Quality Medical Care Begins with You: The Patient

In recent days, there has been much talk in the public space concerning the general subject of quality of healthcare in Kenya. The discussion, unregulated and undirected, has generally pitted health workers on one side against the public on the opposite side. The media and a motley other organizations including the KMA (Kenya Medical Association), KMPDB (Kenya Medical Practitioners and Dentists Board) have found themselves somewhere in the middle-ground and often drifting to one of either sides to advance their points. Pointedly, there is absolutely nothing wrong in the various interest groups drumming up to their tunes; it is their duty to inform either side of why things are as they are. As long as a modicum of objectivity is maintained, this kind of engagement is as healthy as it is necessary.

Curiously, not the entire public is involved in this discourse. It is the ‘aggrieved’ public whose voice is loudest. These are relatives of people who died or suffered injury in circumstances that were less than satisfactory in their eyes. While I empathize with this group as an individual who has also lost a parent in similar circumstances, I am alive to the fact that such loss and the attendant emotion often do not make for an objective background upon which a critical evaluation of a system can be carried out. Nevertheless, that does not negate the import of such claims. On the other hand, those silent cannot expressly be presumed to be at peace with the quality of care in our hospitals, neither can we assume they share the sentiments of the aggrieved public. Their silence in a matter of life and death is to say the least disturbing. Archbishop Desmond Tutu once said, “If you are neutral in situations of injustice, you have chosen the side of the oppressor. If an elephant has its foot on the tail of a mouse, and you say that you are neutral, the mouse will not appreciate your neutrality.” It is this silence from the rest of the public that is my concern.

Politicians, loud and macabre as ever, have shouted themselves hoarse at us with Bishop Tutu’s timeless quote when galvanizing support for their causes; noble or otherwise. There has never been a shortage of takers to this call; young men, women and people of all walks of life have taken part in political discourses of one type or another as a way of dispelling even the mere thought of their neutrality. The commendable pinnacle of this national duty has been the electoral process; a period during which the country literally grinds to a halt as people queue up for hours to vote and diligently keep tabs on the counting and tallying process for days on end. Indeed, until the winners are declared (or even sworn into office), it is not over. I am least suited to explain the reason for this kind of enthusiasm.

The average voter has little grasp of the technical details of democracy and governance; not unlike the average patient’s grasp of the technical details of medicine and health. In both cases however, these two individuals clearly understand what they want of the process. The voter may have no more a reason to vote than to put their tribesman in office in the same way the patient may have no more a reason to visit the hospital than to have a safe delivery, surgery or relief from a nagging headache. It is for the professionals to sift through the tomes of theory and practice in order to meet the client/patient at their point of need. This interaction between technical expertise and client demands is the basis of quality. For historical perspective, I will quote a 1988 article published in the Journal of American Medical Association (JAMA) by Dr Steffen Grant that defines quality of medical care as “the capacity of the elements of that care to achieve legitimate medical and nonmedical goals.” It is instructive to note the word ‘elements’; as this signifies a system of multiple components. The healthcare system brings together health workers, medical infrastructure and clients: management and finance play overarching roles to enable the first three components achieve legitimate medical and nonmedical goals. It is therefore preposterous and sensationalist, nay defeatist, to blame lapses in quality of care on any one of the components without giving the rest a fair share of scrutiny.

nurse-waiting-room

While it is obvious health workers need proper training and skills with appropriate medical tools and equipment as well as a well-financed and managed system to be most effective in their trade, the role of the patient is seldom emphasized. Without the patient, there would be no need of a health care system in the first place. Patients have the pride of place as consumers in the health system. It is for them that everything else in the system works. It is therefore incumbent upon patients and their carers to not just be passive goods on the health conveyor belt but active participants in every stage of the decision process. The best time for any patient to make a contribution to the health system is not when they lay prostrate on their hospital bed; it is when they are healthy, strong and able. That is to say, we all have a duty to improve the quality of care in our hospitals. We must demand to have our hospitals staffed with enough qualified personnel. We must demand that these hospitals have running water and electricity as well as the appropriate equipment. We must demand that the system is well financed to handle emergencies without asking for money beforehand. We must demand to have a working health facility within no more than half an hour’s walk. If we leave these demands to only doctors and other health professionals to make, we shall continue making unfounded and salacious claims (of 30% of patients dying of poor care and 10% of all patients being misdiagnosed) as have been carried in the print and electronic media recently.

It does not make sense that a poor Kenyan will prepare a makeshift bed in his living room for an overnight visiting friend but accept to share a bed with a sick stranger in hospital! Why should anyone have to sit in a queue at the hospital for 30 minutes? Or have to walk in labour in the rain, in the dead of the night for 2 hours to reach a hospital? The same energy we exhibit in showing our love for politicians, music, dance and enterprise must be directed at advocating for quality of care in our health system. The doctors have done their part in exposing the problems; you must do your part in demanding for better from your leaders at the grassroots to the President. And in the inevitable event that you fall ill, be forthright and candid with your health provider: amicably share with them your pain and agony and help them meet your needs; medical or otherwise.  They will be in a better position to prioritize your legitimate needs and make a sound plan of action. Even then, ask questions and get answers; every doctor is trained to listen to and act on their patients’ concerns with humility and empathy. Should this not happen, speak out about it even if you suffered no obvious loss. This is the only way to better healthcare; all players of the system pulling in the same direction openly, frankly and with unity of purpose.

Finally, the mass media has the unique role of arbiter and educator. As the late Paulo Freire, an internationally acclaimed 20th century thinker and educator, once said, “The educator has a duty of not being neutral.” The media must highlight failings of each of the components of the system with equal zeal. Without trying to appear irrationally optimistic and escapist, I know for certain there are positive stories of doctors, managers and other players in the system who are selfless and going beyond the extra mile to make healthcare in Kenya of better quality. It is not a waste of space to mention these in the media.

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