On a normal occasion when you walk into a hospital ward, you may not expect to see a cat.
At the Mama Lucy Kibaki Referral Hospital in Nairobi, however, as nurses, doctors and other staff go about their business, a brown cat trots around the ward and disappears under one of the beds at a unit housing newborns.
Nobody here appears bothered by the feline 'doing its rounds'.
In a normal fully equipped hospital, when a patient needing emergency care is brought in, one would expect a gurney or a stretcher to be rushed to get the patient to the emergency room for medical staff to save them.
One would also expect quality service at a facility with the status of a referral hospital named after a former first lady.
But as The Standard found out, Mama Lucy Kibaki Referral Hospital, located between Umoja-II and Komarock estates, 11 Kilometers East of Nairobi, faces teething challenges. Some patients say the facility neither lives up to its name nor its status.
The Standard investigative team visited the hospital five times in four days, between September 15 and September 19 to observe the goings-on following complaints against it.
At around midnight on the first day, an ambulance drives into the emergency area. A woman dressed in a white jacket and green trousers, medical service uniform, jumps out of the vehicle and walks into the hospital.
She is looking for a gurney to wheel the patient in. She walks around the block and after a minute and 25 seconds, as our clock records, she comes back with a wheelchair that is fastened onto a white plastic seat.
We watch as she wheels a half-unconscious patient into the emergency area and somehow stands there with no one to receive the patient.
The patient is wheeled into a room. Medical staff in purple and blue uniforms are seen moving about, assisting where they can. It is certainly going to be a long day for that new patient. Many patients are here and are in distress, some are in wheelchairs. One is supporting his head with his palms while his elbows are getting support from his thighs.
Some got lucky and are now lying on the metal gurneys; A woman is kneeling on the gurney in a bow-like posture her hands stretched and her head hidden between them.
A man is on the other gurney lying heavily on his right hand, his knees folded so tight that they are touching his chest. The other patient is lying on his back, eyes closed, his left hand covering his head from the left side. We move to the wards; there's construction going on in a ward that has new mothers. The room consists of five beds; each bed is shared by at least two patients. There's no privacy for the new mothers.
Male contractors are drilling and painting the walls. They play loud music as the mothers, some who are still in pain, keep changing their clothes, and others try to catch some sleep before going to the nursery to feed their newborns.
In the male ward, a teenager is lying on a bed. His injured right leg is oozing blood. The bandage and the bottom side of the bed are soaked in red. The female caregiver handling the youngster says the nurses claim the bandage was changed. The teenager refutes the claims.
"Kutoka Tuesday sijabadilishiwa bandage. Leo ni Thursday (They have not changed my bandage from Tuesday and today is Thursday)," he says.
He tells The Saturday Standard team that he was injured by a wheelbarrow after it was hit by a lorry three days ago. The accident happened at an estate he does not disclose. He was taken to the theatre two days after the accident.
Patients in that ward complain of mosquito bites and that the bedcovers cannot shield them from the cold at night. Outside the male ward, a woman is contemplating bringing a sweater for her child.
"They don't even allow us to carry sweaters. I will have to bring one," she said.
On the same floor, a nurse is asked whether one can be allowed to bring a mosquito net. "We do not allow. But I will ask the management," she says.
"They have told me to come back after two weeks to check if they will have my drugs," says a patient outside the hospital pharmacy. "The other option is to buy outside."
"These public hospitals! I am not even sure I will get mine," another patient seated on the bench outside the pharmacy chimes in. "They will tell me to go and buy outside."
The following night, a family is seen stranded in the corridors. Upon inquiring, the investigative team found out they had been told to go and buy drugs from a pharmacy out there.
Bled to death
"Babe make sure you buy Nan (powdered milk) for the twins." Those were the last words that Robert Omondi, 28, heard from his wife hours after making him a father of twins.
Omondi is now withdrawn and wears a disturbed look. During our interview, he looks up and down as if in search of answers to questions that whirl up in his mind. He had a bad experience at the hospital. He tells us his story.
In a distant voice only nine days after walking into an ICU where he broke down and cried uncontrollably on his wife's lifeless body, Omondi says he wonders how he will take care of the two boys born seconds apart.
