EMERGENCIES WAIT FOR NO MAN

The last six years have been characterized by unremitting highlights on the poor state of our health sector. Despite advocacy, industrial unrest, devolution of health, increased medical tourism and many other key occurrences in the health sector, not much has changed by way of improving public health.

One of the most neglected sectors of health care in Kenya is emergency medicine. This sector is so heavily neglected that in the seven decades we have trained medicine, we have never bothered to train emergency medicine specialists.

Our emergency medical response if fully dependent on the private sector, led by The Kenya Red Cross and Saint John’s Ambulance. The government has no public emergency medical response unit!

Some years back, in our maternity unit, we received a patient who was in her third trimester of pregnancy at 2.00a.m. The unit had been quiet before the nurse at the triage area called for help. The lady had come in with a life-threatening pregnancy complication known as abruption placentae. This is when the placenta may spontaneously or as a result of direct trauma to the abdomen or very high blood pressure, start to separate from the uterine wall before the baby is delivered.

As the placenta is the sole conduit of oxygen and nutrients from the mother to the unborn baby, separation means disruption of this conduit, putting he baby at risk of death if not delivered immediately. The mother, upon separation of the placenta, depends on the uterus being empty and contracting to stop further blood loss. Unfortunately in this case, since the placenta, the baby and the bag of waters are still within the womb, contraction fails to occur and the mother continues to bleed to death. The bleeding may be concealed for a while before it starts to flow out vaginally, deceptively creating an illusion that the loss is not much.

Any gynaecologist will tell you that this is not a condition they wish to encounter at any time. Worse still, when the patient presents to the doctor eight hours after the symptoms started. Our patient noted the bleeding early but as she did not have much discomfort, she did not give it the seriousness it deserved. She took three hours before seeking help at a local clinic. The nurse who saw her referred her directly to our facility but the patient did not want to go to a public facility.

Eight hours and five stops later, all in smaller private facilities with no capacity to handle surgery and blood transfusion, she showed up in our labor ward. She was severely pale, hovering on the brink of unconsciousness and had lost her baby. With one loss already, we struggled to save her life, fingers tightly crossed that she would not develop further complications. We were grateful to have enough blood and other blood components necessary to save her life. We all sighed with relief when she came out of anesthesia and breathed spontaneously.

What we all went through was no mean feat. It revealed our soft underbelly. We are completely unprepared as a country when it comes to emergency medical care. In an ideal set-up, the first nurse who saw her would have called for the emergency medical response team immediately, to evacuate her to a hospital that is appropriate for her emergency. They would have had a fighting chance to keep the baby alive long enough to get to an obstetrician. She was already swimming with the sharks when she stepped out of that clinic.

The situation is even more dire when The Kenya Red Cross emergency medical service team makes it to an accident scene, they successfully evacuate the casualties and then take them to the nearest hospital that is so ill-equipped, the patient is better off in the ambulance. The accident and emergency departments are sorely lacking in life-saving equipment. We fail to understand the definition of emergency medicine. This is the care that keeps you alive long enough for the definitive treatment team to have a patient to treat. It stops progressive worsening of the situation, saves limbs and where necessary saves sight.

Emergency medicine may appear heroic on television but it is not an exaggeration. In 2003 after the newly elected government, we lost many new politicians in a plane crash in Busia. Despite these ladies and gentlemen possessing handsome medical covers, these meant nothing at that point in time. There was need for skilled personnel, infrastructure and resources to keep them alive long enough to get to their hospital of choice.

We have seen a lot of senior politicians in the country fly off to Europe, USA and South Africa to seek treatment. It is wise to know that a heart attack or a stroke does not give anyone four hours on board a plane to their hospital of choice. If we do not develop our emergency medical response and emergency medicine locally, we shall continue to bring home our beloved in caskets from other countries.

Accessing emergency care should not be for the privileged few who can afford private evacuation by road, sea or air. It should be available to all. A robust medical emergency response service should be a priority for our ministry. All our medical facilities must have the necessary infrastructure to support emergency care and we must train and continuously impart skills to our emergency medicine specialists of every cadre to run these emergency rooms.

As service users, every Kenyan must understand the importance of emergency care so as to make the right decisions for their health. Otherwise, we shall continue to mourn the loss of those we did not need to lose, with a lot of regret.