I have seen some melodramatic Nigerian movies but only believed them to be sweetened tales. Now here I was!
"Daktari, can you kindly proceed?". the mother roused me from my incomprehension.
I asked to be told what exactly was going on because it looked to me some stinking fishy bit of business.
"Which part of 'she has been raped' don't you understand?".
I inquired from the lady what had then happened. She tells me Kevin was just her boyfriend and she had willingly spent the previous night with him. She was stopped midway by two well aimed slaps from the mother amidst a torrent of unprintables.
That being the case I tried to explain that there really was nothing much to be done here. In fact nothing at all. Wasting valuable daktari and genuine patient's time in this manner was not so cool. Complicated matters of rejected choices were best handled privately and civilly in chief's courts or behind their palatial residences.
"Test her for HIV", barked the mother, evidently smarting from her temporary setback.
The daughter saved me the trouble by flatly declining to have anything to do with a forced HIV test. Out went the mother cursing and wailing and making such a scene that you would certainly believe the greatest calamity had struck home.
Compelling the young lady to compose herself I was itching to get to the bottom of this trifling matter. It turned out to be nothing but a rich girl, poor boy antagonistic family story. She was from a very well-off family from the neighborhood. The mother was a college lecturer, the father a university don. She was herself at the university pursuing a degree in fine arts. Her boyfriend who she confessed to love dearly was in another campus pursuing actuarial science. He was however from an underprivileged background and thus her parents would have none of that social tomfoolery. Only that? Yes. They are despicable egotistical maniacs who have gone to very laughable lengths to achieve their objectives. They have bribed the police and the chief to fabricate and backup this rape story. But they will not succeed. I need to see him daktari.
It would be expected that in any community with a significantly big proportion of well read people would also boast of a corresponding social advancement with scant prejudices and full of understanding and that elusive erudite pity. Wrong.
I can't clearly recall how those Nigerian movies ended. I can't say how this one ended either. The family left the hospital in a huff, young lady remained behind with her boyfriend who was still under police custody though undergoing treatment for his injuries. I asked a police friend of mine how they felt being in such farcical and ridiculous situations and being used thus and he just laughed.
Thursday, 3 September 2015
Brothers in the Deep End..
I have in my village a very wealthy decade-shy septuagenarian who has made the bulk of his money selling meat. Now he himself is a vegan. He made the rest of his money supplying cane to one of the moribund sugar factories in the countryside. He takes no sugar also. Life must be one bland tasteless affair for this tycoon then! You would bet so...but such is life.
Then we have all heard about great teachers whose own sons or daughters turned out epic academic failures. Not in that rude sense of below par cerebral abilities but in a more socially humiliating manner; truancy, obstinacy, utter contempt and rejection of the academic life. These sons and daughters of famous teachers have ended up the village vagabonds, well steeped in notoriety and went on to lead pitiable base existences. Well some of them. There was an age when teachers were one of the foremost elite professionals in the neighborhoods. They commanded an unquestionable, unadulterated kind of universal respect that was well earned and merited. This may not be still the case but the reasons for this are not the objective of this post. It is then baffling how some of their sons and daughters turned out to be the complete antithesis to all that these noble souls stood for; the embrace of knowledge and all things knowledge. Little paradoxes that stack together to enrich our existence and make for the colorfulness of everything, but then such is life.
The morning ward round was rather uneventful. Just the usual cases to be encountered in a busy private hospital. Well till we got to the male ward. One of the night admissions was a middle aged morose man. Here is the brief description of the case. Brought in at three in the morning with bruises following an assault at a man's home that also doubled up as a cheap liquor den. The details of the events are embarrassing and tedious and so I wont go there but the long and short of it; well some money owed and some bills unsettled. So he had sustained bruises and lacerations here and there. He being rather weak looking and with a lanky physical disposition it was obvious the opponent or opponents had gotten the better of him and that he had borne the brunt of the altercation. He was as they say dead drunk himself then. And so a few friends who had intervened had brought him to the facility.
On examination it was discovered he had a lower chest infection in addition to his physical injuries. He was also known to suffer from gastric ulcers. He was started on the appropriate management at admission and this involved reviving him since he had passed out at some point. Enough of the case though, now the man himself.
Forty years old, separated with the wife (a nursing officer practicing in Nairobi), with one known child (daughter in form two) he was a public health officer by profession. He was however now living like a homeless dog in the backstreets of the township. Mr PHO came from a very rich academic and political family. It really is to be believed that some persons are favored with very special powers of the mind, for despite his well known enmity with sobriety he still managed to pull in some decent work. How he managed is still a subject for scrutiny but manage he did.
I won't be the one to judge any one who waddles through life the way he chooses to in the name of living it. And so I won't criticize Mr PHO for having sort of a very open social life; sleeping wherever a door was open to him and only going back to his resident hostess (a cheap liquor vendor herself) for maybe a change of clothing. Needless to say, he enjoyed very dire financial circumstances perennially. He was the object of ridicule and derision in the community.
So we had seen him in that ward round, run some tests and recommended others and retained him for continuation of treatment. Many hours later he requested to see me privately. Says he, "doc I am required at the office for some work related reasons."
Me; but you are sick, I mean you are sick, what is so urgent over there that your illness has to be suspended?
He replies; I know that but I can handle it, I just have to be there myself.
Me; can I talk to your boss myself and maybe make him understand or rather believe that you are unwell?
He; oh no, I would not bother you with that, let me just then explain to him the situation.
Me; doc, now that we are here I think it's important I point out something that I meant to talk to you about. It has to do with your drinking and smoking. You well grasp what a precarious place the two have led you to. You are not any ignorant fool out there...you have been on this road long enough to understand its perilous destination. you understand the effects on your health.
He; I understand everything perfectly well, though you must realize how hard it is on me.
Me; I appreciate how difficult it is and that brings me to my point. You need help, serious professional help.
He; oh doc just do what you can do the rest will come in time..
Me; now this is equally important just like anything else that we will do for you. Your recovery is of top priority now and I think this is best addressed now rather than later.
