Note: No pictures are allowed to be taken inside of Moi Hospital.
After we “got strong” for the day, Izzy took me on a tour of Moi Hospital and the patient wards. The hospital, like most I’ve been to in America, has many buildings that have been added to it over the years. However, unlike the American hospitals, the climate allows the buildings to be connected together via an outdoor covered walkway rather than the rabbit-warren-like passages I’m used to in American Hospitals. The main inpatient wards are situated at the far end of this walkway. As we approached, the first thing that I noticed was the gate. There is a guarded gate which connects to high fencing that runs all the way around the men’s, women’s, and children’s wards. This is not a gate to keep people out, but rather to keep them in. In Kenya, only a small percentage of the population has something that approximates health insurance, and even this often does not cover the costs of a hospitalization. And until one pays one’s bill, one is not allowed to leave. Patients will be medically discharged, but will still be taking up room in the bed (and their bill keeps getting higher accordingly). Also, dying is no escape. Any family members of a deceased patient who are with the patient inside the wards – and family is often the only consistent nursing care a patient is likely to get – are also not allowed out until someone they know has raised the money to pay for their family member’s outstanding bill.
After we “got strong” for the day, Izzy took me on a tour of Moi Hospital and the patient wards. The hospital, like most I’ve been to in America, has many buildings that have been added to it over the years. However, unlike the American hospitals, the climate allows the buildings to be connected together via an outdoor covered walkway rather than the rabbit-warren-like passages I’m used to in American Hospitals. The main inpatient wards are situated at the far end of this walkway. As we approached, the first thing that I noticed was the gate. There is a guarded gate which connects to high fencing that runs all the way around the men’s, women’s, and children’s wards. This is not a gate to keep people out, but rather to keep them in. In Kenya, only a small percentage of the population has something that approximates health insurance, and even this often does not cover the costs of a hospitalization. And until one pays one’s bill, one is not allowed to leave. Patients will be medically discharged, but will still be taking up room in the bed (and their bill keeps getting higher accordingly). Also, dying is no escape. Any family members of a deceased patient who are with the patient inside the wards – and family is often the only consistent nursing care a patient is likely to get – are also not allowed out until someone they know has raised the money to pay for their family member’s outstanding bill.
Moving inside, the wards (which are surprisingly small in
proportion to the total size of the hospital grounds) are separated into adults
on one side, and pediatrics on the other. Izzy and I moved first to the pedi
side, and a rat greeted us, moving stealthily across the floor of one of the
procedure rooms. Both adult and pediatric wards are separated into six cubes.
Each cube has 8 twin-sized beds. On the adult side, patients sleep 2 patients
to a bed. On the pediatric side, often a parent of the patient will sleep in
the bed with them, but with some of the older patients, they also sleep two to
a bed with patients either sleeping sitting up next to the beds on stools, or
taking turns sleeping on the edge of the bed with the two sick children.
In general, the acuity is significantly higher on the wards
here than in American hospitals. In any one cube, there might be 4-6 patients
who really belong in an ICU setting. But while there is an ICU, it is both
beyond the means of many of the families to afford, and is itself overwhelmed
by the level of need. Nursing is woefully understaffed. One nurse is expected
to take care of up to 16 patients, and in consequence, many things get missed.
Family members, or even neighbors, of the patients are heavily involved with
their loved-ones’ daily care. They routinely can be seen re-positioning
patients, cleaning them, as well as obtaining food and medicines for them.
We briefly looked for one of the interns Izzy had
befriended, named Kamisa, an Indian-Kenyan doctor who, like several of his
fellow interns had done his medical training in Russia. That’s right, Russia.
He had gotten accepted, learned Russian, and studied there for 6 years before
returning to Kenya for his internship year. Interns here are completely
unprotected. They are essentially on service and on call for 365 days, 24 hours
a day and while they are generally able to structure the amount of time they
actually spend on the wards, they are also hugely responsible for the care that
is given. The way that Kamisa described it to me later, “so much of the quality
of care – of whether a sick patient will live or die – depends on the attitude
of the intern. If s/he cares and stays extra time, a sick patient will live. If
s/he is tired and decides to leave it until tomorrow, the patient will die.” Kamisa
was busy performing a procedure on a child, and so we visited the adult wards.
The smell here is even stronger than on the pediatric side.
It is a harsh mixture of industrial cleaner, urine, body odor, and feces. This
is not unpredictable, however, since about 200 patients are packed into an area
that would hold about 20 in the US. We
took a quick walk down each of the hallways and I watched the eyes of patients
and their families follow us.
No comments:
Post a Comment