The Kibera slum of Nairobi should be ridiculously healthy…
Walk through Kibera for just a short time and I can guarantee you’ll have passed a hundred ‘duka wa dawa’ (chemists) and almost as many clinics. Wow! Medical care here must be awesome. No long waits to be seen, no distance to be travelled when feeling less than 100%…have we found primary care utopia?
Don’t get me wrong, some of the Kibera clinics are run by people who actually have a medical degree. Most are not. The ‘doctor’ you will see at many of the clinics has never set foot in a university (after all, if you’ve got a degree, there’s not a great deal of attraction in returning to the slum). Experience can be passed down through the generations in lieu of formal training. Of course, these people can recognise common ailments such as malaria with no trouble at all – they’ve seen a lot of cases. But keeping up with new developments, new knowledge, new research, new treatment guidelines…forget it.
Need medication? If you have the money then there’s a lot available to you, and no need for a prescription. However, many drugs common in the UK are either unavailable here or ridiculously expensive. If you CAN get hold of it, and the price is reasonable, you’re still not home and dry. There are an awful lot of fake imports doing the rounds. These can be, at best, ineffective, and at worst, dangerous. Now say you have found a drug, it’s a fair price, and it’s legitimate. Great? Actually, possibly not. Three out of four isn’t bad but the fourth can be rather important: expiry date. So many drugs here are out of date. For some preparations, that’s not a problem. Indeed, some benevolent suppliers from richer countries will donate out of date supplies specifically for use in places where they would usually prove too expensive. However, some drugs chemically alter over time and they have an expiry date for a reason. Some lose their effectiveness whilst others actually become more potent. So, for the average consumer, using them smacks a little of Russian Roulette.
Seeing a doctor isn’t so straightforward
Kiberians face a few hurdles if/when they become unwell or have an accident.
- Money. Everyone needs payment: the doctor or clinician; the chemist; any additional supplies. The money is not always available, particularly in a population where the average wage is around $1 a day. It pretty much excludes a visit to the big hospitals and clinics, leading many to rely on the cheapest care they can find in Kibera.
- Religion. Kenyans can be passionate, devoted followers (see my previous post about Christianity in Kenya) but this has drawbacks. Prayer is promoted in a big way, and this can actually cause some real problems. Many choose to rely solely on prayer to treat their ailments and never seek medical care. Yes, you may get a healing miracle through prayer…but you probably won’t. God often works through people (eg doctors) rather than intervening directly. Yet many avoid all treatment through a commitment to their faith, with potentially disastrous consequences.
- ‘Old wives tales’. This is an issue all over the world, even in some of the most advanced cultures. People would rather use the cure or treatment that their grandmother ‘swore by’ than try a new medical approach. Of course, this also links in with the money issue. It’s a lot cheaper to ‘treat’ at home than to see a clinician.
A few experiences around Kibera
- A young child with burns to his fingers. His family immediately asked me for help and I was able to clean and treat with some basic supplies. This family had the means to take the child to the hospital so I improved the situation only by saving them some money.
- A second small child with fingertip burns (common injury from inquisitive tots touching cooking pots or the wood/charcoal fire itself). This time, the family had treated in the way they were familiar with – they had dipped the child’s fingers in charcoal dust. I’m interested to investigate the origins of that one but can’t immediately see the benefits beyond possibly drying up the burn. It took a long time to properly clean and dress the injury yet the child never made a sound.
- A man with a fairly extensive bacterial skin infection. He had visited a clinic previously and received a prescription – for calamine lotion. I guess it may have helped the discomfort but it certainly wasn’t going to treat the infection. I provided a suitable antibiotic (not an easy task – see ‘the chemists’) and thankfully the infection cleared up.
- Blood pressure monitoring. A simple task to check the blood pressure of a few adults. With one reading rather high (an increased risk of stroke, particularly as the man was inactive) I provided a little advice. I wasn’t in a position to start suggesting appropriate medication as I’m not a doctor and I know very little about the man’s medical history. However, I was able to advise him to attend the hospital.
Even basic medical care appears to be a luxury. Many simply do not seek treatment, which leads to higher mortality, higher morbidity, and poorer long term outcomes. Those who do attend a clinic often choose the cheapest as they simply cannot afford an expensive doctor AND a bag of rice.
There are some good clinicians in Kibera…but there are many who are not. It takes a real calling to practice in the slum after graduating university, not least because the graduates have spent a lot of money earning their degree and they could earn a lot more by working elsewhere. Yet some still choose Kibera. I love those people; I admire those people. And I hope their influence spreads. Kiberians deserve good medical care, as does every human being on the planet, and it can be heartbreaking to see what is often the reality.
Thankfully, investment (often by international NGOs) is having an impact. There are a decent number of good quality, affordable, clinics being constructed/opened. At present, these seem to focus mainly on issues such as pregnancy and childbirth, family planning, HIV/AIDS care and child development. These are certainly very important areas needing good healthcare, however I do hope to see international (and governmental) investment in more general clinic services over the coming months and years.
Back in England we complain endlessly about healthcare provision and the NHS. We complain about long waiting times. The government is bleating about a ‘7-day-NHS’ whilst simultaneously breaking up the system that was once the envy of the world. I have come to develop a real appreciation for the care I receive at home. If I need a doctor, there’s a doctor. If I need to be treated in hospital, there’s a bed for me. Okay, so I may not get everything I want NOW but I do know that I will be cared for in a crisis AND it won’t bankrupt me. I don’t have to live in fear of developing malaria, or meningitis, or of a broken bone. Those things may happen, but I don’t have to choose between getting treatment and feeding and clothing my family. Of course, I do understand that people in the UK face struggles. Not everything is offered by the NHS. But those people are in the minority. The vast majority of us receive an amazing level of care. We need to stop taking it for granted. If the government have their way, we will soon be forced to realise what a good thing we have/had. In the meantime, I look at the people of Kibera and feel incredibly lucky to have been born British.