He; doc let me be frank with you for once. I have tried many remedies and gone through many extreme paces to reform but only met with disappointment after disappointment. As you see me now I am just resigned to fate; let be what will be. You know this thing runs in our blood. I won't be the first nor the last to go down this way.
Me; (after some brief pause) you really need to encourage yourself, you are still very young, at your prime, why would you throw away such a productive life at the price of a penny?
He; no one would mind. In the whole wide world no one would miss me, because no one cares and that is my only consolation.
Me; now is there any particular way that we or I could be of help?
He: yes, we could start with an immediate discharge from the ward now...the rest will come later.
Me; huh!
I ended this conversation on that unpromising and resigned note. A cloud of defeat had never hung any heavier than it did around our consultation room.
The precursor to this conversation had been a visit I had received earlier that day from an acquaintance of our friend. She had urged me to do anything within my power to insist on his rehabilitation as a key factor in his treatment. We had briefly discussed it and she had given me a number to call; our patient's father. Many life situations will come our way. In facing them options are always open to us. Sometimes too many options. Sometimes just one or the other. Choosing one over the other may make all the difference. Extracting just a tiny fraction of learning from the myriad possibilities is an awkward preoccupation of mine. And so I had called our PHO's old man who was himself a retired nurse but then engaged in private business.
After the usual introductions and niceties had been gotten out of the way our conversation took this turn;
Me; he needs help now more than ever.
Old Man; (after a momentary pause) he should himself realize that first. Then we can only come in to facilitate. We have in the past been the initiators of many a process and all our good intentions and noble efforts have always come to naught. As it is we are all resigned to fate.
Me; a one last grand effort; a concerted effort bringing together his family, his friends, his colleagues maybe?
Old Man; huh! I would never be the one to waste another man's time in vain pursuits and endeavors. Do you even believe he has friends? Or any friends who would care for his well-being for that matter? Let me ask you something young man.
Me; Yes?
Old Man; how old are you?
Me; thirty something.
Old Man; and how old is your patient who happens to be my son?
Me; forty.
Old Man; a man of forty should be very embarrassed with himself for leading his life like a homeless dog (I was stupefied by him for expressing my very own sentiments in the exact same words), he went on; I feel the humiliation very acutely myself but I have tried all the known tricks in the book. Nothing has permanently worked. I will be very honest with you; I have even consulted witch doctors just in case you know how our people are, just in case his addictions are the product of some malicious underhand efforts. All I have got was more and more disappointments to add on my expenses.
Me; sorry to learn about that, it really must be heartrending but all the more the reason for a last grand effort at rehabilitation. As we speak now I believe even a visit from his relatives may do him some good since he feels abandoned and neglected.
Old Man; but I can not drive all the way from Eldoret just to come and see him, and above all he has brought all of that on himself. In reality I can't summon the strength to realize that all I can do for him can't go any further than mere pity. As it is I am resigned to whatever designs that both fate and the devil may have on him.
Me; don't you believe that that very effort from you might make a positive impression on him? Or anyone you know who may be of help here, his wife maybe?
Old Man; I am positively persuaded that it may have no impact whatsoever. It would thus be very pointless of me to hazard the ramble. I can not speak for his wife either, i can't bother her even. As I told you already we have left all to the will of fate.Till then we still pray for him and as for now daktari do whatever you can do for him.
Thus had we ended our little discussion and then I had grasped the depth of the hopelessness of the situation. So I had intended to speak to Mr PHO myself and as he had happened to bring himself my way so had our chat passed as earlier described.
Thus passed he the day rolling up and down the hospital grounds, but what happened in the night was one of those occurrences that really torments a man's patience and rudely fries a man's cool. Not being able to hold out any more and finding his getaway efforts thwarted at every turn Mr PHO had played a smart one by having the liquor brought to him instead of he going to the liquor. And so in a discreet corner had he treated himself to his toxic cocktails. A patient ending up dead drunk in the ward was a sight that really worked me up and did so to the point that it was the only incident in a very long time that the flat of my palm had the opportunity of encountering the ill prepared cheek of another man (not the patient though).
The following morning I had gone about my business in a rather quiet and self absorbing manner. I spend a little time turning over in my head how to handle this obstinate hopeless colleague with a bad habit. He saved me the trouble himself. As I sat at the nursing station in the pediatric ward just observing the children get well along comes he seeking my indulgence. I grant him audience out of sheer curiosity and in admiration of his nerve. So the first thing he does is apologize profusely about the events of the previous night. He goes on and on beseeching me to the point of disgust and so I cut him short and ask what he wants.
Doc just give me twenty minutes I sort out an issue at the office, don't even bother to remove the canular. This is a humble request.
And so out of an ember of professional respect I give him twenty minutes to sort out an issue at the office. He never came back.
Brothers in the know,
Battling petty and gigantic addictions.
But shall we let them go?
However the swell of their afflictions,
Shall we lose them our sight?
Seeing a brother in the know in his woes
Fills one with morbid fright..
However undoing a pact with the devil's claws
Only the brother in the know can do.
Then we have all heard about great teachers whose own sons or daughters turned out epic academic failures. Not in that rude sense of below par cerebral abilities but in a more socially humiliating manner; truancy, obstinacy, utter contempt and rejection of the academic life. These sons and daughters of famous teachers have ended up the village vagabonds, well steeped in notoriety and went on to lead pitiable base existences. Well some of them. There was an age when teachers were one of the foremost elite professionals in the neighborhoods. They commanded an unquestionable, unadulterated kind of universal respect that was well earned and merited. This may not be still the case but the reasons for this are not the objective of this post. It is then baffling how some of their sons and daughters turned out to be the complete antithesis to all that these noble souls stood for; the embrace of knowledge and all things knowledge. Little paradoxes that stack together to enrich our existence and make for the colorfulness of everything, but then such is life.
