by Tracy Liloe
Over the weekend I attended a doctors’ funeral service accompanying a doctor friend of mine. Let us for once suspend the mourning and remind ourselves that doctors also die. They die painful and sometimes needless deaths as we all like to refer to majority of deaths in Kenya. The funeral was somber as is expected for a funeral of a 30 year old promising lady who had barely scratched the surface of her career and her life. She was married to a doctor with whom they have two sons. She had died least expectedly just hours after a caesarian delivery in a private hospital. She was being attended to by ‘very many’ doctors – some as professional friends and obviously as her care providers. She was not sick except if you consider pregnancy as illness. The details of her death were shrouded in so much mystery that a post-mortem exam was demanded. The post-mortem was conducted by an independent pathologist engaged by the deceased’s family.
During the funeral service, I could not help but notice that the family members were so bitter with doctors so much so that a mere hugging from doctors welcoming each other infuriated them. The mourners were doctors in their droves. I bet doctors were more in number than the villagers. These doctors had travelled far and wide to pay their last respect to a young colleague they loved and enjoyed working with. They were mourning too. Speech after speech, family members swore to find justice at whatever cost because professional misconduct is inexcusable. Speech after speech, doctors somberly paid their last respect while attempting to subtly defend themselves of any wrong doing that may have caused their colleague’s death. The church minister summed it all. ‘Let me beseech this family to find it fit in their heart to pursue God’s forgiveness. And let me tell our doctors that life is so precious and must be handled with respect and dignity. We shall now pray that the departed finds eternal peace in the life after,’ he mumbled.
A number of us have been in funerals where healthcare workers are blamed for lackluster performance. But in a doctors’ funeral? That must be something strange – especially for people like myself and 48 million others who are not doctors or nurses or health professionals. And with that ‘shock on me’, I began to view our healthcare from a different perspective. By that I mean I began not to blame the professionals only. Though I will for a moment.
I began to listen to healthcare workers and connect their stories with those of the Kenyans who dread the day they would find themselves in a hospital because a friend, a loved one, or someone they don’t know suffered or even died while seeking help. Our healthcare system is sick. The televisions are no longer eager to air the many stories of sorrow. But social media has picked it up without effort. Just a phone in the hand, every Kenyan has become a policeman, journalist, jury and regulator for doctors and nurses in both big and small hospitals – public and private. And that too is hurting healthcare – and your life in the process. We can talk about it another day.
Which is why I felt compelled to write about our hypocrisy. The false pretense by Kenyans not to care about the systemic challenges facing the healthcare sector beyond which the efforts or expertise of doctors and nurses mean little to life. Such challenges include staff numbers. If there are only two doctors to attend to 200 patients, the two cannot multiply themselves and make you wait less because your disease is an emergency. You will have to wait for hours or days or die waiting. That is a sad reality. Another such common challenge is lack of an ICU bed or lack of a drug to treat you. A nurse or a doctor cannot cure absence of drugs except if they did not order for them in time. But your president and his minister for health can. The Governors can. And you the ordinary Kenyan can – I will show you how in a jiffy.
Let us also mention the false pretense by doctors and nurses and other healthcare workers that the problem doesn’t lie squarely with them. This behavior is not limited to the healthcare sector professions. Professionals being part of the system often are removed from their work preferring to simply explain what is necessary without taking responsibility for the poor systems in which they function. So they use their inability to function within the system as an excuse for not doing their work. In this case, health workers have become master blamers. Blaming Kenyans for not taking their health and their healthcare systems seriously. They are right in my opinion except blames solve not their problems. They are also blaming patients for being sick – who chooses sickness? – for which our health workers do not deserve the privilege to treat any Kenyan.
But there is more to the horrible behavior of health workers that has made our healthcare a death trap. Their lack of team work and lack of team spirit. They compete each other. They hoard both knowledge and equipment that would have been helpful for a patient’s life. And they demean each other so much so that the military world would pass as a cocktail party. They say it is historical but must it be the future? This makes doctors depressed and then their depression depresses our healthcare system. And when the healthcare system is depressed you pay for it with your money and your life. The doctors are dying for it too. How I wish they would ask for help from the ordinary us who have never known how to open a brain. But for their hypocrisy, they would consider that a weakness.
These hypocrisies have driven the two divides between Kenyans and the health workforce into a bitter and destructive cold war. It is the norm with an easily angered, easy to forget and easily appeasable population – the typical Kenyan once described by Sunny Bindra as a peculiar human being who thrives in lack of authenticity. But for that peculiar art of lacking authenticity, lacking follow-up and lacking in-depth; we are killing each other because solutions are never sought after. Solutions are frowned upon by policy makers. And the culture of hypocrisy after hypocrisy reigns.
