By Adongo Ogony
“Courage My Friends We Can Still Make The World a Better Place”-Tommy Douglas 1961
Something big happened last week.
No it is not the convulsion in the Narc cabinet. That’s not news any more, that is as stale as the Narc leadership itself. Talk about a stalemate(s).
The big miracle last week happened in a humble hospital in
May be not so humble.
This is actually the Nyeri Provincial Hospital, which is supposed to be the referral hospital for complicated cases in the whole of Central Province.
On November 28, 2004 Our First Lady,
Mrs. Lucy Kibaki
while visiting the Nyeri Hospital was shocked to find women sleeping on the concrete floor of the hospital. She also found out that the hospital has no basic things like painkillers and that the Intensive Care Unit was non-existent. The First Lady was stunned and asked the matron if she ever saw people sleeping on floors anywhere, even in their own homes.
I think the First Lady should visit more hospitals, particularly the District Hospitals in and outside Nyeri District. She would be lucky to see a bed in those ones and even luckier to find the matron at the hospital to talk to leave alone the nursing staff. I would plead with her not to set foot in the Divisional Hospitals and local clinics. I don’t want our first lady to get a heart attack from the horror she might see there. We have many problems with our so-called health system and they are monumental.
The reality in our hospitals is that women not only lie on the cold concrete floors like prisoners at the Industrial Area Remand Prison, they give birth on those floors under extremely difficult conditions. They loose their young babies on those hard floors daily and not a word from our so-called pro-lifers parading at Nairobi courts. What the first lady show in Nyeri is a daily nightmare for Kenyans across the land.
Why do I say this is a huge discovery? There are two reasons why I think this was a huge discovery.
For one thing, the first lady’s experience explodes the silly myth that once “our man” gets to power then development will come flowing through the doors and we will all be living large and enjoying the fruits of the presidency. For example under the Narc regime, tribalists have been feeding the Kikuyu community and Kenyans in general the porojo that now we have a Kikuyu presidency, which will help the Kikuyus and by extension deserves every support from the Kikuyu community. In fact some of us who cannot stand Kibaki’s incompetence and the sheer dishonesty of the ruling clique have been accused of being anti-Kikuyu. That doesn’t bother us because yesterday they said we were anti-Kalenjin when we fought against Moi and Kanu and it never stopped anybody.
It is pitiful to see that even some well-educated young folks, some actually living in diverse communities in Canada, the US and UK are really into the tribal crap. Log into any online forum and you would be appalled to find many Kikuyu paper warriors, hiding behind anonymous names crowing everyday about how their tribe has got a hold on power and things be looking good upstream. Of course this is just as pathetic as the poor Luo fella mourning day and night how the Luos are being finished because of Raila this and Raila that or the Kisii intellectual who thinks Nyachae is the best thing since sliced bread.
Well now you heard it from the first lady herself. Right on Kibaki’s backyard Kenyans who are actually Kikuyus are suffering just like everywhere else in the country when it comes to medical services. This should be news to the tribal warriors walking with their heads stuck in the wrong place to wake up and smell the coffee. The whole country is in trouble and it has nothing to do with your tribe.
We have buildings, which we call hospitals and we use these as human warehouses for the working poor who are sick and cannot afford to pay for private medicare. Our leaders on the other hand whether they are LDP, NAK, the FORDS, whatever, enjoy the state of the art medical facilities in some of the best hospitals in the continent.
When you go to Nairobi Hospital, they don’t ask what tribe you are, they ask you about your health insurance. Just like Lucy has never seen a dirty warehouse masquerading as a hospital before, millions of poor Kenyans have never seen what the inside of a real hospital looks like. Theirs is a gloomy line in a place that perpetually stinks of a strange concoction of invisible meds and they are lucky to escape with an aspirin at the end of it all. That is what we call misery and it abounds in Kenya, thanks to our siasa mbaya politicians.
Did you guys hear about the big dance by the ministers and their spouses where Murungaru was getting down some with Ida and all. Some people were surprised how social these guys are with one another in private. What we forget is that these are supposed to be part of the crème de crème of the Kenyan elites. Of course there are a few just uncouth people in the mix who got rich too quickly and have no etiquette or are just out and out morons with no manners.
In general these guys go to the same exclusive gyms, they step on those imported leather stuff, no mitumba shoes and of course they love to hit the brand new big engines with gusto. No mitumba cars from Dubai. And who is paying for all these? You are, but they have no money for your painkiller. That hurts, right?
I think we waste a lot of energy pontificating and even ready to die fighting for our tribal leaders. These guys don’t give a damn about you and your tribe, except come voting time. They have their tribe and its membership is determined by the amount of cash in your bank account not by which ritual you followed into your adulthood for those who still bother with those things.
The second reason I say Lucy stumbled upon a major discovery is that right now our country is in the midst of a controversial debate about what some call Madame Ngilu’s pet project. Just yesterday President Kibaki, for the first time went against the better judgment of his kitchen cabinet and ordered the NSHIF bill back to parliament for debate.
This is the first major debate about healthcare we have held in our country since independence, if we leave the IMF imposed cost sharing implemented since 1986 which has completely destroyed whatever little we had in terms of healthcare services. That is why I am so mad to hear the IMF and World Bank are some of the forces opposed to NSHIF. These are the people who ruined our hospitals and now they want to lecture us about what we need? Please, we will take the money if that is okay, after all we are paying it back.
The thing that puzzles me about the big health care debate is that nobody is talking about the real conditions of our so-called hospitals which are beginning to look more and more like death traps. If a prominent provincial hospital like Nyeri has no basic facilities and staff, what else is happening in the system. How much money has our government set a side to rebuild the hospital infrastructure and employ staff? How are we going to standardize our hospitals to provide a semblance of care across the country? How are we going to get at least bandages and painkillers not to mention prescription meds to the hospitals? This is an urgent debate because people are dying daily in the crazy places we call hospitals while our leaders are getting “lobbied” apparently with money meant for hospitals.
