Emily's Worldview

I spent a recent afternoon in the public hospital in Kisumu. The hospital is a complex of small buildings set in a grassy space, and it is the best cheap option in town. We started at the administration office, a perceptibly decaying building at the back of the complex. The head administrator’s office had a tiny waiting room presided over by a secretary with a manual typewriter. The maternal and child health clinic had a room smaller than my living room, jammed with mothers holding sick babies and children. In this room, the babies were weighed, vaccinated, and seen by the one doctor.

The worst was the maternity wards. There was one room for women in labor and women with complicated pregnancies, which was full of patients and their family members. There was a non-sterile theater for deliveries, and then another room for women who have delivered. The nurses told me that the bed shortages are so acute that they keep women for about 6 hours only after delivery, and that sometimes women who have had caesarean sections or who have just delivered have to share a bed. It makes you understand why 60% of women here deliver at home.

The best, most impressive thing about the hospital was the determination and caring of the staff. They all obviously knew and felt bad that they were not providing a high enough standard of care. All of them have insane workloads, and despite the fact that this hospital now has HIV treatment and medicines for preventing mother to child transmission, they are missing other essential supplies and their patients often can’t afford to buy the prescriptions or follow the advice that the doctors give them. At the public hospitals they work longer hours and are paid less than at private. So many of them burn out on patient care, and if they are well-connected, they find a position in the private sector, or an administrative role for an NGO or aid agency or in another country. They know that they are needed at the bedside but without support, the task is too hard and the sick patients are too many. Without enough resources, patients will never be well served.