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September 19, 2018

How our hospitals are killing us softly

Patients sharing beds at Kapenguria hospital, creating chance for infections.
Patients sharing beds at Kapenguria hospital, creating chance for infections.

In your life, you should visit the hospital a minimum of two times, when you are born and just before you die. That should be the absolute minimum. Of course you will visit a health facility more times than this.

Modern healthcare includes quite a number of programmes that improve the quality of life, such as vaccinations and rehabilitative health interventions that restore reduced organ function such as kidney transplants, heart surgery, cancer therapy and so on. Every time you visit a health facility, one thing that you should be assured of is that the treatment you receive improves the health that you currently have.

Within the health system, a hospital is a step up from a clinic or health centre. It takes care of conditions that cannot be managed at the lower levels and employs staff that in theory should be more qualified than those referring patients to them. When you visit a health centre you walk in and the expectation is that within an hour or two you will walk out. A visit to a hospital is an admission, that is you may be lucky to walk in, but often you are wheeled in, placed on a bed to be examined, given medication, operated upon before being released, often in a wheel chair to go home and recuperate. The trust we place in a hospital is that it is above all else, a safe place.

And yet that is not often the case. Most of us know that we live in a society that is riddled with corrupt practices, where people placed in positions of responsibility breach that trust placed upon them. Much of what plays out in the media are what are termed grand corruption, the swindling and stealing of massive sums of money, that is con-people hatching plots, they hope one day will allow them to live movie lifestyles.

But the reality of everyday corruption is the systemic one, the little ones that mirror traffic policemen, government offices where little bribes are paid for non-performance. In a hospital set up the danger to the ordinary patient is not that some business person has done a deal in the hundreds of millions to non supply equipment and medicine; it is the nurse or doctor not giving the patient the very best treatment at 9am during a ward round.

Often a patient admitted and their relatives too can see that the health personnel standing before them, does not seem to have the patient’s best interest at heart. The lack of motivation on the part of the health worker stems from several sources. While management literature repeats that money is not a motivator to work, after all even people paid millions of shillings do not work any harder than a person paid a few thousand shillings, a major de-motivator is when a highly skilled person sees that a person of lessor talent and work output is paid much more than them. One of the major outputs of corrupt practices are people who boast of how without putting in the hours, the training they have so much money. A second problem health personnel face is a lack of skill and experience. Over the last twenty years there has been a progressive brain drain especially of nurses to western countries, robbing us of a generation of experience. Visit any hospital in the country and you are likely to find many young nurses, few older experienced nurses. Medicine is a science and art that incorporates knowledge, skills through continuous learning. There is no substitute for experience and collectively it is lacking. Through in the culture of corruption and we have a system of trained but poorly motivated health workers with limited experience to manage many health conditions.

 

The result is that many patients are admitted to hospital and leave without getting the right treatment at the right time. In Kenya it is estimated that everyday about four percent of patients admitted acquire an infection from the hospital. The easiest way to prevent an infection happening is for the clinician to wash their hands when moving from one patient to the next. When you next visit a hospital caste your eye to see whether the health workers wash their hands frequently, even the state of a hospital’s toilets gives you a good clue. Equally of concern are medication errors, where what is prescribed is not the right medicine, is given in the wrong dose, at the wrong time or even with the wrong combination of medicines. Medication in this case includes not just medicines but blood transfusions as well.

Communication by health staff is often across several languages, a senior doctor speaks in English, the nurse replies in Swahili, talks to her colleague in sheng and to the nurse aid in mother tongue. The patient is asked to behave as per the noun and be patient. It may sound like the basis for a good comedy, but underlying all of this are very serious health system issues that are costing lives. One solution is for patients and relatives to not be afraid and to speak out whenever they see or are subject to such practices. We do not want health care workers to descend to the level of our police force.

 

 


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