All in a day's work: Despair, joy and hope
The approach to Gota ‘Agulu hospital hugs Lake Victoria. The view is breathtaking if one has the time to pause for it. When we caught up with the nursing officer in-charge he was having his day’s first cup of tea. It was 3 pm. He shrugs it off, as this is not unusual for most healthcare workers in rural Kenya.
Their work is doubled at times because of inadequate numbers, broken down or non-existent equipment or simply due to lack of knowledge. At moments of crises, improvisation is sometimes the solution — how to save a life is the only goal. “We will lose lives if we stop thinking on our feet,” says Dr Namung’ang’a at St Mary’s Hospital Mumias in Kakamega County in Western Kenya.
“There were days when we used to run of oxygen stock. We had this patient in respiratory distress. Our oxygen stocks were over. And the concentrators were not sufficient for the amount required. We sent our vehicle to Kakamega town, but there too there was no oxygen. So the vehicle headed for Kisumu town in the neighboring county. We were losing crucial time. We had to do something or we would lose the patient. We put our minds together and used tubes to create a y-connection to link 2 concentrators to form a 6-liter supply of oxygen. We were able to save the patient.”
The motivation to improve how healthcare is delivered drives most of the healthcare workers. “It is frustrating and sad to watch mothers and babies die for lack of proper facilities,” says Edwin Rabar, who was a nurse at Siaya County Hospital before he decided to do more and become an anesthetist. “I keep remembering this pregnant woman while I was a student. As soon as she was admitted she collapsed. She was convulsing. We took her vitals; her blood pressure was high and she had eclampsia. The anesthetist was called. He instructed a nurse supervisor over the phone, who in turn instructed me. I was holding down the convulsing woman so that she would not fall off the bed while I tried to carry out the instructions at the same time. It was no good. We lost the mother and the baby.”
Have things changed since he has acquired the new skills? “Of course. In the first 2 months of being deployed, we have done 98 odd C- sections already and I don’t feel helpless any longer like before. The department which has really embraced us is the maternity department.”
The outcome is not always positive and that makes the job more difficult for those at the heart of the action. The mission hospital in Rang’ala is a lifeline for villages in this area. The Siaya County Hospital is an hour away on a good day. For patients, the journey — even for a pregnant woman — is longer. The Rang’ala hospital receives patients in critical stages. “Parents come with children with severe pneumonia and malaria. We try to assess the condition and see if referring to Siaya County Hospital will be better,” says clinical officer Victor. “I remember how we couldn’t keep a small child, 3 years or so, alive even for the short duration it for necessary for us to organize transfer to Siaya. The child was suffering from malaria and her oxygen saturation level was low. She was struggling to take each breath. It was sad.”
His counterpart at Dophil Nursing and Maternity Home in Siaya County, Felix Otieno, says he feels much more in control of the situation these days. “We cannot rely on a steady power supply. So having oxygen concentrators is useless at times. It feels good to revive tiny babies struggling to take each breath. We no longer have to worry if we have power or not when it comes to reviving a baby or keeping him or alive till the referral hospital,” says Otieno.
The hospital now buys oxygen and has been able to save the lives of many children. For many health centers and clinics in rural areas, the ability to provide oxygen still remains a dream. Hewa Tele has dared to give them a reason to hope as it expands its services in Kenya. Many small health centers have started buying oxygen for the first time, some others have decided to unplug the concentrator and depend on cylinders.
When healthcare workers are equipped with essential equipment and medicine it brings credibility and confidence in the service provided. “Our staff feels more confident now in handling maternity cases now that we have oxygen. Patients too feel confident in coming to us,” says Natalie Odipo of the Disciples of Mercy health facility.
Supply of oxygen is not a problem usually at a large hospital such as Kisumu County Hospital, which sees more than 6500 newborns and pediatric cases every year. Despite that, with the number of patients growing day by day, and many of them referred from outlying areas, there is a fight for oxygen. “With introduction of devices such as CPAP now we see survival of smaller and smaller preterms,” says Dr Madgalebe Kuria, who has been championing greater usage of this life-saving device in the country. “We have been able to resolve our issue of oxygen after using CPAP.”
The healthcare workers in Zomba Central Hospital in Malawi echo the same feeling of confidence. They had given up hope on any change in the infant care at the hospital after watching for 3 years expensive equipment packed away in the store in the absence of anyone to set it up.
Anthony Kagiri, who is in charge of operation at Mediquip Global which finally came to their rescue, was a witness to change in the nurses and other staff when the machines were plugged. “Everybody was excited to learn about the new machines. They were confident that more patients would benefit from the newly installed machines.”