The morning ward round was rather uneventful. Just the usual cases to be encountered in a busy private hospital. Well till we got to the male ward. One of the night admissions was a middle aged morose man. Here is the brief description of the case. Brought in at three in the morning with bruises following an assault at a man's home that also doubled up as a cheap liquor den. The details of the events are embarrassing and tedious and so I wont go there but the long and short of it; well some money owed and some bills unsettled. So he had sustained bruises and lacerations here and there. He being rather weak looking and with a lanky physical disposition it was obvious the opponent or opponents had gotten the better of him and that he had borne the brunt of the altercation. He was as they say dead drunk himself then. And so a few friends who had intervened had brought him to the facility.
On examination it was discovered he had a lower chest infection in addition to his physical injuries. He was also known to suffer from gastric ulcers. He was started on the appropriate management at admission and this involved reviving him since he had passed out at some point. Enough of the case though, now the man himself.
Forty years old, separated with the wife (a nursing officer practicing in Nairobi), with one known child (daughter in form two) he was a public health officer by profession. He was however now living like a homeless dog in the backstreets of the township. Mr PHO came from a very rich academic and political family. It really is to be believed that some persons are favored with very special powers of the mind, for despite his well known enmity with sobriety he still managed to pull in some decent work. How he managed is still a subject for scrutiny but manage he did.
I won't be the one to judge any one who waddles through life the way he chooses to in the name of living it. And so I won't criticize Mr PHO for having sort of a very open social life; sleeping wherever a door was open to him and only going back to his resident hostess (a cheap liquor vendor herself) for maybe a change of clothing. Needless to say, he enjoyed very dire financial circumstances perennially. He was the object of ridicule and derision in the community.
So we had seen him in that ward round, run some tests and recommended others and retained him for continuation of treatment. Many hours later he requested to see me privately. Says he, "doc I am required at the office for some work related reasons."
Me; but you are sick, I mean you are sick, what is so urgent over there that your illness has to be suspended?
He replies; I know that but I can handle it, I just have to be there myself.
Me; can I talk to your boss myself and maybe make him understand or rather believe that you are unwell?
He; oh no, I would not bother you with that, let me just then explain to him the situation.
Me; doc, now that we are here I think it's important I point out something that I meant to talk to you about. It has to do with your drinking and smoking. You well grasp what a precarious place the two have led you to. You are not any ignorant fool out there...you have been on this road long enough to understand its perilous destination. you understand the effects on your health.
He; I understand everything perfectly well, though you must realize how hard it is on me.
Me; I appreciate how difficult it is and that brings me to my point. You need help, serious professional help.
He; oh doc just do what you can do the rest will come in time..
Me; now this is equally important just like anything else that we will do for you. Your recovery is of top priority now and I think this is best addressed now rather than later.
He; doc let me be frank with you for once. I have tried many remedies and gone through many extreme paces to reform but only met with disappointment after disappointment. As you see me now I am just resigned to fate; let be what will be. You know this thing runs in our blood. I won't be the first nor the last to go down this way.
Me; (after some brief pause) you really need to encourage yourself, you are still very young, at your prime, why would you throw away such a productive life at the price of a penny?
He; no one would mind. In the whole wide world no one would miss me, because no one cares and that is my only consolation.
Me; now is there any particular way that we or I could be of help?
He: yes, we could start with an immediate discharge from the ward now...the rest will come later.
Me; huh!
I ended this conversation on that unpromising and resigned note. A cloud of defeat had never hung any heavier than it did around our consultation room.
The precursor to this conversation had been a visit I had received earlier that day from an acquaintance of our friend. She had urged me to do anything within my power to insist on his rehabilitation as a key factor in his treatment. We had briefly discussed it and she had given me a number to call; our patient's father. Many life situations will come our way. In facing them options are always open to us. Sometimes too many options. Sometimes just one or the other. Choosing one over the other may make all the difference. Extracting just a tiny fraction of learning from the myriad possibilities is an awkward preoccupation of mine. And so I had called our PHO's old man who was himself a retired nurse but then engaged in private business.
After the usual introductions and niceties had been gotten out of the way our conversation took this turn;
Me; he needs help now more than ever.
Old Man; (after a momentary pause) he should himself realize that first. Then we can only come in to facilitate. We have in the past been the initiators of many a process and all our good intentions and noble efforts have always come to naught. As it is we are all resigned to fate.
Me; a one last grand effort; a concerted effort bringing together his family, his friends, his colleagues maybe?
Old Man; huh! I would never be the one to waste another man's time in vain pursuits and endeavors. Do you even believe he has friends? Or any friends who would care for his well-being for that matter? Let me ask you something young man.
Me; Yes?
Old Man; how old are you?
Me; thirty something.
Old Man; and how old is your patient who happens to be my son?
Me; forty.
Old Man; a man of forty should be very embarrassed with himself for leading his life like a homeless dog (I was stupefied by him for expressing my very own sentiments in the exact same words), he went on; I feel the humiliation very acutely myself but I have tried all the known tricks in the book. Nothing has permanently worked. I will be very honest with you; I have even consulted witch doctors just in case you know how our people are, just in case his addictions are the product of some malicious underhand efforts. All I have got was more and more disappointments to add on my expenses.
Me; sorry to learn about that, it really must be heartrending but all the more the reason for a last grand effort at rehabilitation. As we speak now I believe even a visit from his relatives may do him some good since he feels abandoned and neglected.
Old Man; but I can not drive all the way from Eldoret just to come and see him, and above all he has brought all of that on himself. In reality I can't summon the strength to realize that all I can do for him can't go any further than mere pity. As it is I am resigned to whatever designs that both fate and the devil may have on him.
Me; don't you believe that that very effort from you might make a positive impression on him? Or anyone you know who may be of help here, his wife maybe?
Old Man; I am positively persuaded that it may have no impact whatsoever. It would thus be very pointless of me to hazard the ramble. I can not speak for his wife either, i can't bother her even. As I told you already we have left all to the will of fate.Till then we still pray for him and as for now daktari do whatever you can do for him.
Thus had we ended our little discussion and then I had grasped the depth of the hopelessness of the situation. So I had intended to speak to Mr PHO myself and as he had happened to bring himself my way so had our chat passed as earlier described.
