Wednesday, 3 October 2012

No CT scan = unavoidable death

Dr. Emmanuel Ayodi Lusigi tells his story.

Today i spent my day at Nyanza Provincial General hospital{JOORH},and am an angry man.angry at the system.i went to pick the body of my dear friend Eric Lugaya Kikuyu who had suffered a head injury 48hrs earlier following an RTA.Am angry because all that was needed for Eric tu ride his bike again was a CT scan but because the is no scan in a public hosi in the whole of western region and nyanza,and the familly dint have 100k to deposit in aga khan there is liittle that could be done in time to save this bright 22yr old who was doing bodaboda to help him raise enough money to continue his bachelor of agribussiness at egerton university after being opharned 2yrs ago and thus becoming the sole bread winner of his 4 younger sibblings

As we sat on t

he mortuary lawns with Dr.Belinda akinyi waiting for the forensic pathologist to come we reviewed the case and for sure it was a clear case of subdural heamatoma and our fears were confirmed as Dr muturi o
pened the vault and walaaaaa!all that was required to save him was a Ct scan.

The blood eric shed,the tears the family will cry,the superless nights his siblings will have are squarely on NYONGO,KIMANI and the Rest of the MAFYA at AFYA.

how can over 1/4 of the kenyan population lack a ct scan at there disposal.no Ct scan all the way from the highs of mt elgon to the plains of the isbania boarder yet mediheal hospital less than 10 YEARS after its establishment has an MRI!!!!

So today we struggle for all kenyans from the boda boda riders and our freinds and relative who use them, to those of us are lucky enough to drive around and incase of an unfortunate eventuality we will end up in a govt facility and face the same fate as Eric.

So REST IN PEACE MAN and for as its ALUTA CONTINUA.

The Registra question..

MY NON-MEDIC FRIEND,I AM YOUR DOCTOR FRIEND, AND I WANT TO SHED SOME LIGHT FOR YOU. I AM TIRED,TIRED!! OF THE MEDIA SAYING A REGISTRAR IS AN INTERN,AMONGST HIGHLIGHTING OTHER INACCURACIES FROM OUR POLITICIAN HEAD OF HEALTH. HERE IS THE REAL TRUTH.

I choose to offer free and fair education to you, my friend.. and clear the air..

QUESTION 1.) JUST WHO IS A REGISTRAR?

ANSWER- It starts like this...FORM FOUR LEAVER - MEDICAL STUDENT (Either in UoN, Moi teaching and Referral, Eldy,au Majuu) - GRADUATE -,and then...

MEDICAL OFFICER INTERN(this is the KYM of all Medicine cadres..the real backbone of the district and provincial hosis.. actually, all hosis.. kama housegirl..working like a donkey!!for a year,no leave,no life, no time to date,drinks to drown sorrows..Internshit, i wouldn't re-do it even if I got paid a milli a month, why lie!!) -

MEDICAL OFFICER (fully licensed after one year of completing internshit..yes, that's what we call it.. it's like torture chambers!)

SENIOR MEDICAL OFFICER(having worked two yrs for gava post internship.. but don't let the word "senior" fool you!,ni ufala tu,no promotions are going on! ) - and then...

REGISTRAR (huyu sasa ameamua ku-apply shule aingie Masters, either gava-sponsored, or has kusanyad his peanuts and scrambled them together to pay 1st year fees, au ameomba loan..this one works exclusively at KNH, or MTRH, practically on their own, coz they are QUALIFIED DOCTORS,seeking to specialize..I only have one way to describe this world of a registrar.. HELL ON EARTH.. RIDE, OR DIE. Internshit kando. Nuff said.) -

JUNIOR CONSULTANT(finally after going through hell and kissing Satan's a**,then kickin' it, by God's grace and nothing else, one attains his/her Master's degree) -

SENIOR CONSULTANT/PROFESSORS,ETC..(hawa sasa ndio ma-Roc Boys..HAWA WAMEFIKA..hawa wanaishi Runda et al..hawa wako na magari za strength.. haijalishi ati nywele zao ni za grey..)

So, based on this, enyewe kuita registrar ati Intern, the only excuse ni ati umevuta bangi kutoka Jamaica. Ile ya Bob Marley.

QUESTION 2.) DESCRIBE THE WORK THAT THESE REGISTRARS DO.

