What Happens When a Country’s Doctors Go on Strike?
From March 14th to May 10th of this year, physicians employed by the Kenyan government public health sector went on strike.
Many of these physicians had been providing vital care for an already stressed healthcare system. I am not going to comment much on the cause of this as it is much too complicated to unravel. But what happens when a country’s physician’s go on strike? I think for many reading this in America, it is unfathomable. But what if I told you that all of the public hospitals and clinics wouldn’t have doctors to care for you or your loved ones?
As a mission hospital we were one of the few hospitals with physicians continuing to work. To the best of my knowledge, I was the only pediatrician and internal medicine physician working in Elgeyo-Marakwet County, which has almost half a million people living in it. Being one of the only hospitals with physicians working, we naturally received more and often sicker patients who had not been able to access proper medical care. Almost daily we are receiving critical ill patients, a patient volume we are just simply were not equipped to handle. It is hard to choose just one day to portray what life was like as a physician here, but I will try my best.
One day after finishing rounding on a sea of babies in our newborn unit, I was called by the emergency department that they had a very sick 1-year-old girl named Beka just arrive. I ran up to the emergency department to find a little girl having full body convulsions on the stretcher. I asked how long she had been having seizures. The nurse told me they were referred from an outside hospital and she had been like this for hours. We started her on anti-epileptic medication, but the seizures continued. We then gave her a second-line medication, still without success. Finally, we tried a third medication and the seizures finally abated. The parents then told us that Beka had been having high fevers and that her neck was rigid, very concerning for meningitis or an infection around the brain, so we started her on antibiotics.
Then the nurse notified me that her blood pressure was starting to drop meaning Beka was going into septic shock. So we gave her IV fluids and then started her on noradrenaline, a medication to keep her blood pressure up.
Just after we stabilize Beka, I was notified that a 27-week premature baby had just born and required resuscitation including CPR. So I told the nurse to monitor Beka for any further seizures and I went to see the newborn baby. Thankfully, when I arrived the newborn looked stable and had already been placed in an incubator. However, while examining the newborn I received a call from the nurse taking care of Beka, “Please come quickly,” which is often an ominous line. I ran back to Beka’s bedside I our outpatient department only to find that they were doing CPR. They told me that Beka’s heart had stopped and that they had started CPR immediately. I felt so downtrodden as I took over doing compressions. I remember praying “Please not this one God, please don’t let her die.” I gave orders for adrenaline and we continued CPR. After four minutes of CPR I check for a pulse and felt it there! A glimmer of hope!
However, when a patient’s heart stops at our hospital, there is often a very high mortality rate and a long road ahead. Beka was not breathing so we were forced to intubate her (when we put in a breathing tube) and put her on a ventilator. This process takes a considerable amount of time at our hospital because of the limited critical care training at our hospital. I often have to act as a doctor, respiratory therapist, nurse, and pharmacist. By the time Beka was stable it was late into the night. As I trudged home in the dark I reflected on the past several hours and after arriving home, having missed dinner again, I found Regan and the kids fast asleep.
The next morning I was relieved to find that Beka and the newborn baby were still alive and stable. Furthermore, Beka hadn’t had any seizures overnight and her vital signs were stable. The nurses were able to wean the noradrenaline and sedation medication off which was a fantastic sign. Later that day we were also able to take Beka off the ventilator as she was breathing on their own again. After several more days of intensive care Beka’s fevers abated and she began to respond to our instructions.
Day by day over the next two weeks, to our joy and amazement, Beka began to recover. However, following a recovery, the next obstacle many families face is the growing bill. Kenya does have a medical insurance program, but many of our poorest families cannot afford the $2 a month to cover their family. And often, when the daily need for food, school fees, and shelter are so pressing, it’s hard to devote a day’s wage to an unforeseen medical need.
Beka’s family came from three hours away, and her parents are subsistence farmers. So like many in Kenya, their farm their piece of land for food, and any extra they sell for income. They did not have NHIF (medical insurance) at the time, but signed up for it after Beka’s stay. Beka’s father was extremely grateful for the care Beka received, and was able to gather from family and friends 60% of the total bill of about $800 - close to a year’s wage for most people here. The remaining amount we were able to cover with our patient assistance fund that came directly from Wellspring church.
By God’s grace Beka went home several weeks later without any neurologic deficits, a true miracle. The family was incredibly grateful for their help with the bill and health of Beka. Her father said:
“I thank the hospital that helped me to clear my daughter’s medical bill. May God bless you and add more to help others. I appreciated also the hospital that did the best to save the life of my child Beka. Thank you so much.”
Beka with her mom and dad, ready to go home!
There have been several of these amazing cases and we praise God for watching over our patients, include the premature baby born at 27-weeks who went home with her mother just the other day.
However, despite the successes, we have had some terribly tough cases with very poor outcomes. We received many babies who had severe brain injury due to poor care while mothers delivered at outside facilities usually run by physicians who were out on strike. For example, one day we had two babies arrive at the hospital severely ill. One had sustained severe brain damage during birth and presented to the hospital with seizures that had been occurring for hours. The other had not been feeding well for several weeks and was emaciated when they arrived to the hospital. Both received critical care, but despite our best efforts they both died within hours of each other.
Later that day I was called to the women’s ward for a patient who had suddenly collapsed and whose heart had stopped. We performed CPR for over 30 minutes without getting her heart restarted and she died. She was only 37 years old and had several children. As we talked with the family the patient’s elderly mother was rubbing her hand over her lips saying what were her children going to do? There was a lot of silence and crying as the rain poured down around us that night.
I suppose the phrase that comes to mind writing this is that we certainly live in a broken world. That has been on display almost daily here at the hospital recently. Yet, we keep putting our feet forward, one step at a time. We thank God for the wins and mourn the losses with him. In the Lord’s Prayer there is a line “thy Kingdom come as will be done on earth as it is in Heaven.” This is what leads us onward. We have the assurance that everything will be made right in the end, but the work we do now has such an incredible impact and carries with it so much meaning and importance. God wants us to live our lives in a manner so as to bring His Kingdom here now, to sow his seeds of peace now, to start loving each other now.
L to R: Keritch (a nurse who helped take care of Beka), John (visiting Internal Medicine doctor), Jack, Beka’s Dad, Gladys (the nursing director) followed by Beka’s mom and Beka (hidden under the yellow jacket).
A couple months after Beka’s discharge, the hospital team had a large dinner to celebrate Beka’s miraculous recovery! Beka’s family made the three hour journey to join in the special event.