Thus passed he the day rolling up and down the hospital grounds, but what happened in the night was one of those occurrences that really torments a man's patience and rudely fries a man's cool. Not being able to hold out any more and finding his getaway efforts thwarted at every turn Mr PHO had played a smart one by having the liquor brought to him instead of he going to the liquor. And so in a discreet corner had he treated himself to his toxic cocktails. A patient ending up dead drunk in the ward was a sight that really worked me up and did so to the point that it was the only incident in a very long time that the flat of my palm had the opportunity of encountering the ill prepared cheek of another man (not the patient though).
The following morning I had gone about my business in a rather quiet and self absorbing manner. I spend a little time turning over in my head how to handle this obstinate hopeless colleague with a bad habit. He saved me the trouble himself. As I sat at the nursing station in the pediatric ward just observing the children get well along comes he seeking my indulgence. I grant him audience out of sheer curiosity and in admiration of his nerve. So the first thing he does is apologize profusely about the events of the previous night. He goes on and on beseeching me to the point of disgust and so I cut him short and ask what he wants.
Doc just give me twenty minutes I sort out an issue at the office, don't even bother to remove the canular. This is a humble request.
And so out of an ember of professional respect I give him twenty minutes to sort out an issue at the office. He never came back.
Brothers in the know,
Battling petty and gigantic addictions.
But shall we let them go?
However the swell of their afflictions,
Shall we lose them our sight?
Seeing a brother in the know in his woes
Fills one with morbid fright..
However undoing a pact with the devil's claws
Only the brother in the know can do.
Wednesday, 26 August 2015
Consultants and their Consultancies!
Time flies and is dead serious at its business of flying..
It feels just like the other day when me and a bunch of my colleagues were being oriented as college freshers. Orientation meant observing, asking and helping out wherever it was one happened to be placed but one had to eventually graduate from being a hand person to an actual doer. The one month was meant to prepare us for what it was that we were getting ourselves into. I remember one very good friend of mine who used to faint away at the sight and smell from a very bad wound in the male surgical ward. But he has gone on to make a world class anaesthiologist!
Observing was the best part for most of us, the more aggressive and daring were however able to establish their competencies early enough during this period. My very good friend C developed a particular affinity for maternity and went on to be a small authority on matters obsgyn in our class..
Overall everybody was able to pick some small trick or the other from the people we had to work under. Well if you had to be mentored by guys like Dr. O, you had no choice. O was a specialist surgeon. He provided my very first up close experience with a consultant, that department happening to be my first placement. Pompous in style, he was known to make it clear to you that his knowledge well ran deep indeed. He gave instructions concisely, precisely and eloquently in a style that was only his. Known to be a bit too laid back in the wider scheme of things, he ingrained in most of us the idea of a doctor's (especially surgeons) self worth as being well superior to the other medical professions. He was eccentric just as he was a genial being at heart. One day during a tiresome operation (I can't recall what) he happened to cut himself through the gloves and to the utter shock and disbelief of his assistants went on unperturbed to the completion of the procedure. All pleas to change gloves fell on deaf ears. Now that patient happened to be HIV positive. Did he then deserve what befell him? For he succumbed to the very same HIV some years later. But had he taken precautions would the world be less one good surgeon?
We were also acquainted with a certain Dr. OO. A physician who actually believed that books treat patients. His customer care relations was a phenomenal disaster and it's why his private private practice was not only a case study on how not to run a private practice but how not to relate with people. It was hard to believe he had not heard of or purposely disregarded a very simple Second Law of Medicine which stated thus; that patients did not care how much you know but only want to know how much you care. Lacking in that universal element called empathy he only made a good ward round and lecture hall academic doctor but a bad actual doctor.
Then came internship. I remember vividly what a lovely mess our morning meetings used to be. The Med Sup who happened to be a consultant surgeon himself was always in a state of war with about everybody else. His most frequent combatant was one old general practitioner. Now this old good fellow was Russian trained and had lumbered on his practice and was coming to the sunset without the honor of a specialty. He was the most agreeable chap you would ever encounter but all this changed the moment Med Sup picked his unending wars with him. Then Good Old Fellow in a supreme defense to his ego could go hard at him. It always ended with one calling the other medieval, archaic and the other 'a surgeon and no doctor'.
The points of conflict were as varied as they were baffling; why do you still give frusemide in this day and age? Why can't you get your anatomy right? You are not going to patronize how I deal with my patients! And so forth and on. My own reading of things then was that the one was a poor master of logic whereas the other was a poor defender of his position. Just a small dose of modesty could take one far. These roles however kept swiftly changing from one to the other in the course of the many encounters they had.
It was clear Good Old Fellow could not stand the, ''I am a consultant you know'' attitude that Med Sup wielded mercilessly.
Then there was Dr. W! Now this guy was and still is a joke! If doctors have occasionally been accused of some unfounded queerness in character and personality then W is probably one of the reasons. He was the obstetrician gynecologist. He hardly attended any meetings with the rest of the team. He came late, most of the time drunk and he owed no one an explanation nor apology. Did he himself keep his appointments? He was known to engage in some out-of-nowhere banter that was discomfiting to some patients of his. Many were the times that a junior doctor was called in to go handle his clinic. I can not for sure say if 'The 48 Laws of Power' was the only book he read but the number of times he carried this book along with him are infinite. He believed himself to be the master but I believe his patients were the real masters for they made their displeasure known and eventually he had to be let go.
Good Old Fellow might have been in err but he had a point all the same. How many times have you had a physician say, ''I will now send you to Dr. D the diabetologist!'' Or a pediatrician proudly quip, ''I am not a physician!"
And so it was that after some reluctance I took the mother to a colleague friend of mine (who based abroad) to the resident physician of one of the high end treatment facilities in the country. With reluctance because I have come to understand how these people think and work and I wanted a different physician but they prevailed, for some reason to be seen shortly. The old lady in question has been hypertensive for close to a decade now. The blood pressures had however been under remarkable control. For some time she had also been on anti failure regimen. Then she developed a progressive swelling of the feet and weakness in the hip to the point that she could hardly move without support. Many tests done and nothing. The case was clearly confounding. Now this is where the Big Hospital Physician comes in; he was actually for the longest time the personal physician to the lady in question till around two years before when she chose a nearer (and cheaper) alternative. Much of what she had been on was however retained.