ANSWER- I'll give you one example..out of a million.. Obs/Gyn registrars do >90% of the C/S (ceserean sections) at KNH without supervision. A C/S costs say 12 gees, and the registrar is paid nothing, to do it.. In one night on call, a registrar easily does OVER 7 C/S, earning the hospital 180K or so. Is asking for half of what you bring in in one night too much??!! SERIOUSLY???!
World over, registrars are paid, and DO NOT pay school fees. Look for examples from Africa. A good example is Aga Khan closer home(yet Aga Khan is a private institution)

QUESTION 3.) WHY DO SOME REGISTRARS OPT TO "PRIVATELY SPONSOR" THEMSELVES?

ANSWER- Due to the frustration in waiting for the rare Government scholarships. I think if one privately sponsored registrar gave their own story on this, that would help.
Note that even though these private sponsors may pay your tuition fee, they do not provide a monthly stipend. Registrars are often in their late twenties and thirties, with families to feed, school fees and rent to pay.WITH NO MONEY.
The 80 hours/week, needless to say leave no room for extra work for one to support themselves. These hours are ridiculous in the first place. In Belgium for example, registrars are not allowed to work for more than 48 hours/week, because beyond this, you cease being effective, your patients get a raw deal.
SO,IN A NUTSHELL.....
If indeed the registrars are not that important, why is KNH and MTRH empty? This is because registrars RUN these hospitals, they run the clinics, the wards, the theatres.

EWE,MWENYEZI MUNGU,UTUSAIDIE TUEPUKE UKOLONI MAMBOLEO!!!


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AN open letter From a pathologist to Prof

Prof Anyang' Nyongo,

Bwana Minister, as you would so painfully be aware, the definitive diagnosis of any cancer relies on evaluation of biopsy specimens. However, I do not know whether you are aware that outside the Major Public Referral Hospitals (KNH and MTRH), Public Hospital Labs are not capable of processing and analysing tissue biopsies to render the diagnosis. Instead, the majority of patients who are poor have to send their biopsies to Private Labs.

How many times have patients remained in the wards with no diagnosis on the cancer that's eating them away since they are not able to afford the cost of histopathology in Private Labs? How many times have I seen patients flush biopsies down the toilet since the cost of processing them is beyond their reach? And how many times have the few patients who've managed to send the biopsies to Private Labs have their specimens rejected or biopsies not rendered since our hospitals lack formalin?

More times than I care to remember Bwana Minister! Lucky are you who are able to go to San Fransisco to enjoy such privileges and land back in the country after diagnosis and treatment only to give lip service to the direction of cancer management in the country!

Ask yourself, as a privileged patient who understands the ravages that cancer wreaks what you have done to help the poor Kenyan cancer patients who depend on your Ministry for Healthcare.

Let us have functioning Public Hospital Labs with equipment and reagents, not peremende talk from you. Let our practice of Pathology not be limited to Post-Mortems but to helping rid out nation of this scourge.

#cancersucks #peremendemovement

Yours sincerely,

Kenyan Pathologist.
By Dr. Julio EtabalĂ©

pure slavery..

In the late 1990s my Mother and I came to Kenya when I was just barely 2 years. My father had come the year before. We were fleeing from the war that was there in my country. Since then I have lived in Kenya. I attended nursery school then began my primary school. In 1999 I sat for my Kenya primary school certificate and was lucky to get into one of Kenya’s prestigious high schools where I successfully completed my kcse.
My admission to the university was guaranteed but I was compelled to be treated as a foreigner requiring me to pay an extra 20% more than the average Kenyan. This made it quite a challenge for my parents to pay the fees and this was compounded by the fact that I was I was interested in the medical program. This meant I had to enter into the parallel medical program which was expensive by all standards.
This forced me to look for a cheaper alternative. I was lucky to get a good Samaritan who offered to give me a chance to pursue my dreams of being a medical doctor.
As soon as I graduated from abroad I came back to Kenya. A place I have always known as Home.
To me Kenya has always been my home. This is where I have been brought up and went to school right from nursery. My siblings were all born in Kenya. Today I am doing my internship at a district hospital and am denied pay just because the government considers me a foreigner.
The current government and officials at the ministry of medical services deem it right that I should render services without pay. Be ready to answer every call regardless of the time! Be in good health at all times, and be as energetic as can be to answer to this noble call when needed! Yet on its part it does not find it necessary to pay for services rendered. The excuse is as we have all heard before the government has no money more so to pay a foreigner. The government of Kenya previously paid all refugees …as now referred to!!
I do kindly ask what more would make one a Kenyan? By virtue of being born to a Kenyan parent? Yes.. One too can be a citizen of Kenya through registration. Where then are those like us bred in Kenya for more than 25 years? What of those born and bred in Kenya? Where do we come in? Are we not entitled to being citizens of the only home we have known despite the fact that our parents are not Kenyans. Why is it that its no longer convenient for AFYA HOUZ to pay so called refugees???””
Is it right neigh moral for the government to expect people to work for no pay? Which law guarantees this kind of barbaric action to be perpetuated in this age and time?
The Chinese as we know them got citizenship awarded by the president himself!!!
Is aint it impunity by mafia houz to expect one to do internship without pay???"


