FINANCIAL INEQUALITIES AND FRUSTRATIONS IN KENYA HEALTH SECTOR

 FINANCIAL INEQUALITIES AND FRUSTRATIONS IN KENYA HEALTH SECTOR 

I have worked mostly in the public health systems and financial woes amongst clients are real. A little bit of exposure in the private has magnified this gap for me and breaks my heart a lot . When I was an intern , one of my seniors warned me that I risked bankruptcy if I continued paying for things for clients out of mercy. I would always mobilize colleagues to contribute and buy clients drugs and emergency essential equipment such as chest tubes. I gave up with time and accepted things as they were. 

When I started working , I.C.Us were only a luxury of the two main national referral hospitals in the country and a few private facilities in Nairobi; things have changed for the better with devolution . It wasn’t uncommon to baby-sit impending deaths because relatives couldn’t afford the 10s of thousands for public ambulance transfers to Nairobi . It was what it was!! I would always peep in to see if client was still a live or if the bed had a new occupant. Most of the times we would try all manner of manouvers documented and undocumented to atleast keep the clients alive but mostly it didn’t work especially if ICU care was the only modality of care to support breathing. 

In 2013, when I was doing my long weekend call on a public holiday , the then regime announced full free maternity services for all. This eased many burdens , admission files were dumped at the tables and we could admit freely without demanding for a receipt , surgeries could be done freely , ultrasounds were for all , we no longer held clients long after their Caesarean Sections due to lack of pay , neonatal unit drugs equipment and drugs became free . I was demanded to go empty the wards and discharge all who had been held for non-payment. It was a joy . This joy extended when I joined postgraduate training and things like I.C.U and dialysis were fully covered for any pregnancy related issues whether procured from high end private facilities or in the public hospitals. I loved being a Kenyan . I remember one time organizing a brain surgery for a client who had just given birth and this was done freely with confirmed free I.C.U after surgery . This is what I had come home to Kenya to practise ; optimal care for all without a worry about costs and family social status. Many of my colleagues undertook research topics that involved pregnancy because they knew any tests they ordered especially after 28 weeks of pregnancy would be covered , D.V.T in pregnancy stopped being a dilemma ; you would get admitted , get your KSh.30,000 stock of monthly blood thinners  and go home without paying a dime , family planning immediately post delivery was covered . 

Somewhere in between, Free-Maternity changed to a fancy word ‘LINDA-MAMA.’ This came with tons of limitations. Whereas we were used to free services , many things changed. It mostly covered chiefly the costs of maternity and delivery . Most of the other things had to be paid for by the clients from the pocket depending on the level of facility. Ideally Linda Mama scope only includes 4 free antenatal visits, 4 free postnatal visits , normal and Caesarean deliveries . However these are the usual nurse-run M.C.H clinics so any mother requiring high-risk clinics run by Obstetrician-Gyanecologists has to pay for consultation from their pockets even in public facilities . Ultrasounds (not even one) are not covered and any other care such as dialysis/ICU/ambulance transfer has to be borne from the pockets. Essential drugs in pregnancy for some select mothers such as the anti-D injections for clients with Rhesus negative blood groups are not covered and lab works including antenatal tests  have to be paid from the pocket . I have seen mothers go on their knees and beg me to see them for free in the weekly GOPC/HIGH RISK ANC CLINIC for lack of the 300 shillings consultation fee ; which I always do without blinking but they don’t get the luxury of having files opened. Despite the above challenges, I still advise all my clients even those in private to be registered to LINDA-MAMA irregardless of their rich insurance covers ; it could favor a free high-end public service waiver if the worst got to the worst (e.g ICU or dialysis) or at least fully cover delivery of one’s insurance small-print goes against them. 

