Tag Archives: Health

Ever Lost A Parent? Losing A Child Is Twice As Painful.

Just over two years ago, I lost my dad and saw the world crush in my eyes. I have a rather low threshold for tears, of joy or pain, but I had (and have) never cried as I did then. A heavyset seven- footer athlete, my dad had been battling hypertension quietly for preceding two years. He was on medication, watched his diet and had a regular fitness schedule at home and away. It was his problem and he had never made it an issue to the rest of the family except for the occasional mention that all was fine. In the month prior to his demise, he had visited his Physician more frequently. Dosages were adjusted, tests done and new instructions given.  All would be fine, the doctor hoped.

This optimism did not last. One fateful night, dad woke up in the middle of the night paralysed waist down. By morning, he had no function of all limbs. At the hospital that morning, he slipped in and out of total memory loss, then coma. In exactly 24 hours since he was last fine, dad was no more.

I had been away in Los Angeles for an exam. After my paper, I suddenly went off moods. I was sullen, withdrawn and disinterested in everything for no good reason. We had planned an after party with the rest of my colleagues but I opted out. I was just not in the mood. Little did I know dad was battling a war back home that he would soon lose. My phone had gone off after the battery drained during the daylong exam. I did not have a charger with me until over 600 km away in San Francisco where I was staying for the duration of this trip. However, when I turned on my phone, it came on briefly and I listened to a voice message from dad asking me to call him. I did and he sounded in his usual element for the first few seconds then went of a tangent in his speech. Someone from the rest of the family spoke to me and gave me an account of the events. Dad, in their assessment had made as remarkable an improvement as the deterioration had been. They hoped to leave the hospital in hours.

I was not convinced. My heart raced, tears welled and a drop fell to my phone. I was in a trance. The world seemed to spin slower by the minute and curtains were drawing! I had a strong feeling my dad was not going to come out of such a major stroke. I saw him on a wheelchair, sagging facial skin, drooling saliva and having all his activities of daily living tended to by others. An athletic man full of vigour and with an ever commanding presence reduced to a toddler all over again. I could not hold back my tears. I cried like a burst dam. I knew he faced certain disability or probable death.

We embarked on our road trip back to SF. All the beautiful stops that had made us opt for 6 hour road trip over a 2hour flight made no sense to me or the rest of the party. A few friends cried with me; the rest just slumped into their seats and drowned in their own thoughts. By the time we arrived, dad was in a coma. It was seven o’clock in the evening, about midnight in Kenya time. Nearly 6 hours later, he was no more.

To date, I have never known what words to tell anyone who has lost a loved one. I was told all manner of kind words but they made no meaning to me. The feeling of loss at that time was beyond any words or acts of consolation. Nothing made meaning if my dad would remain dead. I cried all night. My friends embarked on searching for a flight back to Kenya. They were crying between words as they spoke to the airline contact. She cried with them too on learning why I needed a flight in such a short notice. She put me on the next available flight that would connect to Nairobi quickest. I was grateful but my tears would not stop. I arrived at SFO in tears and after a couple of ‘dry’ quick connections in Chicago, JFK, Heathrow and JKIA, the reality dawned on landing at Kisumu.

I had flashbacks of moments when my dad would pray for us every night before he went to bed long after we had been in bed. The moments of quiet counsel. The moments of harsh punishment. The school visiting days. The gifts. His corner at the church and in the house. His mere presence in our minds even when we were not physically together. I have never really overcome his absence. It gets lighter with the passage of time but no one can condole me for this life changing loss. Perhaps quietly known to us as a family, we never tried to condole each other. I could not describe my loss and I knew my mum and siblings could not describe theirs either. We just mourned together undisturbed.

Looking back, I now think it was fair my dad died before any of his children; it is only fair that way. I cannot imagine what my dad would have felt to be the one mourning my death. The loss is much bigger. I have a nearly-two-year-old daughter with whom I have already made so much attachment. Her death in my life would devastate me. This is why even though I cannot pretend to comprehend Raila’s loss at Fidel Odinga’s sudden demise, I know the loss for him and his wife is beyond description.

The Bible captures the demise of King David’s seven-day old new-born in moving detail in 2 Samuel 12:18-23. King David fasted, wept and did not speak to his servants as he immersed himself in prayer for the life of his ailing new born. When it died on the seventh day, the servant could not muster the energy and courage to break the sad news to the King.

19 But when David saw that his servants were whispering together, David understood that the child was dead. And David said to his servants, “Is the child dead?” They said, “He is dead.” – 2 Samuel 12:19

King David grieved solemnly. He had cried enough, fasted and sulked in prayer while the baby ailed. For Raila and spouse, there was no luxury of time. They just woke up to a dead son. The devastation is beyond any words of consolation. No condolences will make meaning. They will grieve in their own way and live with this loss for the rest of their lives. The loss of a child by a parent is an unnatural event. It deflates and nearly takes meaning out of all you worked for and hoped for your child and their future. It puts a sudden stop to what ought to be a lifetime journey. It kills a parent’s soul. I can only wish them and all other parents in their shoes the strength that God gave King David.

