Sicko !

Wow, brilliant film this...

If you’ve not watched this movie, you must. Michael Moore is a brilliant cinematographer and he certainly didn’t let up in this ironic angle on the American health care system, with comparisons with erstwhile looked down upon states like Cuba. It’s remarkable how big business has taken hold of such an important and basic element of American life.

In one scene in the film one woman, unconscious when she is put into an ambulance, is billed for the trip because her insurer says it was not pre-authorized. Now you wonder how could she get authorization for the ambulance ride when she was out cold on the pavement? Yeah, that bad.

Towards the film's end, he discovers that Jim Keneflick, proprietor of the web's largest anti-Moore website Moorewatch.com, is going to be forced to shut down his site after his wife becomes ill and he can't afford the $12,000 needed to pay for her care. So, keen to protect Keneflick's right to free speech, or so he says, he sends the money to him. Jim is especially grateful for the anonymous contribution. It is only revealed that it was from Michael Moore, when the film is released.

The movie as described by some movie reviewers and critics..

“acidic new documentary about healthcare”

“Michael Moore's litany of horrors about the American health care system, which is run for profit,”

“It's those personal stories, of ordinary lives destroyed one form letter at a time, that make "Sicko" so powerful.”

"It's not impossible that this bitterly funny, bitterly sad call to alms could move reform back up the political agenda. For that reason alone, you owe it to yourself to see this movie."

“It’s a really brilliant movie this, and surreal”

A must watch.

tHE mEDiCinEmAn.

like i said, "Interns don't blog!"

September? Is that the month already? I have to say, I must have been amazingly lazy or incredibly busy these couple of months.

And which is it? Well, a bit of both actually, and so much has been happening. .

For one, I got done with maternity..
Praise God? (Did I hear an Amen?) 3 months of sleepless calls and tonnes of work. I would describe maternity, for lack of stronger adjectives, as laborious and painstaking. Not to mention the kind of pressure everyone puts on you. If anything so much as goes wrong, then you’ll have to explain why 10 minutes after being called, you were still trying to find the bearings out of your bed..

Weekends lost meaning, because more often than not, I’d be on the maternity floor, or theatre working as usual. More of my tales of terror with pregnant women later though.

I’ve now done 2 months of Internal Medicine and have one more to go. This is probably the most relaxing department ever! The calls are light, no emergency surgeries at night and I mustn’t forget the free afternoons…

Then got my internet connection (finally!) and now I’m on the information superhighway like a fish to water. So much to read and learn on the net, that even sparing a moment for my blog has been difficult. But I’m confident that this is the first of many more posts to come.

tHE mEDiCinEmAn.

So many firsts..

First, let's start off with why i've not blogged for, well... such a long time. Simple really. It's the department i moved to from Paediatrics. The good people in KNH call it Obs & Gynae, we, on the other hand, prefer to call it Maternity, Mat in short.

The first first, was me doing my first caeserian section, alone, yipee.. Oh, and that was before i delivered my first baby. hehe..

Another first, the number of hits on my blog pita'd the 1,000 mark. I was always looking forward to that.. now if only 1 of every 10 of those peeps left comments.. hmm..

Then i almost hit another first. I almost got internet in my room, save for a couple of 'gentlemen' that couldn't admit that they couldn't do the job.. story for another day by the way.

Got my first salo'... Making friends became so easy suddenly. Humans!

... i'll add a few more firsts in my next blog, for sure. Keep it locked. And also tonnes of storo's from the Realms of Thika Maternity..

Oh, and guys, props to your mothers. I swear! The kind of sh*t (literal shit and otherwise), pain etc that they went thru' to bear you, is to put it mildly, excruciating. So, big up for my mum!

& i'm back!
Laterz,
tHE mEDiCinEmAn.

in the business of saving lives..

I've only got one more week to finish my internship weeks in Paediatrics, and boy i'm i glad!
The other day, i was in our acute room... (that's like the Paediatric E.R. at this here district hospital) and i was thinking..

