Slow emergency response threatens our lives. Time to fix this.
First published Sunday Standard, November 12, 2017. Kindly reproduced here with permission from the Standard Group
The horrific accident that claimed the life of Nyeri Governor Wahome Gakuru has briefly shattered our sense of road safety once more. Sadly, he joins the worrying NTSA statistics that over 2,000 die on our roads each year. Within five days, it seems we have moved on to avidly discuss witnesses, his successor and burial arrangements. Yet, we have left the bigger question, how do we keep all Kenyans safe from emergencies?
One in ten of us will die in an emergency. Whether on our roads, giving birth, battling a heart attack, attacked by criminals or caught in a fire or collapsed building, we are at risk. Regardless of our politics, ethnicity, age or gender, this is the one equal opportunity destroyer. Without a functioning emergency health-care system we are all at risk.
Two years ago, a young security worker Alex Madaga was hit by a speeding vehicle and died after an unbelievable 18-hour journey in an ambulance. He did not have the power, privilege or visibility of Gakuru. He probably earned a tenth of the Governor’s salary. Like Gakuru though, he had a wife and children that miss him to this day.
The basic conditions needed to save Madaga in 2015 are sadly, still largely absent. Poor response times, under-resourced and poorly integrated facilities continue to facilitate thousands of deaths across this country. It took 40 minutes for the emergency services to reach our Governor and 60 minutes for him to reach Thika hospital. Without an emergency number, by-standers crowdsourced help from friends on social media. Horrified and helpless at what else to do, others simply took photos. Another valuable life was lost.
Propelled by the outcry after Madaga’s death, our Parliament passed the Health Act (2017) to give teeth to the constitutional promise of our right to emergency care. It is now a criminal offence to deny any patient life-saving stabilization care. Administrators of private or public facilities now face imprisonment or a fine of up to Kshs 3 million should they violate this right. Citizens must demand the full enforcement of this law.
It is only by doing this, that the traumatic experience of Madaga’s widow that fateful night will not be repeated. Pressed by the Kenya Ethical and Legal Issues Network NGO, The Medical Practitioners and Dentists Board found Coptic Hospital and Kenyatta National Hospital guilty of professional misconduct. Coptic had demanded Kshs 200,000 before they could admit him while Kenyatta kept him in an ambulance for four hours without referring him to any of the several private hospitals within a five-kilometer radius.
On Friday, national icon and one of the fastest runners alive David Rudisha, Emergency Medicine Kenya Foundation and KTN staged an unkind public stunt at the world premiere of Kenyan movie 18 Hours. He feigned injury, was placed in an ambulance and attempted to travel 2 kilometers in the Friday Nairobi traffic. Predictably, he got halfway and got out and ran the rest of the way carrying his insulin drip. His trip demonstrated the dangers of not having a single toll-free emergency number, our traffic behavior and the lack of an integrated public-private healthcare system.
Without effective ambulance quality standards, too many county governments have been allowed to remove seats and rebrand matatus as ambulances. Most have only one destination, Kenyatta National Hospital. Last week, the Economist magazine pointed out Kenya has 50 emergency ambulance service numbers. Is it time for FLARE? One of them is the NHIF, Red Cross and E-Plus number 1199. I tried it at 10.53am yesterday. Twenty rings later no-one had picked.
The inclination of our first-time responders and everyday heroes to rush all cases to Kenyatta National Hospital needs to be gently challenged. It is behavior learned from hard experience. Private hospitals often do not accept critical patients unless they are admitted with gold insurance cards, sacks of banknotes or a title-deed. It begs the question, is there another Constitution and Health Act that these institutions operate under?
Lastly, until our 47+1 Governments start investing more in ambulances and health-care than we spend in luxury limousines and public office perks, this problem will continue to endanger us. Perhaps, these are the conversations and choices we should be having in the wake of Gakuru, Madaga and all those who have died on arrival at our health-facilities. It would better honor their sacrifice.
Postscript: The day after this article was written, the Kenya Red Cross called me to explain that a technical glitch had blocked any calls from Airtel mobile users. They had been unaware of until they read my article. They assured me this had been immediately rectified.