Financially speaking , it’s very frustrating for me as an obstetrician practising in public . The cheapest ultrasound in public facilities costs 1,200  and clients must pay for it . Drugs are bought out of pocket and surgery needed in between pregnancy such as the Mc-Donald stitch (to prevent 2nd trimester losses in clients with short or incompetent cervix) are paid from the pocket. Of course there is some added relief for NHIF card holders depending on the type of NHIF (with the national cover KShs.500/month scheme users mostly getting a raw deal in outpatient services especially in private facilities). 

I have had crazy experiences . Like a client requiring a Mc-Donald stitch deciding to carry on with the pregnancy without it because of tight finances . The other alternative would be daily vaginal progesterone insert which cost upward of 100-200 shillings per tablet ; a husband once told me that their rent was 2500 per month and they were in arrears so 150 shillings tablet per day would drain them and so they were ready to lose the pregnancy if it came to that . 

I once advised a client that the Shs.5000 Anti-D injection was mandatory for her and she just laughed and brushed it off ; where would she get such an amount if she had to trek to avoid paying the 50 shillings motorcycle transport fee . The effects of lacking the injection can be catastrophic and could lead to an irreversible life long pregnancy losses . 

I still wonder why the government insists on Hepatitis B screening for all pregnant mothers yet the follow-up tests and drugs for those who turn positive are just out of this world to the common citizen in terms of costs yet not available in public facilities . 

I have had to come to terms with a lot in practice and not just to pregnancy related matters . If you suffer from  infertility and you are poor , you are likely doomed if you have an irreversible condition . The tests themselves are exorbitant and procedures such as InVitroFertilization are too expensive unless well covered with a rich insurance cover . 

One night, my covering-nurse on duty called to inform me that the referral facility had rejected a client we had referred because they had no I.C.U space . She was to look for deposit money running into hundreds of thousands and get a slot in one or the neighboring private ICUs. This client  had been brought by good samaritans drunk like a kite from a cheap drinking den ; how on earth was she to afford Kshs. 300,000? We called her relatives and they told us that they didn’t want to be involved because that amount was a dream to them and could be called to collect the body in case she succumbed . In my naivety, I called a senior to try and negotiate for ICU space in private then the government hospital could pay up with Linda Mama ; he duly educated me on the limitations of this scheme and how impossible it was but promised to give my client priority if an ICU bed became available. I remember crying on my drive home and feeling extremely sorry for the client; the Government had failed her , her poverty had failed her. 

On the contrary to above misery , I have seen the wonders of insurance and NHIF-civil-servant-scheme  in offering outpatient facilities in the private sector . Clients freely get seen by specialists and get high end services without paying anything . The same applies to inpatient surgical services all insurance holders including NHIF-national scheme. 

I was a campaigner for NHIF a few years ago and made videos on the same . I reminded my fans to stop limiting themselves to the outpatient challenges but to look at the big picture in case emergency surgeries are needed , in the event of required dialysis or in the unfortunate diagnosis of cancer . I remember commenting how NHIF was only 20 shillings per day if one was to save up for the monthly fees. A few listened and I pray that they keep up at it despite the outpatient frustrations. 

I hear that there are new NHIF terms ; I’m yet to dig in - but I pray that it doesn’t complicate things further for the needy Kenyan Hustler .

HealthCare is costly and I pray that the government gets to widen NHIF scope for national scheme and improves on services available in the public facilities - the usual unavailability falls squarely on the citizenry who are forced to pay cash in private. 

I also hope that we can one day go back to the free-maternity services which had  a wider coverage and benefit to pregnant mothers and under-5-year-old children. 

The government should also consider providing what has been traditionally viewed as rich-private-facility services . For example , our main national and county referral facilities should offer subsidized fertility services such as I.V.F and minimal access surgeries to all; it shouldn’t be limited to the rich only. 

So there goes my frustrations and takes !! 

P.S : Today is Mother’s Day 2023 , I hope our government enhances the free maternity coverage as a gift to motherhood ; women leaders are you listening?

Update in 2025 - I have since changed employment to a government department with a very organized health department  , NHIF has since changed to SHA, the dollar rates changed and some prices quoted above have since almost doubled , Linda Mama no longer exists; my thoughts on the public health sector still apply.

