In the bumpy ride over to Turbo I sat next to Juli and pondered what she had done and is doing for this community. About ten HIV+ patients ranging in age from about five to 75 loaded into the back of the truck. Fridays are their scheduled days to go to the clinic for checkups and medications.
To take the HIV transmission rate from mother to child from near 40% now down to 1% and setting up a hospice center, the only one of its kind in this country, I was so impressed by this woman’s heart and dedication. She spoke both the local dialect of Kalenjin and also Swahili fluently. She had sacrificed so much, and made such an impact. I felt proud of her, and told her so.
"Thanks," she said humbly, blushing a bit. Being witness to so many dying and suffering every day, ones that she cared for every day, I wondered how her heart was able handle this toll. So I asked her. She said, “It is incredibly hard, but knowing that I can help someone die in peace, giving honor to their lives, and help their suffering, lets me know I am doing what God would want. But there is so much work still to be done. You will see when we get to Turbo.”
At the HIV clinic in Turbo, I saw the progress that had been made through the AMPATH/USAID partnership, with computers, electronic medical records, well organized free HIV and tuberculosis medications being distributed to those in need, nutritional counseling, family planning, and laboratory facilities. I was impressed.
I was introduced to one of the physician assistants named Cora at the clinic who was seeing patients for their checkups. Cora and I saw patients rather efficiently throughout the morning. She told me she usually saw between 50 and 100 patients a day. Juli poked her head in every once and awhile to make sure things were going okay.
Around noon time things began to take a turn for the worse. The electricity went out so no x-rays were possible. News came through that the main referral hospital in Eldoret, Moi Hospital where all secondary and tertiary care was provided, was completely shut down because the doctors were on strike. “How can the second largest hospital in Kenya just shut down?” I asked, baffled.
“It is a political situation,” Cora responded. “They do not agree with the recent firing of the head of the hospital.”
“That is the most preposterous thing I have ever heard,” I replied. "They are just going to let people die? What about the inpatients? Or those who need surgery?”
“They will die,” Cora said, with complete lack of emotion, which felt like indifference, but it probably wasn't.
At that moment, an HIV+ man came into the clinic in a wheelchair, his family pushing him and begging for help. The man had become incredibly weak, unable to move, or eat. He was a Kenyan, but his skin was so pale he almost looked caucasian. I looked at the mucosa on the bottom of his eyelid, and it was very white. Clearly this man was very anemic. I ordered a hemoglobin level. The result was 3.4. Wow! I have never seen a level so low. Normal is above 10.
“This man needs a blood transfusion ASAP, or he will die,” I said urgently.
“The only place he can get a blood transfusion is at Moi Hospital and they are on strike,” Cora stated again calmly.
“Well, can anyone donate blood for this man? Is there not a blood bank to help? In America, people would come out of the woodwork to assist in times like this.”
“No, we are not capable of doing that here, and you are in Kenya, young man. This is the Kenyan way," she said. "We will try to send this man to Webuye, where they may have blood, but it is far away, and they will have to pay."
It was at this point that it truly hit me, the difference here in Kenya with medical care. It is not a right. If you can pay you may be able to get medicine. If not, it is survival of the fittest.
The very anemic and near death man was pushed into the hallway, now truly overflowing with patients, and Juli came in asking if we could get a young girl onto the exam table because she currently was lying on the floor in the hallway vomiting and in a lot of pain. Cora looked at me, I nodded, and she took a deep breath and said and unenthusiastic okay.
We brought the young lady in. She was sweating profusely, and breathing at a rate of at least 50 times per minute. She had an IV in her arm with a syringe still hanging from the end? “What the heck?” I said under my breath, “Who has been treating this woman?”
I put a heart rate monitor on her, and her heart rate was fast at 140 beats per minute. Her oxygen saturation was 85% and her temperature was 40.1 degrees Celsius. I immediately made known the urgency of the situation, but those around me didn’t seem to care. This woman was in septic shock.