STOP EXPLOITATION IN HEALTHCARE!!!

From med school..

Weighing GoK and the Doctors’ strike – WHOSE FAULT IS IT?

We have seen lecturers, teachers, nurses and now doctors in all levels (interns, registrars, MOs, and doctors themselves) strike for better working conditions and better pay. But why do doctors have to fight for their pay yet no one can work for free? Has society and culture made us feel that wanting to earn a living should dictate our choice of profession? The so called “noble” professions are seemingly not so any more. They more than most are repeatedly taking to the streets demanding better pay and improved working conditions. “Who is to blame?” we ask; and then we quickly point fingers at each other. The Ministry of Medical Services wants Kenyans to perceive it as immoral and selfish for doctors to go on strike. In my point of view, there are two ways to look at it:
1. Either our society had become so materialistic that it reflects clearly on these professions OR 2. The leadership of our country is becoming questionable in its priorities regarding public interest.
OUR GOVERNMENT’S EXTRAVAGANCE
So maybe doctors are being immoral and selfish. But if doctors are as we judge them, could it not be that it is because of what our leaders expose us to as a nation: Ksh. 400 million vice-presidential mansions, gas guzzlers whose weekly fuel needs could power a small village for a day or twenty, exotic vacations at the sunniest sandiest resorts at the coast, Ksh. 200,000 seats – that are used for only a few hours every week… And as if to mock our collective intelligence, the speaker of the National Assembly goes ahead to say that MPs should receive a salary increment because they are “…paid peanuts…” Such extravagance is not just limited to the august house. At the recently concluded London Olympics, Kenya sent 32 world-class Olympians- whose glory was then watered down by a whopping 200 officials in the name of support. Said supporters were nowhere to be seen when our sportsmen and women needed a much needed morale boost. In fact, the officials apparently travelled earlier to Bristol leaving a part of the team behind training. If provided with this evidence, and that of the countless scandals through which our leaders have siphoned off billions of taxpayer money, the average Kenyan would infer that there is in fact more than enough money to cater for the needs of this country, or that the little that should get the job done is being stolen as they watch.
In light of the government’s extravagance I am forced to ask myself whether the priorities of the government are in the right place.
THE LONG AND TEDIOUS JOURNEY OF A MEDIC
Currently the longest undergraduate degree to qualify for in Kenya is the medical one. It takes 6 years for one to become a general practitioner, who while very capable of addressing a majority of ordinary health concerns, has no capacity to deliver specialized care. For one to acquire specialist skills takes another 4 – 5 years of post-graduate training (compare with 3 – 4 years undergraduate degree training and 2 years post graduate training in most other disciplines- with the option of working, since most of these programs are evening classes).
In Kenya, admission to a post-graduate program in medicine requires at the very least, an impressive academic record and excellent clinical skills. In Kenya, one must either be government or self-sponsored. To receive government sponsorship, one must work for at least 2 years in the public sector before being considered eligible.
After having spent 6 years in undergraduate training, a 2 year hiatus followed by 5 more years of intensive full-time training might appear too great a sacrifice. This, together with the competitiveness of earning government sponsorship (and the demand for specialists) leads many a student to choose to fund their postgraduate training. Once admitted, the registrar- as the post-graduate student is now called; begins a journey of apprenticeship and ceaseless practice. Inasmuch as they are taught through instruction and demonstration, a large part of the learning experience at this level is practice. In simple terms, registrars perform most of the procedures in teaching hospitals. In spite of the patient being charged for these procedures, the registrars receive no pay for the service they render.
In total, one will spend between 11 and 13 years between beginning medical school and becoming a specialist in a medical field in Kenya. During this time, one- who might be married and have started a family- will not have earned a single cent from applying their skills.
But enough of all this immorality and selfishness- wherever it may come from. Something is a-festering somewhere methinks, and someone should attend it soon.
A BIG PROBLEM
In the recent months, we have seen how much more it would cost us if Kenya failed as a nation. In Mombasa, the youth –turned mercenaries- resorted to treasonous acts and hurled grenades at their countrymen. The very fabric of patriotism unravelled as they kissed the foreign hand that fed them, and bit the cruel hand that bred them. It is said that their thirty pieces of silver were a paltry ten dollars per grenade.  Everywhere in Kenya these past two weeks, doctors, teachers and lecturers have abandoned their posts in actions that popular opinion would call heretical. Apparently, the care of the sick and the education of a nation’s youth cannot be abandoned at any cost. Apparently also, patriotism and all things black, red and green are immutable, blood-borne and forever. Why then are our young people so easily sold to the enemy? Why then are the most noble of our public servants so ready to leave their posts? If the government will not respect a (self) empowered group such as lecturers, doctors and teachers- in terms of education level, work ethic in building the society and appreciation by the society; how much less can they care about as vulnerable a group as the youth who unfortunately may not have the same opportunities? It goes beyond just immoral and selfish medics Mr. Nyong’o. It goes down to the fundamentals of the government that you represent to protect the rights of its honorable citizens. And so we are frustrated and angry and abandon principle.
Is there a country in the world that doesn’t pay its registrars? In Malawi, interns are given free housing. Hasn’t Rwanda, a country that is yet two decades old from being war torn, ensured that they treat the healthcare industry much better? Aren’t there on going, serious violations of rights to health (especially maternal and child health) in Kenya due to its policies- perhaps the reason why the country’s maternal and under 5s mortality rates are barely improving? Of poor policies, hadn’t our current National health policy become outdated in 2002? It is the job of the government to spearhead these policies. There are not enough pediatricians and obstetricians (both post graduate degrees) at rural levels yet Mr. Nyong’o can’t help but fire those in training. Instead, isn’t it only rational to motivate Kenyans to empower themselves into taking up these responsibilities? They want it to seem that healthcare practitioners issue threats, yet, it is them who passively threaten everyone.
Private Doctors are concentrated in major cities of Kenya. There is a siege of highly qualified doctors in the environs around Kenyatta National Hospital (still a result of poor government policies). They are operational. Maybe this is the reason why Mr. Nyong’o is not shaken. He either visits these doctors or flies off to America for treatment. Never the government hospitals he represents. What does that say of his faith in a Ministry he heads? Can it be he asks himself for what reason is there to educate our own if the policies the Ministry made aren’t meant to function? Leaders lead by example- it is implicit. Can we really afford to be led to follow considering the evidence that the government’s priorities are not in its people’s welfare?
No matter which way one looks at it Mr. Nyong’o, governance is to blame. I only have two questions for you Mr. Minister: If you had the choice of picking any government profession in the current situation of our country (on condition that you are not to pick your current one). Which one would you? Would you then be ecstatic and thrilled to build the nation for free?