We fix the day and make all other arrangements me being engaged in some other businesses then. The day comes. Old Lady is one of those witty mamas off the old mold. I am more than adequately cracked up all the way to the hospital. Man, is she not a dose of talent, is she not therapy! Sometimes when I have only purposed to briefly check on her I have found myself spending an hour or two laughing and drinking off her ever flowing cup of wit, humor and reason. She will wait at the height of your mirth then whisper something in your ear, "I can see you want that lady but be forewarned, she will lick you dry!" Blessed with such a magnanimous heart it was heart rending that her physical heart was actually failing her.
The reception here is world class and so Mr Physician better be good too.
Appointment or new? New.
General doctor or Consultant? Consultant physician.
Okay, this way.
We find ourselves waiting in line at the physician's offices after the usual routines of registration and booking. Old Lady's turn comes and in she goes. One of those remarkable characteristics of good doctors is their uncanny ability to remember their patients. And so despite the bubbling queue outside about three minutes are spent in cheerful banter between the two; for old times sake. We then settle down into serious business and I state the details of the case. He carefully reviews her medications and asks and asks again one or two issues. Then he sits back in his chair and ponderously stares into the air. We (me and Old lady's son) let him do a thorough physical examination as we wait outside.
So doc how is she? I ask him when when we are re-admitted.
Damn I don't know! She seems to be on optimal therapy but I can't explain her weakness and edema.
Me: It's why we brought her back!
He: But you expect too much from me my friend.
Me: you are the physician! okay then, course of action?
He: (after some brief engrossment) let her do a chest xray.
Me: chest xray! but how useful is that? I believe it will only show an enlarged heart..
He: let us start there, it might show us more..
Me: what about her weakness and hip? Is not an MRI indicated?
He: let me see what the chest xray reveals first then we can do the others later.
Me: (out of sheer respect) okay doc.
We return with the chest xray film about an hour later. It shows us nothing much and so the physician at an apparent loss on how to proceed says this: she will continue with her current medication and i will prescribe some medicine(prescribes) that you will try to get outside since the hospital stock is run out. Then within two weeks kindly let me know(gives me business card) how she is doing.
What an epic underwhelment. But as leave the consultation I console myself with that Ralph Waldo Emerson; every man I meet is my superior in some way, of that I try to learn from him. In my case it's comforting that even the best of them get caught in quicksands.
All the renowned pharmacies in K had never stocked the mysterious magical elixir and so we end up right where we began, only about 15k less loaded than when we walked in that magnificent reception. When you grow up strive to be a consultant in something or the other..
We were also acquainted with a certain Dr. OO. A physician who actually believed that books treat patients. His customer care relations was a phenomenal disaster and it's why his private private practice was not only a case study on how not to run a private practice but how not to relate with people. It was hard to believe he had not heard of or purposely disregarded a very simple Second Law of Medicine which stated thus; that patients did not care how much you know but only want to know how much you care. Lacking in that universal element called empathy he only made a good ward round and lecture hall academic doctor but a bad actual doctor.
Then came internship. I remember vividly what a lovely mess our morning meetings used to be. The Med Sup who happened to be a consultant surgeon himself was always in a state of war with about everybody else. His most frequent combatant was one old general practitioner. Now this old good fellow was Russian trained and had lumbered on his practice and was coming to the sunset without the honor of a specialty. He was the most agreeable chap you would ever encounter but all this changed the moment Med Sup picked his unending wars with him. Then Good Old Fellow in a supreme defense to his ego could go hard at him. It always ended with one calling the other medieval, archaic and the other 'a surgeon and no doctor'.
The points of conflict were as varied as they were baffling; why do you still give frusemide in this day and age? Why can't you get your anatomy right? You are not going to patronize how I deal with my patients! And so forth and on. My own reading of things then was that the one was a poor master of logic whereas the other was a poor defender of his position. Just a small dose of modesty could take one far. These roles however kept swiftly changing from one to the other in the course of the many encounters they had.
It was clear Good Old Fellow could not stand the, ''I am a consultant you know'' attitude that Med Sup wielded mercilessly.
Then there was Dr. W! Now this guy was and still is a joke! If doctors have occasionally been accused of some unfounded queerness in character and personality then W is probably one of the reasons. He was the obstetrician gynecologist. He hardly attended any meetings with the rest of the team. He came late, most of the time drunk and he owed no one an explanation nor apology. Did he himself keep his appointments? He was known to engage in some out-of-nowhere banter that was discomfiting to some patients of his. Many were the times that a junior doctor was called in to go handle his clinic. I can not for sure say if 'The 48 Laws of Power' was the only book he read but the number of times he carried this book along with him are infinite. He believed himself to be the master but I believe his patients were the real masters for they made their displeasure known and eventually he had to be let go.
Good Old Fellow might have been in err but he had a point all the same. How many times have you had a physician say, ''I will now send you to Dr. D the diabetologist!'' Or a pediatrician proudly quip, ''I am not a physician!"
And so it was that after some reluctance I took the mother to a colleague friend of mine (who based abroad) to the resident physician of one of the high end treatment facilities in the country. With reluctance because I have come to understand how these people think and work and I wanted a different physician but they prevailed, for some reason to be seen shortly. The old lady in question has been hypertensive for close to a decade now. The blood pressures had however been under remarkable control. For some time she had also been on anti failure regimen. Then she developed a progressive swelling of the feet and weakness in the hip to the point that she could hardly move without support. Many tests done and nothing. The case was clearly confounding. Now this is where the Big Hospital Physician comes in; he was actually for the longest time the personal physician to the lady in question till around two years before when she chose a nearer (and cheaper) alternative. Much of what she had been on was however retained.
We fix the day and make all other arrangements me being engaged in some other businesses then. The day comes. Old Lady is one of those witty mamas off the old mold. I am more than adequately cracked up all the way to the hospital. Man, is she not a dose of talent, is she not therapy! Sometimes when I have only purposed to briefly check on her I have found myself spending an hour or two laughing and drinking off her ever flowing cup of wit, humor and reason. She will wait at the height of your mirth then whisper something in your ear, "I can see you want that lady but be forewarned, she will lick you dry!" Blessed with such a magnanimous heart it was heart rending that her physical heart was actually failing her.
