Whenever a patient dies, the law requires the attending health worker to fill in a cause of death. Sometimes, it’s pretty straightforward but often we find ourselves in a situation where you have to “certify” a patient you know full well should not have died the way they did. Today, I wanna tell their story; their voices, too, must be heard.

Road Trip

One year ago today, a tragic road trip cut short the lives of two best friends. They had purposed to visit Lake Bogoria but were involved in an accident along the Naivasha-Nakuru highway. One died on the spot while the other sustained a bleed in his brain and was rushed by good Samaritans to the nearby Naivasha District Hospital. He needed emergency surgery to relieve the pressure on his brain, failing which he would certainly die. The attending doctor quickly prepared him for the operation and duly informed the theater staff. However, he was told, there was another patient already in theater with a similar injury so he would have to wait for there was only one set of instruments available in the hospital.

A couple of hours later, he finally made it into theater. By this time, he was already in coma and was barely hanging onto life. Following surgery, he was too weak and remained unconscious. Having no ICU facility in the hospital, the surgeon recommended transfer to another center, the nearest options being either Kijabe or Nairobi. Transferring a patient in his condition was no simple task; he required an ambulance with life support equipment so the hospital’s ambulance would not do. Several calls were placed to get one to drive the 30 or so kilometres from Kijabe; by the time it arrived, the young man was no more.

Cause of Death: Severe head injury

The truth: He died because of lack of surgical instruments, he died because there was no ICU ventilator machine, he died because there was no ambulance.

The Young Mother

She was recently married, and was overjoyed when she discovered she would be “sick” for the following 9 months. She tried her best to eat well through the pregnancy, in spite of the constant nausea. She faithfully attended all her clinics and followed the doctor’s instructions to the letter. When the time came for her to deliver, she checked herself into the nearby sub-district hospital to begin her journey into motherhood.

She had a difficult labour, but finally the baby came- a beautiful, bouncing baby girl. Unfortunately,some complications arose in the period immediately following the birth-she wouldn’t stop bleeding (PPH in medspeak). Despite all the medications the doctor prescribed, the bleeding just wouldn’t stop. She had to be taken in for surgery to take out part of her uterus to control the bleeding. The surgery was successful, but she had lost so much blood. Her blood group was at the time unavailable and the hospital administration had to call the regional blood transfusion centre to request for some. The ambulance that would either have taken her to the provincial hospital or gone to collect the blood had just left to transport another patient. She died waiting for a blood transfusion, her newborn child would never know the joy of feeding from her mother’s breast.

Cause of death: Postpartum haemorrhage (PPH)

The truth: She died because of poor policy, she died because blood transfusion services have not been decentralised.

The Medical Officer

Having just completed his internship, he had his whole life ahead of him. He decided to take a break from his workstation in Busia to visit his parents in Kiambu. They had made a lot of sacrifices to get him to this point, it was only natural that he would want to share this news with them. While at home, he fell sick and was diagnosed with malaria at the Kiambu district hospital. A few days later, he developed kidney failure as a complication of the malaria. He needed urgent dialysis; unfortunately these services were not available there and he was immediately referred to the Kenyatta national hospital.

On admission at the KNH, he was immediately put on the wait-list for a dialysis machine. The list was so long, but he had no other choice as he couldn’t afford to be admitted in a private hospital. His medical cover was a measly 1740 Ksh, not even enough to cover the consultation fee at that private facility. He never made it to the top of the list, his kidneys were too far gone.

Cause of death: Acute kidney injury secondary to severe malaria

The truth: He died because the KNH dialysis unit is overstretched, he died because of inadequate resources.

 

There are so many more stories to tell; only I can’t squeeze them all into this little space. To the friends and families, I say: Kenyan doctors have not forgotten them, their memories will always stay with us. Their memories are what inspire us to want to do better. It is because of these stories that the blue revolution began.

We should always strive to finish what we started; it is my prayer that the blues will not relent until this, too, is done. Here’s to the new year, and a future where doctors will not certify patients because of the shortcomings of the system.