Association of Medical Students of the University of Nairobi (AMSUN).

Response from the public

SOLDIER ON DOCTORS!!!!
by Margaret Ayienda on Saturday, December 10, 2011 at 9:11pm

My first unfortunate and very personal encounter with the public health system was about two years ago.This is the time my mother was diagnosed with cancer,cervical cancer to be precise.I must say it was a long heart rending journey that has and will always be etched in my life.

We first consulted a gynaecologist at the KNH doctors plaza who then referred as to an oncologist immediately,who in turn told as that a sample of the growth was needed for accurate diagnosis and staging of the cancer to enable her to know what course of treatment to prescribe.It was a simple procedure,she said,and it only required that my mom be put under for about 30 minutes and it would cost some Ksh.5000 at KNH compared to private hospitals which would charge at least Ksh.20000.

We opted to for a private hospital due to the urgency and the procedure was done and we got the results in 5 days.The pathology report confirmed our worst fears and here began our never-ending trips to KNH.It was a stage 3 highly aggressive cancer.The oncologist ruled out a hysterectomy and chemotherapy citing it would be in vain because it had already spread to the surrounding areas and mom was to frail.The only option left was radiotherapy everyday for six weeks.

The radiotherapy sessions cost Ksh.330 per session at KNH compared to an average of Ksh.1200 at other private hospitals.Therefore we settled for KNH because the other hospitals were beyond our reach.We were given an appointment time of 8.00a.m everyday.Little did we know that it would translate to 12pm onwards.We would be at KNH by 6.00am but find at least 20 patients already in the waiting room..This was due to the long queues at the radiology department.The technicians would come in at 8.30am.Hitherto,i still shudder at the thought of that waiting room.Most patients were critical,with all types of cancers and worst of all the smell was sickening,nauseating to any healthy person.The washrooms were not any better and any sane person would have to go there with gumboots so as not to pick an infection.

