Being sustainable (26/11/13)
This is Patrick. Two weeks ago he was an 11-year-old running around his village, playing football, going to school. But slowly, he noticed some tingling in his fingers and toes – then he couldn’t pick up firewood properly. He became weaker and weaker, and his family decided it was time to go to the hospital. The pediatric team quickly realised he had a condition called Guillain-Barre syndrome – the body’s own immune systems attacking the nerves instead of a long-gone virus. By Saturday night he couldn’t breathe , and Jennifer had to put him on a ventilator in intensive care – hoping that we could keep him alive long enough for his body to naturally recover.
Incredibly, he didn’t succumb to complications of old ventilators or too-small tubes blocking, or from infections from a hospital that we try to keep clean, but keeps filling with nastily-infected patients. Yesterday, he started to move his leg – then last night his arm. And then today – breathing, on his own, the tube removed. A smile – a spoken word. A boy who will, marvellously, go home.
But every day Patrick spends in hospital costs someone. It costs us $60 a day to keep our ICU running, just for the maintenance of ancient donated equipment, the water and electricity, the salaries of our specialised nurses, kitchen & laundry staff. To pay our Kenyan doctors, who come here to work for a fraction of the salary they could receive in Nairobi because they have a heart for the poor in their own country.
Everyone in Kenya is poor by Western standards, and you can’t provide free care for everyone – so every hospital in East Africa charges something for medical care. Because we are a not-for-profit mission hospital we charge lower rates than average, just enough to cover the costs of our subsidised medications, staff salaries, and second-hand equipment. It is an insignificant amount by Western standards – but it is still a large amount for patients’ families, who often live by subsistence and what little money is earned is needed for food, transport and education.
In Africa, community is family and wealth is shared. And so even if Patrick’s family doesn’t have money to pay for his ICU stay, the chief of his village or senior pastor of his church will organise a harambee – a community fundraiser. Everyone comes together to help friends in need – tuition fees and wedding celebrations and hospital bills are raised together, and the joy of graduations and marriages and recovery are sweeter because they are celebrated together.
But there are so many, too many who do not have a community – women who have been abandoned by their husbands because they have lost too many children, men whose heart problems and diabetes have proved to be crippling to their families, children whose disabilities were too burdensome for their fathers. And when they need to pay a hospital bill, and they can’t afford to pay even our low charges, we rely on people like you to donate to one of our charitable funds: the Needy Children’s Fund, or the Orthopedics Fund, etc. We ask for help – and receive it – again and again and again.
But how do we get to a point where care for patients like Patrick doesn’t rely solely on the generosity of donors in the West? Is it possible to move to a model in which overseas donations help greatly, but the Hospital isn’t forced to shift money away from the salaries of our laundry workers and cooks to cover unpaid hospital bills if these donations dry up for a few months? Do we increase patient fees – there would be more money for needy patients and we could raise our too-low salaries, but fewer patients would be able to afford our care. Do we become a private hospital for the well-to-do only, focussing on medical training – knowing that those trained doctors will just leave us for greener pastures and without us instilling a heart of compassion for those around them?
As medical director, my job is to try to answer some of these questions. And starting next week, we’re going to take some baby steps in the right direction.
We have a small clinic and tiny inpatient ward dedicated to private patients – middle-class and wealthier patients who live in Naivasha or Nairobi who have heard that excellent doctors work here. They are willing to travel to us for care, and to pay a bit more for it to be seen in our private clinic. Up until now, our small private services have helped to cover a few financial shortfalls in other areas of the Hospital, but after a lot of discussions with different departments and management team members, in a week we are launching a new system to help Kijabe Hospital sustain low fees and free care for the poor.
From December 1st, for every private patient seen, a percentage will go into a new Hospital-wide Vulnerable Patients Fund – we hope this might raise between 4.5M-6M shillings ($54,000-$73,000) per year, dedicated purely to paying the hospital bills of kids and adults like Patrick, whose ICU care would be otherwise unaffordable. We are also hiring a case manager (thanks to a generous donation of a group called Workshops with Purpose) so we can better assess during the admission process which patients have enough income or community support to cover our low hospital fees, and which patients are truly destitute. We will also put a portion of the private clinic proceeds into a fund for a small salary supplement for our Kenyan doctors, who not only sacrifice a private Nairobi salary to work for us, but also agree not to work in private practice on their off-days to maintain the integrity of our service. And we hope this will enable us to continue to keep the fees for our regular patients extremely low.
People have asked me about our work here – how will you make it sustainable? How long must expatriate volunteers/missionaries such as yourselves help with healthcare before the country is able to sustain its own? And my answer has become this: as long as we live in a world where our distribution of resources is so massively unequal, we will find it incredibly difficult to make a charitable enterprise in a resource-poor country truly sustainable. My job here is to put systems in place (such as this new private clinic model), to increase efficiency and train doctors to train doctors. But my job is also to be a link, a conduit to the generosity of those in the resource-rich world – a world in which we keep extra televisions in storage units, change our home decor to match the season, tire of unworn clothes because a new season of fashion is upon us, and fly Lady Gaga into outer space to perform for us.
There is a story told in Mark 10:17-29 about a rich young man asking how to inherit eternal life. Proudly reciting his goodness, his adherence to the rules of religion, his external appearance of holiness, he asked Jesus an almost rhetorical question: am I good enough for eternal life? And what Jesus replied was, in essence, this – I don’t care how you come across to people – what do you love most in the world? And if that thing is your wealth – not God, and your neighbour as yourself – then you are not truly living. Eternal life – “zoe aionios” – means literally a different quality of life starting now, not the duration of what happens after you die. And it cannot be yours if your identity is tied up in your wealth.
This, to me, is the essence of Christian sustainability. As a global community, where are our hearts, and the focus of our investments, our policies, our lives? In what do we put our hope? I’m absolutely sure I don’t have all the answers. But I’m going to keep asking the questions until the Patricks of this world have the same chance of life in Kenya as in Australia or the US.