"hmm we must have gotten really good at this."

Gotten good at this, you see, since, it had been more than a week since a child passed away! A personal record, that i felt quite proud of. So there i was, happily remembering that i had only slightly more than a week b4 i was done with screaming babies and endless ward rounds every single morning!

I don't know if i imagine the headache, lakini, i suddenly felt like a pile of bricks had dropped squarely on my head. The nurse i was working with announced that "the child there in the corner doesn't look too good", and as i glanced at the said corner, i could see the mother sobbing and this one dedicated father holding the oxygen prongs on the child's nostrils.

"Oh dear!" My worst moments in the ward usually start this way. Well, actually they start something like... "Daktari, mgonjwa hapumui!" And right there, u've to jump on your feet and do something, anything... usually heroic, heroic-like or somewhere in between.

Back to the story. So this particular kid was gasping at every breathe it could muster, and after 11 weeks in that ward, you can almost tell how long one has to live. A very unnerving skill, and for this kid it wasn't very long. The child's dad didn't make it any better when he confided in me that this was his only kid, and only 1 year after he was born, it would be cruel for him to join his maker.

Time was of the essence, and i proceeded to fix a line. As expected, the kids veins could just not be seen. But we did not give up. Pricked and poked his arms, his hand, his scalp, his neck.. yet nothing. Things seemed to get frantic, the mothers sobbing only got louder, and everyone else held a deathly silence. (deathly, how apt!) .. strapped his leg to look for a vein there. Don't know if it was luck or 11 weeks of experience, but we got it. Felt like time for a war cry just there.

Victory was ours! Having given starting doses of some acute drugs to help the child breathe better i left, felt a bit like i was walking on air. Another young soul saved.

The evening was young and we had been invited for a dinner organised by a drug company to launch a new product.. (more like bribing us with food.. but that's a story for another day.) And we ate and made merry.

I wasn't on call that night, but i really wanted to know how the child i had left earlier in the acute room was doing. When they say life isn't fair, they really mean it. Being a resource poor setting, our 'mortuary' (prior to a body getting to the actual hospital mortuary), is an isolated bed,(or is it cot) placed near the door to the acute room, just as one gets in. And like a really bad movie, was the body of that kid, wrapped in a leso and labelled with his name, well in sight for me to read.

Uuuh!! It's a nasty feeling that. Yo' only consolation is that you did the best for the patient, and many others have survived, thanks in large part to yo' efforts. But ooh! it ain't consoling.. ..not one bit.

Laterz,
aNGuiShEd mEDiCinEmAn.

The mighty shilling..

Warren G's hit, "I want it all.." had it's chorus going like so

I want it all; money, fast cars
Diamond rings, gold chains and champagne
Shit, everydamn thing
I want it all; houses, expenses
My own business, a truck, hmm, and a couple o' Benz's..

I’ve never thought doctors earn enough. Ok, so almost every working Kenyan thinks they don’t get as much as they deserve, for all the nation building they are involved in, kaaaazi hio yote. (Well, MPs still want to earn more, despite not working at all.. Lakini that's a for another day.)

Caller No. 1: My doctor drives a Merc, he bought 2 months ago. And how does one sleep at night after charging you 2,000 shs to ask you a couple of questions and spend another 5 minutes listing a remarkable assortment of drugs worth another 3,000 shillings? Kwanza wakatwe mshahara! Shindwe kabisa!

Hehe… I think I already know which doctor this must be. The difference is this dude and myself is that he's a consultant, and a specialist in his field, and for sure, he’s gonna charge an arm and a leg for his years of hittin’ the books.

At the bottom of the food chain, however, is the eager, i-use-a-matatu-but-look-i’m-a-doctor, kind of chap, who, for the first few months at least, is excited and happy enough to have a new title and shiny badge to prove it.

