When survival is the only option

Guest Writer
18 September ,2018

Ed’s note: On the eve of publishing this piece the governor of Nairobi found 12 bodies of infants hidden in boxes in Pumwani hospital. 

Rationally, I think it’s more profitable for this country if I stay breathing. I was – until recently – gainfully employed. A large chunk of that salary went to various government bodies. I file my tax returns on time. I am, by most accounts, good for the economy. If asked on a date and/or job interview, I would say I’m also a good citizen: I read the papers and watch news; I reflect on national politics/gossip, and often argue about it.

And yet, all this considered, I have a sneaking suspicion that Kenya is trying to kill me off.

Certainly, living in Kenya today has its inherent risks: you could die in the hundreds of accidents that happen monthly; your kiosk could be demolished and your entire family uprooted; you could be robbed and killed; you could die in some natural and/or manmade tragedy like your apartment building could collapse with you and your entire family inside, and so on. Let’s think of these as congenital Kenyan problems; if you are born here, perhaps there are some ground assumptions you must* eventually accept.

These congenital dangers are not what I’m talking about right now. I’m talking about what happens when a good samaritan pulls you from the wreckage and rushes you to the nearest hospital. Or when your children are get cholera and you take them to the local clinic. I’m talking about what happens when your wife goes into labour a month before your loan comes through, when your sister has a mental breakdown and must be committed. I’m talking about what happens when you start coughing up blood and need to see a specialist.

Let me explain.

Our national health policy is straightforward: don’t be sick.There is no gesture more characteristic of our medical infrastructure than a silent shrug. Raced over here at 3am with a sick baby but don’t have cash? Shrug. Performed major surgery on the wrong patient, or neglected them? Shrug. Have to travel across the country from your village to access one of the three specialists in Nairobi? Shrug. Raped women who just gave birth in a national medical institution? Shrug. Can’t bury your family until you clear the enormous medical bills? Shrug. Require access to medication or equipment not available in-country? Shrug. Seriously injured in an accident but medical staff on strike? (your guess)

For all the people who have been advocating for better healthcare for decades, this is old news. In fact, it’s in line with what appears to be our broader national ethos: don’t be poor. The difference between our congenital Kenyan problems and the growing urgency of our (lack of) medical infrastructure may not be too large. Both are engineered and sustained for profit. Both are wide-ranging and seemingly intractable. But I do sense a difference, minor perhaps, but enraging. While both problems are stealing Kenyan lives, the health crisis disgusts me primarily because it strikes me as so profoundly preventable as to be malicious. If I survive a car crash only to die in a queue at a referral hospital, hiyo ni uchokozi. If a nurse gives me the wrong name tag and I don’t receive appropriate care, hiyo ni uchokozi. When a pregnant woman dies giving birth in a rural clinic because there was no ultrasound machine, that is preventable.

Here’s what we know: we don’t have even a third of the required number of medical specialists in the country. The current staff are underpaid and overworked. Those in public hospitals, in particular, are decamping at an alarming rate. All the same, the future workforce – medical graduates – are not finding placements. Of those being placed, the distribution across the counties is uneven despite decentralization; over half of medical specialists are in Nairobi alone. Only a quarter of  all Kenyans are covered by health insurance. The National Health Insurance Fund (NHIF) recently downgraded its cover to a maximum of four hospital visits per family for an entire calendar year. In the region, Kenya spends a comparatively small fraction of its GDP (~6%) on healthcare. The entire sector is rapidly becoming privatized, with marked government support for foreign investment. All this is to say: we are nowhere close to achieving universal healthcare. Yes, several other countries are in a similar position. However, given our current resources, and varied happy coincidences of history, our failure is not justified.

But remember, don’t get sick. If you are a patriotic Kenyan, you’ll get malaria, or a bad sore throat. You’ll go to a chemist, pick up coartem or strepsils and be on your way. If you are a rebel, you will break your arm, or contract an STI. You’ll go to a clinic near you, wait, pay, see a GP, get a quick diagnosis, pay again for the medication, and be on your way. If you are at my point or higher then you make it to enemy of the state, and you’ll do something our government seems unwilling to consider but happy to profit from: you will acquire a chronic and/or severe illness.

I used to consider myself lucky. When I first fell ill, I was a consultant and could thankfully afford my own health insurance. In the time I began to worsen, I had shifted to work that provided me with medical cover. Throughout this time, I was still paying monthly for NHIF. Over the past two years, I have been foisted from one doctor to another, crawled from one hospital to another, first trying to get clear diagnoses, and then to find effective treatments, and compassionate care. I’ll spare you the horror of the inbetween. From January to July this year, I accessed over half a million shillings’ worth of healthcare. This does not include the ‘experimental’ or ‘unconventional’ treatments I tried, like additional physiotherapy and testing, that I had to pay for out of pocket.

I have stopped calling myself lucky because I was employed, had insurance, got diagnosed relatively faster than others, received passable care, and responded well to the treatments. Luck should not have to factor here. Let’s go back to the quick maths I started with. Maybe my frame is too narrow. Taxes on my income, and each of my individual purchases may not be enough to earn my keep as a Kenyan citizen. Maybe I’m worth more sick; my being constantly unwell certainly profits a few big clusters: pharmaceutical companies, private hospitals, government official and unofficial coffers. Don’t be sick.

If this country isn’t deliberately trying to kill me, it is, at the very least, not actively trying to keep me alive and healthy. Something has to give. We will continue to be frail humans and if the government insists on not only ignoring but profiting from this fact, then we are playing a fatal game of chicken; whoever blinks first loses. If you don’t get sick, you win. If you don’t get in an accident, you win. If no one in your circle gets ill or injured, you win. Lucky or not, those odds are tough to beat – and no one wins.  I did not.

Alexis Teyie is a writer and editor at Enkare Review

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