Hospitals, Safaris and Another Week

Hospitals and then safaris…not safaris and then hospitals; just a healthy balance of work and play. 🙂

First of all, sorry for the silence. I have been SO busy adventuring, working and embracing Kenya that blogging has been low on my list! Living in the moment right?! Sometimes its important to put everything down and let the full beauty of the experience soak in. I am fairly active on social media, with nearly live updates of some of my happenings, however;  here’s a more comprehensive, written description of what I have been doing these past 10ish days!

Since the last post we have had the opportunity to further our research, gain first hand experiences in Kenya’s hospitals and overall healthcare system, as well as witness some of Africa’s wonders in the animal kingdom!

I will start with work life and my opportunity to be immersed in the healthcare education and delivery in Kenya. It is very different from Canada, however it is important to not compare for the purpose of judging the differences. We are two different nations, with different governance and different cultural norms, so we must respect these differences so long as they are not causing harm.

The nursing program here at DeKUT (the university where we are working) is a 5 year, Bachelors of Science in Nursing degree program. They have similar courses to ours in Canada with pharmacology, pathophysiology, biochemistry, clinical, nursing concepts etc; however also cover much more in-depth knowledge and skills regarding midwifery and reproductive health. Here, when nurses graduate, are also responsible to perform as a midwife, conducting deliveries and taking full responsibility for women’s pregnancy, something with is a separate professional title in Canada. As nursing students, they must conduct 30 deliveries before they can be passed as proficient. Their clinical rotations are also different as they spend 4 months in clinical placement per year; rotating through different wards for alternating time periods Ex: 2 weeks in medical, 2 weeks in surgical, 2 weeks in psychiatry etc. Their fifth and final year is spent only in hospitals on an internship where they also rotate around departments, gaining crucial point-of-care skills.  From DeKUT, they are placed at 5 different surrounding hospitals, which can be hours away and therefore students will live in “hostels” at the hospital for the duration of their placement- and Canadian nursing students complain about an hour drive once a week!

As interns working with the Nursing Department at DeKUT we were invited to join some of the clinical instructors to the hospitals for students assessments. Here we were given a  tour around the hospitals; meeting patients, becoming familiar with different wards and gaining some insight into the care administration. We also had the opportunity to participate in the student “rounds”, presentation of care plans and discuss their role in the clinical areas.

In Kenya there are there main classes of hospitals; public (government run), private (for-profit) hospitals and faith-based hospitals, of which we visited both public and private. Between these sectors there is an enormous gap in resources, care, quality, cleanliness, staffing, and difference in overall care environment. It was saddening for us to see this imbalance and inequality between the patients who were cared for, and coming from a county where healthcare is “comprehensive and universally” delivered, this was a struggle for us to comprehend.

In the hospital there are separated male and female, medical and surgical wards. In the public hospital these wards hold approximately 12 patients to each section, rarely having even curtains to separate beds. (In some instances we even saw 2 patients sharing one bed!!). The private hospitals however have 4 beds to one room, and even house private or semi-private rooms- close to what you can see in our hospitals at home.
Some of the other wards in a hospital include; paediatrics for children under 7, an ICU, labor and delivery, postnatal, antenatal, new born units, operating theatre, laboratory, outpatient areas, X-ray and imaging, etc.
Nursing shortages are also an issue here in Kenya, occasionally having only 1 nurse to an entire ward (which can be 30 patients)! Subsequently the nursing students are often used for staffing the wards. This is often aggravated by nursing strikes, where nurses will simply not show up to work, unfortunately affecting the health and wellbeing of the patients who are left with no nurses, and the education of the nursing students.

It was also interesting to see the difference between public hospitals in different counties (Kenya has counties instead of provinces) as each hospital is run differently by its respective governor. Some hospitals were more advanced, had more resources and overall impressive care environments, despite being under the same sector of care. Food and family is also a integral part of the health and healing aspect of Kenyans, as when one family member gets sick, it becomes a family issue. Visiting times at the hospital see families bustling in, with one patient seeing 10+ visitors at a time. Food is often provided by the families.

