A #LipaKamaTender story

On January 3rd, I went to Mathari Hospital hoping to see a psychiatrist because I was feeling depressed. I had spent the weekend at a friend’s house watching trash TV and being so down I could barely put together 100 words. I had known something was wrong for a while but the holiday season did a good job of masking just how bad it was (Must! Be! Happy!); things came to a head that weekend.

I arrived at 9am because I didn’t think I’d get to see a psychiatrist; I was really just hoping to get a mood stabiliser to weather the next fortnight and get an appointment. My appointment is later this year and I’m pretty good at the art of “hanging in there”. I’m also on a drug holiday which, if I manage to not get sick, will end in me being ‘free’ from psychiatric supervision. It took a lot to go there.

There was no one when I got there. The registry was not open, the usual long queue on Tuesdays (the day of the outpatient clinic, which I was chancing) was nowhere to be seen.

I’d forgotten there was is a doctors’ strike on.

Yes, I read the paper and follow the news online and on the radio. I think my mind had skipped over this fact again and again as I prepared for my trip there; as I got my card, prepared my clothes, made breakfast. It was a jolt, then, to find myself confronted by the strike.

I asked myself what patients like me were doing. How were patients whose appointments fell during this period coping? How were people in some distress (depressed, anxious, psychotic, manic, you name it) getting by if they couldn’t see a psychiatrist here? If you’re wondering why seeing a Mathari psychiatrist is important to so many of us: it costs us KSh 50 (about $0.50) to see a psychiatrist for a review. Contrast that with the cost of therapy (upwards of KSh 2000) or a private psychiatrist (upwards of KSh 3000) and you’ll see what the stakes are.

Then I remembered what it’s like when there are doctors. All of us have 8.30am on our appointment cards so one has to be there before 8am to queue and pay the review fee to have a stab at seeing a doctor before 9am. Once we pay the fee, we queue again at the inpatient wards where we see the doctor. There’s no rhyme or reason to the queuing; you hand over your receipt and hope you’ll get a good number. Eventually, you’re let in (did I mention we’re waiting to see the doctor at the ward’s locked gate, on forms, in the sun? Well, we are.) in groups of 10 and wait some more for the doctor.

Usually, there’s only one doctor. When we’re lucky, there are two. Once, there were three (THREE!!!) and it felt like a miracle. As we wait, we sit together and talk, kvetch about the long waits, sometimes we walk about because there isn’t enough seating (this happens often, a lot of patients are brought by 2 or 3 relatives so those 10 patients will really be 20-25 people who need seating) and wait some more.

This is the ideal situation. Sometimes the doctor doesn’t arrive till 9 or 9.30 (remember that 8.30 on the card? The stuff of aspirations, it is) and even then, they may not start seeing patients till 30-45 minutes later. It’s not uncommon to see the doctor 2 hours after you arrive. Yes, being at Mathari from 8 (when the cashier’s window opens) to 10 in the scorching sun. Good times.

No, they are not good times. ‘Good times’ and ‘funny story’ are my favourite coping devices. Stuff that.

Finally, you get into the consultation room. While you were outside, you could hear the interaction between the patients ahead of you and the doctor. Now it’s your turn to be subjected to the same treatment. Usually, there are at least 3 people in the room when you enter: a nurse, the doctor, and a trainee nurse/ clinical officer (CO)/ psychiatrist. Add yourself and your relative(s) and it’s a veritable crowd. As the door remains open, you’re assailed with questions (How are you feeling? Are you taking the medicine?) and your caregiver is asked the same questions. While you answer them, the clinical learning opportunity is dissected and sometimes these 2 questions are all you’ll get before the doctor gives you a prescription and sends you off.

Always a prescription. The first time I went to Mathari, I misread my review date and went back the day after. I was given a date (yay!) and a new dose (why? I was feeling fairly OK) to keep me going. It saddens me that my assertiveness in clinical settings – the fruit of several trips to doctors’ offices growing up -is the only thing that keeps me off medicine when I’m well, that allows me to be heard. I once had to tell a doctor not to write me a prescription after I saw her write down my name before I’d said 5 words. It’s a strange position to be in: to assert that you know your mind in a place that people go to when they lose theirs. You’ll be lucky to get 2 minutes with a doctor in this context: too many of us, too little time.

This is what it’s like in normal time. This is why I stand with doctors.

The strike has been framed as greedy doctors seeking fat salaries. I won’t rehash here all the stories that doctors have shared on social media regarding their work conditions. They seek not just better pay (which is their due) but also better work conditions. It’s the latter that has me supporting them. Better work conditions for doctors are better conditions for patients.

