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Reflections

Medical Malpractice and Patient Advocacy in Kenya

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Medical Malpractice and Patient Advocacy in Kenya
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In December 2010, my mother was admitted to an established private hospital in Nairobi for what we considered a routine surgery. This surgical procedure was the culmination of a series of medical tests that begun in July that year in Kisumu where she lived and ended up in a referral to a sister hospital in Nairobi. After several tests and doctor consultations, the second doctor confirmed that she was in the early stages of cervical cancer and the best course of action for a woman her age – 64 years – was a hysterectomy.

It all seemed straightforward really. Armed with health insurance, we accompanied my mother through hospital admission procedures a day before her surgery. What was intended as a three-hour surgery ended up with my mother being wheeled out of recovery at 11 p.m. It turned out that the surgeons had found a hernia, chose to repair it and then conduct the hysterectomy. On the third-day post operation – the day she begun to eat solid foods – my mother developed complications in the night. These complications included difficulty breathing, reduction in urine output, low blood pressure for a high blood pressure patient. All of these symptoms were red flags.

Thirty-six hours later, my mother died of an acute bacterial infection. The doctors told us they did not know the cause of the bacterial infection. We were told infections can be picked up anywhere, we were after all in a hospital. When we asked for a post-mortem, it was suggested that it was unnecessary. To cite one doctor – we would find nothing except a missing uterus. We went ahead and conducted a post-mortem. A relative had the presence of mind to encourage us to get an independent pathologist to observe the procedure. It is the results of the post-mortem that pointed us to the cause of the bacterial infection (septicaemia) tiny punctures to her large intestines that occurred during surgery. In essence the minute she started eating food, the contents of her large intestines leaked into her bloodstream and poisoned her.

The admitting doctor quickly vacated the scene and left us in the hands of the ICU doctors, only offering a full medical report in mid-January 2011, despite our requests for said report in December 2010. She went on holiday. It is both treatment and responses we received to our questions about whether anything could have been done to avoid my mother’s death that set us on a six-year-long process of looking for accountability.

In 2011, we returned to demand answers from the hospital management. At this stage, we were slightly more than angered by the callous treatment we were receiving from the hospital. Yet, even in this anger, all we wanted was an admission that they had failed in their duty of care and an apology. We had proof of the cause of death. We wanted an apology that would for us acknowledge my mother as a person whose life mattered. She was not simply a 64-year-old African woman in bed X. We wanted my mother to be seen and our grief acknowledged.

Instead, we met a management team that was preparing for the possibility of legal action. In that meeting, the two surgeons who had operated on my mother were missing. We were told they were busy. The head of obstetrics confirmed that the case was internally investigated and the outcome of said investigation revealed that a crucial window had been missed. The window being the moment between the observation of changes in my mother’s vitals by the nurses and the time the doctors offered a proper medical response, which was mid-morning the next day. I am familiar with the missed opportunity referred to because I became intimately acquainted with my mother’s hospital records in the months that followed.

By the time the doctors begun accelerating their medical response, the opportunity to take her back into theatre had passed and no surgeon would have risked such a move because she would have died on the table. They made her comfortable and waited for her to die. He also hinted at my mother’s weight and pre-existing medical conditions such as high blood pressure and old age onset of diabetes as factors that did not help her situation. They were not fully to blame, the now deceased patient had to take responsibility for being “unhealthy”. The hospital after discussion agreed to transfer a copy of the medical file to a doctor in a sister hospital in Kisumu for review. They would not hand over a copy of the file to us without a court order. It is the outcome of that review that led us to the Kenya Medical Practitioners and Dental Board (KMPDB) to file a malpractice case.

Pursuing Accountability: Some Lessons

There is often that one case that hits the Kenyan media that reignites public concern about the state of medical care in Kenya. In the recent past, most of these cases have been located at Kenyatta National Hospital (KNH), such as the case of Alex Madaga[1], the rape allegations at KNH[2] which are about institutional care and most recently the patient who had brain surgery for no apparent reason[3]. These cases have occurred in the largest referral public hospital in Kenya, which often leads to the assumption that medical malpractice is a problem confined to public hospitals and that this is a class question. It is not.

