Caroline Njung'e
21 September 2008
Nairobi — Last month's Public Service Week activities were greeted with a lot of anticipation. Thousands who thronged the Kenyatta International Conference Centre, and other venues across the country, hoped that, finally, service delivery would improve in public hospitals.
A month later, in a corridor of Kenyatta National Hospital, it appears that the anticipation may have been premature - at least in Government health facilities.
On a Monday, at around 1.30pm, a middle-aged man is seated outside the X-ray section at KNH. He clutches a brown envelope and a sheaf of papers in one hand.
He is focused on the woman lying on the bench beside him, occasionally leaning over to tell her something. She is in obvious pain, tossing and turning, trying to find a comfortable position.
Doris Gathurima, and her husband, Jeremano, arrived at the hospital at 8am but had not yet seen a doctor. Doris, a cancer patient, was hoping to get a prescription for her chest pain.
"We had to wait for three hours to get an X-ray done," Jeremano offers wearily.
But the visit was in vain because they have just been informed that the doctor cannot see them today. No amount of pleading convinces a lady in a white coat to sneak the results to the doctor.
"Rudi kesho tu," (Just come back tomorrow) is her unhelpful reply.
Wait a month
This is not the couple's first visit to the hospital. They seek most of their medical care here because they cannot afford treatment at private hospitals.
Last year, Doris had a mastectomy after a cancerous lump was discovered in her left breast. Early last month, when she discovered a lump in her right breast, she and her husband boarded a matatu from their Kasarani home to the city centre then another to KNH. A mammogram confirmed that there was indeed a lump in her right breast.
In what seemed like complete disregard for her health, Doris was informed that she would have to wait close to a month before learning the results.
"We're really struggling to pay for her treatment, it is only fair that we receive better treatment than this," Jeremano protests, as he helps his wife to the bus stop.
Two days later, we call Jeremano to find out whether his wife was treated. He informs us that they did see a doctor, but only got painkillers for the chest pain. They were asked to return the following week for a blood test. The Gathurimas have no choice but to consent.
KNH is one of only two public health institutions equipped with machines for treating cancer. The other is Kisumu District Hospital, though mechanical problems make its machines unreliable.
KNH director Jotham Micheni says this has placed a big burden on the hospital, making it difficult for them to effectively handle all the cancer cases they receive daily. But, understandably, Doris and other cancer patients are more concerned about getting the treatment they struggle to pay for.
Deplorable state
Many patients seeking services at Government-run heath facilities would no doubt echo this frustration. And now, State officials have joined the chorus.
Last week, the Parliamentary Committee on Health, Housing and Social Welfare expressed concern over what it termed the "deplorable" state of Government health institutions. Speaking in an earlier interview, committee chairman Robert Monda said that there was an urgent need to upgrade the institutions if Kenyans are to get better services.
Some of the irregularities they cited included patients sleeping in corridors and waiting areas. Hospitals were also grossly understaffed and experienced drug shortages. As a result, many patients got poor services while others were sent home without receiving treatment. The committee is currently compiling its report.Mr Fredrick Outa, committee member and MP for Nyando, blames this sorry state of affairs on the Kenya Medical Supplies Agency, Kemsa, which is responsible for procuring and distributing drugs to public health facilities.
"Kemsa is a big mess and should be dissolved. They supply hospitals with the drugs they think they need, instead of what is actually required," he said.
Kemsa is currently reeling under a Sh1.6 billion debt owed to pharmaceutical suppliers. The Parliamentary watchdog on health has asked the board investigating graft at Kemsa to speed up its work.
Administrative problems are serious enough. But a spot check at two major hospitals revealed a startling lack of proper service for patients.
At KNH, for instance, some patients share narrow beds meant for one, while others sleep on the floor. In contrast to private wards which are cleaner and offer higher quality food, the general wards are significantly unkempt.
Unsanitary conditions abound. In several wards, water and food are spilt on the floor. On the sixth floor, a fully occupied ward with 10 beds had patients sleeping beneath four of those beds.
On this particular day, visitors to the HIV/Aids unit navigate their way round spilled water and several pairs of discarded surgical gloves.
Overflowing bins line the hallways. Two men share a bed in a corridor outside isolation room six.
The quality of food reveals another problem. Today's menu is rice and beans with a small serving of cabbage. Several plates of food have been pushed aside, waiting to be taken away. A few patients lucky enough to receive visitors eat home-cooked meals.
Scenes of relatives pushing the sick on hospital stretchers are common.
Too often, patients already burdened by illness must also deal with unfriendly staff. A youth pushing an elderly man on a stretcher towards one of the X-ray booths tastes the wrath of an employee manning the centre.
When he protests at being kept waiting for a long time, the employee, who stands just outside the full waiting area, suggests he has only just begun.
"So you have waited for four hours? Well, start counting the hours you will wait here, because there are others before you," he snaps.
Dr Micheni agrees that the hospital is facing challenges such as understaffing, inadequate resources and overcrowding. He says these problems occur because though the facility is a referral hospital, most of those who flock there are walk-in patients.
Nowhere to go
KNH has a bed capacity of 1,800, but has a traffic of 2,500 patients daily. Also, some of the mostly poor clientele who are fit to leave have nowhere to go. Another critical challenge is that 60 percent of bed space is occupied by HIV/Aids patients.
Dr Micheni says that relevant authorities are aware of these challenges.
"We have been consulting with the ministry of Social Services as well as the ministry of Health, and are working on a strategic plan to address these challenges."
On the priority list is modernising the hospital as well as equipping it and all other referral hospitals in the country with necessary treatment facilities.
A visit to Mbagathi District Hospital, which serves as the tuberculosis referral centre in the country, though not as busy as KNH, reveals that the infrastructure is in urgent need of a facelift.
Most of the wards are missing window panes while some glass doors are broken, exposing patients to cold nights.
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