Better conditions mean privacy for patients as they speak to their doctor, medication at your hospital, shorter waits as more students choose to become psychiatrists, decent waiting areas for us, more clinic days at a hospital that mostly serves patients with psychiatric needs. Better conditions mean more than a minute with your doctor, and not just because you’re assertive, they mean being able to get psychiatric care at your local hospital, even if you need to be committed for a while. It means seeing patients away from inpatient wards, where patients’ behaviour can sometimes be scary (more than once, screaming, shouting, undressing).

I believe that the government isn’t idly waiting out the strike. It is training us to assign public healthcare the same low value public education currently has. At this moment, we’re all scrambling to see doctors at private hospitals in much the same way as we have been working hard for decades now to put children in private school. Unlike schools, though, all of us are interested in healthcare. I’m a single, childless, woman but here I am, directly affected by the absence of medical services. I would argue that we’re halfway there: most people who have a little disposable income have been seeking private health services for years. Now, those who haven’t yet have to get help in private hospitals. Patients are ‘consumers’ and we’re being directed to seek services in the ‘healthcare market’; soon that market will be privatised beyond recognition and we’ll go along in the way of public education. Wandia Njoya has written better than I can about this; please read her words for a sense of what is at stake.

And now, for the thing that brought me to this point. Last week, KMPDU leaders were handed a suspended sentence and urged (practically ordered) to bring the strike to an end. Something within me broke. I punched out a thread on Twitter and raged. I present as a middle class woman (aaarrgghhh, class politics now???) because of my upbringing, my education, the places I have access to. I am, however, not middle class. I do not have access to the privilege attendant to the class – a long term job, medical insurance cover – and rely on public healthcare for that reason. To stay silent about the cost exacted on people like me by the status quo in order to maintain an idea of myself was to deny doctors and fellow patients solidarity. Standing with doctors is looking out for myself; it’s raising my voice and saying “Patients NEED doctors’ demands met!”. This is my attempt to marshal what class privilege I have to speak the truth of millions of people.

Let’s stop acting like patients are suffering because  of the strike and acknowledge that conditions in public hospitals are deplorable. Let us acknowledge that doctors are barely making do with the little they have; that so many of us are not dropping dead is amazing. Let’s put an end to this “at least” mentality we have (“At least we have the best hospitals in Eastern Africa”) because it only demonstrates how low our bar is when it comes to what we expect from government. Let us start demanding conditions that make the best medical care a reality for every Kenyan citizen.

I stand with doctors; do you?*

*Please let me know if you have a public healthcare story you’d like to share to give us all context about what the stakes are, what patients are up against in ‘normal time’. Thank you.

Happy Birthday, Cumin!

Today was a lovely day. Fantastic birthday 🙂

I’ve made a big song and dance on Twitter about it; complete with wishlist ten days ago. It’s not like me to put myself out there (self-deprecating humour and self-effacing behaviour are pretty standard) but it didn’t kill me to say, “Hey, I’d like this.”

Today, I had a wonderful time and this in the context of a great day with one of my best friends yesterday and another lined up for tomorrow. One’s birthday is one of the few times a year when they are allowed to have the spotlight on them. It was a nice to be treated specially but not to be the centre of attention.

Here’s to a lovely year ahead; may it be memorable.

Your New Year Resolutions Are Doomed To Fail. Here’s Why.

A guest post by Barbara

It’s been more than a fortnight now since the New Year arrived and we were once again plagued with thoughts of the goals we’d like to accomplish this year (dear Jesus let me accomplish just one thing on this list). And once again, sadly but surely, we are doomed to fall into the rut of trying, failing, trying, failing and then finally resigning ourselves to failure.  

Come on. You know who you are.

The reason why our New Year Resolutions always fail is quite simple. They’re made in the New Year. Why, pray thee, must you wait 365 days to decide what changes you ought to be making in your life? Why, pray thee, do you somehow believe that the power of a fresh year is all you need to propel you into achievement? Sure, it helps to have a clean slate, but if a clean slate is all we have, then folks, we don’t have much. It’s like expecting Ernest Hemingway to channel through your fingers simply because you have a pencil and a blank sheet of paper in front of you.

Now, let’s not throw out the baby with the bathwater. It is helpful to have that pencil and the blank sheet of paper. Now all that remains to happen is as simple as it is arduous:

Do the work.

Want to lose weight and get ripped? Do the work.

Want to learn something new and dominate the class? Do the work.

Want to be a success and be a real boss? …

Expect to sweat, plan to lose sleep and prepare to flex your muscles. Make a do-able plan and actually DO IT. Every. Single. Day.

Note: I asked folks on Twitter & Facebook to contribute to the cause that is #CuminWrites366. Barbara is the first contributor to be published; here’s to many more and Thank You Barbara!