On September 5, two days before her due date, Maureen Anyango - now deceased, was preparing supper. She went into labour. Together with her husband, they rushed to Mama Lucy Kibaki Referral Hospital. They were helped by Maureen's sister and friend to get her to the hospital.
"She used to go to the clinic at Kwa DO in Kayole," Omondi says, "and that was where she was scheduled to give birth. After a checkup, they said her blood pressure was too high and referred her to Mama Lucy. They provided an ambulance that took us to Mama Lucy. We arrived at 10:45pm."
Omondi was disturbed when he was stopped from helping his wife with registration at the hospital. "I tried telling the security man to allow me to enter and assist with the registration. He refused," he says
Anyango would deliver through Caesarian-Section the following morning. Omondi went to see her at around 8am. He found his wife in a bad state.
"The twins were beside her covered with a shawl and my wife told me only one had breastfed. So I tried to help with the other one but she was weak," he says. Omondi noticed the bedding was soaked in blood. The blood was running through the intravenous pipes. He would try to alert the nurses whom he claimed ignored him several times.
"One nurse shouted, telling me to remove the syringe on my own. So I did. But the blood between her legs was too much. I kept exchanging cotton wools until we gave up," he says.
Omondi says the other patients raised alarm when blood started dripping on the floor. That was when the nurses came and rushed her to the theatre at 2pm.
"Even in pain, she thought about the twins, and told me to buy Nan...those are the last words I heard from my wife," Omondi says, his voice breaking into an inaudible murmur.
"Eh, kumbe ame bleed to mingi hivi," (Eh, she bled too much) said one of the nurses when they came to clean the bed.
At 4pm, Omondi received a call from one of the doctors to the effect that his wife bled too much. She needed three pints. She was now on the second one. At around 7:30pm, Omondi was called again and was informed that his wife was on oxygen. There were plans to refer her to a different hospital.
"A nurse came and told me they tried to get a bed at Kenyatta National Hospital but were not successful. The only other available hospitals were Machakos Level 5 and Kenyatta University Teaching, Referral and Research Hospital and they required Sh200,000 in cash. I did not even have a shilling," he says.
After telling the hospital he could not raise the money, they would later come and inform him that Anyango would be transferred to Kiambu Level 5, where they will not be requiring cash before admission.
From 9pm to 12:30am they waited for the ambulance. "They brought her out with oxygen and pipes allover. The nurses were not even sure where the pipes were to be put. I even had to carry the oxygen cylinder," he says.
They reached the hospital at around 1:10am. Anyango died the following morning at 7:30am.
The lawyer representing the family Bonventure Otieno says what befell Omondi and his wife was a case of pure negligence from the hospital.
"Already the DCI is investigating the matter, and we are expecting the county government will respond as well as different councils representing the nurses and doctors in Mama Lucy to respond. We will take the next step once we get the report from the DCI," says Otieno.
I watched him die
In another case, a woman believes her nephew, an accident victim, died as a result of lack of equipment and failure by the hospital to act in time.
Prof Emily Rogena, a medic herself, received from her elder sister on the night of Sunday night September 11.
"My sister who is in Kisumu was informed about the accident by a lady in Nairobi. The lady said the doctors could not attend to Eddy until the next of kin arrives. My husband and I rushed to the hospital," she says.
On the way to the hospital, they tried getting ambulances and ways to transfer the young man to Kenyatta University Teaching, Referral and Research Hospital.
"He was lying on the floor next to a black wheelchair. I covered him with a shawl that I was carrying. He was very pale. I examined him and there was no fracture. The only obvious injury was his right eye. It was closed but the left eye could see me," she says.
Prof Rogena walked into a nearby room and found two doctors stitching patients that were in stable condition. She was a medic herself and one of the doctors who came to assist her was her former student.
"They examined him, they were struggling with the blood pressure. He was pale. Those were two danger signs for me," she says. The ambulance arrived but it was too late, Eddy took his last breath.
"Just as we were entering the ambulance, I saw him roll his eyes and die in my arms. At first, I thought he had collapsed and he needed resuscitation," she says.