That’s kinna us.. the medical interns. Enyewe, if there were ever misused persons, we would be them. My consultant visits the wards maybe 2wice a week and barely spends an hour or two, to review difficult cases, or just complain about this or the other. And for this, grosses around 150K from Sirikal every month. I wouldn’t want to imagine how much more she makes from her clinic and hospital consultations. My colleagues and I who slog away the whole day and night, weekends and public holidays, (did I say weekends?) earn 20K basic salo. Well, it’s not that bad, coz with my house and non-practice allowances it fikaz more than 30. Not bad for a recent campo graduate. So why am I complaining?

Caller No. 2: My doctor drives a Bima and lives in Runda. In fact, I want my son to do Medicine…

Me: wololo! Poor son.

Caller No. 2: I know he’ll be guaranteed a job once he finishes...

While I wouldn’t want to discourage any “neurosurgeon wannabe’s”, tread carefully. First, it’s confirmed that starting this year, interns finishing their internship are not guaranteed jobs with the govt. And just to make sure we don’t get any funny ideas in our minds, (u know, like a guaranteed job), they got us to sign contracts indicating that our 12 months employment was temporary with no bearing on future employment.

The other day, I was going through pay slips that had been carelessly dropped in the doctors’ room. I noticed something rather amusing. Most of the doctors were getting a non-practice allowance of 15,000 shillings. Amusing because, I can’t see how that amount will dissuade these doctors from not engaging in private work. Sample this, for part time work at a private institution, one can make that amount in less than a week, and that’s in one’s free time. So what makes the govt. think 15K will make these doctors focus their energies in the public hospitals? It’s not hard for one to rationalize on why he’s left work early to get to head off in search of more money.

Now if I was a neurosurgeon, I’d probably make 15K in a few minutes. And I can see why every top student in Kenya wants to be one. It’s challenging, And would certainly make for a captivating topic at those social events.

This-one-Thinks-Amefika: … so I had to call my agent in Dubai otherwise the cars were not going to be let thru’ the port. That’s when I realized that calling via satellite is so expensive. (laughter..) And what do you do..

Top-Student-Now-N’surgeon: I’m a brain surgeon. There are only 10 of us in Kenya you know. I was the ninth. So you were saying you import cars? From Dubai? Fascinating..

It’s interesting how many of these dreams slowly fade away during the first few weeks of 1^st year, and focus shifts to passing the next CAT…

Anyhow, since I’m not a neurosurgeon, and I don’t think 30K+ a month is enough for saving lives (and that includes nights and weekends) I concluded that I was some what short-changed and I’ve been thinking about several options I could have next year, now that I’m not even guaranteed a job! (Not that I would have taken it up, but that’s beside the point.)

Any ideas? Drop a comment.

5 years? I think i'm getting a headache...
Laterz,
tHE mEdiCinEmAn.

Risky business..

It’s a pity that yo’ never told about those dark aspects of anything you are getting into. Until you actually do and find out for yo’ self.

Actor 1: Oh, kumbe you didn’t know that? E! Si uko vibaya?

You: Wat do u mean, kumbe I didn’t know? You could at least have said something, anything!

Actor 2: Pole a guy..

You: Pole ? I’m messed!

Actor 1: Well, I thought it was general knowledge, you know, common sense?

You: Common sense? Lord in heaven! What sort of people are you?

Actor 2: By the way, it was even on radio. Kwani you don’t shika Kiss @ yo’ place?

You: Kiss? I think I need to leave before I throw bottle at someone!

------------------------------------
Well, it wasn’t this dramatic on the said day. The assistant minister for health made a call by the hospital, and by the paediatric ward, where yours truly was busy saving yet another diseased soul.

The a/minister: Yes daktari, how r u today.

Me: Not bad sir. Not bad. Just fixing a line on this young one.

The a/minister: Hmm.. Fixing a line.. What afflicts the young one?

Me: The poor soul is dehydrated. Severely so. And we need rehydrate him urgently.

(ok, so the English wasn’t as pampered as this, lakini wat’s a story without good story-telling?)

The a/minister: You know, in my times, we used to wear shirts and ties.