Small Mercies

Recently, a friend needed to be bailed out of hospital because of an issue with payment. What had happened was their insurer (Britam through Linda Jamii) had elected, for whatever reason, not to pay the entirety of the bill. Instead, Britam would pay the bill less NHIF’s amount. This is why I needed to  bail them out: their NHIF payments were not up to date.

Being poor is expensive because you’ll probably have to pay for a host of things out of pocket that would be covered by one’s insurance. Sadly, even when a person without means has been paying their premiums, they can easily find themselves in my friend’s position: falling through the cracks.

The last week or so, I have had a situation that I needed to see a GP for. I have also nursed an unhealthy dislike for visits to doctors for a while, a situation fuelled by my pecuniary circumstances. During that time, however, I have continued to pay for NHIF.

As I bailed out my friend, they urged me to check my NHIF status* (send ‘ID xxx’ where xxx is your ID number to 21101) lest the same fate should befall me. I was current and my friend took the chance to tell me I could use my cover for outpatient services, too.

So it is that one’s situation may soon be fixed at no great cost thanks to these things: friendship, the habit of paying for certain things and the bitter-sweet knowledge that not all poverties are equal.

*This is not a sponsored post.

Note: This post is part of #CuminWrites366, my year-long attempt to write a post a day. Find the rest over at readability.com/cuminwrites/

Questions, comments, suggestions or health insurance tips? Send them to cuminwrites@gmail.com 🙂

 

 

Mathari Hospital (Part 4)

My trip to Mathari Hospital was illuminating in a number of ways. The biggest one was the stark reminder of the stigma that accompanies mental health issues.

I bet there’s a reason we evolved to be afraid of people who were mentally unstable yet in this I am reminded of a dear friend who called me to remind me that if your ears are painful, you see an ENT doctor. So too, she reminded me, of mental health issues. A part of me wishes it were that simple.

At Mathari, you have to wait till 0800 to pay for services but you need a number from a clinic to do so. Getting a number means being there before 0800 and having to wait some more to see a GP once you pay. We wasted so much time waiting (to pay, to see a doctor, to be tested) that the 5 hours between 0800 and 1300 dragged on forever.

I wonder about someone who is a wage labourer and would essentially have lost a day’s work. Who would compensate them for the day? How can we make accessing such services the sort of endeavour that doesn’t take away your livelihood?

One of the reasons I went to Mathari was the cost of psychiatric care in private institutions. Like a lot of Kenyans, I found the charges prohibitive and needed an option. Even accounting for the tests, drugs and two sets of registration, I still spent less than KSh 1,000 during the trip. Is this accessible for everyone? It might not be, but it’s a fraction of what a private provider would charge you.

The Mental Health Act was last reviewed in 1989, from what I could gather. In the room in which I saw the psychiatrist, there was a poster with the ‘Mental Health Rights of an Individual’ on it. Yet I felt that between the law and best practice, the things we know fall through the cracks.

One of the romantic notions I had going in was that the staff at this institution would be able to deal with patients such as myself without the stigma that society attaches to mental illness. How ridiculous of me, I later realised. These people are you and I; one’s attitude doesn’t magically transform when they go through school. Hence the disbelief when I speak for myself (who would bring themselves here?), the doctor who doesn’t understand why someone would come to the institution she works at (the whole point of an education is to escape public services) and the nurse who won’t say the word psychiatry.

Because I don’t believe in private solutions to public problems (and yes, mental health issues are public matters), the question for me is how to make things more bearable. Here are my suggestions:

Let’s make mental health help available at the lowest level so that a person doesn’t have to go far from their home and workplace to access these services. This may take a while, but it would be great to work towards it.

Let’s make a place like Mathari more efficient. Put the masses of students and members of staff to work checking vitals, conducting tests, giving directions. Have more payment points so I don’t have a long wait every time I have to pay for something. Create a designated area for adult psychiatric patients so minors don’t have to interact with people having psychotic breaks.

Talk about mental health care. Let’s talk about it in the same way we talk about diabetes, or a toothache. Maybe then we can care for each other with empathy and something approximating normalcy instead of the treatment so easily accorded people in settings like these.

The one thing I’d like to highlight that gave me hope was the sight of friends and family accompanying people who were there for psychiatric services. My mother, the men and women there present. The morning I spent at Mathari she too spent and if it speaks to nothing other than her love for me, I am grateful.

Hopefully, we (patients, patients’ friends and family, everyone really) can move out of the shadows. Remember this: drugs, consultation, waits are things you can pay for and legislate. Empathy, kindness, even handedness, the knowledge that a college degree neither exempts you from these issues nor makes you rich enough to afford private care… These things we need to work towards.

