What we need are more doctors, not video links

Last week we learnt that doctors at the Kenyatta National Hospital can now communicate instantly via a video link with their colleagues at the Machakos Level Five Hospital. Apparently, it was a breakthrough worthy of being unveiled by the health Cabinet Secretary.  

But before I comment on this development, let me remind you of the state of healthcare in the country.

In November last year, we learnt, courtesy of the Journal of Tropical Medicine and International Health, that the quality of surgery in public hospitals is unacceptable and theatres a sorry training ground for new doctors.

It should worry us that training of doctors at the university is done in spotless environments while the actual surgery in hospitals takes place in deplorable conditions.

The study, which looked at 22 district and provincial hospitals offering internship for new doctors, revealed that surgery patients share beds, lack water or soap for hand washing as well as basic medicines, and that in many cases, simple treatment procedures are ignored.

More than half the hospitals do not have clean toilets.

It is perhaps particularly apocalyptic that we have hospitals with dirty toilets. It is criminally negligent to have a dirty toilet in a hospital. A hospital should be a place to get cured of diseases, not one to pick them up.

But we now have video-link services.  

GOOGLE DOCTORS

Back in 2013, a WB report reminded us about the state of our health services.

The profession suffers from a rate of absenteeism almost as bad as that of teachers. A quarter of all medical staff, including those in private institutions who are on a tighter leash, are away from their work stations at any given moment.  The rate of absenteeism is as high as 40 per cent in some public hospitals.

Worryingly, the number of absentees increases with the caseload associated with the hospital, meaning that public doctors are ducking patients in places where their expertise is needed the most.

I hope the doctors will stick around long enough for the video conferencing, though.  

Less than half of medical staff stick to correct medical practice (I’m not sure it is good that our doctors are improvising so much), a quarter cannot accurately diagnose (don’t just sit there, google your symptoms; your doctor could have got it wrong) and slightly less than half of all hospitals do not have medicine. 

Thankfully, we now have video-link services between hospitals.

We aren’t training doctors fast enough. The ratio of doctors to people is growing at the rate of our population growth, according to the World Bank, meaning it will not improve.

 We are also self-sabotaging when in this area. A doctor friend of mine who was forced to relocate from Ukraine could not find a job despite there being a shortage of doctors. Another Uganda-trained friend is volunteering at a district hospital after six years in medical school because she can’t get a job. Several doctors who started working in April are complaining about working conditions and pay.

We do have a teleconferencing unit to think about.

SILICON SAVANNAH HOSPITAL

The CS said that the new system will enable us to achieve universal medical coverage.

Doctors on screen is beyond farcical and turns into a tragedy. Healthcare cannot be silicon savannahed. There are no digital shortcuts: we need physical hospitals with doctors present.

When you need a doctor to perform a procedure or check physical symptoms, you need him in person, not in Nairobi on a screen.

“This will facilitate early detection of infections and diseases such as cancer, which times have shown have always been diagnosed quite late, of course with adverse effects,” the CS claimed.

I asked a doctor how many types of cancer she thought could be diagnosed via a screen and she could only come up with one: skin cancer. How, for example, will these TVs linked to modems test for cervical cancer?

We are also told that the sydtem will enable doctors to share medical information. Yet, there’s no standardised system for recording patient data across the country. That seems to be the first thing the government should concentrate on. Besides, shouldn’t private hospitals be roped in because medicine isn’t just limited to the public sector? Shouldn’t we set up a standardised form of recording patient medical history before putting up a system to share that data.

The CS also said TVs will help rid the country of counterfeit drugs. How exactly does that happen?  

Well, there is already a faster, SMS-based system to check whether drugs are genuine. Should patients queue in front of a screen to wait for a pharmacist in Nairobi to tell them whether the medicine they have is real? How practical is that?  

 Luckily, though, most patients won’t have to deal with the disappointment of being told that their drugs are fake because half of all government hospitals do not have any drugs at all.

Finally, we are told that the screens will eliminate middlemen in medicine. Who are these middlemen plaguing the health sector? Are doctors and pharmacists middlemen?

BAD IDEA

With this scheme, we have a project that was announced very loudly in the hope that we would not notice the inadequacies on the ground. They praise the virtual and ignore reality.

This is an attempt to misdirect us from reality.  The entire sector is underfunded. 

The problem is that this government insists on leaning all its weight on digital baubles when more rudimentary, less PR-friendly methods are what will work.

The CS seems to have an exaggerated view of exactly what a screen connected to the Internet can do to medicine. Perhaps it wasn’t such a good idea to put a banker in charge of medicine.

 The doctor will see you now…on the screen.

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Let Narok people pay for taking chances with nature 

OUR HEARTS GO out to the people of Narok, who were affected by the recent floods.

Floods come through Narok Town around this time every year like clockwork. We have an annual circus of landslides, displacement, and calls for assistance to the national and county governments.

Businessmen have appealed to the county government to assist them, and their their prayers were answered; the Narok County government has set aside Sh1bn to help them, including those who built along waterways.

SUBSIDISING RISKY BEHAVIOUR

The scale of the floods imply that the area’s problem is not caused by a dodgy drainage system. A roiling river that sweeps aside lorries isn’t caused by someone building on a wetland.

Clearly, they are geographically in the way of a mighty torrent.

What if the government refused to pay out to flood victims?

Would people build in the way of a natural disaster that cannot be fixed in the short term if the government actively discouraged it?

The county and national governments can ask those affected to insure  their property. An insurance company will factor in the risk of a disaster happening and charge an appropriate premium.

The premium alone would make their eyes water because it would force owners to shoulder the risk of absolute catastrophe. After all, the floods occur every year, with the only difference being in the scale of the damages they cause.

The net result of demanding that people get insurance as backup rather than waiting for the government is that they will move out of the most dangerous areas. This will lead to less loss of life and property.

Several people died during the recent floods, and an active policy to discourage settlement in areas that are flood-prone would have saved them.

When people take risks, they shouldn’t be cushioned by taxpayers’ money from the effects of their daring. We cannot subsidise risky behaviour. And if we must, then let insurance companies, which are businesses, pick up the tab.

They would charge high premiums and save the state money. They would also force all but the most daring to stay in the path of the deluge.

Taxpayers’ money cannot be used for predictable “disasters”, and life should not be squandered due to obstinacy. We are not a rich country that can afford to beggar Peter who contributes his taxes to pay Paul, who chose to build his house on sand.

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Charging for vehicle emissions using engine size makes sense

I RECENTLY suggested  that Kenyans should be charged per kilometre they drive into densely built areas and also based on fuel emissions.

However, my very intelligent petrolhead friends pointed out the fly in my ointment.

The problem is that the vehicle manufacturers’ stated carbon dioxide emissions always differs from the actual emissions.

It is impossible to tax people based on emissions because the emissions are based on driving style, traffic and the age of the car.

 It now seems difficult to charge drivers based on emissions per kilometre, unless we use estimates based on engine capacity.

That, it seems, is how they do it countries like Singapore, where vehicles are divided into bands based on engine size and charged accordingly. That isn’t exactly fair to the careful drivers, but it seems the best option.

The cost of lax laws on emissions was recently estimated by the Energy Regulatory Commission.

In one report, it put the total communal cost at more than 20 million disability adjusted life years (DALYs), which represents the number of healthy life years lost due to disease or disability over a three-year period.

We will all live longer if we figure out how to deal with the question of vehicle emissions.