Me: (Looking perplexed and disturbed) Oh!

(I was in t-shirt, jeans and sneakers!)

The a/minister: Yes! Sister, (turning to the nurse in the room) your doctors don’t dress up for work!

(..he says as he walked out of the room, cheeky smiles on the faces of many in his entourage)

It was a Saturday morning this, and trust me, was not going to wear a tie, not in that heat, and not when I least felt like working. What made this really sad, is that I was not told that the dude was showing up. Apparently, they were launching the door-to-door polio campaign and he first stop was Thika. Everyone else in the ward was crisp and shiny, dressed up like it was a Monday. It didn’t hit me until the guy left..

Actor 1: You didn’t know mheshimiwa was coming?

Me: What? Who was spreading the word? I missed that surmon!

Actor 2: Hehe.. How can you where a t-shirt when a minister is visiting?

Me: Jus’ shut up!

Actor 1: Kwani you don’t live in around? Si everyone knew?

---------------------------------
The rest of the conversation was mindless and sarcastic. I’ll spare yo’all the empty details. I faced no repercussions, I’m glad to say. Lakini I still can’t do ties on weekends. Iz bila!

Now speaking of risky business, this medicine profession I tell you! Our risk allowance is about 5K.. I think, maybe 3K, but I should confirm that. Anyway, one of my colleagues got TB. Drained 2 litres of effusion (fluid) from his chest! Poor fellow. But he’ll survive.

I understand he was given time to recuperate, free ward stay, drugs, consultation the works. They treat you real well when you fall ill here.

So I wonder, after 5 years, reading and sacrifice, is this what I was waiting for at the end of that proverbial tunnel? You know, bashing from govt’ officials and airborne disease from my workplace? Working weekends and alternate nights? They didn’t mention this when I was signing up for the course. Conveniently I’m sure.

Daktari, sio?

It’s risky, this business.

tHE mEDiCinEmAn

A Tale of 3 Companies

The other day, I was having a lively exchange on why Safaricom is the worst thing that happened to Kenyans.

“What? With 8 bob calls? How do you go calling them such ugly names?, ” you might wonder.

Well it wasn’t very clear to me either, but with 6+ million subscribers, Safaricom has such a powerful resource, you wouldn’t believe. And so much money, any competitors (media-speak for Celtel) can easily be priced out. Last year, they made 1 billion shillings in every month. That’s Kshs. 250 million in one week! And that is pure, clean profit! If any other company made this much in one year, they’d be considered to be doing pretty well…

Let’s talk about Celtel for a bit. Having launched their new Uhuru tariffs with a lots of flair to match, I expected a big switch from price conscious Kenyans. (I’ll tell you something about this later). It did happen, for a few days. I even got 2 Celtel lines for myself to take advantage of both the tariffs. Safaricom hit back with its 10 bob all-the-time calls and later, with the limited offer Saasa tariff, where for 12 hours a day, one can make calls @ 8 bob a minute, Safcom to Safcom of course. And as much as 52 bob per minute to call Celtel! (BTW what sort of name is Saasa? Don’t try to stretch the middle “aa” coz you’ll end up soundin real weird… or was that the idea?)

Anyway, what Safaricom had done was to effectively lock in their customers, all 6+ million of them. And charging Celtel an arm and a foot to allow calls to this pool. So during the discussion an interesting idea was floated. What if it cost you 7 or even 6 bob to call within the Celtel network? Won’t every other Kenyan have 073X sim cards in place most of the time? Besides, it hardly costs them anything to have calls routed thru’ their own network.

Sounds like a good idea, until you remember that it the reverse also applies. Wat if Safcom does the same and weka’s calls at 6 bob also? Subscribers with their other 6 million+ contacts, will stay on this network, coz it’s easier than to go around changing yo’ mobile contact etc, etc..

Effectively, there will be 6 million people calling at 6 bob on one end and only 3 million on the other, it’s easy to see who’ll be wearing the trousers in that relationship!