23 “But now he is dead. Why should I fast? Can I bring him back again? I shall go to him, but he will not return to me.” –2 Samuel 12:23

loss

RIP Fidel Odinga

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Globalist or Statist, Ebola is a Health Systems Issue

As the world holds its breath on how the latest Ebola outbreak in West Africa might evolve, a clash of statist and globalist approaches has been evident all through; from media analysts, to International NGO’s to governments. Statist approaches have their reference point as the state/country and tend to view health risks as security concerns while globalist approaches have the individual as the reference point and tend to consider health risks as human rights issues that know no borders.

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A map of West Africa detailing the most affected areas by the EVD.

In classical statist responses, the government of Zambia has banned entry from or travel to any of the four most affected countries; Nigeria, Liberia, Sierra Leone and Guinea. Neighboring Ghana and Ivory Coast have suspended flights within the region while Guinea, itself the epicenter of the outbreak, has closed borders with her neighbors Sierra Leone and Liberia and even declared a state of emergency! The latter three countries have deployed troops at their borders to help enforce movement restrictions. Similarly, many Americans, in the wake of Dr Kent Brantly’s airlifting, voiced reservations at their government’s decision to import the virus onto US soil. In fact, retired famous Neurosurgeon Dr Ben Carson is on record recommending that the two infected Americans should have been at best treated abroad. Back home, many Kenyans are apprehensive and concerned that the virus might make its way into the country aboard the national carrier Kenya Airways, a major carrier connecting West African countries to Kenya. A suspected case late last week (Aug 9th) threw panic across the city. Thankfully, he tested negative. These measures are reminiscent of the early days of HIV/AIDS when fear and panic rather than sound medical principles informed most reactions.

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An electron micrograph of the Ebola virus

The common theme through statist approaches is the definition of disease as a security threat to the nation akin to an invasion. As a result, nations tend to go onto the defense and shut borders, ban flights, expel victims, declare states of emergency and at the bottom of the list, even deploy propaganda. Granted, the socio-economic disruption across West Africa as a result of this outbreak is indeed a threat to the stability of the most affected nations. While in certain instances some or all of these interventions might be helpful, they are seldom successful of their own. Purely statist approaches, beyond securitizing the health threat and evoking a pervasive sense of fear, often overlook the actual necessary interventions.

“The bottom line with Ebola is we know how to stop it: traditional public health,” US CDC Director, Dr Tom Frieden.

In the case of Ebola, a viral infectious hemorrhagic fever of which there is fair medical knowledge, proper hygiene and isolation of symptomatic victims seem to help forestall further spread even as a cure remains elusive. At best, only about a third of infected patients may be nursed back to health. That said, Ebola outbreaks remain either an indictment or appraisal of a health system’s infection prevention and control mechanisms, sensu lato.  This outbreak has therefore merely put to the fore an underlying and long prevalent rot: health systems that are weak from the foundation up.

In as many Sub-Saharan hospitals as homes, clean running water remains a luxury rather than the basic commodity it ought to be. Further, basic and cheap protective gear like gloves and facemasks are frequently out of supply. It is no guess whether these institutions would have enough of costly supplies like intravenous fluids and colloids for the medical support of potential Ebola survivors or management of other conditions. The last nail on the coffin that such a health system represents is surprisingly not the prevalent biting shortage of qualified personnel nor the mismanagement of the few available skilled hands, it’s the population!

“Ignorance and poverty, as well as entrenched religious and cultural practices, continue to exacerbate the spread of the disease,” President Ellen Sirleaf, Liberia.

Many Africans are yet to adopt the germ theory of infectious disease. Developed in the mid 1800’s, this theory remains the most plausible explanation for infections: that tiny living matter (bacteria, viruses, fungi, etc) must physically enter a susceptible host through a particular mode (air, food, blood, etc) in sufficient numbers to cause a disease. With this knowledge, people are forewarned and therefore forearmed on ways to avoid known infections. For Ebola, this means limiting if not avoiding all unprotected contact with infected individuals and bodies of victims and washing up adequately when such contact occurs. Sadly, many individuals still believe diseases like Ebola are curses that need exorcism or just prayers. The sick and bodies of the dead are handled casually every day; Ebola or other disease.

As more of Africa opens up to itself and the world, future outbreaks might be more complex and widespread in the absence of significant systemic changes on the public health platform. However, this threat also presents hope. The growth that is opening up and connecting Africa might come with more medical workers in the unreached areas, greater economic strength for adequate stocking of facilities with essential supplies and greater population knowledge and practise of basic hygiene and sanitation. Additionally, improved communication networks mean future outbreaks maybe detected earlier and aid to stricken populations availed sooner.

