Kapsabet County Referral: A portrait of a sick hospital

It is 4.45pm on a Tuesday at Kapsabet County Referral Hospital and multiple patients flock the casualty area, majority in critical state. But at the consultation room, patients crowd due to delays caused by shortage of basic supplies such as syringes, cotton wool and antibiotics. Patients have to buy them from private chemists.

At 5.12pm, a patient in his early 30s is brought in by an ambulance. He lies unconscious on the stretcher. Anxious looking neighbours accompanying the patient inform The Standard that he attempted suicide.

Seven minutes later, a nurse comes from Consultation Room 1, pinches his ears and shouts: “Fredrick”.

At this point, Fredrick does not get much attention - he requires resuscitation, but there are no drugs.

The nurse drafts a note, and asks the neighbours to buy medicine at a private chemist. The medicine costs Sh1,060. It is brought in at 5.33pm, and he is placed on treatment.

At Consultation Room 2, the body of an elderly man has been lying for about an hour, according to an employee at the hospital.

At 5.34pm, a mortuary attendant wheels in a trolley and collects the body to the mortuary. The deceased was reportedly referred from Lessos dispensary and was not accompanied.

At the plaster room, Kiptoo, 28, is yet to be attended to. He lacks money for plaster and medicine. His right leg is swollen, an open wound now bleeding. He was taken to the facility after being hit by a vehicle. “What was the point of coming here,” he says, then adds: “I am hopefully waiting for my sister to buy required medical supplies so that I can be treated.”

He is supposed to pay Sh1,200 for plaster. By 8pm, the medics at the plaster room leave the patient unattended - he is told to wait for the night shift team. However, we establish that doctors do not do night rounds.

A nurse at the outpatient unit tells The Standard there has been shortage of basic medicine and supplies at the facility for the past one month. Some patients claim some nurses walk with some drugs that they sell to patients in need.

This is the state of Kapsabet Referral Hospital in Nandi County.

It is difficult to identify patients from visitors at the wards, as there is no specific uniform for patients. The patients carry blankets to the wards, with some spending cold nights on mackintosh mattresses. “I brought my blanket from home because I was not given any at admission,” said Fred Koskei, a patient.

The hospital’s dysfunctional problem extends to wards, where in-patients are kept waiting for doctors for long. Koskei, 38, an amputee, says his wound has not been dressed for the past two weeks. “I have been pleading with nurses to clean my wound, a plea they ignore. I am prompted to use drip water to clean it myself,” says Koskei.

The businessman was involved in a road accident in November last year, and one of his legs was amputated at Moi Teaching and Referral Hospital (MTRH) in Eldoret. He was later admitted to the Kapsabet hospital and now claims his condition has worsened for lack of attention.

“My foot was swollen and the pain was unbearable. I was not attended to, which caused my leg to rot  and it was unfortunately cut. I went to theatre two times,” says the patient, adding that he buys painkillers and drugs to manage pain.

“I better be discharged, go suffer at home, instead of watching people die. That affects my mental health,” he says.

Next to Koskei is a 50-year-old man groaning in pain. He has been wheeled from theatre. He suffered a fracture after an accident. “Why can’t nurses give me painkillers,” he poses.

The patient came out of surgery at 8pm only to be put on painkiller drip at 10.40pm.

A spot check by The Standard establishes that there are two nurses conducting ward rounds (injecting and giving drugs to patients) between 8pm to around 11.30pm.

Patients cite negligence and laxity by health workers.

Faith Chepkoech, (not her real name), says she was admitted to the hospital on November 29, last year when she was due for delivery of her baby.

At 4am the next morning, she developed complications. There was no doctor to attend to her. A doctor arrived at 8am and recommended C-Section, but the hospital theatre was not functional. Chepkoech was referred to a private facility where she had a stillbirth.

Before referral, she had bought drugs at Sh250 to keep the unborn baby’s lungs functional. “The pain of losing my child still hurts. Why did the hospital admit me knowing the theatre wasn’t operational,” she says.

As one ventures inside the ward, there are bins overflowing with medical waste. They are left open, putting patients and medics at risk of infection. The female ward is not clean, and the bad odour emanating from medical waste on the floor and open bins is repulsive.

It is shocking that among the highly infectious waste at the wards corridor is a placenta bin. It is labelled and has other waste, including body tissues and anatomical waste. A trainee nurse tells The Standard she does not know when the waste will be disposed of. “A number of patients have been operated on, and the body tissues are kept in the bin. It is upon cleaners to dispose it,” the trainee says.

An employee of the hospital tells The Standard majority of patients are referred to MTRH due to shortage of medical supplies and human resource. The ICU is not fully functional due to lack of staff to run it. It is also not fully equipped.

The radiology unit is fully operational, but tests are sent to MTRH for review, as there are no radiology professionals at the county hospital.

The modern medical equipment were installed at the hospital through the Medical Equipment Programme (MES), but as patients struggle to access healthcare, Governor Stephen Sang says the health sector in the county has greatly improved under his tenure.

Speaking to The Standard after being asked about the bad state of Kapsabet Referral Hospital, Mr Sang rather speaks about the health sector in his county in general, saying he had improved infrastructure, human resource and matters of key equipment.

“For over 50 years, Kapsabet had only one operational theatre, and patients would be referred to MTRH, a practice that has since stopped with installation of modern medical equipment,” Sang says.

He says the county has four theatres, and that there are plans to set up three more at Kabiyet, Serem and Chepterwai, with a total 15 ICU beds.

“We have increased allocation of pharmaceuticals and non-pharmaceutical supplies from Sh60 million to Sh250 million in the past five years,” the governor says.

But he remains unclear on why there is shortage of basic medical supplies at the Kapsabet and other hospitals in Nandi County.

“There is increased number of patients seeking care in public hospitals, which might be straining on supplies. Legislatures should however come up with laws to allow counties to procure drugs from other entities, away from Kemsa,” he says.

In the 2014/2015 financial year, the total allocation for the county was Sh5 billion, out of which Sh1 billion was set aside for health.

In the current budgetary allocation of Sh9 billion, Sh3.3 billion has been set aside for health. This is 37 per cent of what the county receives.