Use only as directed by a physician

This week marked my inaugural visit to a hospital in Africa. I have had the misfortune of being sick in various locales, on a few continents. While such a statement may imply an inadequate immune system on my part, the fact of the matter is that I am rarely ill, and for that I am thankful.

I came down with what I self-diagnosed as a fever earlier in the week. While the team has occasionally wrestled with bouts of the sniffles, when I was in 4 blankets, a fleece, socks, and awake and freezing at 4:00 am, I decided I would get acquainted with the local medical facilities.

The first step in this process was deciding which clinic, hospital, or practitioner to visit. Luckily, a phone call to our gracious hosts from earlier in the visit (the Khan’s) reminded me that Qaisara’s father worked in administration at the Aga Khan University Hospital. It was suggested that I visit there. It turns out that the Aga Khan is the best (or second best, depending on whose views are sought) health care facility in Nairobi.

A short cab ride later, and I met Mickey (Qaisara's father), who led me through both the paperwork (surprisingly little) and the hospital (surprisingly large). I paid my consulting fee to see the physician (about $10), and about 20 minutes later I met Dr. Thorpe. She is an expat Brit who grew up with her time divided between Kenya and the UK, the latter of which was homebase for her medical education. No nurse, straight to the physician. This reminded me of my surgery in Mexico a number of years ago, where my surgery was performed by 3 physicians, no nurses, and I had outpatient care every second day after the surgery by, you guessed it, a physician. Try getting a doctor in North America to re-assess your wound after surgery every 48 hours for a week. But I digress.

Dr. Thorpe indicated that I did have a fever, red throat, and elevated heart rate, and prescribed me some basic painkillers, an anti-inflammatory, and some throat lozenges. She also ordered a blood test to rule out malaria, which is rare in urban areas. Total bill for all of the pills, about $4, for the blood test, about $9.

The blood test indicated that I had some bacteria or virus; I am sure it was more esoteric sounding, but the gist was that it wasn’t all that serious, and if I took my 17 pills a day (I am not exaggerating, but again I fear this makes it sound more serious than the situation warranted) I would be just fine. This total included an additional antibiotic that came in at a surprisingly high $18. Still not sure the deal there, but when all was said and done, I was $41 poorer for the best care (as defined by price), from a western-trained doctor (we’ll leave the debate as to how much this makes a difference, if any, for those more versed in public health than I) that Kenya had to offer. A side bar about the physician, though: if I paid $10 to the hospital to see her (and almost double for antibiotics), what was her cut? I am pretty sure it is clear that she is not in Kenya for the money…

There is also a medical facility near where I teach in Bahati. The building stands in sharp contrast to the Aga Khan. Its tin roof and benches give the impression that the building could house just about anything. I queried one of our students, who informed me that medical care there costs 20 shillings, or about 33 cents. I asked if he had ever visited, and he quickly said “no”. When pressed for a reason, he said (and I am paraphrasing) that medical care shouldn’t cost 20 shillings. He said he pays a figure close to what I paid to visit a doctor. However, every day when I pass, there is a small gathering in and around the clinic. Apparently there is sufficient demand. There is also a free public hospital in town, but the guidebook advises not to go there, as “you may leave with something worse than you came with”. When I think of the debate over two-tiered health care in Canada, the controversy seems so trivial when on the ground here, given that the resulting “tiers” would almost certainly never be as disparate as they are here. That being said, is a gap in quality or “levels” of public health ever acceptable when we are talking about human life? If you think that I am advocating or endorsing a particular ideology or trying to make a meaningful contribution to a philosophic debate (as I fear I am starting to sound like a bad op-ed piece), I assure you I am not and apologize for my miscommunication (or your misreading). It is just a blog.

Yesterday, I noticed that parts of my body were beginning to become quite itchy and red (I know, I am clearly the weak link on this trip). I consulted some of the other team members, who diagnosed the situation and recommended various remedies, one of which was a topical ointment that was great for these types of things. The only catch (well actually there were two): no one had any, and you needed a prescription. I embarked on a trip downtown in search of this elusive ointment. I did have a feeling that I could get some from a pharmacy, if I could find one stocking the goo. The first pharmacy had some, and like most medication here, it was over-the-counter. Same solution as Canada, but no prescription needed. As I applied the ointment to the affected area (which the pharmacist indicated was likely the result of an allergic reaction to one of the pills I was taking), I noticed the box: use only as directed by a physician….