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.

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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 🙂