Financially, healthcare is provided through the National Hospital Insurance Fund (NHIF), where families and individuals over 18 who make over 1000KES/ month must pay 500KES/month for healthcare coverage . This insurance coverage can be split into 3 categories, with different monthly payments and different levels of care and services included EX: public, private, faith-based, surgeries, maternal health etc.  There are also private health insurance providers which are used heavily in Kenya by those who can afford. Unfortunately however, they still see a large proportion of citizens that do not have the means to pay this monthly fee, with nurses reporting that patients are often kept in hospital until they can pay their bill, or will owe money after their hospitalization. (This is an area of their healthcare which I am still trying to learn, and understand- I apologize for any gap, feel free to do some research yourself.)
So despite all this information: according to the Kenya Vision 2030, the goal is to attain “Universal Healthcare Coverage (UHC) to ensure access to quality and affordable health care for all Kenyans.” Part of this was the introduction of the NHIF which also helps to achieve the mission of the Kenyan Ministry of Health; “To build a progressive, responsive and sustainable health care system for accelerated attainment of the highest standard of health to all Kenyans”,  and their ultimate goal of “Attaining equitable, affordable, accessible and quality health care for all”. This topic of healthcare delivery and financial complexities definitely has aspects that need to be improved and goals that need to be achieved, however it is actively in process and a continuing aspect of the governments agenda.

As a Canadian, or an outsider looking in, it is both a heartbreaking experience visiting the hospitals, but also a encouraging event, realizing how far and how much humanity can achieve in the healthcare field.  It really makes you realize the privilege of being born in a country where we are blessed with SO MUCH. On the flip side, it is important to also remember our values, and beliefs and to be keenly aware of the the dynamics of our perceptions,  knowledge and skills within the culture where we are working, being sensitive and respectful within these different environments.

SO NOW, a brief talk about the safaris! 2 weekends ago we went on a horse back safari through the Aberdare mountain range which was AMAZING. What an awesome experience, riding out of the forest into an open plain teaming with giraffes, zebras, warthogs etc!

This past weekend we accompanied a student trip from the university to Samburu National Reserve, a town a little northeast from Nyeri, at a lower elevation so…it was warm! After some significant delays (leaving 2.5 hours after the expected departure…because Kenya ha ha) we arrived around 9pm on Friday, cooked a dinner of rice, potato and pea stew over an open fire, set up our tents in the windy darkness and settled in for the night. Most of us went to sleep on the hard ground,in tents that were filled over capacity, while some stayed up until the wee hours of morning. Needless to say, I didn’t sleep much; from being squished in a tent that was shorter than I was tall, bruising my hips on the ground and swatting at the constantswirling mosquitos, it was a long restless night. We woke early for a morning game drive, and continued that day with a trip to the town of Samburu, a traditional village visit and cultural demonstration, and some more rice and potato stew. The game drives were one of the best experiences so far; from seeing numerous magnificent animals to witnessing the power and beauty of an elephant fight, it was a once-in-a-lifetime experience. A wonder of the world, if it was up to me! We all gathered around the fire again that night for some games and socialization, before unfortunately getting cut short by the park warden (there was an altercation that occurred and I learned a little more about the power roles in Kenya). I slept in the bus that night which resulted in a much better sleep, however coming home Sunday I was in bed by 730pm and slept soundly until 9am the next morning.

We are now in another week of working at the university and preparing for hosting a Canada Day celebration this weekend! We are researching a little more about projects that we can potentially start here, and health and nutrition workshops and teaching for the community. We are in the process of planning our objectives for the next 6 months and creating proposals for interventions and collaboration in various areas that we see a need for improvement (reproductive health, hygiene, nutritional needs).

One of the highlights so far has been the discovery of a restaurant first; makes a decent pizza, and second; hosts 2-for-1 deals on Wednesdays…a little slice of happiness from home hahah. Unfortunately, it seems my stomach has finally realized it is in Africa and I’ve found a new friend in pep-bismol- hoping its a quick phase!

Otherwise, I still wake up some mornings and can’t believe that this is my life. It is so far, absolutely wonderful and I am embracing every moment of this crazy opportunity.

Enjoy! I appreciate any comments, opinions or added information!

“Travel isn’t always pretty. It isn’t always comfortable. Sometimes it hurts, it even breaks your heart. But that’s okay. The journey changes you-it should change you. It leaves marks on your memory, on your consciousness, on your heart, and on your body. You take something with you….and hopefully you leave something good behind.” Anthony Bourdain.

• Caitlin, The Happier Traveler