I asked quickly for a blood pressure cuff, and took her BP. It was 70 over 25. This is very low. The woman’s neck was stiff and she was burning up. This woman needed IV fluids, antibiotics, and hospital care ASAP. I told this to Cora, who once again informed me that the hospital was shut down.
“Do we have antibiotics or IV fluids?” I pleaded.
“No, we do not, but they may have some next door at the Health Center, but you will have to buy them.” It turns out that at the government-run Health Center next door, they had seen this woman earlier in the morning, noted to have a BP of 80/40 and that is where she had received 500cc of IV fluids and waited in agony on the floor for hours only to find out she was HIV+ and was sent over to us. They had not given her any antibiotics.
Juli and I took over and made a plan to go to the chemist to get antibiotics for her and any other resources we can find next door. We planned on having the patient go to the same faraway hospital in a van with the anemic man as soon as we got her some antibiotics in her. “Do NOT send this woman away until we are back.”
Juli and I went off on a hunt for resources. We found the pharmacy, but it said “Out to Lunch.” Rats! We asked several people where the lunch area was and tracked down the pharmacist. In her long white coat, the pharmacist was taking ugali for lunch and was surprised by the two muzungu (white people) coming towards her to interrupt.
“We need antibiotics from you! A woman is dying,” Juli said. The woman said she would get them for us after her lunch.
“Perhaps you do not understand the urgency of the situation,” I said. “We need them NOW!” Begrudgingly the woman got up, washed her hands and obeyed our wishes. But only after we had paid for the medications, and brought her a receipt proving so, would she dispense the medications. We looked at the two grams of Ceftriaxone (antibiotic in powder form that needed to be mixed with a needle and syringe) and asked the pharmacist, “Where can I get a needle?” The pharmacist shrugged and said, “I don’t know,” as she went back to her lunch.
Juli and I went around the Health Center asking for a needle. “We don’t have needles,” they said. I didn’t believe it. This was like a bad dream. Unbelievable! As Juli distracted them, I began to go in and out of the rooms in search of needles and IV fluids. In the maternal-infant room, I spotted some and quickly put one in my pocket when they weren’t looking (borrowed it) and Juli had talked her way into some IV fluids. We had the supplies we needed and rushed back to the room where the dying girl lay.
When we burst into the room, we saw a sight that pained us dearly. The girl was gone! Cora sat behind the desk, and looked up.
“Wapi the girl (where is the girl)?” I shouted.
“Oh, she just left in the van with the old man to the faraway hospital.”
You have to be kidding me! I searched for the swear words to express my frustration in Swahili but could not find any. I looked at Juli. She looked so sad.
“Well you can leave the supplies for the next patient that comes through here and is sick,” said Cora. "They will benefit from them."
Juli said, “Well, that is not good enough. What if you were the mother of that girl? She needed antibiotics and you let her go.”
“They hopefully will get help at the next hospital if they make it.”
“It is time to go,” Juli announced to me.
The ride back to the living room, neither of us could even talk. We tried to do what was right for the patient, going out of our way to procure resources, and had been usurped by the routine way of doing things, in the face of a power outage and the second largest hospital in Kenya being closed. It was the “Kenyan way.”
Today I am angry at what I saw here in Kenya. Perhaps it is because I come from a country where health care for every citizen is a right for both the poor and the rich. But one would think that a medical professional seeing a person in desperate need of medical care, I mean literally at death's door, would treat that patient instead of turning their back on because that person could not pay, or because they and their fellow doctors are on strike. Or maybe the Hippocratic Oath just means something different here in Kenya.
Seriously, does a country’s second largest hospital, upon which thousands (mostly poor) depend for emergent medical care, just shut down? When have you ever heard of doctors going on strike? This simply would not happen in the USA. Watching people literally dying in front of me today because of selfish political/compensation issues was simply too much. People say it’s the “Kenyan way,” but I say that is BS.
People, humanity, our fellow human beings deserve better. We cannot tolerate this injustice.