STEREOTYPES AND SOCIAL PREJUDICES IN MY LIFE

 STEREOTYPES AND SOCIAL PREJUDICES IN MY LIFE 

 I enrolled for a competitive Accounting Course at Strathmore University immediately after my KCSE before the results . I used my mock-exam results to get admission and it was a very good exposure for me. I lived alone in a hostel at Nairobi-West , got a different experience from a full life of Machakos region schooling (baby-class to high school) and made amazing lifelong friendships from people who I had misjudged as being too boogie or too rich-looking to speak to me  . One of excellent programs there was being paired with mentors to guide in day to day life and career paths. When KCSE results were announced, I was elated to had scored an A plain and had my name on the newspapers but what my mentor told me exposed me to a new world of stereotyping . We had only two As in the entire Machakos that year - a boy from Machakos School and myself. She told me ‘oh, you got an A ? But you don’t look so bright.’ I wondered whether it was the hijab , the way I dressed or simply that I truthfully didn’t look ‘smart.’

This was the beginning of many of such encounters . I got a full scholarship to study medicine in a South-East Asia country and I took the chance . I filled in my University of Nairobi JAB admission paper-work just in case the scholarship experience didn’t work out and I could always come back to start school here in Kenya -university placement used to be two years after KCSE during my time, so I had two years to try things out ; one year went to Strathmore University and the 2nd year was my 1st year med school experience ‘abroad.’ I met more stereotyping in my new-country of residence . I was the only black in a class of 300 students. I stood out conspicuously but my initial stay was ridden with many myths/presumptions - there was always the assumption that I must have been a reject in my own country who missed out on university space back home ( this was false , I got the scholarship due to excellent performance) and there was the general vibe that I must have been from an extremely needy background and saved by the scholarship( this was also false if you dear reader know my family background; I’m Zuhura’s daughter goddamnit !!). I remember one time a girl complained that the black African girl must have wrongly disposed off sanitary products in the W.C because of her needy background and possible non-exposure to such toilets ; man, it broke me . So I embraced the stereotypes and ignored others; I worked super hard and got distinctions to their surprise, got comfortable with the poor-girl tag ; this eased the pressure of going out for unnecessarily expensive outings and helped me plan my holiday trips back to Kenya without necessarily burdening my parents with too frequent air tickets . I enjoyed the eased pressure yet I never lacked , I had all my medical text books bought brand new, my fridge was always stocked up, my pocket money arrived by 2nd of every month and I comfortably travelled home every 18 months (instead of every 6 months)which was perfect for me and gave me space to do life-changing electives and medical observer-ships during the holidays that I remained back in the hostels. Did I mention that I never failed in any medical school exam? I had excellent exposures and I was an easy to maintain child. 

Stereotypes followed me back to Kenya when I enrolled for internship . I doubt if anyone wanted to be paired with the Swahili girl . I supposed many feared that I would be a lazy burden and that I may not have been well trained ; because I wasn’t trained locally and therefore the very false presumption that I went abroad for possibly not making the cut for university. My first experience with one of my consultants left me wondering if I would ever be given the chance to prove myself ( surprisingly , the said consultant is now a fellow specialist who respects my abilities very much). Ladies and gentlemen , I outdid myself - I was the best intern of my year in the county , had and amazing time, learned so much and left permanent marks in the hearts of many. 

One time during my runnings at Cottolengo Mission Hospital where I had been seconded as a Medical Officer by the first Meru County Government, I had a nasty experience. I was very passionately involved in the care of a patient and so when the relatives demanded my attention for updates , I quickly decided to skip my lunch and gave them all my time . I went straight to the science of things , risks , possibilities and prognosis as professional as I could be . I was shocked the next day to hear that I had been reported to the office of the then Women-Representative and to the County Director  Medical Services  as that ‘rude Swahili girl who said that ABC could happen to the said patient’.  The DMS happens to be one of my mentors and he demanded to know how rude I was because he knew me as a competent and  compassionate dedicated clinician ; the relatives repeated what I had said word to word  and added that ‘you know these Swahili women are just rude.’ I was acquitted because I had shared scientific facts with appropriate wording and my care was noted to be very optimal. The family must have been in denial and decided to heap blame on the HIJAB which sold me out wrongly as being rude and unprofessional even when I wasn’t . Quite unfair if you ask me . 

