Our medical malpractice crisis

What you need to know:

  • It is necessary to develop open data in the health-care profession such that from a mobile app, I can check the performance of the surgeon who is about to perform surgery on me.
  • By now, KMPDB should have built a database on the history of malpractice doctors. There is need to know which colleges they come from, where they interned, who supervised them.
  • I decided to tell the nurses that if the chest-pain patient died, I would volunteer to give evidence on how they had neglected him.

The Kenya Medical Practitioners and Dentists Board (KMPDB) has been doing an excellent job implementing of the National Patient’s Rights Charter, which is educating people on how to access justice. 

Medical malpractice is rampant in Kenya. Although KMPDB has completed more than 740 cases, a doctor tells me these were the reported ones. He reckons that only one in three malpractice cases are reported in Kenya. 

It is possible that of the close to 8,000 doctors we have in Kenya, 1,500 or approximately 20 per cent are not up to the task. This is truly a health-care crisis.

It is a serious indictment of the medical profession. At 95 health workers (physicians, nurses, and midwives) for every 100,000 people, we are doing poorly. The World Health Organization estimates that fewer than 230 health workers per 100,000 would be insufficient to achieve coverage of primary health-care needs.

Poor recruitment and training, a shortage of health workers, leading to overworking and fatigue, and morale issues make up the major drivers of malpractice in Kenya. 

Even with good intentions by the government, we are in a crisis of great proportions as a large number of Kenyans have resorted to self-prescribing medication, further complicating the work of the doctor. 

DATABASE ON MALPRACTICE

The selection of medical school students to join universities is based only on grades. Entry into the medical program has become so competitive that only those who score an “A” get admission. 

Ordinarily this should not be a problem if the vacancies were significantly higher to accommodate those who may not score an “A” but have a passion for the profession. In the UK, for example, besides academic grades, applicants are interviewed to determine their motivation to join the medical field, hobbies and personal interests.

Candidates should also be able to demonstrate relevant paid or voluntary work experience e.g. work as a hospital auxiliary, in nursing or residential care. A number of medical schools use clinical aptitude tests such as the UK Clinical Aptitude Test.

By now, the KMPDB should have built a database on the history of doctors found guilty of malpractice. There is need to know which colleges they come from, where they interned, who supervised them. After sometime, a pattern will emerge which will help get rid of bad apples. 

Since we are talking about patient rights, it is necessary to develop open data in the health-care profession such that from a mobile app, I can check the performance of the surgeon who is about to perform surgery on me. 

This is already happening in Britain, such that it is my decision to pick on a surgeon. If that surgeon has done 50 surgeries and only one patient made it out of the surgical table, it is for me to decide if I would be the 51st surgical case.

ONE MORE AIRLIFT

The Ministry of Health has on several occasions stated that they need a minimum of 20,000 more doctors and 75,000 more nurses to meet the global patient-health worker ratio, but this continues to be a challenge considering that there are not enough resources. 

Since one in five medical school applicants is successful, and we have many students with a "B+" and above with medical interests, we need one more airlift like the Tom Mboya airlift that created capacity for the country within a short period. We should get our qualified youth to universities across the world and overcome the shortage challenge. 

In the 1980s, Korea did the same to develop their engineering capability. Virtually all US universities had Korean students in colleges of science and technology. The cost of their education has been offset with the successes of Korea's electronic industry. We can offset the cost by becoming the regional hub for health care.

Morale continues to dog our healthcare sector. It cannot be solved by simply throwing money at healthcare workers. Irrespective of what caused low morale, it is hurting productivity, increasing work errors, increasing absenteeism, while at the same time decreasing co-operation between teams and departments, and if we do not deal with it, it will lead to larger problems than the spate of malpractices we are witnessing. 

Several studies show that the cause of low morale is rarely money. In the healthcare sector, low morale arises when there is a disconnect between management and health workers, when we fail to recognize them (a simple thank you will do wonders), failure to challenge them (routine work can be boring), dealing with bad apples (those with no passion for the profession) and more importantly, when the system is dysfunctional.