To be clear medical malpractice is not unique to Kenya. The scale is accelerated by weaknesses in accountability channels that limit remedial measures taken to address gaps in medical procedures and implementing personnel. Of course, medical malpractice cannot be understood outside the larger training and labour issues associated with the health sector in Kenya. Nonetheless, I want to focus on accountability as a critical pillar to medical practice that does not necessarily disappear or reduce when better labour conditions are put in place. There is a general “utado” attitude that sits at the heart of accountability questions everywhere. It is that daring people to act – a dare that is located in an acknowledgement of structural powerlessness – that must be dealt with.

This is Kenya

When we arrived at the decision to file a malpractice case, we received many responses from friends, the most common being “this is Kenya nothing will come of it”; “she is dead, this will not bring her back”. However, the most disturbing in my view, were the litany of medical malpractice examples recalled with ease, as though they were describing the decision to use Vaseline and not spirit on a wound. The casualness with which people spoke about patients who were given wrong medicine thus ending up dead, surgical items left in patient’s bodies and misdiagnosis was disturbing to say the least. In all the cases I heard, no one took any action, because either the patient had survived or they were dead. Beyond the costs – both emotional and financial – associated with pursuing accountability for medical malpractice, we are resigned to the fact that systems will fail us and if “you don’t know someone” why put yourself through the process of looking for justice. The number of medical malpractice cases that go unreported are anecdotally high, the number of cases reported at the board with limited response is equally high[4]. However, the failure to address these cases and therefore improve the system is deeply reliant on an unholy alliance between our silence and the collusion of legal and health systems to protect “their own”. Our experience with the KMPDB points to this unholy alliance.

Professional Accountability

In the KMPDB, the body charged with the responsibility of holding medical professionals accountable to the highest standards of service, we find a manifestation of all weaknesses of the medical sector in Kenya. The slow responses by KMPDB to cases filed before it is indicative of the lethargy that accompanies a real commitment to hold medical professionals ethically accountable. This lethargy is evident in the speed with which KMPDB will deal with cases that attract public attention such as the death of former IEBC commissioner Letangule’s wife[5] or Mugo wa Wairimu,[6] while keeping non-high profile cases waiting for six months to a year for a hearing date, if you are lucky.

Second, in most jurisdictions outside Kenya, institutions such as KMPDB are considered independent professional bodies. This means that legal orders cannot be used to stop proceedings within the board. However, if someone is dissatisfied with the outcome of the board’s process, they can file a civil suit. Even if there is a concurrent matter before a court of law, the two processes are considered independent. This is not the case in Kenya. The medical malpractice case we filed at the medical board was stopped twice by the hospital asking to be de-linked from the case, yet they were the admitting hospital. My mother did not have her surgery on the highway. Every time the hearing was stopped it meant that we spent time and financial resources fighting court orders that went unchallenged by the very hospital that had filed them. It also meant that we went into a longer waiting period for another hearing date at the KMPDB.

It is clear this was a tactic used by the hospital to frustrate us. Most disturbing though was what appeared to be a collusion between the hospital and the board. This was apparent on one occasion when the director of the board, shouted into the corridor where we sat: “the case of the woman who died at X hospital. We will not hear your case today because there is a court order on the way to stop the proceedings”. Our hearing was being halted by a court order that had not been served to anyone. The board members then took an extended tea break ostensibly to buy time for this court order to arrive so that they did not have to begin hearing the case. When we questioned board officials about this apparent collusion, they as would be expected denied that they had engaged in a stalling game designed to benefit the hospital and ostensibly the doctor.

Third, procedures at KMPDB remain opaque, which means that for families who do not have the requisite understanding of evidence collection and most importantly the resources to do so, most cases will not see light of day. On one occasion as I sat outside the KMPDB hearing venue, I spoke to a family whose case involved a deceased family member’s organs being harvested. This case was eight years in the making. I knew that case was not going anywhere because they were predictably asked for evidence. The family member had long since been buried, no post-mortem was ever conducted and all they had was a story.

Finally, the opacity surrounding institutional procedures is aided by the unwillingness of medical practitioners to hold each other accountable. Where malpractice cases require expert witnesses, finding doctors willing to offer evidence remains difficult. In our case, we found a doctor who agreed to provide an expert opinion not because his own medical record is squeaky clean because the assumption is that those testifying have never made any errors. He recognised that there was a major lapse in the duty of care and he knew the deceased – my mother. His motivation was therefore personal.

