On Wednesday 12th 2017 I woke up jovially, had breakfast and dropped my babies to school. I headed straight to KICC where The Kenya Trade Week was in its penultimate day. APSEA had requested KMA to be represented on that day to see how it can get involved in drafting the Kenya Export Policy and more so how medical services can be captured as an export commodity. I met several wonderful Kenyans, made a few friends. I took tea for breakfast and snacks for 11 am break. JOKINGLY at each food point I asked the servers “I hope this has been checked for cholera?” They giggled and said “sisi ni wasafi (we are clean)”
At lunch time it was announced that lunch would be served at the restaurant. I donated my lunch voucher to a friend who had missed the voucher because I had to leave to review a patient admitted at a hospital for gynecological reasons. Two days later on Friday 14th 2017 news that many of the participants were admitted to various hospitals with cholera-like symptoms. I heard that some cabinet secretaries were also victims of this disease. In my WhatsApp circles news of the death of a person I know and who was reported to have been at KICC on the same day as I was sent shivers down my spine. I would have been either dead or dehydrated in a hospital had I not rushed out to go see a patient.
Cholera at a doctors meeting
The irony of this is that I have been at the forefront of shouting from the hills that our public health is being mismanaged. When doctors were victims of a cholera outbreak at the Weston Hotel on June 22nd we recommended that public health guidelines on management of cholera be followed. The facility should be closed, turned into a cholera treatment centre (CTU), all victims treated, and fumigated. Of importance would be tracing the source of the cholera. This did not happen and instead there was initial downplaying of cholera the ministry of health officials of both county and national government.
Nairobi’s endemic cholera
I spoke to my better half who occasionally works in the slums of Kangemi and what shocked me was her assertion that cholera is endemic. She was wondering why I was surprised by this. She took me for a walk behind Lavington to a place where raw sewage was spewing into Nairobi River and winding round homes.
Frustrations of government public health doctors
I spoke to a public health colleague who has had experience with managing public health epidemics. He confessed of frustrations that public health experts go through. He illustrated this with a story of how some time back they were called to a site which had been hit by cholera. They did the diagnosis and budget to the ministry of health. The monies were released but what they had budgeted for was not bought. The money had disappeared. Imagine someone stealing money meant for cholera victims. He left that department because his work was not respected and is now in a place where when cholera is declared all resources are directed towards its containment. I fear for the day an epidemic of a disease like ebola hits if this is the way government entities charged with epidemic detection and management operate.
Nurses Strike – the deadly silence
The nurses’ strike has hit its sixth week. While the CSs and PSs who got cholera from the lunch at KICC could afford to be admitted to the Nairobi Hospital, other less fortunate Kenyans with no medical cover had nowhere to run to. The public health nurses are on strike demanding for a CBA to enable them serve Kenyans better. Public hospitals are closed. There is nowhere to run for common mwananchi should they get cholera. The media is quiet. Politicians are on the campaign trail. Ministry of Health is quiet.
Diseases do not respect anything
Diseases do not have manners. They do not know that public hospitals are closed. They do not respect your status in society. Mismanagement of public health will be punished. The unconstitutional way in which devolution of health was purportedly done has been the bane of public health mismanagement. Let me revisit the unconstitutional way in which health was devolved.
Unconstitutional devolution of health
Schedule 4 of the constitution of Kenya was very clear on what devolution of health was. Governors were allocated public health and the national government would do the national referral health facilities which in essence was the REFERRAL SYSTEM i.e. dispensary to Level 6 facilities with referral guidelines. Governors forced the executive to politically devolve health facilities – they were eyeing the health monies without thinking of how they would pay the health workers. Doctors and civil society went to court twice. The judgement by Justice Lenaola that he had no authority to defined “national referral health facilities” was misinterpreted to mean that “national referral hospitals” and health was assumed to be devolved. The Transitional Authority charged with managing devolution failed Kenyans dramatically. Instead of doing their work they listened to politicians. I am thinking of suing TA for bungling health devolution. Governors went to sleep on their devolved health function – public health. And the classical case study of Nairobi where cholera has been declared endemic by my better half. Nepotism, tribalism and corruption networks and thievery.
Lessons from this stark failure of public health.
- It is the devolved health function of governors to ensure that the public health of their counties is safeguarded. Misinterpretation of the constitution can kill Kenyans.
- Whenever a cholera outbreak is suspected it should be treated with the urgency it deserves and correct management instituted including tracing the source
- Denial of cholera does not stop cholera from spreading and causing morbidity and mortality
- When you do not speak out against wrong things you will be the victim of the same
- Politics should not interfere with medicine. It is the duty of politicians to listen to the health experts. Unfortunately some health experts have chosen to pursue their own agendas instead of advising their employers correctly. Washindwe na wnanjijua
- Cholera kills
- Kenyans must push the government to conclude the nurses CBA so that public hospitals reopen to avert the suffering of Kenyans.
- Employment of public health leaders should not be based on chronism and tenderpreneurism.
Having been given another lease of life I will continue commenting on social and health matters and say it as it is.
Our next bring problem is the so called NEW EDUCATION CURRICULUM. The implementation is wrong and must be rejected. Kenya should not be sold to the highest bidder
The truth will set you free