The morning began at 8am. Decked out in white lab coats (and admittedly feeling rather pleased with ourselves), we made our way up the stairs to the fourth floor to the pediatric ward (the elevators are apparently a little sketchy). There, we met Mary and Margaret, the two nurses who serve as Pediatric Department Heads. Mary sat behind a large wooden desk in a room that was clearly once an exam room. A rotary phone sat in front of her where I would have expected a computer to sit. Margaret sat across from her flipping through steno notebook. Handwritten in the notebook was a list of patients currently on the ward, and what was scheduled for the day.
Mary and Margaret welcomed us to Kenyatta, and told us a bit about the pediatric unit.
The unit was built to accommodate 60 patients. Yet, at the moment, they have 93 admitted children. Many of the admitted childrens’ mothers are also living on the ward, as they can’t afford a local hotel. So there are approximately 180 people living in a ward built for 60. How do they deal with this? They have, in many cases, two children to a bed.
What’s more, there is a policy in place at Kenyatta Hospital that doesn’t allow patients to be discharged until all hospital bills have been paid. Naturally, being a public hospital in Nairobi, many patients have no money to pay the bills. Amazingly, the hospital’s solution is to keep the owing patients at the hospital. Apparently there are women living at Kenyatta, admitted during childbirth and unable to pay the bill, whose children are now 2 and 3 years old. Imagine that – having a baby at a hospital, not paying the bill, and being forced to stay for years.
Some of these mothers, so desperate to leave, will try to escape by literally jumping off the second and third story window ledges with their babies.
Other mothers – even mothers who are able to pay their bills – strategically choose not to, aware that their children will be forced to stay at the hospital. Their strategy is to keep the children at the hospital until they fall ill again. It’s quite a cycle – one that keeps the children fed and house, and keeps the mother unburdened by the child.
The tragedies, inefficiencies and costs associated with this boggle my mind.
Mary and Margaret took us to spend the day in Pediatric Oncology, but we managed to get a tour of the full pediatric ward on the way. At pediatric emergency, the line was out the door with people waiting to have a minute at a window marked “Pay Here.” The pharmacy next door was the size of my closet in Alexandria, and yet when I looked in it only one wall contained shelves of medication. It struck me that the amount of medication was roughly what you might find in the medicine cupboard of the average Washington DC hypochondriac.
We then toured the pediatric outpatient unit, where, at one point, the power went out. The outage seemed to phase no one but us.
Finally we landed at Pediatric Oncology. The room was about the size of a New York City loft, and steel frame beds straight out of the 1940’s lined the walls – each about three feet apart. The mattresses were no more than three inches thick, and were covered with plastic and a thin sheet. A few children were in their beds, and a few doctors huddled in the back of the room. The rest of the children were gathered in a small room off to the side – in what appeared to be the playroom. The playroom contained no toys, 22 children, about 15 child-sized chairs, two lunch tables, and a pile of the small mattresses stacked to the ceiling.
Since no one appeared to be running the unit, and our arrival was unacknowledged, we took it upon ourselves to go play with the children. They greeted us with excitement, though most of them spoke only Swahili. Two were not only blind – they appeared to not have eyes at all. Another clearly suffered from gigantism, and another only had one leg. All, we assumed, also had a form of cancer.
The children were entirely unmonitored for the first thirty minutes we were there. We were shocked by the lack of structure and supervision. Shortly before noon, a woman in an apron, who spoke only Swahili, appeared with a large tray and a stack of metal plates. On the tray was a large pan filled with rice, and another large pan that was filled with what looked like beef stew. Next to the pans was a plastic bag filled with foul smelling cream.
Each child was given a ladle full of rice, a ladle full of stew, and some cream. Nothing was provided to drink.
The woman motioned for us to help feed the children. We did.
We stayed another thirty minutes and left for lunch.
It was at this point that we realized that not once all morning had we seen anyone wash their hands. Having just left the children, we all desperately wanted to give our hands a good deep clean. We found the nearest bathroom, but there was no soap.
Distressed, we used some hand sanitizer Dami had in her purse. We were grateful she had thought to bring it along to the hospital. Tomorrow we will all carry some in our pockets.
The afternoon was spent sitting in on a pathology class with the crew of third year medical students from the University of Nairobi. The lecture was 2 hours long, and taught by a Kenyan version of Ben Stein.
I could go on and on – about how different, how shocking, how sad the conditions at East Africa’s largest and most well-known hospital are – but I’m still trying to process it all in my own mind.
Tomorrow we go back to Pediatrics, and will map out with Mary and Margaret how we can make the best use of our time at Kenyatta.
I’m actually very much looking forward to it.
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