Access to emergency services an uphill task despite tough laws

Kenyatta National Hospital in Nairobi. The country should train more health workers on emergency care. FILE PHOTO | NATION MEDIA GROUP 

In Summary

• Both the Constitution and the Health Law 2017 state that nobody should be denied emergency medical treatment.
• Chances of survival for these patients depend mainly on the golden hour — which requires a patient to receive emergency care within the first one hour.

By ELIZABETH MERAB
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Matilda Anyango was walking home from work late into the night in Nairobi’s Kangemi estate when she was suddenly attacked by a knife-welding gang.

She sustained deep stab wounds, mainly to her thigh, that left her bleeding profusely.

Unconscious and the clock ticking fast against her, Ms Anyango was taken to the nearest hospital that could offer emergency services to stabilise her.

Her neighbours and relatives took her to M.P Shah’s Accident and Emergency Department on the night of April 11 after she was found unconscious near her place of residence.

There, the 32 year-old woman would spend 10 hours fighting for her life as doctors wrestled to stabilise her vitals organs.

“Her chances of survival are very low, I remember the doctor saying after the second surgery in the wee hours of the night,” Daniel Moro, Matilda’s elder brother, recounts.

DEATH
According to the hospital, health workers resuscitated her before she was transferred to the theatre for emergency surgery to stop the bleeding.

Eleven hours later, at 10am on Thursday, April 12, Matilda died, leaving behind a bill of Sh8,558,000.

This was very huge to her family, which could not even raise Sh200,000 that the hospital had initially requested as financial commitment.

“Ms Anyango received the best medical care possible, and every effort was made to save her life. She was attended to by all the necessary specialists and clinical staff,” Toseef Din, chief operations officer at M.P Shah Hospital, says.

For the hospital to release the body, Mr Moro said they had to part with Sh25,000.

MEDICAL TREATMENT
Matilda’s case, albeit a little different, brings to mind that of Alex Madaga, who died after spending 18 hours in an ambulance for lack of an ICU bed.

Also, his family lacked enough money to have him admitted to a private facility.

READ: Ambulance patient Alex Magada dies at KNH

Although Mr Madaga’s accident and death brought to the fore the state of emergency care services in Kenya, little has changed in how facilities provide specialised treatment to patients, especially those who cannot afford it.

Both the Constitution and the Health Law 2017 state that nobody should be denied emergency medical treatment.

This includes pre-hospital care, stabilising the patient, and arranging for referral in cases where the health provider of first call does not have the facilities necessary to stabilise the patient.

GOLDEN HOUR
Emergency treatment, according to the African Federation for Emergency Medicine, is provision of initial resuscitation, stabilisation, and treatment to acutely ill and injured patients, and delivery of those patients to the best available definitive care, regardless of ability to pay.

Dr Benjamin Wachira, an assistant professor of emergency medicine at Aga Khan University Hospital, Nairobi, says the first point of emergency care is the place the victim or survivor of an accident, disease or robbery, is picked up from.

“Most Kenyans pay little attention to point of injury treatment, exposing the victim to prolonged trauma and pain, yet it is the injured who need emergency care to prevent death and permanent disability, not those who die,” Dr Wachira says.

Chances of survival for these patients depend mainly on the golden hour — which requires a patient to receive emergency care within the first one hour.

“No one walks from their house straight into the ICU. Intensive care is meant to be part of a continuation of care offered to a stable patient,” he says.

OFFENCE
The World Bank says that implementation of “effective, prioritised, timely emergency care can address 45 per cent of deaths and 36 per cent of disability in low and middle income countries”.

The Health Law 2017 defines emergency treatment as necessary immediate healthcare to prevent death or worsening of a medical situation.

It even imposes a fine to facilities and health professionals who break this law.

“Any medical institution that fails to provide emergency medical treatment while having the ability to do so commits an offence and is liable upon conviction to a fine not exceeding three million shillings,” it states.

Yet, from the examples above, patients continue to die for either lack of funds to access much needed care, or for lack of specialists and intensive care services.

FUNDS
Many a times, patients and their families have decried the high cost of receiving this critical care.

In Matilda’s case, the hospital’s bill was so exorbitant that it raised public outrage, while in Madaga’s situation one hospital refused to admit him because his wife could not raise a Sh200,000 down payment.

“The cost should be standardised so that facilities, both public and private, can be more receptive to patients.

"At the same time, the government should come up with an emergency care fund to cover these costs,” Dr Wachira adds, while calling on the National Hospital Insurance Fund (NHIF) to include emergency care in its package.

Private facilities charge between Sh400,000 and Sh600,000 to admit a patient into the ICU, a cost many people who need urgent care cannot afford.

WAHOME GAKURU
But lack of money is just one of the challenges faced in this type of treatment.

Even high profile individuals have fallen victim to the failed health system, which experts say is underdeveloped, underequipped and basic, in both public and private facilities.

Last November, Nyeri Governor Wahome Gakuru died after a horrific road crash at Kabati, on the Thika-Sagana highway.

Dr Gakuru was taken to Thika Level Five Hospital for emergency treatment but succumbed to the injuries.

The country, Dr Wachira says, does not have an organised national emergency care system, lacks specialised trained emergency care personnel, and has not developed standard operational procedures and emergency operation plans.

SKILLED WORKERS
Contrary to popular opinion, Dr Wachira says, many patients succumb to injuries due to lack of proper management.

“No patient dies because of lack of an ICU bed. They die because they lacked critical care from trained personnel,” he notes.

Dr Wachira adds that the country should train more health workers on emergency care.

Currently, there are an estimated 200 emergency care nurses, about 1,000 emergency medical technicians and less than 15 emergency care doctors, many of whom are still undergoing training.

“This means that sometimes those in casualty departments may not be well-prepared.

"Even worse, one nurse might have to shuttle between two patients who need maximum care, compared with the international standard of one nurse to one patient for hourly monitoring.”

EQUIPMENT

Dr Wachira further says that facilities across the country, especially at level four and five hospitals, should have at least two beds properly equipped with ICU facilities for emergency cases.

“We need at least five emergency departments in each county to guarantee us having 250 departments countrywide,” Dr Wachira explains.

But this will not come cheap. At least Sh10 million is needed to equip one emergency room.