On collective accountability

Ours is not a tale that ends in triumph. After six years of running through the courts, lawyers and poring over medical evidence we chose to halt the process. As a family, we were suspended in grief for six years. Every time there was a court or board hearing, we were transported to those traumatic two days in December 2010 when we watched our mother’s body shut down one organ after the next. We decided that sending the message had been important and we stood up for her.

Accountability for medical malpractice is fundamentally a question of attitude. An attitude that recognises patients as human beings whose lives matter and that one mistake is a mistake too many. From my experience, the cycle of collusion that surrounds hospitals and medical personnel doing what is no doubt a difficult job, does not build any confidence in health institutions. There is need for collective accountability for medical malpractice in Kenya that goes beyond looking at individual hospitals and cases. There is a larger system based question that should generate a change process that targets all the actors responsible for medical care and ethics. A critical actor in this conversation is the patient. No one files a medical complaint because they are out to get doctors. Grief is too painful a process to prolong by choice.

[1] https://www.nation.co.ke/news/Ambulance-patient-Alex-Madaga-dies-at-KNH/1056-2906238-4pr29bz/index.html

[2] https://www.nation.co.ke/news/Outrage-on-Facebook-over-rape-allegations-at-KNH/1056-4270106-g9u9x2/index.html

[3] https://www.standardmedia.co.ke/article/2001271660/knh-on-the-spot-after-brain-surgery-is-performed-on-wrong-patient

[4] https://africahealth.wordpress.com/2012/07/02/medical-negligence-and-malpractice-is-rife-in-kenyas-health-facilities-a-public-inquiry-reports/

[5] https://www.nation.co.ke/news/Thomas-Letangule-Wife-Death-Family-Care-Medical-Centre/1056-2371320-bxxihlz/index.html

[6] http://allafrica.com/view/group/main/main/id/00038738.html. See also https://www.the-star.co.ke/news/2018/02/19/doctor-accused-of-rape-and-murder-attempt-still-at-work_c1716525

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Awino Okech has been involved in social justice work in East Africa, the Great Lakes region and South Africa over the last twelve years, focusing on women’s rights in conflict and post-conflict societies and security sector governance. She is a lecturer at the Centre for Gender Studies at the School of Oriental and African Studies.

Reflections

Just Do It!

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Just Do It!
Photo: Joanna Nix on Unsplash

This ‘Brazen: Reflections’ series was born out of a desire to continue the conversations springing out of the ‘Too Early For Birds: Brazen’ theatre performance in Nairobi in July 2018. TEFB-Brazen was a mix of straight-up scripted theatre, narration, poetry, music and dance that featured the little-known stories of six fearless women in Kenya’s history – freedom fighters like Field Marshall Muthoni wa Kirima, Mekatilili wa Menza and Wangu wa Makeri; democracy activists Philomena Chelagat Mutai and Zarina Patel and even one iconoclastic yet nameless woman warrior who brought down Lwanda Magere, the legendary ‘Man of Stone’ in Kenyan folklore. The story of each hero was narrated by a corresponding mirror character on stage. The ‘Brazen: Reflections’ series seeks to explore the idea of brazenness, what it means in our daily lives, whom the idea of brazenness privileges or erases, and the place that brazenness has in imagining freedom. 

 

* As told to Christine Mungai

 

A few months before Too Early For Birds: Brazen was due to be performed, the writers of the show – Aleya Kassam, Laura Ekumbo and Anne Moraa – invited a number of women for a pre-show reading of the script, to see how it landed and what could be improved. I attended the reading, and brought my mother along.

The reading got underway, evoking frank conversations about the struggles that women face – at home, at work, everywhere really, as we fight to stay alive and sane in a society that constantly works to degrade and diminish us. My mother listened, patiently as she always does, and then said something that surprised the group – that she was struck by the fact that women in 2018 were facing the very same struggles that she was battling forty years ago.

My mother, Lucy Wanjiru, is now is her 70s. She told the group how she raised my four siblings and I as a divorced woman in the 1970s. Which, as she pointed out was not the kind of thing done at the time. But she was different. She’s the kind of mother that had the “sex talk” with us openly, and answered all our questions as best she could. She was the first to take me out, to teach me what alcohol did to my body, and how to handle it. She bought me my first miniskirt.