Healthcare has many parts that must move together to produce a result. That result is that when you are sick, you can get a cure as first as possible without more harm to your finances or your health. These parts include 1) a competent health professional, 2) an environment – physical and otherwise – from where the professional can attend to you and 3) equipment and drugs that would be helpful for alleviating your suffering as prescribed by the professional. Kenya’s health system is mixed. There are private players, government players such as counties and the Ministry of Health as well as Faith Based organizations. The coordination of this mixed set-up and the jellying of the different healthcare parts too is haphazard. That can only be streamlined by our government. But the hypocrites in there will rather import 100 Cubans while denying our Kenyan doctors jobs. If you are in government and reading this, please concentrate on the coordination of policy, regulation and enforcement of standards. Will you also remind Mr. President on this duty?
Majority of Kenyans seek health services in public hospitals. But this majority is the ‘powerless’ majority who can only be treated at public hospitals. This group forms 65% of the 48 million Kenyans. How can such a huge group be powerless? The reality is that the group has been disempowered by their poverty. Poverty in material and money and that comes with poverty in demanding accountability. This group remains gullible to be lied to by politicians who exploit them for votes. The politicians then supply and launch truckloads of condoms and unnecessary clutter to the public hospital and then invite them to cheer on as the politician retreats to squander public money that would otherwise employ more doctors or purchase vital drugs and commodities for a different kind of healthcare.
These Kenyans who must be attended at public hospitals aren’t the problem and neither are they the reason Kenya’s health system will transform. They, however, are the reason public healthcare hasn’t been privatized. The real culprits are the 35% Kenyans who own smart phones, stay in urban centers, have a form of employment giving them not so useful insurance covers with an illusion that comes with the insurance and an influential opinion on the 65% ‘powerless’ majority. This is the group I belong to. And if you are reading, here is your group too. All health workers and especially the doctors that we so love and the doctors we so hate also belong in this group.
Way forward? Bluntly, the pretense must stop. Let me go back to the funeral service and express my feelings. The doctor friend I accompanied was quite grieved. He felt much betrayed for the loss of a colleague. And he felt remorse that her death couldn’t have been explained. All the emotions exhibited by my friend and all the other doctors got me sympathizing with how doctors could be hurting for being blamed while at the same time mourning like everyone else. That must be such an impossible oscillation to deal with.
I respect all doctors for enduring this scenario on a daily basis in our various hospitals where they too mourn the inability to provide the best care for patients while at the same time taking slack from us when something unexpected or expected happens. And I thank health workers for not giving up when they have options to abandon medicine for ‘entrepreneurship’ where talk has it that more money can be made.
They must want to change the healthcare system and make it better for them and for all the Kenyans. The healthcare workers must speak amongst themselves first. Doctors and Nurses suffer because other doctors and other nurses in higher offices do not serve their interest. If this analogy seems farfetched, remember the tenure of Dr. Muraguri and Dr. Mailu at the helm of the health ministry during the 100 days doctors’ strike. This scenario plays out daily at the county government level where Chief Officers and County Executive Committee (CECs) members who are health professionals do little or nothing to engage their colleagues in healthcare policy making. They often stifle their progress and misadvise or fail to correct county governors for making statements that hurt healthcare or make decisions that hinder reform. In short, let health professionals retreat and give us a reform because even though they do not control the country’ purse strings, somehow they control decisions of people in higher officers. No wonder these people in higher officers often blame health workers for what health workers themselves view as failure in governance.
The second solution is the good old accountability. But it must be the 35% demanding accountability rather than retreating to the victims’ corner. The 35% must join hands with health workers and understand the details of healthcare financing and healthcare quality. If your taxes have been stolen and you did not raise a finger for it, please spare us the rant when your mother or cousin has missed an ICU bed at Kenyatta National Hospital. The 35% Kenyans who form the so called middle class must begin to love themselves and love Kenya at the same time. Let’s not love a doctor when he or she is our sister or brother or parent (because health workers are our family members) but blame them when we could have done our bit to ensure they have the necessary enablers for work.
And lastly, Kenya cannot develop on mediocrity. Mediocrity means we hide in our hypocrisies while not caring for care givers. Responsibility means sparing Kenyans from that sensational rant for losing a patient when it is your daily inaction that is hurting all and sundry. Hypocrisy is our undoing to healthcare.
Tracy Liloe is a Human Resources Manager who roams the corridors of healthcare.