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"Taking Injustice Personally"

An open letter to the Cabinet Secretary of the Ministry of Health regarding the ongoing health crisis

Dear Cabinet Secretary - Mr. Cleophas Mailu,

My name is Wanjiku. I am 65 years old. I am a Kenyan voter at the Kosovo polling center. I am a law abiding resident of Mathare slum. I am a mother of 5 children. Two of them live with conditions that have made them my permanent dependents. Like any other mother, I was very happy every time I brought forth new life into this world. One of these children is autistic and the other one has cerebral palsy. While I love my children so much and thank God for them, there are moments I have asked questions which have barely had answers. Mr. CS, I am sure you are a parent; how would you feel every time you visited the local health centres with a child suffering from flue, malaria, normal diarrhea, cough etc but because the child has cerebral palsy no one attends to your child all because no one has the capacity to deal with special needs of this kind? Everyone takes the earliest opportunity to refer my child Kenyatta National Hospital- KNH. I have felt discriminated against and experienced negligence of the highest order but what would you expect where one doctor is attending to 17,000 people? I have, though painfully, learnt to live with the effect of neglect, mistreatment and discrimination. Sometimes the need is so urgent that KNH is not a feasible reality and so I walk into a quack’s clinic well aware that the said doctor’s credentials are questionable. At such a point, my most immediate need is the survival of my child. All the other considerations then are secondary. Meanwhile, my family and I devote to seeking divine intervention for special grace.

Mr. CS it might be sounding already burdensome to you to listen to me narrate all this. To be honest it is not my cup of tea for me talk about the indignity that I have endured since I was a young girl. The other child who is epileptic is 30years old. This young man who began his journey of life so promisingly was reduced to a cabbage when a vital procedure could not be done when it was required mainly because I could not afford the cost in the private hospitals. My relatives, friends and neighbors of good will supported me to raise just enough for a public hospital, unfortunately the necessary equipment was out of service. My appointments were perpetually reviewed in the hope that the equipment would be fixed. I made persistent trips to hospital to the extent I depleted the very money that had been raised for my child’s treatment. The machines were replenished a little too late to save my child.

I feel like a voting machine only useful in determining who gets to power. During the colonial days we looked forward to the day we would self-govern and have some problems in our past. The present is as bad as was then.

Mr. CS, as a senior citizen, I definitely have my own health issues that usually set in with old age. I have had to shelve all these to prioritize my children. I stopped worrying about my arthritis, high blood pressure and another condition I suspect could be diabetes not I have been diagnosed but from the stories I hear from my peers. I will not belabour on what people of my age go through to cope up with accessing medical care in this critical stage in their lives.

Our support groups in the slum have provided very strong pillars for strength and survival. In one of the gatherings, I felt like it was criminal to be poor. The stories of horror shared by my fellow women left my head spinning. Mr. Mailu, a sick nation cannot be productive; a sick nation is a doomed nation!

It is so painful to have doctors on strike for over 2 months because we the poor bear the brunt of the health crisis. However, the doctors may just be the unpopular voice in wilderness. They have provided the opportunity for us to tell the chronicles of doom, destruction and death that engulf our national health care provision.

I hear people talk of the oath that doctors took. I am torn between facts and imaginations; in the support group we heard of this doctor in one of the level 5 hospitals Kenya… listen to this and judge for yourself… this lady who is due to deliver and cannot afford maternity services is brought to the hospital at the eleventh hour when everything has failed at the hands of traditional birth attendants –TBAs (who by the way have been filling the gap especially in the slums). Meanwhile she has profusely bled and lost significant amount of blood and must be replenished before any Caesarean Section is conducted. Her death sentence is almost signed when they realize that although there is plenty of blood in the bank, it is spoilt for lack of functional storage facilities. The CS team is frustrated that they cannot clean the blood since the machine used for cleaning is equally dysfunctional. This team is left to choose on allowing the poor lady to die or play a messianic role of restoring life. So the Caesarean Section team leader decides to quickly donate blood necessary to afford the expectant lady strength to go through the procedure. Thank God, they succeeded albeit all these odds and saved the life of the baby and the mother.

Imagine doctors having to tear tens of condoms to access the oil that lubricates condoms for lack of the requisite jell applied on a woman before a sc is conducted.  I am not educated and might not be privy to the exact words of the oath that doctors take but the little knowledge I have of oaths persuades me that these deeds are strong illustrations of passion and commitment to their work. These are heroic acts that require national recognition of and support for these altruistic sons and daughters of this nation charged with the duty to ensure our well-being.

Mr. Mailu, I know that people of your status do not use these public hospitals. I wish you did. It would be a shoe easy to understand where and how it pinches. Visit our public hospitals and you will understand the true meaning of indignity to a people whose state has taken a ‘legal oath’ through signing of international covenants and its constitutional commitment to ensure that everyone accesses the highest attainable standards of health, which includes the right to health care services, including reproductive health care. This remains aspirational as long as we the over 60 per cent of this nation will remain unable to afford drugs, quality health services and facilities. It remains aspirational as long as people increasingly resort to self-treatment.

We are caged in a prison of lack of options. We are like cows in a slaughter house lead to their death! I forgot to mention that in the slum when we are critically ill, our obvious means of transport are wheelbarrows and hand pulled carts. Ambulance is a vocabulary that is rapidly fading in our language in the slum. Our children interact with the word ambulance during their early stages of learning in the memorable ABCDs where sound ‘A’ is said to represent ‘ambulance’.

I guess you know that the slums, especially in Nairobi do not have public hospitals. We have been told repeatedly that it is because they are not in the Nairobi Master plan which determines who deserves a hospital and who does not. Incidentally, the rural folks also seem to have their fair share of agony. We know that the allocation of public resources in this country does not portray equity and boost public confidence. It is deeply worrying that only 2% of us access emergency services. I beg to know Mr. CS, what is used to determine who gets drugs, a doctor, a hospital, functional equipment and diet in this country?   

I am aware that as a public officer you swore to protect the constitution of Kenya that Wanjiku worked hard to get. Under this oath, you owe us the duty of care! I believe that my government, the one I voted for and have given my tax should be concerned that health care in this country has deteriorated to necessitating doctors to down their tools for over 75 days. The poor continue suffering. I am writing this letter with high emotions. The thought of how many preventable deaths have continued to occur in this country is disturbing. The sad part is that there isn’t much evidence on enough effort in your ministry to better the situation.

In conclusion, I believe, as a public servant you want to leave a legacy by doing the right thing, by ensuring the rights of Kenyans to highest attainable standards of health as enshrined in the constitution are safeguarded. I urge you to take a bold step and do exactly that. I also want to see monitoring mechanisms in place to prevent glaring loss of public resources meant for provision of public health care and controlled pricing of drugs.

Yours sincerely

Wanjiku

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