How emergency response failed Baby Travis at hour of need

“Mum, please remove this thing from my head. These were baby Travis’s last words to his mother before being wheeled to the theatre room. 

Using her right hand to hold the fork jembe that was lodged into her son’s head by his elder brother, she held him at her elbow and handed him to the nurses. The two never had the chance to speak and chat again. Baby Travis breathed his last. 

A two-week fresh grave is now the new resting place for the two-year-old baby, a victim of a broken health care system. 

But this is not just a grave of a faceless victim. His grave is a clear indication that an emergency case does not stop a hospital from demanding money before attending to patients. This has become the norm in many hospitals in the country. Many Kenyans have gone through the same. Many have died while some are lucky to be alive.

Unfortunately, Baby Travis becomes the latest unfortunate statistic in the number of Kenyans who have died awaiting urgent medical care, which many health facilities, including Kenyatta National Hospital, have been unable to handle. 

He was the last born to Ms Judy Muthoni, a 28-year-old mother of three boys aged eight, six and two years.  She lives with her mother in the struggling Ndula hamlet in Kiambu County.

“This is where I call home, this is the home where Travis was buried,” weeps Judy while pointing at the baby’s grave. “I told you I am poor that’s why I had to lose my son in such a manner. If I had the money, my son would be alive now,” she tells Healthy Nation that doctors left her baby unattended to for 24 hours. 

Sitting pensively on a broken wooden chair opposite her hut, Judy regrets why she left the boys at home unattended while she went to fetch grass for her sheep.

It was on October 10. Immediately after having their breakfast of chapati and black tea, she left the boys under the care of her aunt who had a grocery stall next to the road. She left. The boys sneaked and came back to their house. 

At the door of an unfinished house covered with blankets and old mosquito nets, Judy had left a fork jembe that she used to collect garbage from her garden. 

The two elder boys took the jembe and proceeded to the shamba just next to their house. Left in the house alone, Baby Travis followed them. 

While at the shamba, the baby fell asleep. The two decided to let him have his nap in a shade just next to where they were digging.

His nap was cut short when his six-year-old brother mistakenly hit his head with the fork jembe that two of its teeth ended up lodging on the left side of Baby Travis’s head.

On her way back, his mother received a call from her aunt informing her that the baby had been rushed to the nearby dispensary for first aid. 

She dropped the grass and rushed to the dispensary, but “on arrival, what I saw scared me. I cried and so many questions ran into my mind, which I did not have an answer to.”

At the dispensary given that they did not have a theatre, all they did was tie a bandage around the head for the fork jembe not to move.

Judy and her son arrived at the hospital around 12pm that Monday and they were then referred to Thika Level Five Hospital, where a head scan and X-rays were done. 

“This is a complicated surgery, from the scan that we have done, we may not be able to perform the surgery here, we have made calls to Kenyatta National Hospital and they are expecting you,” said the hospital management. 

They arrived at 4pm but according to Judy, they were never attended to until the next day on Tuesday, 1 pm when Baby Travis was wheeled to theatre room. 

Judy recounts how she was left at the casualty area sitting on an uncomfortable seat for 14 hours as she watched her son battle through the minutes and hours that seemed like an eternity. 

At the casualty, Judy says no one bothered to attend to them and all she was told was that the doctors were having a discussion about the case before they could attend to him. She was then instructed by a nurse to pay Sh1, 260 for admission.  

After two hours, a nurse came asking whether they had paid Sh20, 500 for the surgery, an amount they did not have. Ms Muthoni believes that this is what stood between his son’s life and death.  “Since I did not have the money, my son died,” weeps Judy.

From the time they got to the hospital at 4pm to the next day at 1pm, she was asked not to give the child anything to eat or drink. But the child wailed asking for tea and water. 

“He died during the operation,” cries Judy. 

Even after paying for admission, Judy says her son never slept in any hospital bed the whole night. 

“My sister and I spent the night in the cold corridors of the casualty sitting on a chair while holding the fork jembe in my son’s head waiting for instructions from the hospital.

At night, she says, the nurses would come, pinch him while he was sleeping, and when he cried, they would go back. “We are coming to pick him up for surgery, don’t give him anything,” they would tell her.  It took another four hours for them to come back, she says.

“The patient had lost a lot of blood and as a result, the clotting process was not occurring as expected thereby delaying the surgical procedure as this would have been dangerous to the patient,” the hospital explained.  

Critical condition

Such cases are increasingly worrying Kenyans  as needless deaths occur due to the delay in responding to patients in critical condition.

In early September, Robert Omondi watched for four hours as his wife writhed in pain with her lower body soaked in blood. Robert made several calls to the nurses at Mama Lucy Hospital in Nairobi after realising that his wife was lying in a pool of blood and in the same bed with their twins wrapped in blue baby shawls. He says no one responded. 

Robert still believes his wife died because he did not have the Sh200, 000 that some private hospitals in Nairobi demanded before she could be admitted. Since they did not have the money, they waited for hours before they were finally referred to Kiambu Level Five Hospital.  She died three hours later after arriving at the hospital.

In 2018, Matilda Anyango was walking home from work late into the night in Nairobi’s Kangemi estate when a knife-wielding gang suddenly attacked her. 

Following the injuries she sustained during the attack, Matilda was taken to the nearest hospital that could offer emergency services to stabilise her.  

