Mr Ekiro* was an elderly patient in the orthopaedic ward during my undergraduate rotation.
I could not help but notice how still he lay in his bed. His sixty-year old body was broken in so many places, but he did not wince.
He was a victim of armed cattle rustlers who raided his village frequently. His people had long given up resisting. All they could hope for was to survive the attack unharmed.
On the fateful day that led to his state, he was going back home from the cattle market, after selling a few goats when he heard the familiar war cries. He was walking straight into the attackers.
He turned into the bush and fled, but not before they spotted him. Being an old man and knowing he could not outrun the young men pursuing him, he climbed a tree to hide.
But luck was not on his side as the rustlers were accompanied by a dog that gave away his hiding place. He was shot and came crashing down, breaking several bones in the process. They left him for dead.
The attack lasted 48-hours after which the unconscious Mr Ekiro was found by good Samaritans who ventured out when the coast was finally clear.
They took him to the local mission hospital where he was given pain medication and referred to our facility for further treatment.
It took the ambulance 16 hours to get through the rough terrain, bad roads and unsafe territory to get the poor man to hospital. It was too late to save his foot.
The man received in the emergency room had broken his left leg near the ankle, a compound fracture that had an open, infected, oozing wound.
He had a broken jaw bone and broken spine at the level of his neck (cervical spine). He also had two bullets lodged in his right thigh, having narrowly missed the major blood vessels and nerves. The infection overwhelmed his frail body, but he hung in there.
It took 72 hours to stabilise him enough to tolerate surgery. His leg had to be amputated below the knee to rid his body of the debilitating infection. His right thigh had to be operated to retrieve the bullets and clean the bullet track wounds.
His mouth was wired shut by the maxillofacial surgeon and he could only consume a liquid diet. His head was held in a vice to provide traction for the fractured spine to prevent injury to the spinal cord and to allow the fracture to heal. He spent his days lying on his back, staring at the ceiling, grateful to be alive.
He lay in hospital for weeks without visitors. His relatives had no idea of his whereabouts. They probably assumed he was dead and his body was yet to be found. Without the simple luxury of the mobile phones we currently enjoy, our patient had no way of communicating to his people to reassure them that he was alive.
I couldn’t help but wonder what kind of life awaited him. Before, he had made an attempt to save his life by running and climbing a tree. How would he flee the next time his village came under siege?
It has been 13 years since I met Mr Ekiro, but nothing much has changed. The wild and beautiful North Rift still remains insecure. Every now and then, residents face vicious attacks. The people of Tiaty in Baringo County live like they are children of a lesser God. Often, those who survive the bullet succumb to their injuries in hours, days or weeks because they can’t access healthcare. Conversations on universal healthcare cannot be complete without addressing the issue of access.
We have to talk about the oft-ignored issue of access to healthcare in the face of insecurity, because the areas that are rife with insecurity lead in all the negative health indicators. They record higher maternal and infant mortality rates, low vaccine coverage, high malnutrition and lower life expectancy.
I have known mothers who bled to within an inch of their lives in the house because no taxi would venture into their neighbourhood after dark to bring them to hospital.
I have seen babies brought to the hospital at the crack of dawn, already in coma as there was no form of public transport available to them at the height of insecurity, leaving the meningitis to creep in and take over without timely intervention.
When thugs roam the streets and bandits roam the countryside by night, causing terror, health access is the first casualty.
Imagine the terror a young woman goes through as she spends the night in a cold ditch awaiting dawn so she can seek help at the hospital, after being gang-raped on her way home from work at the local supermarket. What would stop her from being raped a second time in an effort to get to the hospital?
How many healthcare facilities have been deserted in the face of insecurity? We have seen the exodus of health workers from areas deemed insecure.
Who will take care of the casualties of these attacks if or when they do make it to the hospitals? How much longer will we rely on the Red Cross to evacuate the casualties?
Achieving universal health coverage is not a premise of the health sector alone.
We must make room for internal security teams on the universal healthcare decision-making table because without security, we will not have any health to speak of.