More often than not,we were required to carry our own gloves because the radiology technicians always said they were out of stock.It was either you buy the gloves or if you are the caregiver,undress your patient and ensure the diseased part is exposed under the machine before they put in on.After each session was complete,the caregiver would be called upon to dress the patient and wipe the surface with a disinfectant.I recall, that with time i had to force mom to wear adult diapers simply because one of the side effects of radiotherapy,diarrhoea would not let up.I did this for her and myself to avoid infections from the washrooms because she had uncontrollable diarrhoea and could soil herself anytime of day.

After a gruelling one week of radiotherapy,the oncologist stopped mom's sessions since she had become too weak due to a dangerously low hb of 6.She consequently ordered a full blood count,fine needle aspiration of the inguinal nodes and a doppler because her thigh was swollen such that she couldnt walk.All these tests were carried out in different parts of KNH as i discovered that day.You can imagine my frustration having to take someone who cant walk even 50metres to the farthest ends of Knh for these tests.I got a 'good samaritan' (cleaner) who volunteered to get me a wheelchair for Ksh.50 so that i could take my patient for the various tests.We became' good friends' with this cleaner as he would provide me with the wheelchair everyday,of course at a fee,as eventually mum coudnt walk.

Results which were due the next day got lost.They had supposedly been sent to the prescribing doctor who in turn said she had not seen them.I was only given the doppler results that day.So i concluded they were lost and crossed over to the privatley run lab at doctors plaza where i got tangible results within an hour.Afterwards i came to discover that they would take blood for testing while in fact the blood count machine was faulty and non-functional most of the time!

Within those six weeks of radiotherapy mom got 4 blood transfusions of two pints each, definitley not at KNH.Our thinking was if the blood count machine wasnt working,what other machines were not working?How do they test blood types and anything else to do with blood?I dont know, but at that time we were unwilling to take the risk of a wrong blood type being administered.All this while,the oncologist would change mom's medication at will due to the adverse and worsening side effects.Up to date i still remember all the 15 types of medications by name. Amazingly,I only got two in the KNH pharmacy,immodium and morphine, the rest were out of stock.Surprisingly the prices of even the 'out of stock' medications would be pinned on the wall!Why even bother,i would wonder.All these medicatons would cost at least Ksh.1000 per day owing to the high retail prices in town.

Mom completed the radiotherapy sessions successfully as the growth had shrunk substantially.But more was yet to come since she was still in immense pain.So our oncologist,not one to give up easily, prescribed a procedure called brachytherapy, but on the other hand she was quick to inform us that the machine at KNH had not worked for at least 1year.This procedure,she said,was strictly for pain management in mom's case.Other private hospitals that had the machine charged at least Ksh.200,000 for the 24hour procedure.Frankly,my family was financially,emotionally and psychologically drained.But what were we to do?We would go to the end of the earth if it meant mom would be pain-free.The oncologist suggested Mulago hospital in Uganda which did the procedure at way less than its kenyan counterparts.This,i can say was the worst time for mom because she starved herself for 2 days prior to the trip reason being she didn't want to soil herself during the trip.Nothing or no one was able to convince her to eat but she would still take her pain medication,which in essence made her crazy.She even refused to put on the adult diapers during the journey and God was on our side because she didn't soil herself in the course of the 12-hour bus ride.To cut a long story short,we went and had the procedure done then resumed our ever endless visits to KNH.It was downhill from there as she developed kidney failure and subsequently general organ failure.

Mom succumbed to her illness two months after the brachytherapy procedure,that is six months after the diagnosis.

In my opinion,anyone who has never had a critical patient at a public hospital should zip it!!They should not under any circumstance, condemn the doctors intimating that they are selfish.You who has never seen the walls of a public hospital,have no moral authority to criticise.The working conditions at this public hospitals are deplorable,to say the least.The basics like gloves and disinfectants are lacking.Patients lose their lives due to treatable diseases like malaria.These doctors have a right to work under a conducive working enviroment,they are no more human than you or i.

And doctors out there bravo!I can say you are doing a damn fine job with the little that has been availed.Thank you for fighting for the right to better healthcare,thank you for fighting for our children and thankyou for fighting for us all.

Imagine this is happening...

Post by Dr. Tony Ramogi in the US. Yet another reason for #peremendemovement

Tee Rams
9 hours ago near Pasadena, CA ·

Today I meet a former senior consultant district surgeon in early 50s from Kenya, a university of Nairobi product,Starting a fresh here!!! I mean starting with usmle step 1....then residency.He has been here 3yrs working as a nurse in the operating theatre!!
Trust me its not easy to give up these privileges in any country at such an age.For such a doctor to work as a nurse,take orders etc.That takes heart.
As the doctors strike in Kenya continues,maybe our Prof should ask why a whole senior consultant surgeon would prefer to work as a nurse in foreign land ,let alone starting all over again at 50+ years.
Am just saying,No ill intentions.No offense.

