What a place! MTRH - Moi Teaching and Referral Hospital

Let’s make this clear – I came to Eldoret ready to work -if David could return to work, so could I! I had brought only the pair of pants and shirt I wore on the flight... and 5 pairs of scrubs! It never occurred to me that I wouldn’t be needed somewhere to do something, but it didn’t work out as I thought...it worked out even better. Instead of sentencing me to 2 weeks of hard labor on the wards, the personnel dept. at the hospital gave me free rein to go, see, do, (even photograph) whatever I chose. It didn’t take long for me to realize that the learning experience I would gain from “free time” was immeasurably productive. In retrospect, the British/African system of nursing was not just foreign, it seemed almost from another planet for me, an American trained RN.

I got a map of the hospital and was given a contact person in any dept. I wished to visit, who would explain to me the machinations of the 2nd largest hospital in Kenya. MTRH (Moi Teaching and Referral Hospital) is run more as a mini-macrocosm of life outside the hospital, than as the institution of health care we know in America. Families gather and usually stay all day, sometimes even sleeping at night on the floor next to the patient. They bring in food, bathe and care for the patient and wash/dry the patient’s laundry, since frquently the hospital runs out of patient’s gowns. Nurses work all shifts rotating thru this schedule: Day #1: 7:30AM – 1:30PM, Day #2: 12:30PM – 6:30PM, Day #3 and #4: 6PM to 8AM, and then they have 4 days off (the overlap 30-60 min. is allotted for report).Then the cycle is repeated. The RN I spoke to on the orthopedic ward carries a typical load of 18 patients on day shift but does have assistance from 2 or 3 nursing aides. If patients are ready for discharge but perhaps live in the countryside or have no one to take care of them, they stay at the hosp. as long as needed, and that may be for many months (a patient was recently sent home after 3 years). Those awaiting surgery also just “reside” until they get their operations. This may take a while since there is only 1 neurosurgeon, 1 ENT, 2 opthamologists, 1 cardio-thoracic surgeon and 2 orthopedic surgeons and 10 general surgeons.There are no extended care facilities or nursing homes in Kenya. Basic hosp. cost is KSc 2,000 a night ($24.). Approx. 20% of patients are able to buy insurance for the private hospital close by; those without insurance are not charged for care or surgery.

My first day at MTRH, I felt like I was in a busy American mall on a rainy Saturday – it was a constant hub-bub of people everywhere, so crowded that it was often difficult to walk. Patients were admitted in a public area, and since medical records are not computerized all paperwork was stacked higher and higher up the walls in those ubiquitous manila folders in a small office. It was noisy, hectic yet cheerfully boisterous. Due to the temperate climate, most wards and buildings are open to fresh air and connected to other parts of the hospital by breezeways. The hospital has 800 beds but usually has 1200-1600 patients. How do they do this? Simple...2 and sometimes even 3 patients per bed (you can see this in the two photos showing patients: one picture of 2 moms holding their newborns, all sleeping in one bed, and the other picture showing one male patient with his head at the head of the bed, the other with his head at the foot of the bed). The catchment (service) area includes over 20 MILLION people, many from south Sudan, Uganda and Ethiopia; and an average of 1,000 patients come in daily for care. MTRH births approx. 10,000 babies a year, many high risk due to poor pre-natal care. Home deliveries, without trained mid-wives, are very, very common and add to a high infant mortality rate. Only 1 kidney transplant was done in 2004-5. It cost 1.2 million KSc (US$13,480) and was deemed too expensive so it’s no longer avbl. For this entire catchment area there are only 13 dialysis machines and the charge is US$400. cash per session, clearly only for those who can afford it.

The average monthly wage for a prof. driver, such as our Kirui, is KSc 18,000 (US$216.). A young everyday Kenyan professional earns a monthly salary of approx. KSc 25,000 (US$300.) and a physician approx. KSc 100,000 (US$1200). Doctors receive a monthly housing allowance of KSc 30,000 (US$385.) and nursing and administrative staff KSc 5,000 – 13,000 (US$62. – $184.) Doctors frequently live in the “Doctors Village” adjacent to the hospital, which charges nominal rent. Small building lots outside of the central area are for sale and cost US$3,400 –$3,800, sometimes without electricity and usually without water. Banks offer loans to the brave souls who choose to build and dig wells at 15% with a 3 -4 year payback, which is automatically deducted from your paycheck. OUCH!

The hospital even had its own choir! Its members would dress in lovely African regalia and sing at important functions, on holidays, or just do “cheer-up” rounds at the hospital. Their voices were beautiful, and I was lucky enough to hear their singing at 3 events.

                                                                              

                                               

Medical Records - not yet computerized

There's my David, ready to go to work!

Very crowded wards, notice 2 patients sharing the same bed in the back.

Lunch time for the patients, who must bring their own plate and silverware in order to receive a portion.

Two new moms and their babies, also sharing a bed for several days until dischar