If press reports are anything to go by, then religion has no place in KNH. It is a pleasant surprise to find staff members holding prayer sessions in their staff meetings, and before starting the day, a far cry from what one would expect from an institution that was involved in illegal organ trade.
The link between religion and medicine is an ancient one. Historical writings from the middle east and Asia have documented religious leaders carrying out medical duties. In the past ill health was associated with the supernatural. It was not till during the mid 1800’s, following the discovery of germs that sickness would be explained away in terms of infections, parasite infestation, deficiency, congenital abnormalities and trauma.
Christian missionaries are credited for introducing modern medicine to Kenya, in the late 1800’s. this was after some of them lost their lives, or those of their beloved ones to deadly diseases like malaria. Subsequent missionaries had to carry medical supplies of their own, which they were forced to share with their porters, and workers. The efficiency of the white man’s medicine attracted the attention of the natives in large numbers. Sensing a great opportunity, the missionaries quickly established health facilities to treat the afflicted natives.
At that time, the concept of land ownership revolved around usage. A community only owned what it used. The rest of the unused area was a no man’s land. It was therefore easy for the white missionaries to acquire land on which to build their mission stations. In some places, land considered unfit for habitation was allocated to the missionaries.
There was a semblance of scramble and partition of Kenya, with each denomination laying a claim to a particular geographical area. It is for this reason that SDA is prominent in south Nyanza, Methodist, PCEA, catholics in central, church of god, quakers, catholics in western etc. as usual, the northern frontier districts missed out, in line of the colonial mentality of viewing them as unproductive.
The Roman Catholic Church had prior tradition of incorporating health care in its missionary activities. Several orders of nuns existed to serve the sick, who were regarded as the brothers and sisters of Christ. However this level of manpower was inadequate, necessitating the recruitment of the natives, some of whom were trained in basic nursing skills, under the supervision of Nuns addressing each other as ‘sister’, a title that has stuck to date, in spite of alternative non religious titles being instituted. Since the locals had no formal training, they were often referred to as ‘orderlies’, and their main task was maintaining cleanliness.
While Christian missionaries were scrambling for converts, the crow government was contented in exploitation of the riches of the country. An instrument for that purpose was formed in 1890 in the name of THE IMPERIAL BRITISH EAST AFRICAN COMPANY. The employees of this company were accorded medical care. Most of the health care workers were army personnel. It was not until the break out of the First World War that attention was shifted to the health of the natives.

Every year, all heads of department submit their budgetary needs to the ministry headquarters, so as to be included in the national budget. The economist in this ministry compiles them and makes a budgetary proposal, in line with the government’s policies. The final estimates are then tabled in parliament alongside other estimates from other ministries. Parliamentarians dully pass these estimates, many times without understanding the repercussions. Therein lays the seeds of conflict between the MP’s and the civil servants.
Remember hurricane Maitha doling out a tongue lashing to a perplexed hospital matron in front of the cameras over non repair of a broken down toilet? Borrowing a leaf from the boss, the then Nairobi deputy mayor Mr. Aketch threatened to sack some health workers in front of the cameras. It is noteworthy that this type of camera administration is no longer being practiced.
As a matter of fact, it is a publicity gimmick aimed at deflecting the attention from the failings of the executive and turning the civil servant in a scapegoat. It is akin to crucifying a maid for non repair of a leaking roof, in her employer’s house.
Hidden in the fine print of the estimates is the wage bill. Had our MP’s been keen enough; they would have questioned the duplicity of duties among the medical fraternity.
Community health nurses, clinical officers and doctors have adequate training in diagnosis and treatment of minor ailments commonly presenting at peripheral institutions. More serious maladies are best treated at the district or provincial hospitals, where diagnostic facilities are available. A common sense approach would suppose that more specialized work force be located at referral facilities. However, the bosses of nurses, clinical officers and doctors do not work in harmony. Each formulates a separate manpower structure independently.
Consider a situation where a community health nurse has been diagnosing and treating patients at a peripheral health facility for a long time. Then in comes a newly qualified clinical officer. Protocol demands that the community health nurse vacate office in favor of the clinical officer, then be assigned other duties. The clinical officer becomes the new administrative head, and declares that he is the only one responsible for patient care. Initially the provincial public health nurse was not aware that his counterpart in clinical medicine would be posting more manpower to the institution. As a result an element of overstaffing creeps in. the nurses will finish their work early then loiter to the nearest shopping center, doing their evening shopping. In the meanwhile, the clinical officer will remain with a long queue outside the consulting room. He will not even consider asking for reinforcements, especially after ejecting the nurses from the consulting room. In his monthly reports, he will indicate that the work load is just too much for one clinical officer!
The plot thickens when a medical doctor is posted to the institution. The clinical officer will relinquish his administrative roles to the doctor, and concentrate on clinical matters. Initially the doctor will go to the ground to get the feel of things. Then he will discover that life is not all about wielding a long title, with a shallow pocket. He will venture into private practice, leaving the clinical officer do all the donkey work, while he will be contented to make technical appearances, sign the occasional paper before disappearing to his private practice.