Just in case...

Just in case Nyong'o is wondering why doctors are "sulking for sweets", here is a story that is sadly too familiar within the Kenyan healthcare system...

By E.N. Mburu

The day I did surgery dressed like a priest
I remember that fateful Friday as if it was yesterday. I had been on call for two days, and I left the hospital at 7.50 am to dash home to grab a shower before going back to the district hospital where I was working as an intern. No sooner had I gotten home than my phone rang. It was maternity, and anyone who has been there knows how the story goes…. You know, rifaroos and emergencies as the sisters like calling them. I dashed into the bathroom and showered as fast as I could. There was no time to eat breakfast, for the ambulance was waiting outside. I got to the hospital, and there was an emergency for real. She was a primigravida, who had been draining liquor for more than 3 days in a certain dispensary which did not deem it appropriate to refer a patient who was clearly having obstructed labor. Somehow the fetus was still fighting, but the distress was obvious. A foul smell was emanating from the birth canal and the fetal heart rate was misbehaving. For once I heard those acceleration and decelerations that they describe in obstetric books.
I quickly prescribed a caesarian section, and not long afterwards, the patient was wheeled to theatre as evidenced by the meticulous nursing cardex. Nurses love to cover their asses. As the anesthetist was receiving the patient, I scanned through the cardex. It had all the details anyone wishing to crucify you would look for, including the time when the ambulance came for me and when I arrived at the hospital. These things are recorded in real time.
I rushed to the changing room to put on my scrubs in readiness for the operation. My fellow intern, Dr. Doreen, had just arrived. I welcomed her to theatre. The anesthetist was ready and the nurse was busy setting for us. Dr. Doreen and I had scrubbed, and we were waiting for gowns to be placed on the cart. Then something unexpected happened. The nurse announced that there were no gowns. I was furious. It was true that we had done a couple of caesarian sections the previous night, but that was no excuse as to why there were no gowns. The nurse explained that the autoclave machine had broken down in the wee hours of the night, and the maintenance guys could not figure out what was wrong with it. In short, the gowns were stuck in the damn machine.
We stared at each other as we pondered our next move. In our naivety, we thought of referring until one of the nurses suggested that we improvise. Believe it or not, she got two abdominal sheets for us, and we put them on. The sides were clipped with artery forceps. One nurse walked into theatre as we just about to start operating and her words echo in my ears up to date. She joked about it. “Dr. Mburu and Dr. Doreen, have you changed professions? The place of priests is in the altar where they consecrate bread and wine into the body and blood of Jesus Christ, not theatre, where blood is the order of the day.”
As the anesthetist gave us the go ahead to cut through the skin, another nurse joked. “Mass is about to begin! In the name of the Father, Son and the Holy Spirit.” We literally waded through the operation, and our encounters in there are events that made me very sad. As we made a smile incision in the lower uterine segment of the uterus overt chorioamnionitis was staring at us. A foul irritating smell that is similar to that of pungent chlorine hit our nasal cavities, but then we were keener on extracting the fetus. It could not get worse. As I handed over the kid to the receiving nurse, I saw her face drop. I could tell it was a fresh still birth. They tried resuscitating to no avail as I battled with bleeders. Streaks of blood were dripping to the floor as if it was a stream. I tried packing, but the bleeding was still torrential. I requested the anesthetist to pump more oxytocin for the uterus to contract more, but that did not help either. I requested the sister to call the lab to get blood for the dying mother but as it is in our labs, there was no blood. It was only when I clumped the uterine arteries that the bleeding stopped. I asked for plasma expanders, only to be shocked that a whole district hospital did not know what those were. At that moment the MO called the consultant to bail us out. Our woes were far from over. Long before we knew it the anesthetist mumbled something that I did not quite get. I watched as his instincts swung into action. The patient was still lying supine on the table with an open abdomen as the consultant scrubbed when the anesthetist did something unexpected. He reversed the general anesthesia he had administered to the patient. We stared at him in shock. I could not understand why he would do such a thing given that our patient had almost gone into shock. Then he explained. “The cylinder that supplies oxygen is out of gas, and there is no reserve. I had to reverse GA so that she can breathe for herself.”
As I paved way for the consultant to proceed with the operation, I felt a wave of sadness sweep through me. My heart was hollow. I chose to become a doctor so that I can help the suffering, but how do I do that if I do not have equipments and drugs to do achieve my goals? The consultant, just like us, was dressed in an abdominal sheet, which served as a substitute to a gown.
To bring this story to a culmination, I wish to state that the mother eventually left the operating table stable, without a child and without a uterus. Please bear in mind that the child she was carrying was her first, and sadly, her last.