Someone asked my mum whether she knew any gay people “those days”. She said yes, we knew men who did “women things”. And that there were girls who “disappeared into some corners with other girls”.

Was there a backlash? Were they ostracized? Was there the same stigma as today?

“Not really,” she said. “It was understood that those girls were not ‘for marriage’.”

And then my friend Nini asked my mother, “Did it occur to you that you could be in a relationship with a woman?” She answered: “Unfortunately I’ve never been attracted to women, but if I was, it would have been a great arrangement.” That blew everyone’s mind, and they all burst out laughing. But my mother meant it.

For Women Who Are Difficult To Love

Read also: The Brazen Edition

I’ve been thinking about that conversation in the weeks after TEF Brazen, about the things that time changes, and what it doesn’t change. My mother sharing her experiences from forty years ago mattered to the people present that day – it reassured them that they were not alone, that others have passed this way before. But it was also a reminder that the forces against us as women are resilient, frequently shape-shifting into more modern versions of the same old oppressions.

I ended up watching Brazen with my mother, as well as Martha Karua, who’s had a distinguished career in public service, Justice Martha Koome, judge at the court of appeal and Marilyn Kamuru, advocate fighting for the implementation of the two-thirds gender rule. It was a veritable cross-section of women representing different generations of Kenyan brazenness.

It made me realize that we need those cross-generational spaces that allow us to access those memories, that let us know that this too shall pass. And for those who have gone before us, it matters that someone is listening. That someone will read the Hansard and retrieve what you said, like they did for Chelagat Mutai in the performance. That someone will quote you, will re-tell your story to little ones one day.

At what point does a girl become a woman in her mother’s eyes? I was lucky that my mother spoke frankly to us, gave us an anchor to hold on to, and helped us find a way to make sense of the world. For too many women however, it is happens too late, too abruptly, or too tainted by the contradictions of life.

I asked my mother that day, “At age 35, you were running a business, running a home, and raising five children by yourself. With all of society’s forces against you, how did you do it?”

She said: “You just close your eyes and get your work done.”

That’s Brazen.

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Reflections

Gonna know we were here

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Gonna know we were here
Photo: Eloise Ambursley on Unsplash

This ‘Brazen: Reflections’ series was born out of a desire to continue the conversations springing out of the ‘Too Early For Birds: Brazen’ theatre performance in Nairobi in July 2018. TEFB-Brazen was a mix of straight-up scripted theatre, narration, poetry, music and dance that featured the little-known stories of six fearless women in Kenya’s history – freedom fighters like Field Marshall Muthoni wa Kirima, Mekatilili wa Menza and Wangu wa Makeri; democracy activists Philomena Chelagat Mutai and Zarina Patel and even one iconoclastic yet nameless woman warrior who brought down Lwanda Magere, the legendary ‘Man of Stone’ in Kenyan folklore. The story of each hero was narrated by a corresponding mirror character on stage. The ‘Brazen: Reflections’ series seeks to explore the idea of brazenness, what it means in our daily lives, whom the idea of brazenness privileges or erases, and the place that brazenness has in imagining freedom

 

I recently found myself in a room with the mother of my auntie’s husband who we all call Cucu. Having lost my biological grandparents, this sweet lady—who, at 98, has always been old to me—was fascinating to observe. Cucu sat in a corner, singing gospel songs with her feet elevated. She was snug and warm and aged in that good way; seen the world and sure of her bedtime.

I thought about the Kenya she met in 1920. A colony filled with fear, hunger and violence. Though I can almost hear Ciru’s character in TEFBrazen chime in, “kinda like now”, I wonder what uncertainties coiled in the belly of Cucu’s mother as she looked down at her daughter. As a woman, I feel certain the same dread extends across each generation facing a hostile world that needs unmaking: Will they survive? Will they thrive?

Not enough to make it.

This is where we need the radicals and their rage.

They find the words, the exact colour and stroke, the perfect verse and tempo, the opening, the safety, the fearlessness, the cunning, the voice needed to challenge the world. March 16th, 1922 was Mary Muthoni Nyanjiru’s time to be Brazen. She rallied a crowd of 7,000 agitating for the release of Harry Thuku, a political activist fighting against the colonial government.

