September 10, 2012
NAIROBI, KENYA – Alice Mwongera, 42, a mother of two, lost her husband two years ago at a public hospital in Nairobi, the capital. The memories of that tragic day still haunt her.
Her husband, Moses Mwongera, was suffering from kidney failure, so she rushed him to receive dialysis at the emergency unit of Kenyatta National Hospital, KNH, the biggest referral institution in the country.
Mwongera says that although they were a middle-class couple, their health insurance had run out because of her husband’s prolonged illness, forcing them to seek treatment at the public facility.
When they got to the emergency room, they found the place crowded, as it usually is. Mwongera says she pushed through the crowd to get a mobile bed. After 15 minutes, which she says felt like hours, she got one and wheeled her husband to the waiting room.
“I stood patiently on my husband’s bedside waiting for someone to at least examine him,” she says. “But six hours later, he was yet to be attended to. I tried to grab every medical personnel that came our way, but they all passed hurriedly.”
She says they finally snagged a doctor, but it was too late.
“When my husband’s condition got worse, that is when we got the attention of a doctor,” she says, tears welling in her eyes. “He tried to resuscitate him, but it was too late.”
She says the grief was overwhelming, but she was able to bear the situation and start life as a widow. But six months later, she says another tragedy struck because of medical negligence and, once again, changed her life forever.
Her younger brother, Morris Njoroge, 27, whom she was living with, caught a cold. After two days, he developed breathing difficulties and was admitted to Nairobi’s Metropolitan Hospital, a private health facility.
But his condition continued to worsen, and the hospital advised the family to move him to a facility with an intensive care unit, ICU. Mwongera says she hailed an ambulance and, minutes later, she and her brother were back at the KNH emergency unit, where her husband had died half a year earlier.
“By that time, my brother was gasping for breath,” she says. “It was around 9 p.m. Fearing that my brother’s case could end up like my husband’s, I tried frantically to get him admitted.”
But she says the hospital denied her brother’s admission to the ICU.
“Despite having documents from the Metropolitan Hospital stating that my brother needed to be admitted at the ICU, a doctor insisted that he gets a CT scan, then vanished,” she says. “We queued for the procedure, and, as soon as the CT scan was done, I started a hunt for the doctor.”
It was not until 5 a.m. the next day that she found him. By this time, her brother had passed out.
“The doctor asked me to go look for a bed at the ICU myself,” she says. “I tried all I could and got a bed at 4 p.m. – almost 12 hours later.”
Ten days later, her brother was still in a coma. She says each time her family asked questions regarding her brother’s sickness, the doctors turned hostile.
“They took it as a personal affront,” she says. “I complained severely to the hospital’s CEO, but he told me to let the doctors do their work.”
One day, she visited the hospital and found that her brother had been moved to the general ward. He was still in a coma. Mwongera rushed back to the chief executive officer, but she says she didn’t get any help.
She says her youthful and strong brother, a local basketball star, wasted away unattended until he was reduced to skin and bone. He died 20 days later.
Kenyans say that medical negligence is a frequent problem even in the nation’s capital, leading to unnecessary deaths. Doctors say they are doing the best they can with staffing shortages. The Chinese government handed over a newly built hospital this month to the Kenyan government, and universities have been training more doctors. Meanwhile, the national medical board takes on cases of medical negligence to hold personnel accountable. But some dissatisfied citizens say punishments aren’t stringent enough and have formed a foundation to speak out against medical negligence.
There are 1.4 doctors and 11.8 nurses and midwives per 10,000 citizens in Kenya, according to the World Health Organization. The national adult mortality rate per 1,000 Kenyans is 319, compared with the global average of 176. The under-5 mortality rate is 84, compared with 60 on average worldwide.
Simon Ithai, KNH chief public relations officer, says the hospital has addressed Mwongera’s concerns.
“We have responded to her allegations many times,” Ithai says. “Why don’t you visit the hospital yourself and find out whether the claims are true?” he asked Global Press Institute.
It is 7 p.m., and there is a lot of hustle and bustle in the KNH emergency unit. Bedridden patients queue at the examination section, and just two doctors appear to be on duty.
At the X-ray section, more patients – some heavily bandaged – line the corridor on their green metallic beds. They are waiting to have X-rays done so they can be admitted to the hospital.
In the waiting area, Beatrice Achieng’ stands at her sister’s bedside, shifting her weight from foot to foot.
“We have been here since 11 a.m.,” she says. “I’m glad that she has finally been examined, and we are now waiting to be admitted.”
At the customer care section, a plate hanging from the ceiling reads, “Huduma bora ya afya ni haki yako,” which means, “Quality health care is your right.”
