We're back.
On Friday, as we were driving to the airport to leave America, the doctors in Nakuru County went on strike, again. Only a few counties have resumed their strike, but the general public health situation in Kenya is, in a word, sad. After 100 days of striking from December to March, the government promised a 50% salary increase among other things. However, the April salaries, paid out a week late, did not reflect this increase, and no salaries for the strike period were released. It's messy. The president claims funds were sent to the county governments, the county governments say they don't have the money, and in the general obscurity of corruption the doctors have once again thrown up their hands and walked out. And as always, the patients pay the price.
We arrived late Sunday night, and showed up Monday morning to see what was happening. Maternity services had been suspended over the weekend, but once Scott showed up the Medical Director cobbled together a plan to reopen. All the paediatric ward patients had been sent home or transferred, except the burn patients who are cared for excellently by nurses. But the newborn unit (NICU) babies had nowhere to go, so I found 25 still admitted. Over the last three days, we've both plunged once again into that ambiguous zone of trying to walk a fine line. We don't want to prop up a corrupt system; but we don't believe leaving the poorest people to die is a good way to effect change. So here we are, again.
This baby, for instance, is alive by the mercy of God. And here is why we work. On Friday, her mom came to Naivasha which is the busiest maternity unit in the region, and offers reasonably safe deliveries to 500-600 women a month. She was in labor. She was told to go find a private hospital because the doctors had just walked out. So she went a few blocks up the road to a small private hospital with questionable standards, who told her that she needed a place with capacity to do a C-section because her baby was in distress. This hospital does C-sections at ten times the cost of Naivasha, so I suspect the real issue was that she couldn't come up with that money. Next she went to Mai Mahu, which is about an hour away. On arrival there, she was close to delivering, and her baby came out covered in meconium with Apgars of 4, 4, and 5. Not good (good = 9 or 10). So they told her, this baby needs higher level care, go back to Naivasha. So she did. 20 hours of run around and poor care and danger, to get back to her starting point. By God's mercy this baby actually is perking up and doing fairly well. But she could easily be dead, or permanently disabled, due to the run-around, due to the finance departments, the governors, the health departments, the unions, the doctors, the broken systems in Kenya and the sadness of this world. Similar story for another baby, same private hospital, this time the family came up with a deposit so they did the C-section. But the mom was Rh-negative, so the baby had a high risk of severe jaundice with brain damage. As the baby became jaundiced, the little private hospital (with no capacity to treat) told them they would need referral, but held on to them for an extra 24 hours until they could clear their bill. Finally they returned to Naivasha. Not sure how that one will turn out yet. 
Here is another reason we work. This line-up demonstrates Kangaroo care. Each of these moms is holding a baby weighing between 1 and 1.4 kg next to her skin (2-3 pounds). I have 9 of them right now, and they are either going to get some antibiotics and tube feedings and daily weights and occasional labs and oxygen at Naivasha, or they are going to die.
Or another reason: Nurses who care. We have some pretty dedicated women (mostly) who are going the extra mile, once again, during the strike, and we like supporting them. Or another: Clinical Officer Interns whose education has been chaotic in the months of uncertainty. I have six now, and they are learning a lot about babies, labs, feedings, xrays. Or another: Scott just got back from doing an emergency surgery on a woman whose uterus ruptured when she went into labor with her 6th baby, after a previous C-section. The baby died, but the mom was saved.
Or one more reason. A 14 year old girl goes missing for 4 months, then is dumped off back in her neighborhood severely anemic, traumatized, not speaking, so her mom brings her into the hospital. This town has some dark pockets of unspeakable evil. A colleague asked me to see her, and she held onto my hand and whispered in Swahili, "I want you to help me. Let me stay here. I don't want to go home." Thanks to my neighbor who volunteers at a safe house down the street from us, we hope to move her there tomorrow. She can get counseling and the staff will help with a police investigation. My heart breaks for her. And I can't conscience her being left with no resource for care.
And this is only the tip of the iceberg of only three days back.
Meanwhile USAID announced they would cut off funding for the Kenyan Ministry of Health. 40% of the Ministry's budget comes from USAID. In subsequent clarifying announcements, America is saying they are "only" cutting funds for administration until the massive scandalous corruption is addressed, and Kenya claims that all TB and HIV programs will continue. Really?
These are hard days for Kenya. We feel the compassion you might feel for a friend who is going through hard times--even if they bring much of the problems on themselves (doctor friend shakes his head and says Kenya has the resources, we should be able to provide health for our people) you still grieve the sorrows.
Yesterday we celebrated 30 years of marriage. May 9, 1987. We were med students, looking forward to this life. 30 years later, we're old(er) doctors who worked all day to plug the holes in a failing system, then went out to our favorite Indian restaurant which is technically a truck stop on the East African Highway. Wouldn't ask for anything else than the ongoing adventure of living day by day with this man, on the edge where evil eats away at the poor, and a simple faithfulness pours out a bit of the world-changing love we have received.
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