Kenya Update #1 - Nairobi day 1
Lots to report - and the days so full, it is hard to take notes, swat mosquitoes, snap pics and somehow process it all; the good news = that is happening!! Yet my intentions of updating this blog are proving a bit difficult. I have some amazing photos to share, yet my connection slow enough it is difficult to upload any photos.
I will re-edit these comments when I have the time, but for now, easier to simply upload my notes and correct them later.
Kenya – Nairobi 14 Feb 2012
Walked maybe a mile to B-fast. The Java Hut.
1. Off to Hurlingham Private Women’s Hospital in Nairobi. 61 beds; 61 nurses. Converted from a hotel to a hospital in 2001. Generally 90% occupancy.
Casualty requires first generating a hospital MR #, then pre-paying for your casualty visit, then being seen. Very kind people all along the way working in this nice private hospital, yet in tight spaces. Medical records is amazing – crazy piles of charts piled high and rubber banded together.
The IT dept is staffed by 2 people who are surrounded by junked out monitors and towers. Their goals seem to be more about computer info RE: staffing, laundry and benefits for staff, than about actual MR’s. No intent to go to an EMR, no intent to put a patient’s labs or x-rays or PMH in the computer. No intent or plan to connect all 3 of their private hospitals together with one computer system. Suggested it would be nice to pull up doctor notes, RN notes, patient history, meds, HIV status, last admit, current plan, even current admission – but NONE of this is available; nor any plans to make it available. Yet they rated their IT system an 8/10 (??? Amazing!!!)
Delivery costs 40,000 shillings and a 2 day stay; C-Section 150,000 shillings and a 3-4 day stay.
[talking to Dr. Omoto over dinner his hospital in Siaya District charges 500 shillings for NSVD and 3,000 shillings for a C-section.]
They do transfer people out who cannot pay to other public hospitals.
They had 1-3 beds for males.
1 ultrasound machine, 1 x-ray machine. No back-up.
Lab runs 24/7 with something like 7 people in a small cramped area maybe 200 sq feet. The lab machines “free”, but they pay for reagent and tubes, etc….. Blood bank, TnC, HIV, and apparently send out very few things.
Doctor’s offices in bldg. Generally clean and yet open windows, ventilation. No AC. A rare fan or two. Equipment everywhere looks like it is mostly from the late 60’s – early 70’s. Yet a lot of pride in what they do and how they do it.
2. Next – Kenyatta National Hospital (KNH). On a huge campus with medical school. Between Cairo and Johannesburg, this is the largest hospital. Something like 2,500 beds. 70,000 inpatient admits per year, 500,000 outpatient visits per year. Big operation with barbed wire gardens, and fenced areas – unsure why (possibly goats??)
A&E quite busy, lines of people waiting to be seen. No photos allowed at all – only outside. Proud that patients are seen regardless of ability to pay, and insurance information gathered only after the patient is triaged.
Waited forever for one elevator, which was then jammed with people – someone had to help push the doors closed, body against body – we are talking very tight!!
Got up to peds – unsupervised kids with central neck lines roaming the halls – ages roughly 3 to 12, some racing all over – others just hanging with other 4-6 y.o. patients. One maybe 4 year old put her plastic chair on top of a narrow bench over a concrete floor, then tried to sit on the chair! Zero supervision – not nearly enough staff. Saw 2 very sick kids, both ~ 1 y.o. lying head to foot in the same small bed. Many sick kids in one open room, maybe 20, with 20 + adults, and 1 or 2 staff at most. No apparent monitors – even for some kids not moving much. NO TV, no entertainment, though walls painted w cartoon characters; and a group was there handing out candy to kids.
NHIF – National Health Insurance costs 200 shillings per month for a family, including kids up to age 20 (25 if in school). Yet most cannot afford this! BUT if they have NHIF, then 100% of all medical costs are covered at the KNH and other public hospitals. A room charge is typically 100 shillings per day, but VIP and private rooms available for between 7,000 – 5,000 shillings per day [VIP most costly].
OB – lots of mom’s hanging out for observation. Again only a few nurses. Typically 8 beds to a room. Maybe one sink. Some moms waiting for DC to a safe home, they generally stay a few extra days while social work figures out what to do; to find a safe place. Crowded conditions and low staff.
After peds, our nurse and I were offered a sink to wash hands in. Soap and water (Unfamiliar soap brand) and no towels. No towel dispenser, just no towels! Most just then let their hands air dry.
Radiology does have CT and MRI. Area outside the A&E for urgent care (tents in photo). Many lower urgency cases cared for here.
3. Dinner w Drs. Omoto – She, Lana, seemed quite tired. Has been to the US 4 times or more. Working w U of Maryland now on HIV/AIDS.
Jackton – kind, thoughtful. Both have a passion to help Kenyan people at low cost, and a focus on the millennium development goals – malaria, clean water, dehydration/diarrheal illness, HIV/AIDS. Some MDR TB concerns, and yet a lot of basic health like Diabetes screening, and HTN. BIG advocate on community units – his term for comm. health workers. A huge benefit to Kenyans. Thinks training is key for them – but does not have much hope in them even being able to take a BP reading. Pulse and temperature yes. Thinks they can be taught to recognize nearly 80% of common ailments. These chw’s would live in their own village, community – and periodically report into us.
Sees a NIHC developing over 5-15 years; and plans for it to be overseen by even someone else in the future. Sustainability.
Think ED physicians would be a huge help!! Mostly in teaching others at his government supported hospital in Siaya. Really interested in what training we could bring – especially when he found out it was not ALL about trauma that we do. Just anything acute.
A Doppler would be really good, not US. Yet still thinks a fetalscope is the way to go!
Enough for one day!