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“Egeku”: Kenya’s Alarming Death Numbers

Matunda Nyanchama, PhD

Bsc (Elect. Eng.), Msc., PhD (Comp. Sci.)
Nsemia Information Technologies (Canada), London, Ontario Canada

November 11, 1997

In my rural country, it used to be that no two people could be buried in the same “village” on the same day. In deference to the deceased, the living gave each individual his/her own day for the final journey from earth. They suspended their work, except for essential tasks, to pay homage to the dead.

Not any more. Today, with the death rate as high as ever, such past niceties are impossible to honour. In a locality these days, it is typical to have more than one person waiting for burial. Waiting for each to have his/her own day would mean the living would little time to do other things, since life must continue. Unusual as it might sound, there
have been cases of two funerals in one home, on the same day! What is happening people? What is killing all these numbers? And why now?

Christians will point to Biblical Prophecy and call it “a sign of the times”. They will argue that the Saviour’s coming is close and urge people to repent and become saved. Well, that may well be the case, Biblically, the spiritual level. At the human level, we must still ask questions regarding the causes of these deaths. We must find out whether or not there are things that are humanly possible that could save, even if only some of the lives we are losing. Are we people abetting the death of our own people?

Causes of death range from the failure to get manage simple, treatable illnesses such as typhoid, dysentery and malaria to vagaries of more complicated, untreatable ones like AIDS and cancer. Accidents too have their own share of victims. The combined numbers are staggering, even from an amateur’s count. Just open the daily paper and look at the section today popularly referred to as the “album”. Faces among faces of mainly young people, with a sprinkling of older ones, stare at one. Usually the notice would give the cause of death as a “short illness”, “a road accident”, etc. A few of them say something to the effect that “after a long illness borne with courage”. Memorial pictures are not few either. Given that only a fraction of people actually issue newspaper death notices, the numbers in the press could only be a tip of a giant iceberg.

Democratic Party (DP) presidential candidate, Mwai Kibaki, recently challenged the government to publish the “state of the nation’s health”. Were the right figures to be published, they would appear alarming, an indication of the deterioration that the nation’s health care system has undergone. Kenyans’ life expectancy must be on the decline, although demographers have yet to quantify the effects. Anyone’s wishes and prayer must be that one doesn’t get sick or become involved in an accident, minor though it may be, for the potential results could be fatal. Yes, even for simple, treatable mishaps.

In my rural home, a short while ago, I was told of a man who died because the local District Hospital did not have insulin in stock. There was none in the locality either nor at the Provincial Hospital. The man, a diabetic, had been rushed to the facility for help, which help never came! At the hospital, staff calmly and helplessly advised relatives of the sick person to try the Chemist’s shop down the road. There to was none. Or, how about a call to the provincial hospital, some two hours away? There too was none! A man’s life ended simply like that! How Kenyan life has become cheap!

And then there is typhoid, a simple water borne disease that could be controlled with access to clean drinking water and proper sanitation. Water sources, both in the rural and urban areas, are no longer as clean as they used to be. While population pressure has had its impact on traditional clean water springs, local authorities charged with water treatment stand accused of doing a shoddy job. It is said that water treatment workers routinely use less chemicals for water treatment than is prescribe, selling the balance in the black market. In cities like Nairobi with an old water pipe network, it is suspected that leaking sewerage mixes with the clean water through seepage. Thus no matter how well the water may be treated; it will become polluted, as long as sewerage leakage problems persist. However, well one treats water in Nairobi, one friend once remarked, it remains an exercise in futility. To drink water in Nairobi these days is to risk infection and only when one is sure that the water has been boiled is one comfortable drinking it.

As if that were not enough, there is the problem of poor quality health services. In the case of typhoid, there is the chance of confusing the disease with malaria since both present with the same symptoms, as a recent doctors’ workshop heard in Nairobi. Ideally, a laboratory should distinguish one from the other. However, few such labs exist, especially, upcountry. In a number of cases, a typhoid patient can long be taking malaria drugs before either dying or discovering that one has been taking the wrong medicine. Today, typhoid treatment is largely a game of chance, a kind of lottery with people’s lives.