"My husband and the doctor tried to do cardiac massage and put the Ambu bag, but the Ambu bag could not even fit the oxygen in the ambulance. I rushed to the hospital to get a laryngoscope but there was no resuscitation kit at the nurse's desk," she says.
Reached for comment, hospital Chief Executive Officer Emma Mutio referred us to the Director of Health Services-Nairobi County, Dr Ouma Oluga.
Dr Mutio said she could not speak on behalf of the hospital since it is managed by the county government of Nairobi.
"The correct place to get information is the office of the Director of Health. That is the protocol, you know this is a county hospital," she said.
Dr Oluga referred us to the Governor's Office saying he could not speak after his boss had made an address after visiting Mama Lucy Kibaki Hospital soon after the death of Omondi's wife.
"The governor addressed this issue when he visited Mama Lucy Hospital. It would be better to get in touch with his office."
Oluga then sent a text message, "Did you seek authority from Governor's office to interview staff at Mama Lucy? Perhaps a written request so that they can be free to give you all or any relevant information. It is a courtesy. And Standard Media Group can write to the office to grant access. There should be no need to refuse such permission so that staff don't hide while doing interviews."
Efforts to reach Governor Johnson Sakaja have been futile. Phone calls, text messages and emails have not been answered. On September 11, Sakaja visited Mama Lucy Kibaki Hospital. He promised to increase bed capacity and expand the hospital.
"There's need for other facilities to be working. If we fully equip and revive the one in Kariobangi, we will reduce the pressure here," he said.
The Governor later appointed a task force to access, review and propose reforms in the county's health sector. The team is expected to among others; assess the status of all public health facilities and review the supply chain management of pharma and non-pharma products.
A healthcare provider at Mama Lucy Hospital, who spoke on condition of anonymity, said the biggest challenge at the facility is lack of personnel.
"I am not excusing the medical negligence claims but we are overwhelmed. The hospital caters for the entire Eastlands area. That plus inadequate manpower can be overwhelming," the source said.
The healthcare worker added that they get criticisms from the public who do not realise some of the issues are beyond them.
"It's easy for the public to think it's negligence but on the ground, things are different. Again I am not excusing the negligence cases but burnout is crazy," the source added.
The General Secretary of the Kenya Clinical Officers Union George Gibore says negligence claims can be qualified on certain contexts.
"When you say there was negligence, was it that a health professional attending to this patient lacked requisite medication that ought to have saved a life, or did they conduct a procedure which was not necessary? Was this patient not attended to or attended to partially," he said.
Gibore added that there is need to look at how to address gaps which contribute to what can be called medical negligence.
"Ensuring we have enough supply of medication, ensuring KEMSA is doing its work, healthcare workers are doing their work, the leaders are doing their work by ensuring we have everything that we need in the hospital," he says.
What is ailing the health sector is poor planning, said Davji Atellah, the chairman of Kenya Medical Practitioners and Dentists Union.
Attelah told The Saturday Standard that in the last five years, many hospitals have been built while there's a shortage of personnel.
"There's a big shortage of doctors, nurses, nutritionists, and the labs are not operating because of lack of equipment. So there's need to ensure all elements of a working health care system have been put in place," he says.
Dr Atellah says there could be a deliberate effort to ensure the public health sector does not work so that the private sector thrives in the process.
"Currently, 80 per cent of the funds collected by NHIF go to the private sector. However, the accredited facilities in NHIF are 75 per cent public sector and 25 per cent private sector. So it's a prerogative of every county government to ensure doctors are employed, there are drugs in the facilities and pending bills to institutions like KEMSA are paid," he says.
The Kenya Medical Practitioners and Dentist Council said in a letter to The Saturday Standard that it has an elaborate mechanism for handling negligence claims. Such claims are handled by its Disciplinary and Ethics Committee under the Medical Practitioners and Dentists Act, Chapter 253 of the Laws of Kenya. The letter signed by CEO David Kariuki, however, did not indicate whether it the council had received a complaint about Mama Lucy Kibaki Hospital. It did not also indicate whether an inspection had been carried out the facility.