#Peremende Movement Till Things Change For Good#

Tuesday, 2 October 2012

WE WILL NEVER FORGET HIM, NEVER..


On Friday 6th May 2011, a patient passed away while in transit from Kiambu District hospital to Kenyatta National Hospital to receive dialysis. He worked in Busia DH and had gone to Kiambu to visit his parents. During this break he developed severe malaria and two days later he had developed acute renal failure for which reason he was referred to KNH for dialysis - this he never got. This patient was Dr. Henry Gatune Medical Officer Busia DH who finished internship last year and he died because Kiambu DH does not have dialysis facilities. No, let’s put that more accurately,
He died because the only places in a country of 40million people and 47 counties  that the government has bothered to put dialysis equipment are KNH, MTRH, Coast General and Nakuru DH.
Acute renal failure is often easily reversible, you dialyse a patient for two weeks and they are back to perfect health - this young doctor who has literally saved lives couldn't get this. Really!? It also begs the question, if this is what happens to the doctor, what happens to the ordinary citizen? This also highlights the points we have been talking about albeit to a deaf uncaring government – 1. that public sector healthcare provision is a horrific tragedy and 2. that doctors can’t even afford the healthcare they provide – not even when their lives depend on it (and the public so much less so). For instance, if he could afford treatment at the Karen Hospital he would have began dialysis in an hour latest. Better yet, perhaps we should have flown him to Amercia on day one! Instead, his government pays him only just enough to seek treatment in Kiambu district hospital  and KNH – both of which it has severely underfunded, underequipped and understaffed with poorly paid staff.
We have to do whatever it takes, pay whatever it costs to ensure that because of Dr. Henry Gatune, this kind of thing will never happen again in our country. Not while we live.
Dr. Ng’ani.
__________________________________________
"His death certificate read that he was a victim of acute renal failure, but the true cause of death was a healthcare system that has failed to demonstrate regard for millions of Kenyans who have no other recourse for a fundamental, critical service." - The EastAfrican
"Among Kenyans failed by the system are the very health workers we expect to dedicate their lives to selflessly battling disease, but whom we fail to give the resources to deliver that care, even to themselves, and even at the very point from which there’s no rescue or return" - The EastAfrican

IRON LADY OF MEDICINE..


Some people think self sponsored registrars are having it easy/privileged, this might give you a wider perspective

Doing my part one wasn't a walk in the park,self sponsored,paid every single penny of that fees. Locumed so much at night,went to class at chiromo during the day. I remember i once did locum the whole night and sat for an end of quater exam the following morning. My son missed me,my hairdresser missed me,my friends missed me. They all knew about my forthcoming exams. I even asked my son to pray for me n he is only 4! What i hated most about the year was the bank calling me over a loan i had defaulted. They said they will come for my assets. I told them i dont have a car nowadays. I own nothing. I dont have rich parents to fall back on to either. I took the loan to start a business with 5 other idiots n the business went down. It was meant to see me through post grad. When it dint pick i still decided to go back for post grad. I consolled myself i worked through undergrad to support myself. N i told myself i will locum. Someone agreed to sponsor me. I miscalculated since in undergrad i dint have a child,now i do,he needs me,i owe him my time. The person sponsoring me bailed out on me,n i was left to my own devices. I remember feeling so burnt out at some point n what was i told by this sponsor? If u cant hack it just drop out. The bank knows about the strike,i hope.
My hairdresser knows about the strike too,i bumped into her n promised to make regular visits if things look up.
I am told part two is tricky u cant locum as much coz the schedule is tight n unpredictable.
It is my prayer that the strike pays off. If it doesnt i just hope they review the hours post grads work at the hospital,so i can continue moonlighting n meeting my needs. If this is not so i will b left stuck between a rock n a very hard place.
A former classmate today was critisizing the bad service n misdiagnosis she got at one famous private hospital,n she said she has lost faith in the current crop of doctors. N i realised all these people commenting were average students who did B.A n now they take home 6figure salaries,n so they can afford to gloat at the likes of me n the strike. This doesnt feel right at all.
I feel down,the sky is grey outside. Its not sunny. God help me