I could go on and on . Oh one last encounter that happened recently  ; one day I whipped out my phone to open an app that would help me calculate a pregnant client’s E.D.D quick and she asked me ‘daktari are you going to Google like young Doctors do?’ Oh boy !!! I had to show her the app and why it was necessary for me to know her exact gestation as we carried on with our consultation. She went on to say how I looked too young to be a specialist ( and I figured that I may not have looked the part in her eyes). I felt disrespected and misjudged and so I tactfully directed the client to one of my older colleagues to carry on with the rest of her care ; she missed out on excellent services from me . 

So yes , stereotypes and prejudices are in plenty depending on our social-cultural differences. It’s what we do with them that matters ; they are times you fully ignore or other times use them to our advantage . I have swam through postgraduate training and my entire professional career handling and literally ‘lemonading’ stereotypes ( that’s a new word I just came up with to indicate making lemonade out of lemons). Stereotyping affects us all and can happen at any time , whether it’s in traffic when a man abuses and thinks you can’t drive well because you are lady, or in family gatherings , or in the banks or at the airports where it’s common to quickly remove one’s hijab when passing through customs so as to get an easy pass , or even in our churches/mosques and religious interactions . How many akorinos do you know that have been wrongly labeled as illiterate? how many Somalis have been labeled Al-Shabab because of the texture of their hair e.t.c. 

I have learned that I don’t need to explain myself to beat stereotypes because that can only bring unnecessary heightened awareness and self esteem issues ; be you and let your work or ability or character speak for itself!!

Learn to live , expect and ignore stereotyping because sometimes , it’s not in your hands and there is nothing you can do about it !! Stereotypes will always exist as long as we are of different communities, different races, different religions even different genders! 

Have a lovely weekend!! 

LIFE-FAMILY-CAREER BALANCE OF AN OBSGYN WIFE-MUM

 LIFE-FAMILY-CAREER BALANCE OF AN OBSGYN WIFE-MUM

It’s been years and my trend of blogging and vlogging has changed significantly. If you ask me , a girl grew up and got more responsibilities. Those years of daily blogging right after work are long gone ; I was probably doing it to kill boredom or push the night as I always went home to a lonely and very quiet house . My weekends were for blogging and movies ; not any more . 

Well marriage and especially child birth happened . Marriage wasn’t an issue at all , I still vlogged actively when I was married , but a baby changes everything . Your priorities change and you know that you have an innocent human entirely dependent on you in the world . I would say that my marriage and childbearing happened at the right time ; right as I was completing my postgraduate studies . I am a very focused human and I tend to focus on one thing and give it my all ; Masters of Medicine is one of those things I devoted myself into with my heart and soul - a husband and a baby may not have fitted well in that crazy schedule and many hours of quiet studies and strict sleep and study patterns. True , a number of my relatives were worried that I was postponing the marriage subject forever into my mid thirties but it was well worth it and maturity plus financial freedom had set in before I got into the ‘pingu za maisha.’ 