What about Telkom’s wireless fones? It costs only 5.50 to call another Telkom subscriber anywhere in the country, yet the uptake isn’t close to the millions that Safcom has been able to rack up. Surely people should be ready to call at these good rates!

Unfortunately for them, however, the entry costs are a bit too steep. Other than having to buy a line for 1,000 bob, one has to get a brand new handset, coz the technology can’t work with GSM fones. So a cool 5,000 bob+.. to get a fone that you’ll hardly use to call at the celebrated rate of Kshs 5.50 to another Telkom number! It only requires a basic knowledge of arithmetic and economics, to know that you’d rather bamba 50 and call a lot more people @ 8 bob!

So that round Telkom Wireless loses 10 – nil. Unfortunately, they still think in the old mindset of charging people to become your customers! That usually doesn’t work very well. I can get a Safaricom or Celtel line for as little as 40 bob. Why on earth would Telkom charge me 1,000 shillings for a piece of metal? Imagine if it still cost you 2,500 shillings for a Safaricom line? They never learn, I tell you!

So my conclusion? Even a new mobile company will not be able to nudge Safaricom out of their massive market numbers. Unless of course they have a brilliant product, that’s incredibly cheap, different, innovative, and did I say bloody cheap? It’s only in Kenya, where 99% if mobile users answering calls will have their thumbs squarely placed on the “Cancel” button to save that last few cents spent as the fone comes off my face for me to see wat I am doing. Curiously, the thumb-hovering is on calls that they are receiving and not paying for!

What do you think? Leave yo’ two cents worth of comment. Would love to here another perspective.

Should get to bed. Kesho I have a mortality meeting. We get to keep tabs on how many patients we got to kill during the month. More on that later.

Baadayez,
tHE mEdiCinEmAn.

You win some, you lose some.. (well ok, they die)

Today was one of those days that I really dread, which if fate chooses, do come pretty often. Another baby had died, and I had the unenviable task of examining the poor thing, confirming and certifying the death, and proceeding to inform the bewildered mother of the bad news.

This was particularly heart-wrenching since, it was one of a pair of twins, that I had admitted that long Sunday that I had had in the ward.

The diagnosis was pretty simple, GE in a severely dehydrated pt, to r/o Malaria. (Medical lingo for: a patient with vomiting and diarrhea who, as a result, is severely dehydrated, and since the patient complained of vomiting and fever among other shidaz, anti-malarial drugs have to be given, since we are in an endemic area.

Enough of that. Rehydration, replacement of electrolytes and quinine would sort out the problem, ideally anyway.

4 days later, while I was incidentally in the ward, the shell-shocked mother calls me and tells me that she had woken up only to find one of her babies ‘staring at her blankly’ and ‘didn’t look right’. A quick exam was conclusive. The baby had been dead for several minutes if not hours. The mother, by the way, had been staring at me intently all this time, hoping I would ease her mind from the horrible thoughts that must have been whirling around in there. The other twin was crying incessantly by now, almost as tho’ she knew what had just happened to her brother.

The part of the story I’d not told you is that this mother had delivered the twins at home 2 months ago and had not visited a clinic yet. Had not got any immunization shots. Apparently, she couldn’t carry both babies with her. Her husband was in police custody and her 6 other daughters, (yep, 6 daughters and now 8 kids) had not been at home to help her out. While her story didn’t sound particularly credible, it reminded of the many social issues that I have come across.

Many Kenyans, and probably herself as well, are not willing to spend that extra, no not extra, that last few hundred shillings to go to hospital for a problem that is not there. She’d rather spend it to buy food for tomorrow’s supper and use the rest to buy a couple of books for her other offspring that walk barefoot to school.

Poverty is easily the biggest disease in this country. This mother had lost a child from a very preventable condition that probably got worse as she hoped it would get better. Illiteracy comes in a close second. I’d tell you things mothers do to their babies that would make u scratch yo’ head, and roll your eyes. Lakini, that’s for another day. I’m on call tonite you know.

