The conference has been very motivational and stimulating! The presenters were of incredible caliber and the attendees have a commendable willingness to advocate for healthcare rights. Their freedom and commitment to discuss difficult issues and to question the current status of healthcare rights and healthcare is inspiring.
Part of the excitement to be agents for change may stem, in part, from the current charge that can be felt throughout Nairobi. General elections are scheduled for December 27 and Kenyans are anticipating the opportunity to elicit tangible change.
All too often we think of care for HIV-infected individuals in terms of access to antiretrovirals and testing for HIV. It is easy to forget the intimate relationship between development and health. This was one of the topics discussed at length yesterday. Instead of defining healthcare as physical wellness or the lack of disease/physical signs and symptoms, the concept of healthcare should be examined as a whole. Addressing healthcare issues includes also influencing physical, emotional and spiritual health and setting goals to decrease poverty and improve access to education, sanitation, access to clean water, employment and food security.
Another essential aspect of comprehensive health care discussed at length during site visits and at the conference, is how to best care for the health care worker. We heard from many sources how health care workers often do not seek their own health care at their site of employment. Stigma, lack of confidentiality, lack of space, and all too little emphasis on employee health are all contributing factors. As a result, retention and employee health suffer.
While visiting one of the clinic sites, we saw the one room clinic space currently set aside for employee health care. In an effort to provide better care to the health care workers (HCWs), one of the physicians is hoping to gain access to a larger space on the hospital campus to provide more services and greater confidentiality. Along similar lines, the other clinic has begun to take their voluntary testing and counseling services to each of the units, providing stigma training and offering testing. So far they have had a significant number of HCWs testing for HIV. I am looking forward to our meeting with another agency today, that has been attempting to increase care to HCWs by mobilizing professional organizations and taking small steps to improve work place satisfaction.
ShareThis
Political theorist John Rawls poses an intriguing question about human rights: If none of us knew where we would be born, if we would be rich or poor, healthy or ill, male or female, short or tall, American or Kenyan or Indian or Chilean, what human rights would we want to be guaranteed? What choices would we want to have about how to live our one wild and precious life?
Today for me was all about the choices we have in America—and the choices Kenyans have, and what that means for health and human rights and the way we live and work and grow and play and celebrate. So what do I mean by choice?
[Sarah Kalloch, HERAF Chairman Andrew Suleh, MD and Suzy Jed, MSN, APRN-BC at Mbagathi District Hospital]The Choice to Live: In 1997, Mbagathi District Hospital, near Kibera slum, opened its first AIDS centre. Options were limited: there was no treatment, no ART, but there was counseling and psychosocial support—and a special kind of community dealing with sickness, and despair and death mixed with glimmers of hope. Ten years later, people living with AIDS who come to Mbagathi have a choice. The hospital’s Comprehensive Care Clinic has 3500 people on ART. We met one patient—a man in his 20’s or early 30’s named Boniface. Boniface is HIV Positive. But Boniface has choices. His CD4 count when he began ART at Mbagathi in 2004 was about 200. It is now over 800. Boniface has chosen to celebrate by becoming a peer counselor at the hospital: a few minutes after he left our delegation, we saw him giving a talk to patients in the AIDS clinic waiting room, coaching them, supporting them, connecting them, and making them feel like they can fight this disease. People with AIDS in Kenya have a choice now: they can get treatment. They can live for years and years. They can take care of their families and be part of their communities. We know prevention is critical, and many argue it is more cost effective than treatment, especially in Africa. But I wouldn’t want to tell Boniface that—would you?
(more…)
ShareThis
After our visit to Mbagathi District Hospital, we went on to Kenya’s largest referral, teaching and research hospital: Kenyatta National Hospital. The facility has ten floors of wards, and a staff of 4,000. In fact, KNH is overstaffed. A mere five minutes away from Mbagathi District Hospital, the halls of KNH are filled with white coats, and specialists crowd the stairways. The Comprehensive Care Center is two stories tall—a gleaming white building on the sprawling KNH grounds.
And while a single ward may be ready with 10 senior physicians, Kenyans have great difficulty getting care at the hospital. It is a tertiary facility—the last stop in Kenyan healthcare—if you manage to afford the referrals, transport and patient fees. While all services at the Mbagathi CCC are completely free, the CCC at KNH requires patients to pay a monthly consultation fee of 300 Kenyan Shillings, about 4 US dollars. This is a prohibitive cost for most Kenyans: it’s just not possible. And yet KNH receives nearly 50% of all government funding to the health sector in Kenya.
Beyond the numbers and underneath the paint lies a very different, and often unexpected, story. Improving AIDS care in Kenya is not just about the size of the CCC, or the quality of CD 4 machines, or the salaries for staff. US dollars and Kenyan Shillings don’t translate to the improved access and quality so desperately needed. The solutions involve looking beyond the individual facilities and the medicines and the most obvious numbers. We will not find all the problems at one clinic, and we won’t find the solutions in one place either.
[The Health Action AIDS delegation with staff at Kenyatta National Hospital]
ShareThis