The 32-year-old woman died after spending 11 hours waiting for services, leaving behind a bill of Sh8, 558,000. Initially, the hospital where she was taken for emergency care asked for Sh200,000 as a financial commitment.  In 2015, Alex Madaga died after spending 18 hours in an ambulance for lack of an ICU bed. And despite bleeding in his brain, the patient could not be taken in by private hospitals without a cash payment of Sh200,000.

This clearly tells how health care in the country is commercialised. It is no longer the business of saving lives but making money comes first. 

In the same year, Elizabeth Akala, who was pregnant, was reported to have died after medical staff allegedly clocked out at the end of their shift, leaving her unattended, crying in pain and begging for help for 14 hours at Kakamega Provincial General Hospital.        

“These cases were purely about healthcare workers’ poor response to medical emergencies. All the needed resources were available. Many are not trained on emergency care until they are at the postgraduate level,” says Dr Benjamin Wachira, an assistant professor of emergency medicine at Aga Khan University Hospital, Nairobi.

He adds: “The emergency was not what the child presented with but initial resuscitation and ensuring the patient is comfortable, meaning they are not in pain, even though the theatre was not available.” 

Both the Constitution and the 2017 Health Act state that nobody should be denied emergency medical treatment. This includes pre-hospital care, steadying the patient, and arranging for referral in cases where the health provider of the first call does not have the facilities necessary to stabilise the patient. 

Dr Davji Atellah, Kenya Medical Practitioners and Dentists Union secretary-general, however, says most patients die because of dysfunctional public health care. 

“Ideally, Thika Level Five, according to the accreditation by the Kenya Medical Practitioner and Dentists Council, ought to have had all the specialists to conduct the procedure on Baby Travis but since they did not have the equipment, he was referred to KNH,” he says. 

He explains that the dysfunctionality comes in because most counties do not invest in health care to ensure that the services are offered. 

“Had the hospital invested in the health care system, putting in place the necessary equipment and specialists, I want to believe that Travis’ life could have been saved. And many Kenyans are dying in such a situations,” Dr Atellah notes. 

But hospitals need to be equipped and more specialists employed at the county hospitals. 

He says many of the hospitals have lesser manpower because 70 per cent of the doctors who have since graduated are not yet employed hence increasing the waiting time for patients who need emergency care and faster attention. 

“The waiting time is long because there are no doctors to attend to the patients or no equipment has a referral to another hospital or only one theatre is available and it is being used at that particular time. The system is killing its people,” Dr Atellah says. He adds that if emergency services are not improved in counties, the cases will continue to rise.

Dr Wachira mentions that the country needs to think of low-cost interventions in emergency medical care services that can change what we do and how we do it as a country.

To implement the Kenya Emergency Medical Care Policy 2020-2030 through the National Emergency Medical Care Steering Committee, the Ministry of Health has committed to establishing pre-hospital and emergency department standards.

“Develop an appropriate framework for the establishment of the Emergency Medical Care Treatment Fund and amend the Health Act to include the ‘Emergency Medical Care Bill’, which will develop the Emergency Medical Care Authority, this is yet to be done.

“The World Bank says that implementation of “effective, prioritised, timely emergency care can address 45 per cent of deaths and 36 per cent of disability in low and middle-income countries”.

The Health Law 2017 defines emergency treatment as necessary immediate healthcare to prevent death or worsening of a medical situation. It even imposes a fine on facilities and health professionals who break this law. 

“Any medical institution that fails to provide emergency medical treatment while having the ability to do so commits an offence and is liable upon conviction to a fine not exceeding three million shillings,” it states.

According to the African Federation for Emergency Medicine, emergency treatment is a provision of initial resuscitation, stabilisation, and treatment to acutely ill and injured patients, and delivery of those patients to the best available definitive care, regardless of ability to pay.

Dr Wachira, who also serves as the executive director of the emergency medicine Kenya Foundation, says the first point of emergency care is where the victim or survivor of an accident, disease, or robbery, is picked up from. The chances of survival for these patients depend mainly on the golden hour — which requires a patient to receive emergency care within the first hour. 

According to the emergency medicine Kenya foundation, an increasing number of patients with emergencies are presenting in hospitals across Kenya. The Foundation attributes the spike to the rising incidence of non-communicable diseases such as cancer, diabetes and hypertension), mental illness, and trauma (largely secondary to road traffic injuries) in the background of an already existing large burden of communicable diseases. 

“Unfortunately, the healthcare system is often dysfunctional and fails Kenyans. This is because emergency medical care has never been an integral component of Kenya’s healthcare system,” says Dr Wachira, adding that “an ideal system caters to the patient’s needs regardless of whether they have the money or not. This is by law.” 

Understanding an emergency, he says, depends on the system around you (healthcare provider). “For instance, if you are not trained in emergency medicine but you are in a trained system, you will catch up.” 

In 2013, Kenya transitioned into a devolved system of governance. Devolution has shifted emergency care from one government, one health system approach to what is effectively 47 distinct county-based approaches. As most healthcare in Kenya is provided outside of the highest level six health facilities, each county government is responsible for building and maintaining an emergency care system.

Pre-hospital emergency medical services are an integral piece of any emergency care system. Currently, due in large part to disparate county-based approaches, the Kenyan government cannot estimate the total number or location of ambulances across the country.

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