I spoke too soon. There goes my fone! Yet another sick Kenyan...

tHE mEdiCinEmAn.

Interns don't blog...

3 interns, 2 weeks and 1 weekend call have brought me to this conclusion. (Not that I care for it, by the way..) It’s been quite an experience so far, quite.

Well having been certified a medical graduate, given the power to read and do all that other sh*t, I landed in Thika, at the District Hospital, teeming with life and the not so full of life. According to the Medical Superintendent in charge of the joint, we are supposed to be the busiest hospital in Central Province, more than Nyeri (the Provincial HQ) … I didn’t say it, he did! There it was. We’d set our selves up for interesting times here.

After an episode of haggling, bargaining and luck, I ended up starting my department rotations in Paediatrics. (We have to rotate in all 4 dept’s for 3 months each as medical interns. Internal Medicine, Obstetrics/ Gyn and Surgery as well.) Wasn’t too bad, I argued. I’ll be doing Obs/Gyn next, easily the most hectic of the four, and then go on to Medicine and finish with Surgery. Hmm… this should work, I figured. We got a quick tour of the hospital to put into perspective what we would have to contend with for the next 52 weeks or so.

We were 12 interns in all from the Univ. of Nairobi, so 3 interns in each dept. And in our minds, we knew would be getting at least 4 more interns from Moi University’s med school, who hadn’t finished their exams yet. Which would bring the figure to 4 in each dept. We were later to find out, painfully by the way, that this was not going to happen. Something about only 25 of them passing their exams or something… Basically, this means, night and weekend calls are closer to each other, more work per person, and did I talk about the weekend calls?

I must have, coz I just finished one of the craziest weekends I have had in a very long time. Yours truly was on call, and from the experiences shared by my colleague who had covered the previous weekend, it was supposed to be a walk in the park. Started well. I was even able to leave the hospital for the whole morning before I was called to review a neonate in the nursery. Rushed back, 2 reviews and a couple of lines arduously fixed on newborns fragile wrists, I was done. This was better than I thought. As it turned out, this was the calm before the storm. Or more like a miniature tsunami.

I got to see another 2 cases in the ward that evening and that was it. Went to bed wondering if this could get any better! Ha!

10.00 am. I had just had breakfast, and I was on my computer working out some awe-inspiring design (I’m my greatest fan…) Me fone rang.

“Daktari, kuna patients ku-review kwa ward.”

Off I dashed. This could be over in a few minutes. A couple of touches on the design, a couple of episodes of 24 and a couple of hours to nap. Perfect, I thought.

I get to the ward.

“Wagonjwa?”

“Ndio sisi…”, the new admissions raised their hands. They were 3.

Arghh.. I’d have less time for my nap!
So the good doctor got down to work. Did I say walk in the park? It was now a trot across town. But I could be done soon and back home.

2 hours later, there were more than 7 more patients that had checked into the ward.
Oh dear, I thought. Lunch will have to be taken late. There’s good reason why so many doctors have horrid handwriting. It’s coz that’s all they do, and it can get monotonous a lot of the time.

Well, to cut a long story short, I wasn’t able to make it for lunch at whatever time. Not 2, not 3, not 4… The patients came one after the other. Made me wonder if Sunday is “siku ya kuenda hospital” for the local residents of Thika. 9 hours later, (yes 9 hrs) it was 7 pm and the 3^rd shift of nurses had just checked in. This was getting too much; I decided I might as well have something to eat at this rate. Dashed back home. (Thankfully this is a 5 min. walk away.) No one had made up their minds to cook, so no food, and I just had a glass of juice, and went back to the battle field. And there they were, 5 more patients on top of the 2 that I had left!!

WTF! I couldn’t believe this! Did I say trot across town? No, this was like a marathon across the Kalahari!

I did eat my supper that night. Much later, around 12 pm. By half past midnight, I’d passed out..

Talk about being thrown into the deep end..