Talking of misdiagnosis, one can imagine the quality of health care staff, especially in the rural areas. A while back, the government decided to allow as lowly-qualified personnel as community nurses licenses to run medical clinics. Often they would be staffed by other less qualified personnel. They would have little, if any, diagnostic facilities and even less in  stock of major drugs.

The Government’s position was well-intended, to bring health care closer to the people. In fact to a great extent, these facilities allow people access to affordable health care for obvious simple, treatable ailments. What is missing is the ability to solve more sophisticated cases, as many of these places are poorly equipped. Nor is there an efficient referral system for complicated cases. Indeed, even the existing referral system would work much better were it as well staffed as it should be. But we know what happened after the doctors’ strike a while back.

Despite government denials, the impact of the strike was devastating; we are only experiencing the impact right now. Following the debacle, there was a mass outflow of doctors from government service. Typically, they left for greener pastures, usually, in Southern Africa.

The foreign doctors that were brought in their place proved not only expensive but also ill-suited for our specific environment. A former classmate, a medical doctor, once remarked that some Egyptian and Pakistani doctors, were simply too green to even diagnose a case of malaria; they hadn’t seen any where they came from. Kenya, a country
that recorded huge milestones in health care, typified by the huge population increase of the 70s and 80s, was now training doctors for other countries! Has anyone calculated the opportunity cost of our intransigence to address doctors’ concerns? How about someone to quantify the figures, taking into account the increasing death rate as well as the cost of training a doctor?

As if that were not enough, a number of the few doctors that remained in the country chose private practice where they make several times more money than in government. Some are listed as consultants with government and work in government hospitals. However, a number of the latter are also accused of using government facilities for their own businesses. I have heard of stories from Kenyatta National Hospital, KNH, where consultants routinely have to be paid to see patients. Typically, patients will be asked to go to the doctor’s private clinic after which they will be admitted in KNH for nursing and ward care. In some cases, even access to things like gauze for wounds, stitching thread, drugs and the like, requires money in a government hospital. Nothing comes for free, they say!

Sure! Nothing comes for free. Even the government agrees, despite that many of these people are tax payers and health care costs may be out of reach to them. In the 80s, under pressure from the World Bank & International Monetary Fund (IMF), the government put in place a “cost-sharing” scheme under the infamous Structural Adjustment Programmes (SAPs). No longer were health and education services free, as they used to be since independence, but now people had to pay for consultation and medicines at government facilities. And what has the impact of this been?

Today, an ailing person, with little or no money to pay for consultation, will walk to the market-place and buy pain-relieving tablets like aspirin or panadol. They are cheap and affordable. The person will of course get relief from pain but would not have solved the underlying ailment causing the pain. Meanwhile, disease would be advancing. Eventually, when such a person gets proper medical attention, it could be at an advanced state of disease which would be several times more expensive to treat than at the beginning. Such a person would, invariably, require hospitalization and more advanced attention than before. It would cost more for the family than would have been the case otherwise. Cumulatively, it is a very costly exercise for the whole system as it diverts resources for curative, as opposed to preventive, purposes. That is the cost of being poor: no mercy from SAPs.

The Government, IMF and WB’s concerns about the health care bill was right. The tried solution, however, has not helped at all. In a country where less than 1% of the people have access to health insurance, the strategy should have been different. The Government should have put in place mechanisms that would take care of the poorest of the poor that cannot afford the costs now in place. There should have been, either exemption from charges or some form of medical insurance scheme to cover these people that have little or no money to meet set costs. Current policy condemns this lot of people death! If you do not have the money, your sentence is clear: death! Period!

