Kenya Doctor Strike week 11: same tune, another verse . . . bearing witness

This strike may feel like it's been a lifetime long, but for some that is literally true.  The baby above I transferred to our nearest mission hospital the day before the strike started in December . . . and she not only survived but thrived, back for a check-up visit with her mom.  If she had not been shuttled between Naivasha and Kijabe, two places trying to offer a safety net of emergency care, she would not have lived.  So today, let us bear witness.  This is what health care looks like.  A fragile life plumped out, a mother and her smile.

The small successes help us make it through the week, week after week, as the strike drags on.  The union-leaders were arrested briefly, sparking a call for all mission/private hospitals to join in closing down.  A few of the biggest Nairobi for-profit places did a slow-down, saying appointments were canceled and doctors were at a "meeting".  The jailed leaders were released pretty quickly, but no word on change.  The public, resigned as always to a harsh world with little guarantee, trudges on, making do.  The complexities of the situation make negotiation extremely challenging.  A government steeped in accusations of graft lacks the moral footing to speak for the poor, or justify failing to meet the rather dramatic promised perks (massively increased salaries and allowances, loans, training positions, funding for research).  County governments hide behind the National leaders claiming impotence; and vice versa, all the while continuing to gather in their own benefits as the public institutions crumble.  A health care profession who has now turned a blind eye (some very painfully and reluctantly, others with a conviction of the righteousness of their cause and their entitlement to a richer life) to un-marked thousands of deaths nation-wide keeps digging in as the stakes become too high to turn back.  The clinical officers and nurses who try to hold up a minimal net of care are blamed by the doctors for disloyalty or overstepping bounds, unappreciated by the public who continue to suffer, and taken for granted by the government who has failed on more promises to other categories of health care workers as well.  Rumors of more strikes to come.  Bitterness grows.  The narrative becomes more and more about money, about broken trust, about deserving better.

The dry-season air snaps like a tinderbox.  It feels edgy and explosive.

Today, as I was examining patients and writing notes in the room with the sickest babies, an unfamiliar nurse entered the unit and chatted with our nursing staff for ten or 15 minutes, in one of the outer rooms.  Surprisingly after a long friendly visit, they then brought a pink blanket bundle in to my room and announced 'we have an admission for you, a preem.'  I brought the bundle to the bed and opened it, to see a grey stiff little premature boy, his arms and legs extended in a hypoxic seizure.  He was deathly cold, not breathing, but a heart rate still present and low.  His mother had had a complicated pregnancy in Nakuru, the county seat of our county, a much larger town.  She went into labor at 29/40 weeks, landed at a private clinic and delivered this baby at 6 pm the night before, but there was not a single place in this major town that would agree to admit this baby.  The small private hospitals all said they were full, the public hospital was shut down, a pediatrician could not be found, any private clinics functioning said they didn't take preems.  He was left on the only source of oxygen overnight in the operating theatre, and then this morning someone in the family figured out Naivasha was open, so put him in a blanket and an ambulance and drove him out to us (about 2 hours).  It took me a long long time to ventilate and oxygenate and warm and treat him back to life.  I don't know if the damage was too great, for too long, or if he's a fighter looking for a miracle.

So, bearing witness once again, this is what a strike looks like.  

A vulnerable boy, born 11 weeks too soon, no room at any inn.  Finally and desperately brought to our public hospital, because we have one courageous director who is trying to be compassionate and moral in the midst of crisis.  For every baby that finds us, how many die in their village, or on the way?  Dozens?  Hundreds?  More?

For every emergency Scott has responded to, late night bellies full of blood from a ruptured tubal pregnancy, mothers with a womb starting to tear from a labor that is obstructed, babies whose brains are starved for oxygenated blood . . . how many don't make it to any care at all?  He just rushed back to do his 51st surgery since we returned in January.  This is just one smallish place.  Multiply that by hundreds of towns all over Kenya where those 50 life-saving operations aren't occurring.  Surely the toll is in the thousands by now.

And even though we are working at a punishing pace, we can't always be there, and we can't save everyone even when we are.  I lost a 660-gram 25-week baby girl, though she stayed with us about 24 hours.  Her peculiarly bruised head raised questions of whether she was the second baby this week who came out unexpectedly alive after attempted abortion, to desperate moms.  The staff tells me that another who died after coming in floppy, seizing, in kidney failure from dehydration, exposed to HIV, was born after two unsuccessful attempts to abort earlier.  We sutured up a 1 1/2 year old who had been raped by her step father.  We are working to revive a 10 year old with AIDS and neglect and hunger.  Passion to stand against this tide of sorrow, compassion to touch and comfort in this flood of woe, should be the essence of medical care in Kenya.  Evil is out to crush the vulnerable.  It is only by a consistent word of truth, a conscious effort to not love our own lives too much, that good pushes back (Rev 12:11).

So, as we plod on into week 12 . . please keep praying.  Revelations 12 carries the image of a baby-swallowing dragon, a mom in labor.  It's more than a fanciful dream; it is what we see every day.  By pitting one group against another group, the dragon fills its belly.  

What would healing look like?  Leadership that operates with such integrity and accountability, it can be transparent.  Decisions about salaries and infrastructure and oxygen tubing and clean water that are made based on common good and justice, not personal or tribal or class ascendency.  Scores of young people who enter this profession, and stay there, learning from each other, motivated because they can actually do some good.  Willingness to work, hard, and rest, regularly.  Teamwork and respect on all levels.  Innovation and hope.

Pray we live to see the day, or at least the first tinges of rose on the clouds of that dawn.