They say that right there, outside Central Police station, Nyanjiru stripped naked, faced down the bayonets and yelled, “Take my dress and give me trousers! You men are cowards! What are you waiting for? Our leader is in there. Let’s go get him!”

For author Grace Ogot, being Brazen was deciding to publish work in both Luo and English when she realized there was a dearth in work by East African women writers at the 1962 African Writers Conference. Her fellow attendee, Rebeka Njau went on to write a one-act drama that unequivocally condemned female genital mutilation. The Scar was published in 1965 and is the first ever play written by a Kenyan woman.

A decade later Rebeka would rewrite her award-winning debut novel Alone with the Fig Tree into Ripples in the Pool with a queer protagonist, Selina, a married woman who falls for her husband’s sister. In a moment of reflection Selina reveals her motivation: “I have discovered that a woman must fight her way in this cruel man’s world. This is what I’m doing now.”

And women needn’t be pioneers to shake things up. Daring to be different and refusing to be cowed or shamed is just as empowering. It is evident in how musician Akothee, the self-proclaimed ‘president of single mothers’, has made her Instagram account an island of ungovernability. That honesty with which socialites such as Bridget Achieng – featured on a recent BBC Africa Eye documentary – speak candidly about their lives and the cost of choices they make.

Brazenness is in the very bones of the Bar Hostess Empowerment & Support Programme. This organization is a haven for Kenyan sex workers. It also incorporates women who have sex with women (WSW), women using drugs and, bar hostesses. What’s fantastic is that they offer training to sex workers as paralegals which helps them in defending themselves on the streets, in the back of the council vans, and in the courts.

When women refuse to be made invisible, they are able to question status quo. It is a struggle but there is glory in being alive this way. When transwoman Audrey Mbugua challenged the Kenya National Examinations Council to change the name on her certificate, she demanded to be seen for who she was. She won.

For Women Who Are Difficult To Love

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When filmmaker Wanuri Kahiu took the Kenya Film Classification Board to court for banning her film Rafiki, she wanted to give Kenyans a chance to see two young people—who happened to be female—fall in love. She won and made over three million shillings to boot.

But it isn’t about winning. It’s about having the audacity to point out an injustice and not back down. In 2016, lawyers Marilyn Kamuru and Daisy Jerop together with the Center for Rights Education and Awareness led a petition against the Chief Justice and the National Assembly to dissolve Parliament. The Constitution is clear. Everyone ought to be sent home for non-compliance with the two-thirds gender rule. The petitioners openly declared “there is no democracy without women’s meaningful representation in the national legislature.”

How powerful is that?

Yet and still, not enough make it.

Nyanjiru was the first to be felled by bullets that day.

*Liz was gang-raped on her way home from her grandfather’s funeral.

Jackline Mwende’s husband chopped off her arms.

This is still the world we live in. Where our bodies are viewed as disposable, our fate inevitable and our triumphs erasable. That is why I enjoyed Too Early for Birds – The Brazen Edition so much. It hit all the right notes: truth, homage and genius. We need this kind of inspiration. We need our joys and pains documented. We need to grieve. We need to imagine new ways to be free. This is how we survive. This is how we thrive.

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Reflections

EMPTY ARMS: The story of Kenya’s broken maternal health system

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EMPTY ARMS: The story of Kenya’s broken maternal health system

This ‘Brazen: Reflections’ series was born out of a desire to continue the conversations springing out of the ‘Too Early For Birds: Brazen’ theatre performance in Nairobi in July 2018. TEFB-Brazen was a mix of straight-up scripted theatre, narration, poetry, music and dance that featured the little-known stories of six fearless women in Kenya’s history – freedom fighters like Field Marshall Muthoni wa Kirima, Mekatilili wa Menza and Wangu wa Makeri; democracy activists Philomena Chelagat Mutai and Zarina Patel and even one iconoclastic yet nameless woman warrior who brought down Lwanda Magere, the legendary ‘Man of Stone’ in Kenyan folklore. The story of each hero was narrated by a corresponding mirror character on stage. The ‘Brazen: Reflections’ series seeks to explore the idea of brazenness, what it means in our daily lives, whom the idea of brazenness privileges or erases, and the place that brazenness has in imagining freedom. 

