ICU services in Kenya in critical state

Fred Aminga @faminga

It is no secret that in the event of an accident or a sickness requiring instant intensive medical attention, most Kenyans will not make it back home alive.

This is the plight of Kenyans, a country renowned for grisly road accidents that maim and kill thousands daily, amid an increase in heart conditions, including heart attacks and high blood pressure which heighten need for quick intensive medical care.

There are an estimated 100 intensive care units (ICUs) countrywide against a population of 48 million, a stark contrast to billions of shillings spent in healthcare every year.

Despite the steep rise in demand for emergency medical services, stakeholders – both at the county and national level – are burying their heads in the sand.

Some counties that do not have a single functional ICU bed, meaning that patients will either die or end up at a dispensary or a Level Four hospital bed without the lifesaving facilities.

Those who survive are moved to the nearest referral hospitals, mostly public facilities. The alternative are private hospitals which are not affordable to most people.

The proximity of an ICU or a high dependency unit (HDU) bed makes the difference between life and death.

Emergency facilities are, however, few and far between. Most of them are in Nairobi, Eldoret, Kisumu and Mombasa. The others are private hospitals which cost millions.

Even more depressing is that the available facilities can not be accessed on demand with most public ICU facilities having a waiting list that is constantly full.

People Daily has learnt that even private hospitals do not guarantee a patient instant admission to an ICU facility.

Medical practitioners who spoke to People Daily said that in such a situation, there are only two alternatives. Space becomes available either when someone recovers and moves from the ICU to the normal wards or dies.

“In most cases some opt to stay at the emergency ward at the hospital awaiting someone to either die or get better,” says John Kiama, (not his real name) an anaesthesia specialist in Nairobi.

Tales of patients dying after failing to get ICU care in hospitals abound.

Take the case of Uniter Mokeira who last month suffered an infection which was considered mild. But because it was affecting her breathing, she was rushed to Mater Hospital for urgent treatment.

Mokeira was slated for an emergency surgery to take care of a chronic rheumatic disease condition which had afflicted her for four years. Upon reaching hospital, her condition deteriorated and doctors recommend ICU care. But all the beds at the hospital’s ICU were occupied.

The alternative was Kenyatta National Hospital (KNH), the largest referral facility in the region. Unfortunately, all the 31 ICU beds at the facility were also occupied.

“KNH has 31 ICU beds which, in most cases, are all occupied with critically ill patients,” said Dr Peter Masinde of KNH in a statement on the state of the hospital’s ICU’s facilities.

A spot check at the facility revealed that there is always a long queue, with some awaiting admission at the hospital’s emergency area, while others are admitted in regular ward awaiting transmission to ICU.

After a lot of agonising, Mokeira’s family managed to get an ICU bed at private hospital.

“We eventually managed to get a bed at Nairobi Women’s Hospital after a patient died and we were hoping to save her life. Unfortunately, she passed on the following day with a hefty bill in excess of Sh150,000 after being admitted for less than a day,” says Patrick Oichi, an uncle.

High costs

Mokeira’s sad story is replicated everyday across the country. That despite several hospital’s having ICU and High Dependency Unit facilities, many patients end up dying because the facilities are always full, have malfunctioning equipment or lack adequate manpower.

Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) secretary general Samwel Oroko agrees that while ICU facilities are unavailable in most counties, some are not operational because of the high costs of running an ICU.

“If a hospital has 10 beds, seven are probably not working and they probably don’t have enough trained staff to work in an ICU,” he says.

Oroko says that ICU operations are highly specialised and sophisticated and require equally highly trained staff who must operate on a strict 24-hour shift.

Multiple specialists

Doctors and specialists do reviews in hourly basis a day, sometimes involving multiple specialists on a single patient. That costs lots of money.

“To equip an ICU with machines and bedding logistics, you require about Sh20 million to operate a facility with one bed,” he said.

An ICU facility requires at least four doctors monitoring one patient, similar number of nurses and very specialised medication which is also expensive.

While public hospitals charge an average of Sh5,000 a day, private hospitals, which bill for every single consumable and service, charge an average of Sh80,000 a day depending on the state of the patient and nature of ailment.

Constitutional right

Which makes ICU an expensive affair, with bills running into hundreds of thousands or millions of shillings for just a few days.

That notwithstanding, KMPDU boss says the Constitution is clear on right to emergency treatment, adding that the government has not put in place mechanisms for an emergency fund.

“Without such a fund, private doctors will find it difficult to treat patients who can not afford ICU. That is why they are being sent to public hospitals which are often full,” he said.

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