Friendly Fire (9/12/11)
Today is day 5 of Kenya’s doctors’ strike. No doctor employed by the Ministry of Health in Kenya has shown up for work for this whole week, and the strain on the system is starting to show. The private and not-for-profit hospitals are attempting to care for a country full of sick people, most of whom struggle to pay for public care, let alone slightly more expensive not-for-profit care, and the people who are suffering are the poor and the sick.
Kijabe is one of the not-for-profits. We charge a little more than the government facilities, but a whole lot less than the private hospitals. In order to make this sustainable, all of the doctors who are not Kenyan work for nothing. The Kenyans who work for the hospital are paid, but a very low salary, which they do because they have a heart for serving the poor and displaced of their own country. And the government, seeing that we provide care for people they simply do not have the resources to treat, pay for our interns to be here.
Our interns come here because they are Christian and also have a heart for the poor, the lost, the needy. Part of their training here is practical, but it is also a wholistic training facility. We have some excellent interns, and they are an indispensible part of our team – especially overnight and on the weekends. Not only do we miss them – we need them. At the best of times. And these are not the best of times – our workload is the highest it has ever been.
One man went to ICU after 36 hours of bouncing from one non-functional hospital to another after his road traffic accident. Many pregnant women have come here to deliver their high-risk babies after realising that their obstetric care could not be continued at Kenyatta (the state hospital in Nairobi). The maternity service is bursting at the seems.
Peris arrived on my night on call on Wednesday. At 3:30am I received a phone call from our clinical officer intern, a very junior PA-equivalent with no pediatric experience, with a slightly panicked phonecall that there was a “20 week baby in casualty”. Alive? A baby born at only 5 months?
Peris, it turned out, was born at home 16 hours earlier, suddenly, prematurely at probably closer to 30 weeks, and her twin sister didn’t survive. Mum took her remaining daughter, this 700 gram scrap of an almost-baby, to the closest hospital in Kikuyu, which doesn’t provide care to premature babies. And, knowing that our nursery was full, and that the neonatologists at Kenyatta are on strike, they gave her oxygen, some IV sugar, some Vitamin K and sent her to us anyway.
We had no incubators, and nowhere to send her. This glistening pink shiny doll, however, was opening her tiny eyes and looking at me. And breathing, all on her own. Her face seemed to say – I have come this far, on my own. I am a fighter. Give me a chance.
And so we admitted her anyway. Under a baby warming resuscitaire, with antibiotics and oxygen and IV fluids, praying that tomorrow one of the other tiny babies would be big enough to donate her incubator to give Peris a chance. And so far, she has made it.
Today, 4 week old Michael came in. It was immediately apparent that he was born with a heart condition, and it is getting worse. Mum has no money, no insurance. We don’t have a cardiologist, no way to tell what his heart problem is, and we don’t have the right drugs to stop it worsening. The cardiologists at Kenyatta are on strike. So he has been admitted anyway – we will try to do what we can on Tuesday, after a public holiday weekend, if he is still alive, if there are doctors working who can help him. Or we will access our Needy Children’s Fund and pay for him to see a private cardiologist and do what we can here.
And my last patient of the day, Richard, who came in with weight loss and swollen glands, it turns out has leukemia. Dad almost left before doing any tests because he has almost no money. The oncologists at Kenyatta are on strike. So we, with no oncology facilities, will admit him over the weekend, and try, on Tuesday, to talk with a private hospital in Nairobi to see if this curable cancer can be given a chance through their Benvolent Fund.
Frustration – that these innocents are caught in the middle of the tragedy of friendly fire.
Update 11/12/11 – Sweet Peris lost her struggle in the wee hours of this morning. Despite finding an incubator for her the next day and some strong medications, her strength just wasn’t enough to overcome a rough start in life, and her kidneys just didn’t make it.