Globalist approaches to public health crises know no borders. They view health risks anywhere as a health risk everywhere in cognition of the inherent value of human life, right to a dignified pain-free existence and the interconnectedness of humans. These approaches therefore focus on open borders for collaborations, funds, skills and supplies to affected areas, advocacy for action and open reporting of events. An Africa seeking greater ties within itself and with the rest of the world will have to adopt more globalist approaches to our numerous public health perils.

“African states must do more to promote conditions for a dignified human existence within their borders.”

Finally, even though investment in proper health systems is one sure way to healthy populations, these efforts must not stop at the hospital level. The bulk of health dividends will be reaped from investment in other sectors. It is ignominious that 50 years post-independence, many African countries have yet to supply their people with adequate clean water, clean energy, safe public transport, adequate food and enough relevant knowledge. Globalists and other non-state actors will continue to play  a role in this respect but the long end of the buck lies in the hands of our respective states to do that they were set up to do: promote conditions for a dignified human existence within their borders.

Learn about Ebola

The Kenya Medical Practitioners and Dentists Board, What is It?

The Kenya Medical Practitioners and Dentists Board is a statutory body established by Chapter 253 of the Laws of Kenya in 1978. As the name suggests, the primary role of the Board is the determination, licensure and maintenance of an annual register of duly qualified doctors and dentists.

To achieve this, the Board regulates and supervises the general practice of medicine and dentistry, conduct of internship and the academic programs of medical school programs. Contrary to public opinion, the Board is neither a welfare society for doctors nor a tribunal for medico-legal cases. In fact, the Board’s mandate in medico-legal disputes is only indirectly implied in the Act that establishes it! However, its operations and decisions might make it appear as either: depending on one’s perspective.

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By composition, the Board is a ‘special-interests’ body drawing appointees from government, medical schools and doctors. The Cabinet Secretary for Health appoints the Chairman and nominates at least four other doctors. Additionally, the Director of Medical Services and his deputy are automatic nominees to the Board. In fact, the DMS is the Board’s registrar. After government, the next most represented interest group are the medical schools; each sending nominees to the Board.  Finally, duly registered doctors have seven slots to the Board filled through an election. Tenure for all members is a renewable term of five years.

The bare minimum qualification for Board membership is a due registration as a doctor/dentist. In principle and letter of the law, a newly qualified Medical Officer is as eligible to the Board as is a Paediatric Neurosurgeon of 20 years. Traditionally though, members to the Board have been highly qualified and extensively experienced senior doctors. To its credit or disdain, the Board has been an unofficial holding ground for appointment to senior government positions or conversely, a halfway house from top echelons in government.

For more details, follow these links to Chapter 253 of the Laws of Kenya (the primary reference source for this article) and the Board.

Is Universal Health a Public Burden in Africa?

The WHO has a long convoluted definition of health as is typical of most organizations of its stature and mandate. To the average person, African or not, health is subjectively defined in simpler terms; a state of wellness and ability to cope with the daily demands of life. The similarities end here. What counts for normalcy in Western Europe and North America is literally worlds apart from the same in Asia or Africa. While the per capita annual spend on health in the US is about $8000 and $3000 in Western Europe, every African individual spends only about $85 towards their health annually! This comparison, at face value, is damning. Indeed health care in the West is highly specialized and commensurately expensive; in great contrast to the African context where healthcare largely involves basic primary care. The expenditure gap is therefore a result of the size of the health ‘shopping cart’. This cart is significantly small for most of Africa with just a handful of goods while our American/European counterparts have a large cart bursting with goodies. Looked at differently, the African public sector is unable to push the ideal health cart and has chosen to keep only as few goods in it as it can push. This beggars the question; is health a public burden in Africa?

KIDCART

In his book ‘Why Africa Is Poor; And What Africans Can Do About It’, prolific author, researcher and international expert Dr Greg Mills goes at great lengths to demonstrate the central role the health of any nation has on its ability to grow from poverty to prosperity. Health is the very foundation of productivity and growth. A population afflicted by disease and illness spends less time in the production of the goods and services it needs. Complementary to good health is education; the skills to produce, and leadership; the organization of priorities. All developed economies have had to make deliberate provisions for the health and skills of their people to be where they are today. Other factors are subsets of these three pillars. Is it thus plausible to argue that leadership is wanting in Africa for it not to have prioritized the health of her people? The statistics all point to a sector in wanton neglect and crying for attention; life expectancy at birth of 56 years (against 80 in developed countries) and unacceptably high all-cause mortality and disease rates. Viewed against investment in health and other social services, these grim figures are proportionate to the dismal investments in these sectors. However, Africa is a vast territory of 54 nations; each unique in its own right and internally very diverse. A sweeping statement like this may not fly but remains valid for the most part. Analyzing individual countries paints a more accurate if grimmer picture than these continental averages.