Peremende Tales

i Just want to share this personal story by Doctor


I left Teso district for Mount Elgon at the height of tribal cleansing there. I like watching TV and any good action movie is always fine with me. So, every time I turned on my TV set, as I reposed in the lounge, I always saw harrowing footage from Mount Elgon highlighting the operations of some psychopathic killers. Although the news reporters did everything to sanitize their video clips, rivers of blood still flowed on every slope of the mountain. The reporters could mention that a number of people had been killed when the sun was still up in the sky and at times that married women had been violated and their men castrated. We saw a massive exodus of those with faint hearts leaving the area. No one had the time to enjoy the harvest. Warlords donning military garb were wielding guns and other crude weapons with a determination to go on with the atrocities. They were claiming to be defending their land that had been gluttonly grabbed. That is the time I was supposed to climb that mountain as a medical worker and risk being killed with no extra pay. In fact my house allowance was slashed by half because Mt Elgon is considered as another area, not even a municipality. I thought of resigning from government and go into private practice but some wise man, Haggai Mayaka prevailed upon me. He buoyed me to go up there and assess the situation first then decide.

It was a sunny Friday afternoon the day I reported to the yellow walled Mt Elgon district hospital. The place looked green and fertile, vegetation growing in wanton profusion. The atmosphere was so pure with plenty of fresh air. There was a daunting skeleton of staff members at the hospital. Apart from the place being understaffed, it lacked an enabling environment. Many of the health workers were on the run following threats from the insurgents or due to sheer fear. As later I would learn, the hospital was busiest on market days, Mondays and Thursdays, characteristic of rural communities.
After presenting my letter of deployment, I requested for two weeks to move house. Tactfully I was allowing time for dust to settle at the mountain. At the time the Army under disguise of ‘okoa maisha’ was hot on the heels of the blood-thirsty warlords. It scoured the forest and arrested many who were turned into jailbirds, some took the bullet and yet others sought for refugee in the neighboring Uganda. After the group was successfully dismantled and the guns fell silent, I went back to Mt. Elgon hospital and assumed my duties.

Together with other health care providers, I worked under very difficult conditions. There were limited resources and staff to work with. There was no theater or a functional laboratory. The facility was just a forwarding center because we were not equipped to handle complicated cases there. There were no staff houses in the hospital or nice rental ones in Kapsokwony. As I executed my national duty in Mt Elgon, I used to commute to Kapsokwony from Kimilili abode. I lived in Okatch Nyaholo’s house number one next to the gate and not far from a morgue. The road that led to this place used to be terrible. Whenever we had heavy rains in Kimilili, I used to leave my car at a petrol station and wade through the mud to my house.
Even in Kimilili there was no absolute security especially at night. I used to hear people talking in the dead of the night as they passed through the road near my house. My house was once broken into while I was away and my fridge emptied. My colleague had been robbed thrice while still staying in the neighborhood in the same house. It compelled me to buy an axe with an aim of forcibly driving it into the head of any intruder. Luckily, by the time I was living the area on a new assignment, I had not used the axe.
Transport, too, was a big challenge working in Mt. Elgon. Because Mt. Elgon had seen many years of insufficient government support, it was far away from civilization. Waking up every morning and going to work in Mt Elgon wasn’t enjoyable. The roads there were primitive with rugged slippery slopes. During the dry season, the CDF vehicle could pass you by like a bullet leaving you in a cloud of dust. Motivated by the patients we served sometimes we arrived at work covered in a layer of dust from the dusty roads. I was brought up knowing that rain heralds hope to everyone. But in Mt. Elgon, when it rained, it complicated things for us all. No vehicle went up the mountain forcing us to trek for 9 Km to and from work. Big tracks ferrying logs from Mt Elgon forest sometimes used to slide and straddle the road, completely blocking it. Since we didn’t have high quality facilities and specialists, we used to refer our patients to other hospitals where they could access the services they needed. That too was a nightmare. If the Nissan Ambulance took a patient to Webuye district hospital or Moi Teaching and Referral Hospital and it happened that the heavens opened before it was nowhere near the foot of the mountain, then the driver had to look for parking space in the neighboring Kimilili. If you had another patient whose condition had exceeded the institution’s capacity, then you could only pray for him for God to intervene because you wouldn’t want to venture into the awkward road. Even there were no pathologists to do forensic autopsy when there was a contested death. People who were not qualified enough did the postmortems. They could point at loops of intestines dilated with gas and say, “This is what killed your loved one.” After viewing the decomposing intestines, the bereaved would walk away wondering why the world keeps surprising them.
To be continued,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,