The reception here is world class and so Mr Physician better be good too.
Appointment or new? New.
General doctor or Consultant? Consultant physician.
Okay, this way.
We find ourselves waiting in line at the physician's offices after the usual routines of registration and booking. Old Lady's turn comes and in she goes. One of those remarkable characteristics of good doctors is their uncanny ability to remember their patients. And so despite the bubbling queue outside about three minutes are spent in cheerful banter between the two; for old times sake. We then settle down into serious business and I state the details of the case. He carefully reviews her medications and asks and asks again one or two issues. Then he sits back in his chair and ponderously stares into the air. We (me and Old lady's son) let him do a thorough physical examination as we wait outside.
So doc how is she? I ask him when when we are re-admitted.
Damn I don't know! She seems to be on optimal therapy but I can't explain her weakness and edema.
Me: It's why we brought her back!
He: But you expect too much from me my friend.
Me: you are the physician! okay then, course of action?
He: (after some brief engrossment) let her do a chest xray.
Me: chest xray! but how useful is that? I believe it will only show an enlarged heart..
He: let us start there, it might show us more..
Me: what about her weakness and hip? Is not an MRI indicated?
He: let me see what the chest xray reveals first then we can do the others later.
Me: (out of sheer respect) okay doc.
We return with the chest xray film about an hour later. It shows us nothing much and so the physician at an apparent loss on how to proceed says this: she will continue with her current medication and i will prescribe some medicine(prescribes) that you will try to get outside since the hospital stock is run out. Then within two weeks kindly let me know(gives me business card) how she is doing.
What an epic underwhelment. But as leave the consultation I console myself with that Ralph Waldo Emerson; every man I meet is my superior in some way, of that I try to learn from him. In my case it's comforting that even the best of them get caught in quicksands.
All the renowned pharmacies in K had never stocked the mysterious magical elixir and so we end up right where we began, only about 15k less loaded than when we walked in that magnificent reception. When you grow up strive to be a consultant in something or the other..
Tuesday, 11 August 2015
Politicians On Call
The time was around eleven fifty something in the night. The three rough knocks on my door were unmistakable; it was the security officer. But it struck me as kinda odd. There was the hospital phone line that was supposed to come through; this was the agreed on system and for a long time it had never been flouted. But I still remembered this chap's trademark authoritative knock that would be rumble through the entire residence. I was in the middle of one of those MGM movies but had to suspend it. I was on call that week and this sort of thing was to be anticipated.
So I make my way to the door and ask the officer what the matter is.
"The Med Sup wants to see you daktari".
"Damnit, at this time?" "Is it over a patient?"
"Not a patient, the minister is here and they want your assistance."
"The minister! which minister?"
"The Minister of Health himself"
"Is the minister of health sick, I mean does he look sick?"
"Okay that I can not say, that is for you to establish."
"Okay then, I am on my way; let me get my stuff."
By this time I am fully alert and with rising curiosity turning over everything in my head. The minister who happens to be the local member of parliament is here, and he wants my help...!
Damn it, but the minister is known to spend nearly half of a minimum wage earner's salary on lunches at very serene addresses, why would he even bother to experience the well known inefficiencies of a public sub district hospital in the middle of the night! Exactly what does he expect to find? I brace myself for whatever.
So I discard my warm stylish jumper, put on my expected official attire, give the badass flick on the telly one last sorry glance and head out.
This was way before the new constitution was effected in 2010. Fast forward five years and devolved public healthcare is here; a mixed bag. There are some distinguished performers but across many other counties the tale is almost similar; perennial disorder and undermanagement. It's strike season reloaded..
Of course the general consensus across the healthcare professions has been the desire to revert this key sector to the national government. But while other hard boiled unions were lobbying for the retention of their functions by the national government these ones were in deep slumber! Not that devolution is a bad thing in itself but the experience so far points out the haphazard management of health and its functions by people who being neither medics nor proven managers for that matter only understand it from a consumption point of view. Supportive supervision is now replaced with patronizing supervision in most instances.
The matter has raised concern even up to the legislative arms of government but whether a complete or even partial return succeeds remains to be seen. But the factors for the poor showing have have been as diverse as varied. The governors are not taking this lying down and this is for well reasons...this is human nature in Third World Africa! But let's all wait and see.
Enough of the state of devolved healthcare for now though..
I head straight to the general admission ward. There I meet the nursing officer on duty and quickly inquire what the matter is. She confirms to me what I already know; that the minister is here and he is looking for some information about a particular patient!
"Sister, you can't possibly be serious!"
Do you mean me or the minister! If you don't believe it go to the records room, you are awaited there.
It takes me just a few minutes to the said records office outside of which are the official security officers of the midnight dignitary (poor souls are still on important national duty.) I enter and find the hospital Med Sup, the Nursing Officer in Charge, a harassed looking records officer (it's his lucky day of soberness!) and the hallowed guest; the Minister of Health himself. Both are standing except the records guy who has before him open registers from the outpatient, laboratory and from his own department.
I determine to shake hands with at least the minister but even before I take a couple of breaths in that room the Med Sup cuts to the chase. This is what he says; daktari sorry for the small bother. I know you young men switch off the moment your official hours end (his house and mine are within negligible proximity and so he must be well aware I keep late hours blasting Lords of The Undergrounds, Rakims, CL Smoothes, Gangstarrs, De la Souls et al)
Now you must recognize honorable minister here who also happens to be the area member of parliament.
"Yes I do." I notice the minister is surveying me with that lackadaisical, erudite air of muffled curiosity, is it my unshaven beard? Or that chronic look of distant distraction about me that has won me some unnamed trophies before?
Med Sup goes on; the minister sent a patient here earlier in the day (I surreptitiously glance at the wall clock in the room and it's just a few minutes past mid night!) and we can't seem to find any proper documentation about the patient, do you know anything about the said patient?
I request for the name. I vividly recall the man and say I do.
