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!