Medical Dealings

Real life restarted on January 4th. E is very glad to be back with "her kids" and I have returned to my research and clinical work.

I spent a recent morning in clinic with one of the medical officers (read: generalist physician). The usual suspects showed up: lots of hernias, hydroceles, keloids, etc. After the hospital’s surgeon left in the fall, the surgical caseload at this hospital has dropped dramatically, as only the cases that are simple and have a very low likelihood of complication are attempted, as the doctors and nurses have no backup if something goes wrong.

So, we were referring most of the cases to Coast General Hospital in Mombasa, which is the tertiary care government hospital for Coast Province (one of seven districts in Kenya). Coast General has many “consultants”; specialists such as cardiologists, pediatricians, surgeons, and the like. One patient was brought in by his son, who happened to be a clinical officer (read: nurse) at the hospital. The man needed a hernia repair, and the son said that he knew that they weren’t doing that surgery at this hospital anymore. They discussed how much money they had for the surgery, and after some math that I didn’t understand, the man was booked for surgery the next day at our hospital! After the patient left, I asked the doctor what the 6,000 KSH was in her math.

“That’s for us!”, she replied.
“I thought that the 2,500 for ‘theatre fees’ was the extent of the charges?”
“Oh, it is, but this is just a small corruption because I’m doing them a favor and I give some to the anesthetist, and some buys the normal saline.”

Apparently saying that someone has to go to Coast General is essentially ensuring a six month to one year wait for an elective surgery. The patient’s son fully understood this, and seemed delighted that the doctor would accept some under-the-table money to do his father’s surgery. From the doctor’s side, she otherwise has no incentive to take patients to the OR, as government doctors are paid a salary, and if she messes up in the OR, she can be charged with malpractice for performing surgery without a surgeon around. Corruption is so pervasive in this country that this isn’t surprising, and I honestly wasn’t even very upset by this graft. This extra fee seemed to me like a roundabout malpractice insurance. Though definitely not condoning it, but it goes to show how quickly one can become accustomed to a corrupt system.