All the while the minister is harmlessly silent and hardly recognizable but I am on the lookout for his rather well known sharp wit.
"Now daktari we can't seem to trace any meaningful attention the patient received, why?" he breaks in in a slow measured baritone.
I believe it was all captured in his outpatient consultation booklet. And he was referred with it.
That is besides the point, why is there no record of the very same information in your registers?, he ferociously asks.
"Well that I can not definitively answer, I only do my bit and so I can not say why so and so did not do his part."
"Now that is a new one, this is supposed to be a system, it should work like clockwork, a person on every point of the chain should not only care for but actually know what happens at any other point."
By this time my energy is up and my agitation is climaxing but I keep my cool. It is all a situation I can handle but the Med Sup joins in the fray in this manner; "So you know about the patient, what happened?"
Okay the patient was a frail looking elderly man who came here yesterday in the morning. His chief complaint was a progressive growth in the abdomen. It has been there for close to a year now. And so when we reviewed him we thought it was most likely a malignancy and that is why we referred him to the provincial hospital for further work up.
"You mean even no simple test was done?"
"We did an HB on him and it was not low enough to warrant any immediate intervention."
"What was it?"
"It was ten."
"Was an HIV test done?"
"Yes but the result I can not disclose to other parties."
"That patient is my neighbour and it is me who sent him here, now was there nothing more you could do for him? Could you not have admitted him?"
"In his condition of presentation, nothing much and he had no current complaint to warrant an admission here, I am sorry to say that."
"Now daktari why was that patient kept here the whole day awaiting the said referral?"
"Our ambulance was out on other official hospital duties and the patient had no single coin on him, so he had to await his relatives who came very late."
I see, I will make a follow up the provincial hospital in the morning, bwana Med sup you are doing some good work here but I firmly believe you need to crack the whip on this leniency, records are invaluably important and if this is just one case how many others are missed this way?"
It is an issue we are working hard to fix, of course you realize how hard it is to keep everyone in check in a setting of this magnitude but overall i can say we are doing much better now.
"And we shall keep at it till we achieve perfection." This was from the Matron who all along had been a silent participator in the proceedings.
I believe this will be diligently done. Bwana Med Sup I am getting you a proper ambulance like I had promised. Will instruct the PS to effect it once I get back to Nairobi.
Oh that would be a great relief waziri. Our facility is breaking at the seams from activities and if we had an alternative means of transport such cases as this one would happen less.
This is the time for us to do as much as we can for our people. You know it is such an uncertain terrain that we traverse, so this is the time, let me see to it when I get to Nairobi but make it a point to remind me too.
Okay Bwana minister.
I quipped in, "You have yourself been a big proponent of social justice and equity but my observations tell me healthcare is still miles off in this respect. This makes the case for universal health insurance schemes even more dire."
That is correct, a particularly important and pet concern of mine. We have a team of consultants currently working on this very issue at the ministry and we expect that they give us their report and recommendations in a month or so. Then we can see how best to go about the whole issue.
A little more prattling on policy issues, developments, recommendations, projections and even politics followed that left me with a clearer conviction that he was still more suited for the lecture halls and university departments than he was for the rough tumble of government and politics.
The time was some minutes past one when everybody scattered into the night to their either warm or cold beds depending on each one's social arrangements! I personally headed straight to the homely couch, me being a notorious bachelor then.
The next day I woke up to the news, with obvious distortions of course about the minister's night call. Who had received a dress down or who was being moved or worse still who was being summarily dismissed. But lost in all the noise was what the minister meant by sending a poor neighbor of his to hospital utterly penniless and then making the follow up in the deep of the night. Only a few voices commended him for this, others condemned him for this funny guerrilla like operation. A honorable minister should move in light! And so on and on the buzz went on into the day.
It was unfortunate the old fellow succumbed a few months later having been diagnosed with cancer of the intestines which had aggressively spread in the later stages.
And so now in many facilities we have local politicians haranguing overworked, underpaid, unpromoted and yet to be paid healthcare providers. The discord between many county governments and the national government is not helping matters either. It is hilarious sometimes when these very uncivil elected or selected politicians want their relatives to receive particular treatment to the point of dictating the same to providers.
It happens that many of my colleagues in county government employ have to endure the wrath of internet educated MCAs or county executives imposingly asking them how for instance why if they can not diagnose or treat cancer then what good are they!
The promised ambulance never materialized!
So I make my way to the door and ask the officer what the matter is.
"The Med Sup wants to see you daktari".
"Damnit, at this time?" "Is it over a patient?"
"Not a patient, the minister is here and they want your assistance."
"The minister! which minister?"
"The Minister of Health himself"
"Is the minister of health sick, I mean does he look sick?"
"Okay that I can not say, that is for you to establish."
"Okay then, I am on my way; let me get my stuff."
By this time I am fully alert and with rising curiosity turning over everything in my head. The minister who happens to be the local member of parliament is here, and he wants my help...!
Damn it, but the minister is known to spend nearly half of a minimum wage earner's salary on lunches at very serene addresses, why would he even bother to experience the well known inefficiencies of a public sub district hospital in the middle of the night! Exactly what does he expect to find? I brace myself for whatever.
So I discard my warm stylish jumper, put on my expected official attire, give the badass flick on the telly one last sorry glance and head out.
This was way before the new constitution was effected in 2010. Fast forward five years and devolved public healthcare is here; a mixed bag. There are some distinguished performers but across many other counties the tale is almost similar; perennial disorder and undermanagement. It's strike season reloaded..
Of course the general consensus across the healthcare professions has been the desire to revert this key sector to the national government. But while other hard boiled unions were lobbying for the retention of their functions by the national government these ones were in deep slumber! Not that devolution is a bad thing in itself but the experience so far points out the haphazard management of health and its functions by people who being neither medics nor proven managers for that matter only understand it from a consumption point of view. Supportive supervision is now replaced with patronizing supervision in most instances.
The matter has raised concern even up to the legislative arms of government but whether a complete or even partial return succeeds remains to be seen. But the factors for the poor showing have have been as diverse as varied. The governors are not taking this lying down and this is for well reasons...this is human nature in Third World Africa! But let's all wait and see.