Take Kenya for instance, a country with a per capita GDP (PPP) of  just under $ 2000 spending a meager 4% of her GDP on healthcare. Two thirds the citizens live on less than $ 2 a day and predominantly rely on the state-run health system for their health needs. The health system is mainly funded by central government taxes (direct and indirect) in addition to co-payment into a largely voluntary national insurance scheme that covers nearly two million of the 40 million citizens. Those not covered, an overwhelming majority, are expected to share costs with the state in the form of user fees at points of care. These direct fees amount to 60% of all the national health spend. There is no explicit provision for the care of the worst-off in the society; the elderly and the extreme poor. Where provisions exist, like for children under five, free treatment is often negated by a lack of an assortment of supplies including drugs which patients routinely have to buy out of pocket. In addition to the direct costs of healthcare, majority of the population bear disproportionately high indirect costs in accessing health. Transport costs are highest in the rural areas where physical access is lowest and poverty highest. The opportunity cost of time in seeking care also tends to be higher for the worst-off of the society; they make no income when sick and have to pay to get back on their feet. As though not already overburdened, the poor further face a silent hidden cost: counterfeits and illegal practitioners. Illegal practitioners take advantage of the unmet health needs of those disenfranchised by the formal system. It is here where counterfeits are passed off for genuine drugs and overall quality of care much lower than anywhere else but at a fraction of the direct monetary cost. This situation is not unique to Kenya: across Africa, millions of poor peasants have to make the choice between their health and food or work. While it is obvious that productivity is lost with every episode of illness, most African governments have failed to embrace this rather simple fact that a good health status is the basic unit of productivity; even ahead of education/vocation.

A sad irony is that while majority wallow in poor health, a small middle class in Kenya (like in other African countries) has access to fairly comprehensive employer-financed health covers tenable at some of the best health facilities around the country. These people do not lose much income (if at all) for their sick-time and do not have to pay for their health costs at the point of care. This sad state of affairs ensures that only a small subset of the nation enjoys good health and subsequent productivity and therefore carries the resultant burden of the sick and less productive. This further widens inequalities and keeps entire nations stuck in poverty, disease and underdevelopment; a reality so prevalent across Africa and within nations.

On the contrary, Germany spends 12% of its GDP on healthcare with direct private fees amounting to only 25% of the total health spend. The health basket in Germany is certainly larger but it is important to note that the bulk of the financing for health is prepaid. Public funds shoulder nearly one quarter of the health budget with the rest covered by prepaid compulsory universal health insurance into which employees and employers contribute. Further, the government makes payments for those out of employment or otherwise unable to make an income. This single feature creates a system in which ability to pay is not a determinant of access to health services. Efficiency and collaboration between private and public players in financing, service delivery and research into healthcare is high and the overall result is a system that meets the health needs of all citizens including the less fortunate. Needless to add, the dividends of a healthy nation are self-evident; greater productivity, longer lives and greater quality of life.

However, a good national health service is not by itself a guarantee to improved national health status. The health service is only one of a retinue of factors that determine the health status of individuals. Commodities like food security, water and sanitation, education, clean energy and social cohesion achieve greater health benefits and savings than the health service itself. It takes leadership to define programs that integrate these individual components into a system that delivers health to the nation. This demands an awful amount of political capital and ownership for any meaningful success. Africa must begin making homegrown decisions for her people. The introduction of user fees in hospitals and state divestiture from several key public sectors (including water, electricity and transport) can be remembered by all to have been a top down condition by the Bretton Woods institutions in the infamous Structural Adjustments Program era of the 80’s. Today, fragmentation of healthcare in most African countries amongst disparate donors with as many interests has made sure that only modest gains have been made in the improvement of healthcare. The presence of these programs if for nothing else is testimony to the fact that our health systems are not functional as presently constituted. A conscious effort must be made to ensure the attainment of universal population coverage as the first step in achieving universal health care. To ensure a meaningful health package, the financing of health – as a necessity – needs to be prepaid rather than at the point of service. Mechanisms must also be placed to ensure the most disadvantaged of society are not disenfranchised from the health system by way of fees. And more importantly, there must be efficiency at every level; collection and pooling of funds, purchasing of health goods and services, management of the health workforce and research. This calls for closer mutual public-private partnership and for emphasis; leadership. Only then shall we begin to have a healthy enough population that can engage in production and economic and social development. Fortunately, these developments are already taking place in countries like Ghana, Rwanda and Burkina Faso with steady and remarkable results. It must remain alive to us that universal health is a public burden; not to be shunned, but one to be borne by everyone in a way that especially seeks out the most disadvantaged in the society.