How systemic ailing healthcare is leading people to graves, disabilities

Once a towering figure in the bustling matatu industry, Melkizedick Muchesia, a 29-year-old driver on Kiambu Road, was renowned not just for his robust stature, but also for his infectious energy and deep voice that made heads turn. Baptised on the Nairobi streets as Melky, he epitomised vitality-until a silent crisis began to envelope his life. In the shadow of Nairobi's soaring skyscrapers, where life rushes by frenetic, Melky's world came to a haunting standstill. For months, he endured persistent colds, relentless headaches, and an alarming loss of appetite. The muscular frame that once admiration by many began to wither away, leaving behind a spectre of his former self. "I visited several medical facilities, which prescribed me different medications one after the other, but my whole body was in pain, and my health gradually deteriorated," Melky shared with The Standard. His symptoms escalated to coughing, chest pains, and chilling episodes. "I started losing my confidence, which pushed away many friends and customers. I had to quit my matatu job because I felt no one wanted to get close to me or see me," he explained. The situation worsened to the point where his fiancee walked away, unable to cope with Melky's inability to put food on the table, be active between the sheets or just be present. "I didn't have the strength to look for money to pay bills or even satisfy her in bed. This forced me into isolation, unaware that I was drifting towards death alone," Melky said, adding, "I understand her; juu how could stand to the occasion literally, yet I am broke and sick!" Desperate, in pain, and sinking into depression, Melky sought refuge at his brother's house in Kayole, Nairobi. "I had visited two hospitals and several pharmacists; they gave me medicine that could not treat me," he lamented. At Mama Lucy Hospital, X-rays and tests revealed a grim reality: his left lung was damaged and collapsed, tilting the position of his heart. The hospital, crowded and underresourced, could not provide the attention he desperately needed. Without funds for treatment at a better facility, Melky resigned himself to fate. Months passed until friends from Kiambu visited and took him to Kenyatta National Hospital (KNH). There, he faced a long, agonising wait for treatment among many patients. "The lines were long, and I had no money, relying on well-wishers. Mungu awabariki," he narrated. Despite financial hardships, Melky clung to hope, determined to overcome his ordeal. His struggle underscores the urgent need for reform in Kenya's healthcare system, a sentiment echoed by many others, including Juliet Biketi. "The doctor opened the envelope in front of me, called my name, and said, 'Here are your test results. Unfortunately, you have breast cancer.' I was devastated," she told The Standard, adding, "I thought it was a bad dream that would pass, but reality dawned that I had a battle to fight." The 28-year-old alumna of Cardinal Otunga High School in Bungoma discovered a lump in her right breast in April 2020. Initially reassured by her gynaecologist, her world shattered six months later when scans and a biopsy confirmed the lump as cancer. Depleted insurance and a job loss in accounting compounded her nightmare. "The doctor's delivery of the news still haunts me," she said. At the time of our interview in June 2023, she was desperate, seeking Sh8.5 million for local treatment or Sh3 million in India. The toll of her illness was crushing. Silvester Nduati's story adds to this tragic narrative, where Kenyan public health facilities are experiencing multiple strikes from the medical staff, led by their unions, over failed promises by the government. Misdiagnosis His wife was misdiagnosed with tonsillitis, but later died of throat cancer in November 2017. "I spent money treating the wrong disease. By the time we got the throat cancer diagnosis, it was already advanced," Nduati recounted. These accounts of misdiagnosis and delayed treatment are not isolated incidents. Melky now lives with one lung, a consequence of his delayed care, impacting his health and daily life. "Doctors warned me about reduced lung capacity and susceptibility to respiratory issues," he said, tears in his eyes. Doctors and clinical officers led by their union officials demonstrated along the streets of Nairobi on April 16, 2024. [Collins Oduor, Standard] Juliet faced a similar grim reality. Her cancer spread aggressively, and after accepting her fate, she fought valiantly. "The PET scan turned positive, indicating the cancerous cells had attacked my spine. The doctor said it had advanced to stage IV," she described, detailing her struggle with palliative care. Juliet ultimately passed away in December 2023, her battle lost to a system that failed her. Melky's combined burden of his health and police harassment forced him to abandon his matatu driver job. In another sad story, Alex Kamau, a driver with Umoinner Sacco experienced a devastating loss when his wife, Joyce Wanjiru, died due to medical negligence during childbirth in June 2020. Doctors at KNRH revealed that inadequate medical assistance during delivery caused pus in her uterus and other complications, leading to her painful death. "They told me she wasn't medically assisted well enough," Kamau shared. And while cases of misdiagnosis crowded the justice system, on September 15, the High Court awarded an 81-year-old former nurse, Caroline Menganga, Sh4 million in compensation for a misdiagnosis that left her with severe vertigo and partial deafness. Justice Freda Mugambi ruled in her favour after she appealed a lower court decision that cleared Dr Fathiya Abdalla of negligence. Menganga sued Pandya Memorial Hospital and Abdalla, claiming she was wrongly diagnosed with tuberculosis and given incorrect treatment. Justice Dennis Magare, reading the judgement on behalf