Patient abuse an epidemic in Kenya’s public hospitals

By Gatonye Gathura

The magnitude of patient abuse by public health workers is a major concern within the Ministry of Health despite public assurances by outgoing Cabinet Secretary Dr Cleopa Mailu that all is well.

After the recent rape allegations at Kenyatta National Hospital (KNH) CS Mailu has taken a defensive position claiming he is yet to be shown the smoking gun.

But the ministry’s in its own report says one in five women in Kenya has been humiliated, abused, hit or asked for a bride during their most recent birth.

Nine out of 10 health workers, the report on which the Heshima Project is anchored on, have heard or witnessed colleagues treating women inhumanely.

Heshima Project is an ongoing initiative of the ministry and donors to address endemic abuse of delivering women by health workers.

But this seems not to be working with new reports showing many mothers are still being abused by health workers.

While the KNH rape remains most visible, women in the sub-county of Magadi in Kajiado have opened up on how health workers pinch them with scissors to hasten delivery.

In a report published on 3rd January by Amref Health Africa in Kenya and the University of California, US, the women tsay despite the Heshima Project they are still being physically and psychologically abused by health workers.

The report published in the journal BMC Pregnancy and Childbirth said abuse by health workers was a major  reason many women in the area choose to deliver at home.

A community health worker attending women in the area is quoted telling of cases where nurses pinch woman with a pair of scissors so that they can push harder.

In the same report area chiefs say doctors no longer work at night hence women laboring after daytime are largely on their own.

But poor and even life threatening health services are not just limited to maternity wards as reported in the ongoing Kenya Patient Safety Impact Evaluation (KePSIE) project.

KePSIE, a project of the health ministry and the World Bank shows 98 per cent of health facilities in Kenya do not comply with key patient safety standards.

A KePSIE report blames poor governance, accountability and lack of supervision in the country’s health facilities for exposing patients to serious dangers including hospital acquired infections.

For example in an ongoing controversy at KNH, a group of doctors  collaborating with the University of Manchester, UK,  had put 40 women on an experimental treatment which could not have been allowed in Britain for safety concerns.

The study however led to a breakthrough cervical cancer treatment with the UK taking all the benefits for the drug to be manufactured by Douglas Pharmaceuticals of New Zealand.

There is no recognition or benefits for the participating Kenya women, doctors, KNH or the government.

But the hardworking General Secretary of the Kenya Medical Practitioners, Pharmacists and Dentists Union, Dr Ouma Oluga has strongly defended health workers for the alleged poor performance.

Instead he has blamed poor working environment, lack of equipment and supplies and shortage of staff for the poor service delivery.

But the KePSIE report shows while Oluga may be correct to some extent much of the decay in the sector has nothing to do with resources but individual responsibility.

For example, while more than 90 per cent of health workers in Kenya are aware of the importance of hand washing less than one per cent wash their hands while attending to patients.

This is even after the facilities and supplies for hand washing are made available. Hand washing, is classified by the World Health Organization as the single most crucial factor in reducing hospital acquired infections.

Yet another report, showing massive health workers negligence at KNH, says a third of laboratory test results never get back to patients because requesting clinicians do not indicate a return address.

The job request, the study says did not indicate to which patient, ward or attending doctor the results should be returned.

Published last January in the Asian Journal of Medical Sciences by among others an Assistant Chief Medical Laboratory Offer at KNH tells of mind- boggling laboratory errors at the facility.

The errors the study says result to repeated testing, extra clinician appointments, unnecessary medical procedures and treatment, increased duration of hospitalization, extra cost, disability, and even patient deaths.

Most of the errors, the study says can be minimized if workers at the facility are more professional and diligent.

But politically driven policies, such as the free maternity project without corresponding resources have also been blamed for poor services in the health sector.

An unpublished study by Dr Diana Marion of the University of Nairobi concludes that the quality of care declined with the introduction of free maternity services at KNH.

Dr Marion in her 2016 study reported increased cases of bleeding after birth, uterine rupture and post caesarian section complications.

“While the policy led to a rapid increase in facility deliveries, this was not matched by an increase in health facility capacity and hence compromised quality of care,” says a November study led by Kemri and the World Bank.

But the sector is also bleeding from poorly trained and incompetent health professionals.

A report appearing in the journal BioMed Research International in October shows maternity workers at Kakamega County General Hospital do not know how to dry or keep a newborn warm which is crucial in the first minute of life.

 

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