What SAPs have done to Kenya, they have done in Zimbabwe. A while back, the “New African” reported on unprecedented high number of deaths, especially, in rural Zimbabwe. That report attributed the cause to the implementation of SAPs in that country. Kenya too is having its day.

There have been proposals to restructure the National Hospital Insurance Fund, NHIF, to have it become a fully-fledged medical insurance scheme. If and when this comes to be, the implementation should ensure that the scheme is all-encompassing to accommodate the weakest elements in our society so that they too have access medical care.

The foregoing notwithstanding, Kenyans must face the greater debilitating cancer: corruption. The NHIF, even in its current form, has been badly hit by corruption scandals. It is conceivable that more people would benefit from the fund than has happened in the past; hospital drugs have been sold by rogue health care workers; water treatment chemicals find their use for private personal gain; corrupt medical personnel continue to use public facilities for their own gain; ad infinitum.

The combined cost to the country is for economists to sample. In the past the Ministry of Economic Planning has said that it would take into account the impact of AIDS in its projections. Now, they should include the impact small, treatable diseases; they should include the impact of doctors’ departure from the country and the public service; let them include the impact of the SAPs, the corruption in the profession and all. This way, things might become a little clearer and may lead someone into action! Let’s have the stack figures.

There is yet another angle: public education. If every Kenyan boiled drinking water, almost all new typhoid cases will be eliminated. The same goes for AIDS. How about a frank talk about this scourge, especially to the young people? Continued government intransigence about sex education is surely not for the good of the country. AIDS kills and the only way to “cure” it is prevent infection. We should borrow a leaf from Uganda’s case where the number of reported new cases has been on decline. Public education is what the Kenyan public need and keeping quiet about the disease will not make I go away.

As we mourn our departed loved ones, let’s think whether we are not part of the current problems.


Comment from mnyanchama
Time: November 18, 1997, 6:02 pm

The death numbers may be alarming, but the death rate may not be.

Egeku’s puzzled was almost answered in his motivation – but got lost. To start with, the fact that in the past there were few deaths was the consequence of fewer people alive, i.e. it is a population growth question. Nowadays we have more people hence more deaths. However, I’m not convinced that deaths per 1000 people has increased today compared to the past (need empirical evidence). Please note that naturally, we have to die.

In addition to the natural death, technology has ascertained that we die soon enough. For example, death through road accidents is alarming: the more cars we have the more deaths counts will be – but accidents per 100 cars may be constant today, yesterday and tomorrow. The mystery behind accident motivated deaths is that technology cancels itself. Can you count how many technology motivated births are there! Let me simply say: “Technology helps us to solve problems, so that it can create new problems”.

Well population pressure goes a long way to explain death. But the other side of the puzzle is that while we increase in numbers, the space remains the same: attempts to create a living space in the space have been exhausted, and we can’t explore any more – the moon is impossible! Now, in the past the Masai people had the freedom to move around the Great Lake region, but now they will hit against the Kikuyu people, save the Hutu people outside the so-called Kenya. In the past people were widespread and didn’t communicate frequently and easily such that twenty funerals taking place at the same time were not noticed. Today, people have been concentrated (the health reasons Egeku postulates also come to effect), and administration gets sophisticated – where a village, a township or a suburb is expected to have a single cemetery or even share with other localities (very typical in South Africa). Then the dead always have to collide!! I hope their spirit(s) don’t collide.
This problem has eroded some of our cultural norms, such as the kids forbidden to neither attend funerals nor know about the dead: In Sepedi (Northern Sesotho) culture children were told that the person was taken by a hyena (O tsere ke phiri). Nowadays children do kill and bury. Women fight against the in-laws over burial rights – so that she can own the estate by herself. Priests offer commercialized burial services, and so on. Is this the end of times or the beginning? Can medical or health help provide solution? Should we go back to understand how death came about?

Egeku…it is yours again – hope we meet in heaven not in hell!!

Moraka Makhura
University of Pretoria
*** We die once and live forever ****

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