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?”
“Yes.”
“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.
In
1798, Thomas
Malthus published An
Essay on the Principle of Population,
in which he wrote:
"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
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