Your Tenwek Orientation - Part 2: What is it like to be a patient?
Across the world, typical hospital visits will share some universal elements: hustle and bustle of medical professionals, patients and visitors doing the hurry-up-and-wait dance, a steady choir of beeps accompanied by the frequent whoosh of beds being rolled down echoing hallways. Yet, there are many other components of a hospital experience that vary considerably from country to country. These variances are not the result of a hospital doing something “right” or “wrong”, but often is reflecting some of the cultural, and structural characteristics of that country.
The differences between a typical patient experience in the USA vs Kenya are many, but they certainly seem to parallel cultural differences between these nations. I have outlined a few interesting practical differences below. Take a look!
Note: this is part 2 of our Tenwek Orientation series of posts. Check out #1 here, describing some of the different titles and roles of Kenyan medical professionals.
Tenwek Aerial View
1. Hospital experience / culture:
USA
There is a general expectation that a western hospital will not only treat a patient’s illness, but hospital staff will also provide for other needs such as food, laundry, bathing, assistance to use the restroom, etc. The more upscale a hospital is, the greater the amenities are that are provided. Optimizing the patient experience is an important piece of hospital operation, influencing the reputation, and thus the success of a hospital.
Patients also value and expect privacy, with solo rooms many times, or curtains to draw around a bed to isolate a person in a ward.
Kenya:
Generally speaking, patients at Kenyan hospitals do not expect the hospital staff to attend to their non-medical needs. While Tenwek does provide food and washing of linens and hospital garbs, it is common practice for one or more family members to stay with the patient and attend to many of a patient’s other non-medical needs. This aspect of Kenyan family support system is challenged by the COVID requirements to have only one visitor with a negative test per patient.
The Kenyan hospital experience, consistent with national culture, is more communal than in a western hospital. Wards are open, and patients and family members often pass the time mingling with others. In the maternity ward, Moselle often sees neighboring mothers assist each other in little ways, like looking after babies if a new mom has to go to the restroom.
Tiny feet of a quadruplet in the ICU.
2. What if people need blood?
USA:
There is a large country-wide infrastructure of blood donation, purchasing, selling, etc. for the purpose of keeping the “blood bank” decently stocked for surgeries, emergencies, and the like. The hospital and other outside organizations and businesses work this out.
Kenya:
Tenwek Hospital manages its own blood bank, primarily through requiring 2 to 3 family members of patients to donate blood before surgeries, even C sections. This keeps the blood bank stocked, hopefully with the proper blood types needed for that very surgery. There are often calls for family members and even other missionaries to donate blood as needed for complex surgeries.
A romantic mid-day blood-donating date!
3. How do people pay for healthcare?
USA:
Medicare, Medicaid, and Insurance can cover some, if you are fortunate enough to qualify and/or have good coverage. Outside of insurance “Co-Pays”, typical payment for procedures, checkups, tests, etc. are usually charged to patients after the fact. Medical debt is quite common among Americans.
Individuals are expected to pay for their medical debt over time with payment plans, etc. This certainly causes problems for many American families. They will often seek the help of a few well known individuals in their family, or potentially other government, religious, or community organizations if the need is great. Still, nearly two thirds of all bankruptcies in the US are tied to medical issues/costs (1).
Kenya:
National insurance exists for those whose employers pay for it, or who pay for it themselves. The National Hospital Insurance Fund (NHIF) covers some preventative care, outpatient care, and some tests, but most high dollar surgeries and other inpatient hospital care is not covered.
There are not good structures in place to ensure that payment happens after a procedure. As a result, patients are typically required to pay for their elective procedures, tests, and care up-front. Healthcare professionals try not to turn people away for emergency treatment, but there is no clear-cut solution to guaranteeing that these patients pay afterwards. Tenwek, just like the rest of Kenya, is still working out a best way to not lose money over emergency procedures. One method is through the collection and use of departmental “compassion funds” in place to assist patients in moments of great need.
Often, individuals do not have emergency funds saved up to afford hospital surgeries or treatment on their own. Paying for these procedures is typically a family and community effort. A fundraising event, called a “Harambee”, is typically held with efforts made by relatives, neighbors, and friends in the weeks preceding the Harambee to collect funds to help reach the required goal. This community safety net is integral to the culture in the Tenwek surrounding area. Community members are expected to help others in their Harambee, and others will return the favor when a great moment of need hits.
Kenya Coat of Arms (2)
Note #1: Harambee is Swahili, meaning “all pull together”. It is the official motto of the nation of Kenya. You can see it at the bottom of the Kenyan coat of arms.
Note #2: As Kenya is becoming more urbanized and the culture shifts towards individualism in the cities, the safety net available to families in rural areas such as Tenwek has disappeared. In places such as Kenya’s capital city of Nairobi, there are no structures in place for people to pay large medical bills.
Dr. Steen performing ultrasound on a patient (pre-Covid times!)
Appendices: Extra tidbits for those who are curious
A. Estimated costs for procedures:
Vaginal delivery
Avg US cost (depending on the state): $5,000 – $11,000
Tenwek cost: $70 - $150 (without epidural)
C-Section
Avg US cost (depending on the state): $7,500 – $14,500 depending on the state (3)
Tenwek cost: $150 - $300
Diagnosis and treatment of broken arm:
Rough US cost:
$16,000 with surgery (4)
Tenwek cost:
Surgery for a broken leg at Tenwek costs roughly $1,000, or 108,000 Kenyan shillings.
Note: ~$5 or 500 shillings a day is a nice wage for someone without a university degree in Kenya.
B. Comparison of leading causes of mortality in 2019 (5):
USA:
Cardiovascular diseases
Cancer
Chronic respiratory diseases (e.g. asthma and COPD)
Neurological diseases
Diabetes and kidney diseases
Kenya:
HIV/AIDS
Cardiovascular diseases
Respiratory infections + tuberculosis
Cancer
Diarrhea and enteric diseases
C. Footnotes
(David U. Himmelstein, Robert M. Lawless, Deborah Thorne, Pamela Foohey, and Steffie Woolhandler, 2019: Medical Bankruptcy: Still Common Despite the Affordable Care Act American Journal of Public Health 109, 431_433, https://doi.org/10.2105/AJPH.2018.304901
Xavi Garcia, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons
https://vizhub.healthdata.org/gbd-compare/
