John Kamau’s mother had been ailing for some time, but on March 18, the family rushed her to hospital when she developed symptoms indicating that she had a low blood oxygen level.
At Komarock Modern Hospital, lab technicians conducted the re-agent and polymerase chain reaction (PCR) tests. It turned negative for Covid-19. The family was, however, not satisfied, and they took her for a scan.
The scan showed that she was infected with the coronavirus. She needed to be admitted for treatment, but the hospital’s high dependency unit (HDU) was full. That was the beginning of a desperate search for a hospital that could accept the patient, whose condition was steadily worsening.
“The doctor at Meridian Hospital said she could not be admitted without a Covid-19 PCR test. We were asked to come back the next day because that was when the hospital could conduct the test. We did not agree. Her blood oxygen level was already low and we knew she could not wait. We took her to the Lancet medical laboratory at about 11pm. They agreed to do the test, but the results would only be available after 48 hours. How could she wait for 48 hours in her condition?
“We pleaded with the owner of Meridian Hospital to allow her to be put on oxygen. He agreed, on condition that we produce the test results later. However, when the doctor saw the test from Komarock Modern Hospital, he said we had to leave because there was no bed for Covid-19 patients. We were back to square one. It was already midnight, and we did not know where to start. The only saving grace was that the hospital allowed her to remain on oxygen as we searched for a hospital that could accept her,” Mr Kamu said.
The family started calling hospitals in search of a vacant bed for a Covid-19 patient. The wards at Kenyatta University Teaching, Referral and Research Hospital (KUTRRH), Aga Khan, Metropolitan, Nairobi West, and Kijabe hospitals were all full. Tigoni Hospital had a bed available, but could only admit patients from 5am.
A Covid-19 vaccine dose as pictured at the Kenya Medical Practitioners and Dentists Council headquarters in Nairobi on March 31, 2021.
Limited beds
At around 2.30am, Kamau called a doctor he had worked with several years ago and he referred the family to Ruai Family Hospital. They could admit her, but they had to pay an upfront deposit of Sh150,000.
“We quickly contributed the money and paid. We paid Sh8,000 for an ambulance to transport her from Meridian to Ruai. For the week she was in hospital, we paid a bill of Sh475,000. We had to pay cash because the hospital was not accepting insurance cards for Covid-19 patients,” Mr Kamau explained.
He was disappointed that, although he was paying the monthly premiums for National Hospital Insurance Fund (NHIF) cover for his mother, it could not help her when she needed it the most, because the fund has declined to cover treatment for Covid-19.
His mother’s case is just one of many similar struggles that families are grappling with. Kenyans are scrambling for limited beds, oxygen, and high cost of hospitalisation, if one is lucky to get admission.
“In the past three weeks, our ICU has been full. This means that as patients are discharged, many more are waiting in the wards to take their place,” Dr Jeremiah Gitau, the chairman of the Covid-19 response team, who is also the head of the Accident and Emergency Department at the KUTRRH, said in an interview earlier this month.
In the wake of the first wave of Covid-19 infections, the government disbursed a conditional grant of Sh5 billion to all the 47 counties to bolster their preparedness.
However, a special report of the Auditor General on the utilisation of Covid-19 funds has revealed that only 10 counties have complied with President Uhuru Kenyatta’s directive issued in May 2020 that each county should have at least 300 hospital beds for the Covid-19 response.
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KNH overwhelmed
The 10 counties that have complied are Machakos (525), Kajiado (500 isolation and 20 ICU), Nakuru (458), Laikipia (341), Narok (340), Kilifi (335), Makueni (318), Mombasa (300), Nyandarua (300), and Kericho (300).
Nairobi bore the brunt of the pandemic in the first year. It also received the lion’s share of the allocation to counties (Sh294,385,000).
Dr Kibaru-Mbae, the Director of Health Services at the Nairobi Metropolitan Services (NMS), in January said Nairobi had 1,196 isolation beds set aside for Covid-19 patients, including 95 in intensive care units.
The majority of these beds were in the two national referral hospitals – KUTRRH (476 isolation beds, 24 ICU beds) and Kenyatta National Hospital (134 beds, 7 in ICU). Private hospitals and the three county hospitals handling Covid-19 accounted for the other beds.
However, after low numbers of infections were recorded in December 2020 and January 2021, most hospitals either closed their isolation centres or found it prudent to transfer some of the beds set aside for Covid-19 to serve other patients. This was the case at KUTRRH, which has 182 beds for its isolation wards and ICU. Eight wards with 160 beds were set aside for the general ward and 32 for ICU.
East Africa’s largest referral health institution, Kenyatta National Hospital (KNH), is also overwhelmed, impacting bed capacity, resources, and staffing. The Infectious Diseases Unit (IDU) has six beds with the necessary machines, oxygen, and ventilators set aside for critically-ill patients.
The Mbagathi section run by KNH has a 40-bed capacity and is only admitting those who have tested positive for Covid-19, are clinically sick, and are stable, with no underlying conditions or diseases. The unit that had been set aside for health sector staff who contract Covid-19 in the line of duty was closed due to under-staffing and lack of resources, a source said.
Specialised treatment
The plan was that the section of Mbagathi Hospital that is run by KNH admit patients who test positive for Covid-19, KUTRRH was to admit surgical patients, and the KNH’s Infectious Diseases Unit was to accept critically ill patients.
However, doctors and nurses realised that some of the patients taken to Mbagathi had chronic diseases and were in dire need of specialised treatment. Some were cancer patients, others had kidney failure, neurological conditions, and diabetes, and because of their transfer, they had missed their chemotherapy sessions, dialysis, and routine check-ups. Mbagathi does not have the specialists and equipment to handle such patients. Therefore, the patients were allowed to remain in their wards.
During the Ministry of Health’s Covid-19 briefing of March 17 this year, Cabinet Secretary Mutahi Kagwe asked counties to take care of their own patients.
“Moving forward, it is very likely that counties will have to take care of their own patients at the county level because Nairobi County has got a large population and is already beginning to feel the stress of having more patients than most of the hospitals are able to accommodate,” said the Health CS.
There is a perception that Nairobi hospitals are better, but this is not the case especially if people are not very sick and do not require ICU care.
Other challenges that have added to the pressure include staffing shortages. BY DAILY NATION