When my first born ; baby-Q was born , I was thrown off balance . He thankfully came barely a week after my final postgraduate exams . I loved my solid hours of night sleep and day freshness - this disappeared with a new super-breastfeeder Ingoh-omwami baby.  I almost got into postpartum depression and I guess my friends/family couldn’t understand me ; how does a moneyed girl who can afford a million maids and everything she needs get stressed ? Postpartum blues are unique and different for each person due to previous lifestyles . I soon adjusted and snapped into full parenting sacrifice . I learned to take a back seat and delegate . I was a zombie for 6 months due to demanding exclusive breastfeeding. My businesses plummeted and I lost lots of income , my research publishing enthusiasm disappeared(my postgrad professor still awaits my manuscript; I told him to wait till I finish my reproductive cycle), and I stopped focusing on my looks and make-up ; as long as I was clean and with some brain freshness , that was sufficient for me . The new life of having outsiders ‘read maids’ in my house also quite stressed me ; how was I reliant on strangers in my own space ?? My privacy went , my habit of hiding memorabilia disappeared - I no longer cared as long as baby was healthy and fed . 

I started work as a consultant a few months after childbirth . I had outbursts ; I couldn’t understand inefficiencies in the public system especially by fresh men who were not breastfeeding . It was frustrating to adjust . Then came weaning season when baby wouldn’t sleep due to stomach aches and constipation yet I had busy clinics to run and major surgeries on subsequent days . I wondered how I would cope with patient safety in mind. I also live 23Kms from my work place so the idea of driving down with a sleepy head always scared me lots . I used to literally whisper to my baby to sleep well in the night because we were operating on Kajuju or Kawira the next day ; and somehow it worked .  I also did the mistake of hosting in this season ; unadvisable!! The thought of balancing my own sanity , a demanding baby , a busy career and a guest was baaaaaad!! I almost flipped . I remember one day parking my car under a tree and sleeping because the thought of going home to a relative who also expects my attention in my mental fatigue was tiring . So nowadays , I politely decline any unnecessary visits if my schedule is crazy. 

By 9 months , baby was sleeping all night and I had a very reliable nanny . I was fresh and back on my game . It took one senior friend in a related speaciality to introduce me to after-work private practice . He is one colleague who believes in my potential very much and he would always ask me to bounce back from too long a maternity mentality. He even offered me an office space free of charge ; I’m grateful. So I bounced back . I made my first good lump-sum cash  within a week of practice courtesy of him calling me to do a quick major emergency surgery on a client who insisted on a female Muslim Gyanecologist in private; patient paid upfront in cash. That jolted my mind into exploring my potentials and learning to balance . From there it was an upward trend with a fresh mind , a well settled household and a fulfilling clinical practice . I must confess that I probably over-did it sometimes ; it’s like I was paying back for the previously lost few months. There are weeks I would do up to 8 major surgeries in a week far and beyond  and still exceed my public practice expectations. My public clinic became overbooked and my name was spreading fast . I realized that it was possible to be a mother , a wife and Gynaecologist after all. 

I have however have had to create boundaries . I stopped over-doing private work ; I had to drop a few clinics so as to maintain a healthy life balance . I learned that money hunger wasn’t everything , I give my public day job utmost importance , I don’t pick calls after work unless hospital emergencies and I selfishly create some time exclusively for baby and husband. The idea of another baby even popped up( you never know!! check this space ). 

So dear patient , if I insist on surgeries on particular days ; it takes some planning and balance . When I don’t pick any calls post working hours ; it’s because I have designated hours for clients that I have sacrificed away from my family , when I don’t blog/vlog as much it’s because a day only has 24 hours surprisingly, when I don’t entertain coffee dates - it’s because hours are  tight , and when you see in scrubs and rubber shoes mostly - it’s because it’s an easier dress code with no worry on ironing , fashion or discomfort . 

Motherhood made me discover that I’m stronger and versatile that I imagined , I became tough and focused ( if a maid brings nonsense; they go - I won’t be stressed by work and by an employee), my priorities changed (if you see me with same old car, it’s serving me very well and I’m probably deep into a huge fulfilling investment for my babies), if you see me quiet and somewhat in my own world world, it’s because sometimes I selfishly and unapologetically want space, I don’t work over weekends unless very necessary and I don’t pick unnecessary calls or chats in my family time . For my clients , I would do anything to ensure your safety  and career progression is something I’m passionate about . In the near future expect more babies, more balancing and more school for career progress.