Enough of the state of devolved healthcare for now though..
I head straight to the general admission ward. There I meet the nursing officer on duty and quickly inquire what the matter is. She confirms to me what I already know; that the minister is here and he is looking for some information about a particular patient!
"Sister, you can't possibly be serious!"
Do you mean me or the minister! If you don't believe it go to the records room, you are awaited there.
It takes me just a few minutes to the said records office outside of which are the official security officers of the midnight dignitary (poor souls are still on important national duty.) I enter and find the hospital Med Sup, the Nursing Officer in Charge, a harassed looking records officer (it's his lucky day of soberness!) and the hallowed guest; the Minister of Health himself. Both are standing except the records guy who has before him open registers from the outpatient, laboratory and from his own department.
I determine to shake hands with at least the minister but even before I take a couple of breaths in that room the Med Sup cuts to the chase. This is what he says; daktari sorry for the small bother. I know you young men switch off the moment your official hours end (his house and mine are within negligible proximity and so he must be well aware I keep late hours blasting Lords of The Undergrounds, Rakims, CL Smoothes, Gangstarrs, De la Souls et al)
Now you must recognize honorable minister here who also happens to be the area member of parliament.
"Yes I do." I notice the minister is surveying me with that lackadaisical, erudite air of muffled curiosity, is it my unshaven beard? Or that chronic look of distant distraction about me that has won me some unnamed trophies before?
Med Sup goes on; the minister sent a patient here earlier in the day (I surreptitiously glance at the wall clock in the room and it's just a few minutes past mid night!) and we can't seem to find any proper documentation about the patient, do you know anything about the said patient?
I request for the name. I vividly recall the man and say I do.
All the while the minister is harmlessly silent and hardly recognizable but I am on the lookout for his rather well known sharp wit.
"Now daktari we can't seem to trace any meaningful attention the patient received, why?" he breaks in in a slow measured baritone.
I believe it was all captured in his outpatient consultation booklet. And he was referred with it.
That is besides the point, why is there no record of the very same information in your registers?, he ferociously asks.
"Well that I can not definitively answer, I only do my bit and so I can not say why so and so did not do his part."
"Now that is a new one, this is supposed to be a system, it should work like clockwork, a person on every point of the chain should not only care for but actually know what happens at any other point."
By this time my energy is up and my agitation is climaxing but I keep my cool. It is all a situation I can handle but the Med Sup joins in the fray in this manner; "So you know about the patient, what happened?"
Okay the patient was a frail looking elderly man who came here yesterday in the morning. His chief complaint was a progressive growth in the abdomen. It has been there for close to a year now. And so when we reviewed him we thought it was most likely a malignancy and that is why we referred him to the provincial hospital for further work up.
"You mean even no simple test was done?"
"We did an HB on him and it was not low enough to warrant any immediate intervention."
"What was it?"
"It was ten."
"Was an HIV test done?"
"Yes but the result I can not disclose to other parties."
"That patient is my neighbour and it is me who sent him here, now was there nothing more you could do for him? Could you not have admitted him?"
"In his condition of presentation, nothing much and he had no current complaint to warrant an admission here, I am sorry to say that."
"Now daktari why was that patient kept here the whole day awaiting the said referral?"
"Our ambulance was out on other official hospital duties and the patient had no single coin on him, so he had to await his relatives who came very late."
I see, I will make a follow up the provincial hospital in the morning, bwana Med sup you are doing some good work here but I firmly believe you need to crack the whip on this leniency, records are invaluably important and if this is just one case how many others are missed this way?"
It is an issue we are working hard to fix, of course you realize how hard it is to keep everyone in check in a setting of this magnitude but overall i can say we are doing much better now.
"And we shall keep at it till we achieve perfection." This was from the Matron who all along had been a silent participator in the proceedings.
I believe this will be diligently done. Bwana Med Sup I am getting you a proper ambulance like I had promised. Will instruct the PS to effect it once I get back to Nairobi.
Oh that would be a great relief waziri. Our facility is breaking at the seams from activities and if we had an alternative means of transport such cases as this one would happen less.
This is the time for us to do as much as we can for our people. You know it is such an uncertain terrain that we traverse, so this is the time, let me see to it when I get to Nairobi but make it a point to remind me too.
Okay Bwana minister.
I quipped in, "You have yourself been a big proponent of social justice and equity but my observations tell me healthcare is still miles off in this respect. This makes the case for universal health insurance schemes even more dire."
That is correct, a particularly important and pet concern of mine. We have a team of consultants currently working on this very issue at the ministry and we expect that they give us their report and recommendations in a month or so. Then we can see how best to go about the whole issue.
A little more prattling on policy issues, developments, recommendations, projections and even politics followed that left me with a clearer conviction that he was still more suited for the lecture halls and university departments than he was for the rough tumble of government and politics.
The time was some minutes past one when everybody scattered into the night to their either warm or cold beds depending on each one's social arrangements! I personally headed straight to the homely couch, me being a notorious bachelor then.
The next day I woke up to the news, with obvious distortions of course about the minister's night call. Who had received a dress down or who was being moved or worse still who was being summarily dismissed. But lost in all the noise was what the minister meant by sending a poor neighbor of his to hospital utterly penniless and then making the follow up in the deep of the night. Only a few voices commended him for this, others condemned him for this funny guerrilla like operation. A honorable minister should move in light! And so on and on the buzz went on into the day.
It was unfortunate the old fellow succumbed a few months later having been diagnosed with cancer of the intestines which had aggressively spread in the later stages.
And so now in many facilities we have local politicians haranguing overworked, underpaid, unpromoted and yet to be paid healthcare providers. The discord between many county governments and the national government is not helping matters either. It is hilarious sometimes when these very uncivil elected or selected politicians want their relatives to receive particular treatment to the point of dictating the same to providers.
It happens that many of my colleagues in county government employ have to endure the wrath of internet educated MCAs or county executives imposingly asking them how for instance why if they can not diagnose or treat cancer then what good are they!
The promised ambulance never materialized!
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