Kenya: Report Reveals Huge Toll of Neglect at Mathari Hospital

12 December 2018

The government's reduced funding to Mathari National Teaching and Referral Hospital in Nairobi has seen doctors forced to prescribe drugs that are not very effective, and which have serious side affects on patients, a report by the Senate Health Committee says.

The report, based on the committee's investigations at the hospital, notes that funding for medication for the institution, which houses 700 inmates, was reduced from Sh17 million to Sh2.6 million in the 2017/2018 financial year

The hospital's entire budget, which is never enough, at the best of times, was reduced from Sh114 million to Sh92 million.

NO MANAGEMENT COMMITTEE

Apart from the budgetary cuts in the last financial year, the hospital did not receive any funds because it did not have a management committee.

Hospital management committees draw up budgets based on needs and present them to the national government for funding. They also oversee the spending of the funds.

Mathari hosts patients with some of the severest forms of mental health problems, including those taken there by relatives and those from prisons awaiting psychological analysis, or who develop mental health problems in prison.

The hospital was established in 1911, and should, ideally, accommodate 600 patients.

The level-six facility is an apt reflection of the systemic neglect of the country's mentally ill, right from its infrastructure to staffing levels.

There are only 10 psychiatrists serving more than 700 patients. There is also a shortage of nurses, with the maximum security section having only one female nurse attending to more than 120 patients.

A study in 2008 by the University of Nairobi's Prof David Ndetei of the Africa Mental Health Foundation, found that half (51 percent) of the patients admitted to the hospital are schizophrenic.

Another 42 percent had bipolar disorder, while substance abuse disorder (34 per cent) and major depressive illness (25 per cent) were common in the depressive group.

CAN'T AFFORD MEDICATION

But medics at the facility not authorised to speak to the media, told the Nation that the hospital cannot afford medication for severe forms of psychosis disorders, such as Olanzapine, and for depression, Citalopram.

"The newer medication would reduce hospital stay considerably, as well shorten the time for recovery, but we cannot afford it, so we prescribe the older drugs, which also have worse side effects," a medic told the Nation.

Dr Simon Njuguna, the Head of Mental Health at the Ministry of Health, Mathari Hospital's medical superintendent and doctors would not comment on the issue and referred the Nation to the Senate committee's report.

According to the report, the hospital, Kenya's only mental teaching and referral facility, has dilapidated buildings and lacks toilets, bathroom and proper drainage.

Appearing before the Senate committee, Health Cabinet Secretary Sicily Kariuki did not deny the issues raised, acknowledging that the facility had suffered "perennial" neglect.

She said that the national government alone could not upgrade the hospital to a standard where it offers patients an acceptable level of care. The CS said that the ministry only built three extra wards and upgraded the laundry.

OWED SH40 MILLION

She revealed that the ministry owes the hospital Sh40 million, which is being disbursed in instalments, and appealed to the health committee to increase the funding.

The financial challenges are compounded by the National Health Insurance Fund's (NHIF) allocation of only Sh300 for three months per patient, when the most basic care costs Sh1,500 per session. In fact, the ministry has had to step in to demand that the NHIF pay the Sh105million owed to the hospital.

A doctor at the hospital said: "Regarding the NHIF, it is particularly sad for patients who are addicts since the capitation is just Sh60,000 per year, when it actually costs Sh135,000 to stay here for a month, even on these subsidised rates."

Families that have more than one addict have had make the tough choice of whom to treat and whom to leave out of such medical care.

Cases of patients slipping back into addiction in the course of treatment have been reported, and some never make it out alive.

Ms Kariuki said that since most of the patients lack identification documents, the NHIF cannot provide medical cover for them.

The Senate committee also raised concern about congestion in the maximum security unit, which hosts suspects with mental illnesses, mentally ill offenders or those who develop mental illnesses while in prison,

This section of the hospital was built in 1978 -- when the country's population was a fifth of what it is now -- and has never been upgraded to accommodate the increasing number of patients.

'DUMPS PATIENTS'

The Prisons Service "dumps" patients at the facility, and does not contribute to cater for their food or treatment.

Currently, there are seven patients who need round-the-clock care, who were abandoned by relatives, and have been in the hospital for more than two decades.

Despite the serious cases the hospital manages, often requiring in-depth diagnostic examinations, the facility was, surprisingly, passed over in the provision of CAT scans and imaging equipment by the national government. Equipment such as CAT scans and MRIs would rule out brain injuries and other diseases, which often complicate, or manifest in patients, as mental illnesses.

Patients at Mathari have been left out of the medical procedures used in other parts of the world to improve the quality of life of mental patients.

Mathari does not have procedures such as electroconvulsive therapy (ECT), often used on severely depressed patients in a catatonic state, meaning they cannot move, eat or talk. ECT, often performed under general anaesthesia, sends acceptable levels of electric currents through the brain to "awaken" it by triggering a brief seizure and change in brain chemistry.

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