A HABIT OF SELF-PRESCRIPTION

The confusion around devolved healthcare has not helped at all. Our fractious, politically charged and ethnically slanted decision-making can scare away any rational healthcare worker. We should never have rushed to devolve healthcare at all. 

Our higher education has created ethnic communes. Some public universities could teach in vernacular. It is such uncertainty that creates low morale. If we build good housing and recognize our doctors more than we do, we shall achieve more in healthcare reforms. 

We cannot develop state-of-the-art facilities in the more than 400 hospitals, but we can create a number of centres of excellence in order to improve our overall healthcare. Every county hospital should be reasonably equipped, but not every county hospital should be a referral.  If we get into such a competition, we shall lose it all.

Doctors rely heavily on what you tell them because it helps them plan their intervention. But Kenyans have gotten into a habit of self-prescription and sometimes they do not disclose some of the medications they have taken, leading to serious problems. Often we rush to blame the doctors when our indiscretions fail us. Perhaps the following two cases may help demonstrate the situation we put ourselves in.

Sometime back, I lost a good friend to what the doctors described as a raptured aneurysm of the brain. To most of us it was a simple head ache that went awry. Pain killer adverts warn us that maumivu yakizidi, muone daktari (if pain persists, see a doctor), but he had decided to cool the pain with self-prescription of various pain killers, including the very strong ones.

HEREDITARY OR ACQUIRED

The persistent pain was blurred to the extent that when he was rushed to hospital, he was declared dead on arrival. There are myriad pain mitigation measures, but there is very little education on the threshold for seeing a doctor. We focus more on pain relief, not knowing that pain could be a symptom of a more serious condition that could be fatal.

Like most diseases, when discovered early, an aneurysm is easily treatable. Medical doctors that I have talked to refer to aneurysm as a localized, blood-filled balloon-like bulge in the wall of a blood vessel due to weakened blood vessel walls. It may arise as a result of a hereditary condition or as an acquired disease. 

A blood clot due to prolonged sitting that cuts the blood flow, especially on a plane, can also cause an aneurysm. When it raptures, it causes bleeding that often leads to death. This is perhaps why you need to see a doctor if the headache persists and if you find yourself increasing the strength of painkillers, or you get a headache immediately after a long flight.  It is not allowed anyway, but Kenyans find ways of self-prescribing themselves strong pain killers.

There are also several cases where doctors have misdiagnosed patients with aneurysms, especially where there is no imaging equipment.  Most doctors do not even follow Standard Operating Procedures (SOPs) in handling emergencies.  

COMPLAINING OF CHEST PAIN

A medic tells me that in Kenya only two out of more than 400 hospitals utilize SOPs especially with emergencies like heart attacks (Myocardial Infarction) or accidents.

I can confirm this, because at some point I volunteered to take an accident victim to hospital, but the ordeal I went through at the hands of nurses was such that they did not have any feelings for the patient. They were more concerned with legal issues than emergencies. 

After six hours of trying to get everything right for “my patient,” I watched many other cases. There was a particular one that I paid more attention to.

A middle-aged man had been brought in complaining of chest pain. As usual, his relatives were asked to fill in the admission forms and make some payments. The man lay there writhing in pain with what seemed to be laboured breathing. 

My instinct dictated that I check on Google what happens for such a case, and to my surprise, chest pain in most hospitals that observe international SOPs is a serious emergency with very clear procedures. I decided to tell the nurses that if the chest pain patient died, I would volunteer to give evidence on how they had neglected him. Within minutes, they started attending to the patient.

What I discovered on Google is that in an emergency with chest pain, the triage nurse gives such a patient priority. Within the first ten minutes, this patient should have had the clinical observations done (these would entail BP, temperature, the usual heart rate), cannulation and drawing of the blood, and echocardiogram. From these tests, one may rule out Myocardial Infarction which can be fatal if no early intervention is made. 

After the incident, I grew to like watching "ER" (Emergence Room), a reality TV show that makes our response to emergencies look like we are a century behind where the rest of the world is today.

 Dr Ndemo is a senior lecturer at the University of Nairobi's Business School, Lower Kabete campus. He is a former permanent secretary in the Ministry of Information and Communication. Twitter:@bantigito