THE GLARING BURDEN AT KENYATTA NATIONAL HOSPITAL

Picture courtesy KNH website

The past one year has been a bitter-sweet one for Kenyatta National Hospital. It has been peppered with great news that put it on the map in the delicate world of medicine with the separation of the three-year old Siamese twins last year and the delicate re-attachment of a severed hand heralding the start of 2018.

However, 2018 has brought more negative news than ever before. Kenyatta National Hospital has been haunted by accusations of rape of mothers with babies in the newborn unit, stealing of a baby from a mother within its premises and most recently, wrongful brain surgery. The woes are never-ending.

In the wake of things, the public outrage has been fast and furious. On both mainstream media and social media, the institution has taken a serious battering. Top management has been sent on leave and the Board of the institution has made terse statements indicating their displeasure at the turn of events.

The doctors have vocally come out to try and explain the scenario of what really goes on behind closed gates but the public can only read one thing, that they are defending their own. To this end, the institution is currently crippled as the doctors have withdrawn their services until the systemic issues in Kenyatta are addressed.

So, where is Kenyatta National Hospital coming from? Kenyatta National Hospital is 117 years old, having opened its doors in 1901 to the general public. It was named the Native Civil Hospital, designated to take care of the Kenyan people during the colonial era. The European Hospital, currently named Nairobi Hospital across the street was the white equivalent, providing service to the white settlers.

The Native Civil Hospital went operational with a mere 40 beds, undergoing sustained metamorphosis to the King George VI Hospital in 1952 and eventually to Kenyatta National Hospital after independence. The 40 bed hospital has expanded to an 1800 bed super-specialty hospital with multiple departments.

The growth of this institution automatically resulted in it bearing multiple responsibilities. It houses many other health departments within its 47 acres, which have been domiciled there for ease of operations. It is the leading teaching institution for health –related courses in Kenya, from the University of Nairobi, to The Kenya Medical Training College, to several other newer institutions that have come on board over the last few decades. It is a centre for medical research and innovation.

All these roles are separate from its core function of providing medical care to the 40 million Kenyans who have depended on since its inception. From common ailments such as respiratory infections, malaria, diarrhoreal diseases in children, and acute surgical emergencies, to complex conditions required specialized care such as cancer, complex surgery, rare infectious diseases, HIV care, severe burns and complex eye, ear, nose and throat diseases.

For such an important institution, what ails Kenyatta National Hospital? Like most other public entities in Kenya that have been forced to undergo rapid growth to meet the needs of the public, lack of proper planning is the biggest challenge.

The planning of the main hospital infrastructure was extremely well designed. What is popularly known as the tower block in Kenyatta is a work of art. The architecture is marvelous. The symmetry and functionality are in place, a whole second level is designated for emergency evacuation with extra exits and ramps and several lifts designed for different functions. The out-patient clinics are all arranged along two corridors outside of the main in-patient complex for efficiency.

However, over the years, the number of patients requiring care at the institution has far outweighed the resources. For this reason, many practices have been entrenched in the running of the institution without questioning their validity and effectiveness.

One such area is in human resource. For an 1800 bed facility that is usually forced to carry almost twice its capacity, the number of clinical staff employed by the hospital is grossly inadequate. The reason this has not been obvious for decades is because, by virtue of being a teaching hospital, a lot of the work in the clinical areas has been borne by the training students, some who may be forced to bite more than they can chew due to necessity. The existing memoranda of association between the hospital and teaching institutions cannot replace the much-needed human resource. The ties back to the Ministry of Health are also oppressive. For instance, since the Ministry is directly responsible for management of the payroll of the hospital, it means that if it does not think it is important to employ more staff, the hospital cannot change that.

The chronic underfunding of the institution and corruption that bites into a chunk of the meagre budgetary allocation leaves the institution on its belly. For this reason, it is impossible to procure equipment in a timely fashion to sustain the pressure to keep up with the need to improve services. It is also impossible to train staff to keep up with the new technologies in a timely fashion.

Leadership and governance has been a long-standing problem in the institution. The top leadership of the hospital has for years been viewed as a political reward. For this reason, most of the people who have held the docket of the top job have their hands tied when it comes to trying to streamline the institution and route out the rampant corruption entrenched at various levels. Some have bullets lodged in the spine for their efforts.

For a hospital, clinical management is a core function in ensuring patient safety and must be completely delinked from politics. The professionals who provide medical care are the ones who understand their job, how to regulate themselves, set up standard operating procedures and develop protocols on patient safety. They must be free to do this within a setting where there is no fear, intimidation or interference. The team leaders must be answerable to their patients first!

However, when politics comes in to cause knee-jerk reactions that intimidate office holders, the result is an institution with weak leadership because those best qualified to lead prefer to avoid the political drama. Let us clean up the mess that’s glaring at us and restore this institution to its glory!