of Mugambi, agreed the doctor breached her duty of care by prescribing TB drugs without proper tests. The court ruled that hospitals are liable for negligence committed by their staff, holding both Dr. Fathiya Abdalla and Pandya Memorial Hospital responsible for Caroline Menganga's misdiagnosis. Menganga was awarded Sh4 million in general damages and Sh16,180 in special damages, with interest from 2000. Dr Yusuf Karim, a witness for Menganga, testified that she would live with the effects of the misdiagnosis, including vertigo and partial deafness, for life. Despite negative tests for tuberculosis, Dr. Abdalla prescribed anti-TB drugs in 1999. Menganga later sought a second opinion, confirming she was not suffering from the disease. Last week, a pathologist brought attention to the Ministry of Health's procurement practices, which endanger lives. Dr. Okemwa accused the health ministry of favouring less sensitive, but more expensive HIV testing kits, leaving millions of Kenyans exposed. "A1 assigned kit (Trinsreen HIV) and unfair testing or screening for HIV infections might compromise test results for millions of Kenyans," he stated. The consequences of such decisions reverberate through the healthcare system, exacerbating the struggle against HIV. Dr. Okemwa's concerns highlight a broader issue within the healthcare system. The Ministry of Health's response to criticism has been to dismiss allegations rather than address the core issues at hand. This pattern of negligence is not unique to HIV testing, but extends to many aspects of healthcare delivery in Kenya. In 2019, the Kenya National Union of Medical Laboratory Officers (KNUMLO) raised the alarm that 30 per cent of patients received incorrect diagnoses or treatments due to poor-quality medical laboratory services. Enock Wanyonyi, KNUMLO's secretary-general, highlighted the misdiagnosis of diseases like HIV, TB, and malaria, which has led to fatalities and complications. Wanyonyi's warnings echoed the sentiments of healthcare professionals who have long struggled against the tide of systemic failures and corruption within the healthcare system. It was a year after a neurosurgeon at the biggest referral hospital in the region performed brain surgery on the wrong patient due to a mix-up, leading to dire consequences for both individuals involved. The hospital's statement admitted the incident, saying, "The management has suspended the admission rights of a neurosurgery registrar and issued him with a show-cause letter for apparently operating on the wrong patient." Last year's audit by the Auditor General released in July stated that Kenyans may be receiving substandard healthcare services due to over 9,000 unlicensed health facilities since these facilities are not licensed by the Kenya Medical Practitioners and Dentists' Council (KMPDC). "Review of the KMPDC database provided for audit and available on the KMPDC website revealed that out of the 16,527 registered health facilities in the year 2023, only 7,518 or 46 percent complied with the licensing rules," the report states, which meant that 9,009 or 56 per cent of all the health facilities are not licensed, raising concerns about the standard of services offered. Need for Reforms The National Taskforce On Police Reforms report noted that police officers, prison guards, and National Youth Service members frequently face barriers to accessing quality healthcare. Despite having comprehensive coverage, many are turned away from health centres due to bureaucratic issues, leaving them vulnerable. "Despite clear guidelines in the Service Standing Orders for training to prepare officers psychologically, financially, or on health management upon retirement, this is not done, resulting in many officers dying soon after their service due to life changes they are unprepared for," the Marag-led taskforce noted. However, speaking to The Standard PS Health, Harry Kimtai admitted that the sector has had challenges and that the government was addressing them. He said that it was wrong to turn away patients, referring to cases where hospitals have failed to treat people because they don't have the required amount. "It is actually against the law," he said. Joseph Mugachia, a convenor of the Concerned Citizens Movement, said that the healthcare system is not working. "Unless you go to a private hospital, you will suffer in a public hospital before you access a doctor or get treated," Mugachia said, adding, "What we are seeing in healthcare is happening across all sectors of the country." To solve the crisis, President William Ruto launched Universal Health Coverage (UHC) in October 2023 when President William Ruto signed laws aimed at strengthening health financing and service delivery. These laws include the Primary Health Care Act, the Social Health Insurance Act, and others designed to improve health policy and financing. "We now have a law establishing the Critical Illness Fund to cover illnesses like cancer. No Kenyan will have to sell property to pay medical bills," Ruto announced. The president disbanded the National Insurance Health Fund and introduced the Social Heal Authority (SHA), which has experienced massive rebellion from Kenyans due to a lack of communication and massive technical challenges in the rollout. In addition, the president added that all the NHIF staff will be absorbed in the SHA despite the Auditor General stating that 9 billion were misappropriated by NHIF. This comes at a time when the government is reeling under a backlash by the public over wastage and plunder of national resources. Speaking to The Standard last year, deputy secretary general of the Kenya Medical Practitioners, Pharmacists, and Dentists Union (KMPDU), Dennis Miskellah, pointed out that the situation remains dire and that it requires reforms, accountability, public practice, equipping of hospitals, and recruitment of more staff. "We don't have the equipment, medicine, or