INSECURITY: A BARRIER TO ACCESSING HEALTHCARE

Mr. Ekiro* was an elderly patient in the orthopaedic wards during my undergraduate rotation. I could not help but notice how still he lay in his bed. His sixty-year old body was broken in so many places but he did not fidget. His face had a permanently distant look.

His journey to our wards was one of the hardest I had come across. Mr. Ekiro belonged to a community that was on the receiving end of their neighbours. His village was constantly raided for cattle and the attackers were always armed to the teeth. His people had long given up resisting and all they could hope for was to survive the attack unharmed.

On the fateful day that led to his current state, he was coming from the cattle market, having sold a few goats. He was walking back home when he heard the familiar war cries. He was walking straight into the cattle rustlers. He turned into the bush and fled but not before he was spotted. Being an old man and knowing he could not outrun the young men pursuing him, he opted to climb a tree and hide.

Luck was not on his side as the rustlers were accompanied by a dog that gave away his hiding spot. He was shot down from his perch up the tree. He came crashing down and landed in a heap, breaking several bones while at it. He was left for dead.

The area remained hostile for the next 48 hours. He was first seen at a local mission hospital where he was taken by good Samaritans who found him unconscious in the bush. He was given pain medication and referred to our facility. It took the ambulance 16 hours to get through the rough terrain, bad roads and unsafe territory to get the poor man to hospital. By then, it was too late to save his foot.

The man received in the emergency room had broken his left leg near the ankle, a compound fracture that had an open, infected, oozing wound. He had a broken jaw bone and broken spine at the level of his neck (cervical spine). In addition, he had two bullets lodged in his right thigh, having narrowly missed the major blood vessels and nerves. The infection was overwhelming his frail body but he hung in there.

It took 72 hours to stabilize him enough to tolerate surgery. His leg had to be amputated below the knee to rid his body of the debilitating infection. His right thigh had to be operated to retrieve the bullets and clean the bullet track wounds. His mouth was wired shut by the maxillofacial surgeon and he could only tolerate a liquid diet. His head was held in a vice to provide traction for the fractured spine to prevent injury to the spinal cord and to allow the fracture to heal. He spent his days lying on his back, staring at the ceiling, grateful to be alive.

For weeks he lay in hospital with no one visiting him. His relatives had no idea of his whereabouts. They probably assumed he was dead and his body was yet to be found. Without the simple luxury of the cell phones we currently enjoy, our patient had no way of communicating to his people to reassure them that he was alive.

I couldn’t help but wonder what kind of life awaited him. Before, he had made an attempt to save his life by running and climbing a tree. How will he run next time his village came under siege?

It has been 13 years since I met Mr. Ekiro. 13 years where not much has changed. The wild and beautiful North Rift still remains insecure. Every now and then, our media is dominated by stories of attacks on the inhabitants of this region that are vicious and uncontrolled. Kapedo has known no peace. The people of Tiaty live like they are children of a lesser God. Those who survive the bullet will surely succumb to their injuries in hours, days or weeks as they are unable to access healthcare.

The conversations on universal health care cannot be complete without addressing the issue of access. Restriction of access to healthcare as a result of insecurity is something that is never spoken about. Areas that are rife with insecurity lead in all the negative statistics. They will record high maternal mortality and infant mortality rates, they will document low vaccine coverage, high malnutrition indices and lower life expectancy.

Achieving universal health coverage is not a premise of the health sector alone. Nothing demonstrates this louder than Mr. Ekiro’s situation. I have known mothers who bled to within an inch of their lives in the house because no taxi would venture into their neighbourhood after dark to bring them to hospital. I have seen babies brought to the hospital at the crack of dawn, already in coma as there was no form of public transport available to them when the meningitis started creeping in due to insecurity.

When thugs roam the streets by night and bandits roam the countryside by night, causing terror, health access is the first casualty. Imagine the terror a young woman goes through as she spends the night in a cold ditch awaiting dawn so she can seek help at the hospital, having been gang-raped on her way home from work in the local supermarket. She was an easy prey in the dark. What would stop her from being raped a second time in an effort to get to the hospital?

How many healthcare facilities have been deserted in the face of insecurity? We have seen the exodus of health care workers from areas deemed insecure. Who will take care of the casualties of these attacks when and if they do make it to the hospitals? How much longer will we rely on the Red Cross to evacuate the casualties?

It is time we made room for our internal security policy holders on the universal healthcare decision making table for insecurity and health do indeed make very strange bedfellows!