 

The pain

The morning of 3rd November 2013 is still so clear to me, almost five years later. I remember waking up at 2:11 a.m. in so much pain I could barely stand. I remember waking my husband who was sleeping next to me. I remember how calm his voice when he said, “dress up, let’s go to the hospital”. I remember what I wore – a green dress with black floral patterns. I remember touching my belly and wondering why it felt so hard. I remember my husband driving like a crazy person, ignoring every red light on the way to Nairobi Hospital. I remember how the emergency area of the hospital looked dreary and depressing. I remember the relief I felt when I heard my daughter’s heartbeat but then a twinge of anxiety when the sonographer said her heart rate was higher than it should. I remember the next nine hours clearly, up until noon, when my water broke and I pushed my baby girl into the world. I remember seeing her tiny body on a tray and hearing the doctor say “I am so sorry she didn’t make it”. Then everything from there is a blur.

The people that came to visit us in hospital were very kind, but for the life of me I cannot remember any of the conversations we had. A few pastor friends stopped by and prayed. I had trouble closing my eyes though. I was sure if I closed them, the darkness in my heart would overwhelm me. The only thing I remember about the days that followed is my first shower. I stepped out of my bed, legs shaking and eventually made it to the shower. And I touched my belly and there was nothing where my baby bump had been. And I sobbed in the shower, wishing I could die. But I didn’t. And at first, I was deeply disappointed with God for letting me live. But I went home and experienced so much love from friends and family. I remember Timo and Lo (a couple who lived near us) coming to our house with food. That was the first night I laughed since my daughter died. And my journey of healing began.

Seeing in colour

A month after coming from hospital I wrote about losing our daughter on my blog. I had resigned from my job. So here I was, unemployed, with no baby to look after. The blogpost was my way of trying to understand what had happened to me. Then, I felt, if I just wrote it down, it would stop having so much power over me. And the writing helped. I felt lighter – the kind you feel after a good cry. But soon after I received numerous calls, emails and messages from people who had lost a baby or knew someone who had. I don’t know why I did it but I reached out to these people. Here I was, still raw from pain, listening to other devastating stories of loss. For some reason, holding hands with these parents, crying together and encouraging each other started me on my healing journey. Somewhere along the way my heart was strengthened. At some point I started to see in colour again. And though some nights were long and teary, there was a new hope in my life.

I started Still A Mum officially in October of 2015. It is a not for profit that provides psychosocial support to parents who have gone through miscarriages, stillbirth and infant loss. In the three years I have been doing this I have met over 850 men and women beaten down by the death of their baby. Broken by the lack of support from their family. Angry because of the myths their neighbours have about why the baby died. I have met couples that have lost an eight-week pregnancy and people dismissed their loss and called their baby a “mass of cells” not knowing that they had been trying to get pregnant for six years. I have met university students who were terrified when they found out they were pregnant, and even considered abortion, but decided to keep the baby. Then sadly lost the baby. And this baby, not wanted at the beginning, but loved over time brought them such sadness when they were no more. Every year we plant trees to mark Pregnancy and Infant Loss Day in October and my heart is so full to hear a man tell me, “Thank you for giving us a chance to plant this tree in memory of our baby. This is the first we are speaking about our son since he died.”

For Women Who Are Difficult To Love

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Sure, my life took a detour I am so grateful for – from a career in tech to running Still A Mum. Half the time I feel like I have been thrown to the deep end because I am not a counsellor, yet I am here to offer comfort to grieving parents. Of course, I often feel boggled down by the high numbers of pregnancy and infant loss. We are barely scratching the surface and it breaks my heart to know there’s a woman who has lost a baby and has no one to walk with her. Yes, I have missed the glamour of employment life, and the security of a paycheck. But that passes when I meet a mother I have counselled and she’s laughing again. When I run into a mum who tells me that they have recovered from a loss and are even thinking of having a baby again, I get overwhelmed with joy. That’s being Brazen.

***********

The broken health care system

That being said, every day I come face to face with Kenya’s broken health system. Perennially, I see how much more work needs to be done. Did you know that Kenya has 23 stillbirths for every 1000 live births (the rate is 10 for Mauritius and Seychelles, the safest places to have a baby in Africa, and just ten in the US and UK)? Did you know that in Kenya we define stillbirth as the loss of a pregnancy from 28 weeks while developed countries it is from 20 weeks? That means that in those countries a baby born at 21 weeks can make it?