This is my little thing.

Note: This post is part of #CuminWrites366, my year-long attempt to write a post a day. Find the rest over at readability.com/cuminwrites/

Questions, comments, suggestions or thoughts on mental health? Send them to cuminwrites@gmail.com 🙂

Mathari Hospital (Part 3)

We got directions to the psychiatric clinic (same place as the lone cashier) and went to get signed up.
The guy who did my intake (a nurse, I presumed) asked who it was getting registered & I handed over my ID for him to take down my details. The process is basically copying down the things at the back of your national ID; the idea being that it’ll help them ‘find your people’ should the need arise. Strange moment: he asked me my level of education and I told him I have a university degree. He then promptly turned to my mom, “Anasema ukweli?”. It ground my gears; I was present, I had answered questions till that point, and I could speak. My mother redirected him, reminded him that the patient speaks her truth. Now I understood the urgent “Who are you with?” from the nurse. The assumption is that every patient is psychotic, delusional, and someone else has to speak for them. What would have happened, I wonder, if I had come alone and been sent that way? Who would have been there to answer his questions?

Anyway, I paid the KSh 200 registration fee, was issued with a file and sat outside a room waiting to be called. When I was, I found a small crowd of student nurses and doctors yet there was only one person taking temperature and blood pressure readings. No wonder the queue was moving so slowly, I thought.

Back outside and a short wait later,  I was called in to see the psychiatrist. In the very same room so no points for privacy. My mother came in with me and as we settled into it, I noticed adverts for psychotropic drugs on the walls. I am still curious about the ethics of adverts in that setting but that’s just me.

I told her about the sleeping, the compulsive eating, the other things, and she asked my mother questions too. Had she noticed these changes? Yes. She asked me, with a sincerity I found startling, why I had come to Mathari if I have a university degree. Why not, I asked. I needed mental health services, they offer them.

She said she would put me on a mood stabiliser and I had my usual routine of asking for non-drug solutions. What would you like, I was asked. Therapy, I was quick to say. She explained to me that she’d send me for psychotherapy after I was done with the dose and it worked. The other option, she pointed out, was psychological care as a walk-in patient at Kenyatta National Hospital (KNH).

I agreed to be put on the drug for a fortnight and was issued with a prescription as well as a note to be given an appointment for review. I went to the ‘Appointments’ window and got a date and place as my mother filled my prescription. I went back to get the talk from the chemist about taking the drug at the same time every day and I could leave.

We were there almost 6 hours and in the next instalment, I’ll tell you about some of the thoughts and observations about mental health care that came to me during my visit.

Note: This post is part of #CuminWrites366, my year-long attempt to write a post a day. Find the rest over at readability.com/cuminwrites/

Questions, comments, suggestions or thoughts on mental health? Send them to cuminwrites@gmail.com 🙂

Mathari Hospital (Part 2)

Maximum. So named because it’s where people who are under some armed protection are admitted. (Now is probably a good time to say that there are security guards everywhere. I can’t quite tell if it’s a factor of the psychiatric services on site or if I’m just sensitive to it.) There were APs and prison guards; making for a strange environment.

The lab and x-ray services are in a basement area that looks pretty run-down. There’s an abandoned feel to it, haunted even. Probably apt in the days after Halloween.

The tests took a while to be done and there was a strange moment as the most senior person censured the lab technicians for not following procedure (ensure payment before conducting a test, in this case). Once they were done, though, I was able to carry them back to the doctor.

Some context: I’m generally good at reporting my symptoms and I had told the GP I may have anaemia (the fatigue I had been experiencing was a factor) or I may be clinically depressed (ditto). She sent me to the lab to rule out anaemia &, because I am a woman, pregnancy, before we moved to step two.

When I got back, I gave another GP my results & repeated the things I had said before then I was sent to the psychiatry clinic. The GP gave a nurse my file, the nurse sat me down and asked me in Kikuyu who I had come with. “A friend” I said in English, “my mother” I corrected myself.

She went outside, called my mother aside and told her she needed to speak to her. “She’s been told to go to the other side for this,” she said in Kikuyu, pointing at the word ‘psychiatry’ as she said ‘this’. My mum, being who she is, read the word out loudly to force it out of her. The nurse was mum; we were now firmly on the silence track, the valley of the shadow of the unspeakable thing.

Next up: the psychiatric clinic

Note: This post is part of #CuminWrites366, my year-long attempt to write a post a day. Find the rest over at readability.com/cuminwrites/

Questions, comments, suggestions or thoughts on mental health? Send them to cuminwrites@gmail.com 🙂