Being in medical school is always perceived as a period of unending studying, long hours spent cramming and the terrifying examinations. Yes, all that forms the backbone of the course, but there are lighter moments too.
In our time, we all looked forward to the fifth year of school. It was a year of elective period abroad and attachment in the local district hospitals. The attachment was intended to expose us to the management aspect of healthcare as many of us would be running these facilities in the next few years as medical superintendents.
We needed to learn about the system in which the patient received care and not just about treating their illness. I must admit it was an eye opener to learn management processes from hospital administrators, procurement officers, store managers and accountants.
On the first day of the attachment, the medical superintendent gave us a tour of the hospital. They were only two doctors in the hospital with a bed capacity of 60, though only half of those were occupied at any one time. As we went round the wards, we did the daily patient rounds too. Typical of any district hospital back then, the male ward was the smallest, with a few patients recovering from various common infectious diseases such as malaria and pneumonia.
What caught my eye though, was a 57-year-old man in a room at the far end of the ward by himself. He did not appear to be ailing and did not speak at all. The good doctor said hello to him in vernacular and then we moved on. As we walked over to the maternity unit, the doctor explained that the man had been in the hospital for seven years.
This man was brought into the emergency unit late one night with multiple injuries. His neighbours brought him in claiming he had been assaulted by his wife. He was admitted to the ward for treatment and close monitoring as he had sustained a mild head injury too. He went on to make a full recovery, but he refused to be discharged. His main reason was that he was unsafe at home as his wife was intent on killing him.
The man said he had never experienced a peaceful day of marriage in his home. He was an only son, his parents had died and he was not close to his extended family. On numerous occasions, his wife had quarrelled with him, a dispute that always quickly degenerated into a physical fight. Repeat interventions by the local elders, the area chief and local administrative police had failed to resolve the dilemma. He was unable to chase her away.
This man was convinced that if he went back home, she would eventually kill him. As she had never visited him in the two weeks he had been in the hospital, he had felt safer than he had in years. This was his new home and he was not leaving! The hospital management let him be, promising to find a solution. The hospital social worker paid a visit to his home and was chased away by the man's wife.
Over time, attempts to get this man to leave the hospital dwindled and he eventually became part of the institution. Medical superintendents changed over time, but the man stayed. The current one inherited the problem, but ignored it just the same as he had no solution. In the six weeks we were there, we also got accustomed to his presence.
Two years later, during my internship, I met at least one of these long-term patients in every department I rotated through in the national referral system. One woman had pregnancy complications and she was in the intensive care unit for weeks.
When she eventually recovered, she had suffered a major, permanent disability. Though she came from a financially stable home, no one wanted to care for her in her disability although they had taken her newborn home. She was abandoned at the hospital for eight years and the family only came for her when the press ran her story, shaming them for the abandonment.
In the paediatric ward, a preteen was abandoned by her mother. The feisty little girl was a darling of the ward staff, helping the nurses care for the little ones battling cancer and attending the class set up for children hospitalised for long periods so as to continue with a semblance of education. Her mother was single and struggling to survive in the slum. She could not afford to care for a child with diabetes.
It was a struggle to raise the Sh500 monthly to pay for her insulin when she could not even afford to feed her properly to keep her healthy. Storing the insulin was another challenge. The young girl was eventually transferred to a rescue centre after three years, which was really no place for someone of her condition.
In the orthopaedic ward, a middle-aged man with a hip fracture had been in the ward for four years. He suffered osteoporosis and all attempts to surgically repair his fracture had failed. He had developed a chronic open wound at the fracture site that just wouldn’t heal, and though he was no longer in pain, he was immobilised. We joked that he should just run a shop at his bedside as an income-generating activity to while away the days.
While hospitals are places where the sick come for treatment, they easily transform to safe havens for some while for others, it is the only place where they feel wanted and cared for in their incapacities. This is especially true for those with chronic disabilities.
In advanced countries, these challenges were long identified and catered for by establishment of nursing homes for those in need of long-term nursing care. There is also establishment of halfway houses that prepare those in need to ease back into the community and live an independent life.
In view of our changing social structures, these establishments are becoming increasingly necessary in our country. The government needs to start now, to set up these institutions, plan for their funding and establish frameworks that guide the transition from hospital care for those in need.
Dr Bosire is an obstetrician/gynaecologist