But there’s only one man at the desk whose badge reads “patient porter.” He moves patients around the hospital but is now on a break and not helping anyone in the queue in front of him. A woman begs him to register her so she can get a bed and remove a patient from an ambulance, but he tells her he is not in charge of the desk.
Enoch Murunga, a nurse at one of the mission hospitals in Nairobi, says negligence is not limited to KNH. He says he once told off a colleague whom he heard insulting a mother who was giving birth.
“She was very rude to the patient, and she made me feel really bad,” he says.
Dr. Albert Saningo, a naturapathic doctor who runs a clinic in a Nairobi suburb, says his father also died because of negligence at KNH.
“My father was taken to KNH after an accident in Narok,” he says, referring to a town in the Rift Valley province. “He was left unattended for four days, after which he died.”
Saningo says the few doctors at the hospital may have been overwhelmed by the large number of patients, and that is why they have a negative attitude.
A doctor at KNH, who declined to be named, says that staff members do the best they can but that they are overstretched and the number of patients is always high.
“Nurses are very few, and at times those on annual leave and off duty are asked to come back to work and earn some overtime,” he says. “The doctors’ workload is made a bit lighter by trainees from the University of Nairobi School of Medicine, but the number of specialists is still very low.”
To ease the pressure felt at KNH, a new referral hospital opened this month in Nairobi. The Chinese government financed the construction of the hospital, which cost 544 million shillings, $5.83 million USD, and recently handed it over to the Kenyan government. Previously known as Nairobi East District Hospital, it has been renamed Mama Lucy Kibaki Hospital after first lady Lucy Kibaki for her involvement in the project.
The hospital, located in the Kayole suburb, has a 112-bed capacity and equipment such as ultrasound scanners, incubators and mammogram machines. It is expected to serve at least 2 million people in the eastern parts of the city. It currently offers outpatient services and aims to provide inpatient and pediatric services before the end of August.
Peter Anyang’ Nyong’o, medical services minister, said the government was also upgrading 23 more hospitals nationwide to reduce the number of patients seeking treatment at KNH.
Dr. Daniel Yumbya, chief executive officer of the Medical Practitioners and Dentists Board, which regulates the practice of medicine in the country, says the government is doing all it can to improve public hospitals, including training more doctors to fill the personnel shortage.
“Four universities are already training doctors, and we are in the process of licensing four more,” he says. “Each year, the universities are churning [out] 400 doctors.”
Yumbya says professional negligence is a serious offense punishable by law, and that the number of doctors being trained is no excuse.
“These [numbers] may not be adequate, but there is no excuse for medical practitioners to do wrong,” he says.
He says aggrieved patients and families should lodge complaints with the board instead of living with bitterness.
“Mwongera should have come to us instead of complaining to KNH,” he says. “We are the regulator.”
Yumbya says allegations that the board doesn’t discipline errant medics are untrue.
“Some 602 complaints have been lodged with the board, and out of these, 250 have been resolved,” he says.
The board is currently investigating a case in which a mother died last month after surgeons at Kitui District Hospital in Eastern province allegedly left a surgical towel in her womb and ignored her pleas to revisit her post-operation complications.
Last month, the board also suspended a doctor for six months for negligence. Dr. Angela Chekoko, who was a consultant gynecologist at the Kiambu District Hospital in Central province, had been accused of failing to attend to a pregnant mother, leading to the mother’s and baby’s deaths. Chekoko has been sent for retraining at the University of Nairobi.
But Mwongera says this punishment is not enough. Yumbya says the laws under which the board operates don’t allow it to give harsher penalties.
“We can only suspend doctors and send them for retraining,” he says. “But we are reviewing the laws. We also cannot handle many cases because of financial constraints. We do not receive any funding from the government.”
Mwongera says that dissatisfaction with the public hospitals here and the lack of consequences for medical negligence drove her to start her own organization, the Morris Moses Foundation. The foundation, named after her brother and husband, advocates for the rights of patients.
“No one has ever told us what killed my brother,” she says. “I decided I would not keep quiet anymore.”
After her brother’s burial, she banded with friends who have had similar experiences at various public hospitals to start the foundation. Mwongera says she quit her profession as a human resource consultant to embark on this mission full time. The foundation members have been circulating the country to generate more awareness about patients’ rights and implore Kenyans to speak out if they are badly treated.
“We lobby for compassionate, quality and affordable health care,” Mwongera says. “Medicine has become a tool of trade, instead of a calling. Doctors’ negative attitude is killing patients.”
Saningo is a member of the foundation’s board.
“Some of us have been bitter with the hospital for years, and we are now saying we shall be silent no more,” he says.