Now before I forget let me say a thing or two about Ngilu’s bill. It is a bright idea, but it is more on the vision side than the to do list right now. What I mean is we should start it now with some modest payroll deductions as well as taxes on alcohol and tobacco, but we should be honest enough to acknowledge that our generation might never be able to directly benefit from it.
This is for our children and grand children and believe me they are going to be truly proud of us when this thing kicks in forty to fifty years from now. Anybody telling you we are going to pull this thing off in ten years or so need to give his or her head a shake and take a deep breath. The question we should ask; is our generation of Kenyans with its legendary greed and recklessness ready to sacrifice for another generation? That is the question the NSHIF debate will answer. My fear is that the Narc government is going to do what it does best. Pretend they are doing something and continue doing nothing.
Here in Canada we have universal healthcare, meaning every single Canadian can go to any hospital of their choosing show their health card and get as good a treatment as the Prime Minister of Canada. My prescription meds and that of my family are covered by my employer, but for those not employed the government pays for their prescription meds. Medicare is one of the things Canadians revere the most, in fact Tommy Douglas, the Social Democrat who introduced and fought like hell for medicare in the 1960s was a few days ago named as the greatest Canadian that ever lived. He beat sports legends, scientists and other great leaders in that race, but it tells how much healthcare means to people.
The reality though is that Canada is an industrialized country with 6% unemployment rate, meaning the vast majority are working and are able to contribute meaningfully and also most of those employed only use the hospitals but pay for their own meds. That makes the whole thing sustainable. In Kenya we have something like 50% unemployment rate or may be worse. The simple reality is that our workforce and industries cannot sustain a functioning universal healthcare. By the way there is no such thing as free health care. Someone is going to pay for the damn thing one way or the other. The issue is affordability and sustainability. Also remember when the Canadians started universal health care in 1961, Canada too had a lot of economic problems then. So take heart folks.
My approach would be to start the NSHIF now, develop the concept and start building a reserve fund which we can hopefully smartly invest and not squander like we are doing with everything else then tinker with it as we go along and voila come 2040 or so Kenya would be in a position to have a universal healthcare plan.
In the meantime lets talk about fixing the mess we have in our health system starting with the infrastructure. Kenyan politicians have to understand one thing. Our entire infrastructure is broken. Whether it is the hospitals, the schools, colleges and universities, public buildings, roads, railways, waterways, bridges up to and including the jails and police stations. The stuff the wakoloni forced us to build with forced labour is broken to the bone and nothing significant has been done in more than thirty years.
The future of our country is in building our infrastructure. That is where the jobs too are going to be found. But everybody is just fumbling around talking about some imaginary economic recovery, which Narc promised would be realized by ensuring the country gets to a 7% economic growth rate. In their dreams. It is not going to happen without a viable infrastructure.
In Kenya it takes ten years just to survey and design a road or a government building and another four years for tender. By the time the whole thing is ready to go the cost has doubled or trebled. At this rate we are doomed. We need to crash start our economy by changing the way we do everything. We are in a war against massive poverty and disease and the holocaust of HIV/AIDS, we can cannot use peacetime methods. During the Second World War the Americans were producing tanks and weapons in months. No fancy designs and time wasting nonsense. We better get real because this is a war we cannot afford to loose or can we?
We need to start with a massive infrastructure initiative all across the country which is designed to be labour intensive so that we can put that donor money into the hands of Kenyans who in turn will spend it boosting the local economy while building our roads and hospitals. We are getting donor money and loans and we are sinking them into the hands of contractors who hardly employ local people. The wazungu rounded up Kenyans to build roads and hospitals using the cane and terror. We can do the same, but instead of using the cane, we pay folks some cash. Wouldn’t that be nice and we will literally hug the roads because we built them with our own hands. Where is the creativity and vision in our leadership? The beaten path is not working, please lets switch tact.
Finally lets look at disease prevention. I almost feel embarrassed that we are having this big debate about NSHIF when we have no clue how to contain malaria, typhoid and the rest of preventable diseases, which are costing us a fortune in terms of human life and resources.
Folks have no latrines in the rural areas and every little patch of grass is a toilet. When it rains you can feel the stench all over. This is a major health hazard and we need to find creative ways of helping rural homes build good latrines. And then the water that we share with cattle in the villages isn’t doing us much good either. We need clean water that we have been promised since independence. Forty years is a long time to wait for anything. For now we could at least treat the water in some of the earth dams that folks use. Believe me it is much cheaper to decontaminate the water than handle endless cases of typhoid. It is truly a scandal that even those living around Lake Victoria the world’s third largest fresh water lake live a lifetime without tasting fresh water.
One more thing. Lets redefine service delivery systems for our healthcare. It makes no sense for someone with diarrhea to travel from Usenge to Bondo town for treatment. This fella shall have spread enough bacteria to infect the whole community. Why not use simple transport like bikes and motorbikes for nurses and other service providers to deliver some services right at peoples homes. With the emergence of mobile phones arrangement can easily be made for patients to call the hospital and wait at their homes. It saves the one bed at the district hospital for somebody else and that can’t be bad either.
The bottom line is we cannot isolate health issues from poverty and the pathetic conditions the majority of our people live in. The villages are stuck in the stone ages and our leaders have been preaching about poverty reduction for decades. May be it is time we switched to death reduction. Lets take the health debate beyond NSHIF, because quite frankly the bill is a minor aspect of the daunting task we face in this area.
Wednesday, December 01, 2004
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