@ Pasi,

@Murenj was writing when the place was burning down. Let us hope he is ok...

yep! very muc safe. it was a small fire. destroyed 2 rooms. alittle repainting and rewiring will do.

Kenyatta national hospital seems to have started the New Year financially crippled. A series of financial scandals seems to be emerging every passing day.
You may recall various instances where discharged patients are held against their will in various wards, pending clearance of hospital bills. At the moment, KNH has some 300 such patients. This is a reduction from nearly 500 people, at the end of last year.
Most of these patients come from poor background, with no form of health insurance. The beauracracy involved in clearing such patients is long and tedious. The finance manager seems to have this theory that money has to literally be shaken out of people’s pockets, and that an average Kenyan would rather not pay for a service even if he was in a position to do it. For this matter, he is never in a hurry to clear such cases, despite the numerous interventions of the executive officers.
Nurses have been unwittingly turned into jailers, monitoring patients’ movements, and thwarting escape attempts. It is the general assumption that they are accountable for patient’s whereabouts, even though the hospital has many unmanned and uncontrolled exits.
The most favorite way of such patients getting out of the hospital has been to sneak away while the nurses are not watching. The modus oparendi varies depending on level of security arrangements on the ground. Maternity wards have the highest level of security, with a security officer manning the main entrance each shift, they are followed by the children’s wards, which have a sentry patrolling on the floor. The other wards have no security at all, rather depending on the two sentries posted at entrances located at the bottom of the tower block.
Patients in the general ward simply change into their home clothes, mingle with visitors and then walk away to freedom during visiting hours. In maternity wards, all female visitors are issued with some sort of gate pass, which is surrendered back to the wardens on departure. It is no wonder that escape from maternity wards require a higher level of planning, involving both inside and outside help.
Last month, the security warders intercepted a man smuggling out a baby in a briefcase. He was carrying it so tenderly that the warders thought he was carrying a bomb!. A young woman escaped from a ward located from first floor, by simply jumping through the window, then mingling with the crowds outside. A group of 8 mothers formed a rope ladder from bed sheets, strapped their babies on their backs and simply descended from 1st floor to the ground.
The ball game is different in the children’s wards, which are mostly situated on the third floor. For a long time, hospital authorities have been puzzled how children disappear from the floor that has a sentry patrol. The mystery solved itself recently in a comical manner.
A male patient porter, whose main duties includes escorting patients to x-ray department, located on the ground floor, next to casualty, devised an ingenious escape manner, the stuff from which Hollywood films are made from. For only 5,000/=, he would escort the child from the ward with the pretext of taking it for X ray examination. Once outside, the child will be change into home clothes, and then handed over into the waiting hands of anxious relatives. Becoming bolder, and overconfident, he attempted to smuggle out a 3yr old child, who was staying with the mother in the ward. The plan was simple. The porter was to smuggle out the child as usual, while the mother was to follow at a safe distance. The plan was set to be executed in the late hours of the night. Everything went on as planned, except the mother snoozed off! Once outside, the child noting the absence of the mother become apprehensive and started crying, attracting the attention of security personnel on the ground. The porter was picked up for questioning, on suspicion of child theft, and attempted sexually assaulting the child. Faced with the prospects of spending the rest of his life behind bars, he quickly spilled the beans, but lost his job in the process.