Do you know how many hospitals in Kenya can handle a birth emergency? How many health centers have incubators? Or even a theatre for a basic caesarian section birth? Did you read about the mother who lost quintuplets in Kenya last year? I went to visit her in Oyugis and saw how devastated she was to bury five babies. Five babies! And why? Because she could not go for antenatal clinics because the nurses were on strike, and so assumed she was pregnant with only one baby. On the day when labour started she thought she could handle the birth at home, with a midwife. Until she delivered two babies and the midwife saw there were more. And she was rushed to a hospital in Oyugis where she delivered the other three. Who had to be moved to a hospital in Kisii because the first hospital did not have incubators for the preemies. Eventually because of the movement and the cold the three babies died. And just like that a woman lost five children! That is our health care system.

But that is not what riles me most. I am most angry about how Kenyan hospital staff treats mothers and fathers after the loss of their baby. During the support group sessions I have heard some of the most devastating stories I’ve heard in my life.

I went into labor when I was 23 weeks pregnant. The nurse that came to my bed said “mama, huyu mtoto akizaliwa atakufa tu”. She said that because the baby was too young their chances of survival are almost nil. All I could hear was that “atakufa tu” statement. It was so callous. I didn’t know I would be experiencing a lot worse. As soon as I pushed the baby out, the midwife lifted my son and threw him in the trash can as I watched. Soon after, I started to throw up because my blood pressure was really high. Without missing a beat, the midwife handed me the trash can she’d put my baby in so I “stop messing her floor”. Can you imagine how I felt throwing up on my baby?! I had nightmares for months. – Joan*

I lost my baby at 36 weeks of pregnancy. My daughter died in my womb about 24 hours before I came into hospital. “Mama, hapa hakuna heartbeat” The sonographer said while staring at the monitor. Then I was sent to the maternity ward and nobody explained anything. I just saw nurses setting up the drip and putting it in my hand. A few hours later I went into labor. After delivery when I asked if I could see my girl I was asked why I would want to see a dead child. Then I spent the night in the maternity ward – I could not sleep hearing all the babies crying yet mine was dead. It was the most traumatizing thing I’ve ever gone through. I demanded to be discharged the very next day. – Ruth*

I stayed in Newborn ICU (NICU) with my son for 6 weeks. Every day was fighting a new battle. Some days were good, some were tough. One day he’d be doing well the next he’d be fighting a new infection. Because of the bill that had already accumulated my husband and I had decided I would be commuting instead of sleeping in the ward. Most days I just slept in the car. Six weeks in I was exhausted both physically and mentally. I had cried until I didn’t think I had more tears. I had prayed, desperately asking God to take my life instead and spare my son. I didn’t know if I could take more bad news. Then on Thursday May 4th 2017 I walked into NICU and saw a group of doctors and nurses surrounding my baby trying to resuscitate him. Not more than five minutes after I walked in, the machine stopped beeping. Immediately they set my son aside and put another baby into the incubator. They didn’t even wrap him up. They just left him there naked and cold. – Cynthia*

I hear these stories so often and each time it breaks my heart. I meet women who doctors have ignored their calls for help, or the midwife disregarded information they gave that would have saved their baby’s life. I listen as fathers narrate how they paced the corridors outside the theatre only to be told their babies died. And how painful it was for them to break the news to their wives. Our bereavement care is almost non-existent. Our health care is totally devoid of compassion. Medical practitioners leave medical school knowing how to diagnose a patient’s illness and prescribe medicine. They know how to conduct difficult surgical operations. But they are caught flatfooted when they have to break bad news to a patient. They are devoid of empathy. And I understand that most are overworked and already doing more than is required, but a little compassion is required. Saying “I am so sorry for your loss” goes a long way.

I know we can do better. The situation definitely feels bleak but we can start to fix it. Every day we can change systems that don’t work and introduce some new ones that do. Every day we can get feedback from patients and see ways to improve. We don’t have to have world-class facilities to start seeing change – we can be more compassionate and humane and not belittle the loss of a baby. We can start where we are and visit a bereaved parent. And hug them. That’s Brazen.

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