Death of mother exposes woeful state of health facilities in Kenya

Some of the equipment at Machakos Level Five Hospital. Kenya's public hospitals have only 35 functional intensive care (ICU) beds and 25 of those (always occupied) are at Kenyatta National Hospital. PHOTO | FILE | NATION MEDIA GROUP

What you need to know:

  • Ms Ubah Ibrahim Abdi, 24, had been in a coma for more than a week.

  • Ms Abdi went to hospital for a normal delivery but had high blood pressure, eclampsia (convulsions) and internal bleeding.

  • It was also discovered that her baby had died in the womb.

  • Moyale, some 530 kilometres from Nairobi, is eight hours by road or two hours by air.

A first-time mother lost the battle for her life on Friday at the Kenyatta National Hospital, where she was taken unconscious from Moyale because Marsabit County does not have intensive care facilities.

Ms Ubah Ibrahim Abdi, 24, had been in a coma for more than a week.

She was flown to Nairobi by Amref on Monday, 24 hours after undergoing a caesarean section at 3pm on Sunday at Moyale Sub-County Hospital.

A clinical officer in Moyale told the Nation that the county does not have an Intensive Care Unit (ICU), neither does it have scan facilities; so, emergency cases are either “referred by road” or, where possible, flown to Nairobi.

Moyale, some 777 kilometres from Nairobi, is 11 hours by road or two hours by air.

Ms Abdi went to hospital for a normal delivery but had high blood pressure, eclampsia (convulsions) and internal bleeding. It was also discovered that her baby had died in the womb.

Amref Flying Doctors Chief Medical Officer Joseph Lelo told the Nation: “She was induced to deliver the baby but then her blood pressure kept rising and she was rushed to theatre for an emergency caesarean section.

“We discovered that she was haemorrhaging and we transfused almost three pints of blood. However, she did not wake up after the procedure and we had to seek ICU services.”

One of the few lucky ones to access critical care, Ms Abdi was put on one of the only 39 functional ICU beds in the country’s public hospitals.

Twenty-one of those, which are at KNH, are always occupied — as was the case last October, when road accident victim Alex Madaga waited for 18 hours in an ambulance in Nairobi because there was no vacant bed.

SH8M ICU BED

According to Deputy Director of Medical Services Izaq Odongo, KNH has 21 beds and Moi Teaching and Referral Hospital six while Coast General, Jaramogi Oginga Odinga and Nakuru have four each.

Dr Odongo said the capacity will greatly improve with the ambitious Sh38 billion Managed Equipment Service, through which 11 hospitals will be equipped with ICU facilities at a cost of Sh3.3 billion.

These are the level five facilities (formerly provincial general hospitals) of Nyeri, Kisii, Thika, Embu, Meru, Machakos, Garissa, Coast, Nakuru, Nyanza and Kakamega.

An ICU bed — including supporting equipment such as monitors for assessing patients’ wellbeing, defibrillators for resuscitation and ventilators for helping patients to breathe — costs at least Sh8 million.

“Already, Kisumu, Coast and Nakuru hospitals are functioning and the rest will commence soon,” said Dr Odongo. “It is envisaged that all the 11 level five hospitals will have had ICU/HDU equipment by the end of June 2016.”

Each of these hospitals will be fitted with six ICU and three High Dependency Unit (HDU) beds and will have monitoring, resuscitation and support equipment for critically injured or very sick patients requiring intensive care and close monitoring.

HDUs are wards for people who need more intensive observation, treatment and nursing care than is possible in a general ward but slightly less than that in the ICU.

Dr Odongo added: “These are the ones which currently have the requisite infrastructure and capacity to support ICU services.

“However, counties can upgrade hospitals and set up ICUs, as has been done in Kericho Hospital.”

Even then, some regions — such as Marsabit, Samburu, Turkana, Isiolo and Mandera Counties — will have to continue referring their critically ill patients to neighbouring regions.

These include pregnant women with complications such as high blood pressure or severe bleeding, as well as trauma survivors (for instance, road accident victims) and patients who have had surgery.

The medic said such county referrals would complement the national government’s efforts to provide healthcare.

He added that national referral hospitals use funds allocated for service delivery to run ICUs, while for the others, it is “the mandate of the county governments, who will provide the required resources in terms of personnel and supplies”.

Mombasa County Health Executive Mohammed Abdi said there have been  instances of too many babies in need of intensive care.

If the available ICU beds are not enough, basic care is provided, such as giving oxygen to those that need it and “holding on to prayer” that the condition of the sick babies does not get more serious.

Coast General Hospital Chief Administrator Iqbal Khandwalla said parents are advised to take their children to private hospitals, where the cost is prohibitive.

The situation is not any better in the private sector.

According to the chairman of Kenya Association of Private Hospitals Dr John Nyaumah, there are less than 20 ICU beds in all private hospitals.

He told the Nation: “Most facilities actually have High Dependency Units and not ICU services.

“These ICU equipment are expensive, with very few trained personnel and the HDU units act as ICU in most counties.”

Specialised healthcare workers such as physicians, nurses and cardiologists, are also vital.

While it is not clear how many critical care personnel there are in Kenya, the Ministry of Health says: “There are enough personnel to start off ICU services in these hospitals, including those in training. “However, more specialist staff will continue to be trained.”