Emergency medical care shouldn’t be a preserve of the rich

he last six years have been characterised by unrelenting highlights on the poor state of our health sector. Despite advocacy, industrial unrest, devolution of health, increased medical tourism and many other key occurrences in the health sector, not much has changed by way of improving public health.

One of the most neglected sectors of healthcare in Kenya is emergency medicine. This sector is so neglected that in the seven decades we have trained medics, we have never bothered to train emergency medical specialists. It is a pity that the government has no public emergency medical response unit, so we have to rely on the Kenya Red Cross and St John’s Ambulance.

Some years ago, we received a woman in her third trimester of pregnancy at 2am. The maternity unit had been quiet before the nurse at the triage called for help. The woman had come in with a life-threatening pregnancy complication known as abruptio placentae.

This occurs when the placenta starts to separate from the uterine wall before the baby is delivered. It may happen spontaneously or as a result of direct trauma to the abdomen or very high blood pressure. The placenta is the sole conduit of oxygen and nutrients from the mother to the unborn baby, therefore separation means the disruption of this conduit, putting the baby at risk of death if not delivered immediately.

SAFER IN THE AMBULANCE

The mother, upon separation of the placenta, depends on the uterus being empty and contracting to stop further blood loss. Unfortunately in this case, since the placenta, the baby and the bag of waters are still in the womb, contraction fails to occur and the mother continues to bleed, to death. The bleeding may be concealed for a while before it starts to flow out vaginally, deceptively creating an illusion that the loss of blood is not much.

Any gynaecologist will tell you that this is not a condition they wish to encounter at any time, worse still, when the patient presents to the doctor eight hours after the symptoms started. Our patient noticed the bleeding early but since she did not have much discomfort, she did not give it the seriousness it deserved. She took three hours before seeking help at a local clinic. The nurse who saw her referred her directly to our facility but the patient did not want to go to a public hospital.

Eight hours and five stops later, all in smaller private clinics with no capacity to handle surgery and blood transfusion, she showed up in our labour ward. She was severely pale, hovering on the brink of unconsciousness and had lost her baby. With one loss already, we struggled to save her life, fingers tightly crossed that she would not develop further complications. We were grateful to have enough blood and other blood components necessary to save her life. We all sighed with relief when she came out of anaesthesia and breathed spontaneously.

What we all went through was no mean feat. It revealed our soft underbelly. As a country, we are completely unprepared when it comes to emergency medical care. In an ideal set-up, the first nurse who saw her would have called for the emergency medical response team to evacuate her to a hospital that is appropriate for her emergency.

This would have given her a fighting chance to keep the baby alive long enough to get to an obstetrician. She was already swimming with the sharks when she stepped out of that clinic.

In many cases, when the Kenya Red Cross emergency medical service makes it to an accident scene, they successfully evacuate the casualties and take them to the nearest hospital that is often so ill-equipped, the patient is better off in the ambulance. The accident and emergency departments are sorely lacking in life-saving equipment.

SKILLED PERSONNEL

We fail to understand the definition of emergency medicine. This is the care that keeps you alive long enough for the definitive treatment team to have a patient to treat. It stops progressive worsening of the situation, saves limbs and, where necessary, saves sight.

Emergency medicine may appear heroic on television but it is not an exaggeration. In 2003 after the newly elected government took office, we lost many politicians in a plane crash in Busia. Despite these ladies and gentlemen possessing handsome medical covers, health insurance  meant nothing at that point in time. There was need for skilled personnel, infrastructure and resources in local hospitals to keep them alive long enough to get them to their hospital of choice.

We have seen a lot of senior politicians fly off to Europe, USA and South Africa to seek treatment. It is wise to realise that a heart attack or a stroke does not give you ample time to get to your foreign hospital of choice aboard a plane.

If we do not develop our emergency medical response and emergency medicine capabilities locally, we shall continue to bring our loved ones home in caskets.

Access to emergency medical care should not be for the privileged few who can afford private evacuation by road, sea or air. It should be available to all. A robust medical emergency response service should be a priority for our Ministry of Health. All our medical facilities must have the necessary infrastructure to support emergency care and we must train and continuously impart skills to our emergency medicine specialists of every cadre, to run these emergency rooms.

If we do not pay attention to emergency care and make the right decisions for everyone’s health, we shall continue to mourn the needless deaths of patients whose lives could have been saved.