enough human resources to handle the growing number of patients," he said. The dire statistics reveal a systemic failure: the doctor-to-patient ratio in Kenya stands at an alarming 1:17,000, far from the WHO recommendation of 1: 1,000. Only 20 per cent of medical facilities meet WHO standards for quality healthcare. The repercussions of this crisis are devastating. Miskellah emphasised, "We see people dying-people we could have saved-because we lack the necessary resources.." The lack of proper training and inadequate infrastructure has created an environment where healthcare workers are overwhelmed and underresourced. "Why do people live up to 100 years in Japan while here, people die young? It's futile to say God picks the best when lives could have been saved if we had the proper equipment," he said. He echoed the Ethics and Anti-Corruption Commission's (EACC) report that healthcare is dysfunctional because of corruption. He told The Standard that politicians often prioritise superficial projects over essential healthcare needs. "Building hospitals and schools for public relations gains offers more political mileage than investing in medical personnel and equipment," Miskellah stated, adding, "Healthcare professionals are frustrated, witnessing their loved ones die due to the lack of basic medical necessities." Effects of corruption According to the UN and EACC, in a report launched in May last year on the status of corruption and unethical conduct in Kenya's healthcare sector, it said that corruption impedes service delivery and quality standards in both the public and private sectors. "Lack of transparency and accountability, personal interest, lack of public participation, and inefficient procurement processes manifest as major breeding grounds for corruption," the UN and EACC said in a report. The report, which describes the public health sector as a cash cow, said that a lack of public participation and an inflated tendering process hindered access to quality healthcare. Kisii Senator Richard Onyonka said that governance systems are designed to fail so that people can steal from Kenyans. The report demonstrates how these problems-cost inflation, improper influence, and collusion among county officials-have had a detrimental effect on the health sector and contributed to fatalities. The report also exposes the prevalence of bribery throughout the tendering process, with demands ranging from 2.2 per cent to 45.7 per cent. In explaining the reasons behind bribery, health staff stated that it was expected (45.7 per cent), demanded (26.1 per cent), voluntary (26.1 per cent), and avoided service delay (2.2 per cent). Kisii Senator Richard Onyonka said that governance systems are designed to fail so that people can steal from Kenyans. "Governance systems in this country is designed to fail by allowing avenues of looting state resources by leaders and creating dictators whose agenda is to grab as much as they can so that during elections they buy you to vote for them again! The cycle goes on and on. Be vigilant!" he said. He called for immediate action to address this crucial issue, claiming that an ageing population will result in greater financial strain as people spend more on healthcare, risking poverty and building debt. "Politicians and courts tarnish our image despite our efforts to address crucial issues. There isn't even a single child's Intensive Care Unit in a public Nairobi hospital. We're less concerned about their corruption and more about them investing in proper equipment and medicine. Buying ambulances without essential supplies, like oxygen, is wasteful. Recently, a lawyer died in Murang'a due to lack of oxygen in an ambulance, preventing his transfer to the right hospital," he said. He warned Kenyans that government officials were not going to public hospitals despite knowing that they had killed them. "A governor who runs a hospital fails to go to the same hospital for treatment and goes to a private facility. It's like baking bread to sell and buying bread from the next bakery to eat," the deputy SG said. Doctors said that insurance cards were not a solution to the challenges in the health sector, warning that they can be depleted and are rarely used during emergencies. "That card is useless since if you have an emergency, you will be taken to a nearby public hospital. You can also remember that former Minister Raphael Tuju was taken to Kijabe Hospital, and he was lucky because it was a mission hospital that ran better," the deputy SG said. Way forward The stories of Melky, Juliet, and countless others reveal a stark reality: Kenya's healthcare system is in crisis. Victims and medical teams believe that the tragic deaths and suffering highlight the urgent need for comprehensive reforms that address systemic issues, enhance accessibility, and improve the quality of care. He called on the Ministry of Health to collaborate with all stakeholders to enhance healthcare delivery, engage the community, and public awareness campaigns can educate citizens on their health rights, empower them to seek quality care, and foster a culture of accountability. Despite the challenges, there is hope. Melky's journey, though fraught with obstacles, is a testament to resilience and determination. His story is not just one of suffering but also strength. "I am alive today because I found support in friends and family. It's not easy, but I hope my story inspires others to seek help and fight for their health," he said, embodying the spirit of survival. The late Juliet's courage in the face of her illness reminds us of the importance of fighting for better healthcare, not just for ourselves but for future generations. "I fought for myself and every woman out there facing the same battle. I want change; I want better healthcare for everyone," she said, leaving behind a legacy of strength and advocacy.

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