The Alma Ata declaration of 1978 underscored the importance
of Primary Health Care (PHC) as a component of Universal Health Coverage. In
Kenya, a signatory to that declaration does value the role of PHC in healthcare
delivery. As such, our health care system is arranged in 6 levels of increasing
volume and complexity.
Level 1 is composed of the community health volunteers
incorporating the community members. The dispensary is at level II; Health
Centre is Level III, with the Subcounty Hospital being level IV. The County
Referral Hospitals are at level V while level VI is composed of national
The existence of such an elaborate system enables the
country to have a clear chain of command and communication when dealing with
outbreaks (whether communicable or not).
Level I health workers form the backbone of PHC. They
collect data on births, deaths, and a retinue of health parameters covering
every household in their communities in liaison with the government
administrative officers. It is such a beautiful system.
When health emergencies occur, we should not sideline such a
system and demand a new one. We should just beef up our existing system. That
is what should be the case in light of the COVID-19 pandemic. The formation of
the COVID-19 Emergency Response Team does not torpedo our existing system. It
gives them a clearer chain of command and a heightened sense of urgency.
In light of the dusk to dawn curfew imposed by the
government of Kenya as a containment measure for the pandemic, most Kenyans are
left in a lacuna of how to deal with medical emergencies occurring at
The big questions remain:
What happens in the event of an accident at home (children
falling off stairs, suffering burns), or a heart attack? What about the lady
who goes into labour?
Is there a number to call?
Are there enough ambulances to take them to the hospital and
Does the patrolling police officer act as the triage nurse
and determine that someone is seriously sick/injured and needs to allowed to
proceed to the hospital?
Do we postpone seeking medical attention until 5 am?
I had wished away these questions and worries. When I posted
them on social media, I was shushed. I was told the healthcare workers are
essential services and are permissible to travel during the curfew.
Those of my friends in the law enforcement agencies told me
there are means in place to ensure those in need of medical emergency are
allowed to go to the hospital even during the curfew.
As Alexander Pushkin observed, a deception that elevates us
is dearer than a host of low truths. The low truth is that most healthcare
workers do not know what those measures are that are meant to ensure those in
need of emergency medical attention during the curfew can feel comfortable to
stray out of their homes to the nearest health facility.
One of the Kenyan media outlets has published a story of a
pregnant woman who needed such attention. She summoned the only available means
of transport in rural Kenya- the ubiquitous boda boda. When the boda boda rider
was getting back home after dropping the expectant lady at hospital, the media
house reports, he was clobbered by the police as he was breaking the curfew. He
has succumbed to his injuries. One hopes that this is not true!
That means the next boda boda rider will not come out to
take the next patient to the hospital.
Sadly the next patient may be one suffering stroke with just
a two-hour window to reverse brain damage; waiting till 5 am will mean death or
permanent paralysis. It could also mean the pregnant mother with obstructed
labour where every passing minute without access to caesarean delivery brings with
it the reality of delivering a stillborn, or a child with cerebral palsy, and
changing a family's lifestyle forever.
In trauma, we talk of the golden hour during which patients
must reach the hospital and be attended to. Otherwise, mortality rises. And as
experts have argued ad nauseum, trauma mortality supersedes that of
HIV, tuberculosis, and malaria combined.
Posts after posts on social media are awash with medics
decrying the above issues. The Kenya Medical Practitioners, Pharmacists and
Dentists Union (KMPDU) has strongly called out the police for harassing its
members (read doctors) despite them having the necessary clearance to work
round the clock.
Let the fight against the coronavirus pandemic not be more
dangerous than the virus itself.
Research from West Africa has found out that access to
emergency caesarean deliveries reduced by up to 40% during the Ebola outbreak.
It is easy to take our feet off the pedal and ignore other emergencies to our
In the ongoing environment where Kenyans are flooded with
gigabyte upon gigabyte of often alarmist health information, I would not like
to do that.
I have two suggestions on how we can improve on this.
Firstly, I welcome the ministry of Health's suggestion that
all elective surgeries be put on hold. In fact, all elective (non-emergency
problems) should be put on hold so that we address the emergencies only. That
way, we protect our financial and Human resources that are likely to get
Secondly, it will be wise for the community health
volunteers in tandem with the assistant chiefs and village leaders to be put
"on call." Seeing as we do not have enough ambulance services to
reach every nook and cranny of the society, the community health workers and
volunteers should have access to the security agencies and be issued with
special "passes" which they can then issue to the boda boda rider or
taxi driver to take the injured or sick to hospital. It is easier for the
police officers enforcing the curfew to recognize such passes and allow the
concerned driver/rider and patient to proceed to hospital and back. These
should then be surrendered the next morning as soon as the curfew is
Our mantra in medicine is "diseases do not read books." At this hour, I would like to add, 'diseases do not respect curfew.'