Every case that is brought to us requires a different call. In this case I was 99% sure that the problem was malaria. With an older baby our usual response is to give the mother a dose of malaria treatment tablets, (which we keep a lot of). In most cases the treatment works and mother and baby are happy. In the rare circumstances when a child's symptoms get worse despite the treatment tablets it is easy to dash up to the hospital for a second opinion. As this baby was quite young I wanted to be sure of the diagnosis so we set off up the lumpy road to the hospital.
Going to the casualty, (or ER), department of a hospital probably has a number of common features in any country; queues of people in varying degrees of discomfort, an overburdened doctor, an atmosphere of quiet anxiety. The waiting area for patients at our hospital is a wide corridor, open to the elements on one side, containing concrete seats, an admissions window, and a check in desk where a nurse weighs each patient, takes a temperature and/or checks blood pressure. Today it looked like the student nurses had been let out for the day as there was a large number of them manning the cubicles and unidentified treatment rooms. On first arrival I reckoned we were in for a couple of hours waiting around.
As well as being a good centre for treatment the hospital is, by virtue of it's status as a private institution, a well oiled money making machine. Nothing happens without payment. Five hundred shillings for initial check up and booking in – check. Five hundred more shillings before being given the form for the malaria test – check. Two hundred more shillings at the end of the process for the drugs that are prescribed. The whole series of events seems to happen in slow motion. At one point I thought the department that took the blood sample required for the malaria test contained a black hole which all the blood samples were sucked into. A large number of patients had samples taken and it seemed that none of them received results.
Eventually, about three hours after reaching the hospital, we had our final consultation with the doctor.
“The baby has malaria. He should be admitted”
“I see. Is the malaria serious?”
“No, it is a normal malaria but the temperature is high. He should be put on a quinine drip”
“Oh. Would the normal treatment tablets work?”
“So there isn't really any need to admit him. Would paracetamol syrup bring the temperature down?”
“Well, yes. He has had a paracetamol suppository as well so that should last for six hours.”
“That's good then. So it will be OK to take him home.”
“Yes, no problem.”
I think the hospital sees mzungus, (white people), as the closest thing in Kenya to a blank cheque. We have used this hospital a number of times over the years and have frequently queried suggestions that patients be admitted. Each admission cost three thousand shillings, (about £25 or $36), plus any treatment and drug costs. It's a nice little earner. We picked up the prescribed drugs from the hospital pharmacy and headed for home. Total trip time about four hours.
We continue to use this hospital because, cost issues aside, it has the best facilities around. It might seem irresponsible to argue with a doctor's treatment recommendations but we don't like being taken for a ride. The real cost of hospital treatment is hidden from every patient in the UK, because they don't have to pay for treatment. As an organisation in Kenya we are fortunate. When the children who live with us are sick we can afford to pay for their treatment. As an employer we make sure the staff have a NHIF, (National Health Insurance Fund), card which covers their hospital costs if they are admitted as in patients. Our neighbours in the community are not so fortunate. Most of them can't afford medical treatment. It's why so many children die from malaria. Living that close to the proof of Thomas Malthus's work is a sobering experience.
"The power of population is so superior to the power of the earth to produce subsistence for man, that premature death must in some shape or other visit the human race. The vices of mankind are active and able ministers of depopulation. They are the precursors in the great army of destruction, and often finish the dreadful work themselves. But should they fail in this war of extermination, sickly seasons, epidemics, pestilence, and plague advance in terrific array, and sweep off their thousands and tens of thousands. Should success be still incomplete, gigantic inevitable famine stalks in the rear, and with one mighty blow levels the population with the food of the world".
—Malthus T.R. 1798. An essay on the principle of population. Chapter VII, p61