Stacy Harris picked me up from Shalom around 10, just 4 hours after I checked in from an all-night bus ride from Kitale.
We arrived at Karen Hospital in the outskirts of Nairobi. “Do you want to scrub in?” Stacy asked, being serious. I declined, but we put on clean shoes and crossed the red line in the surgical theatre to see Dr. Patel at work, installing a pacemaker into elderly man that had been donated by FICS.
From behind a glass barrier we watched. In front, a line of flat screens and laptops buzzed and beeped, feeding back ECG data to the crowd of 7 people hovering over the patient. Stacy, who just joined FICS two months ago, started rattling off the names president.
“There – that’s the chief cardio surgeon. And there’s the CEO of the hospital. And I think that guy is the president’s own doctor. That doctor flies up from South Africa every time Patel comes. Three or four residents watched as Patel explained to them what he was doing.” Frequent CT scans flashed by, monitoring the movement of the catheter as the team positioned the electrical probe that would keep this man’s heart beeting for another ten years.
“Is that my favorite Stacy’s voice I hear?” Patel shouted from across the room. Somehow, heart surgery and small talk have always been compatible. But a few minutes later seriousness entered Patel voice as the patient’s heart rate took a dive.
“Heart rate? Systolic?” He barked. “Get me more images. And stabilize that drip!” It was ER.
“Yesterday I scrubbed in and watched as he installed another pacemaker into an elderly woman,” Stacy whispered. “I was about to collapse. In the middle, the patient died for three minutes. I actually watched them bring her back to life.”
Stacy spoke not with excitement, but with relief. He’d met the woman and her family several times that week. “I don’t think I could never handle telling the family that she didn’t survive, not after we’d gotten so close.”
Just the day before, Stacy had told me on the phone how he wanted to be a doctor. But after shadowing Dr. Patel for a few days, and riding the rollercoaster of emotions and surviving the non-stop hours of surgery, he’d changed his mind.
This is what FICS is all about. It began as a family operation of Kenyans of Indian descent who’d moved to Minnesota, became doctors, and found a way to give back to the homeland. It’s exciting to see Stacy’s passion for their mission to deliver medical supplies and services to Kenya.
I can see this is such a challenging place to practice medicine. Dr. Betty, the hospital CEO and also a pediacardiologist, explained that there are only five places one can go for heart surgery in East Africa. And in Nairobi, Kenyatta Hospital’s cardiac doctors have been sitting idle for over 2 years, all because of a broken Phillips brand catheter machine.
I also think sterile techniques are questionable. As a neuroscietist I’d worked under sterile conditions and I was shocked at how often I had to stop the people who had scrubbed in from trying to shake by dirty, bacteria-covered hands.
“I’m not being rude,” I explained, “I’m saving your patient’s life.” Hospital-transferred infections kill more people in hospitals than any other disease in the USA. I don’t point this out to disparage any of the work they are doing, but to remind us all that we have a ways to go yet in Kenya.
Even Stacy was a little shocked at my science-lab-standard behiavior. “Marc, if you only saw how dirty the other hospitals were, you would be really shocked!” Stacy said.
It makes me sad and angry.
But overall, I think FICS appeared to be providing exceptional medical care in a place where people simply cannot afford it.
<h1> Understanding one cause of rising health-care costs </h1>
After, I was sitting in the lounge waiting for the team to close up, and Dr. Betty, the hospital CEO came by and fixed herself some tea. On TV, Kenya’s parliament debated the new constitution for yet another week. This was a momentous day. The world court was issuing arrest warrants for those behind the 2007 post-election violence. The country held its breath, watching to see if riots would break out when the criminals were named. It’s no wonder parliament debated endlessly. What good would a constitution be if the country was on fire once more?
Many people had told me they thought this whole parliament was corrupt. No faith in leaders is what I was hearing. So why would they write laws that ended their corruption? Thinking back to the US constitutional congress, I told Betty that ours was written by one man after he’d listened to everyone.
“We tried that first. And the people were able to propose the constitution they wanted,” Betty said. “Only after, the politicians came back to the people and told them their plan would hurt them, and threw it out.”
“What about getting a group of people to write it, who afterwards can never run for election? This way they are captives of whatever law they choose.”
“We’re trying that now. A group of experts met and proposed this second version. Only now parliament has been debating it for a long time. I don’t think they will ever agree to it.”
Somehow the subject came up of the hospital’s problem with medical imaging software. I talked about my experience in neuroscience and recommended they try using the free ImageJ software for 3D reconstructions. We went down to the full-body CT room and had a look. Phillips had sold them software, only to cancel their license a few years later. Phillips corp was holding this hospital ransom. You couldn’t change any settings, or export the images.
“How do you back up your images?”
A tech showed me something that looked like cross between a nintendo cartridge and a ZIP disk, right out of the 1990s. “I’ve never seen one of those before!”
Soon Betty – the hospital CEO – had 2 CT techs, the chief of the CT department, and the systems administrator all discussing the problem. She was passionate in reminding me and everyone that the goal was better patient outcomes, and that we should work hard to get this equipment fixed.
They had been unable to use this equipment for months, and Phillips hadn’t sent a tech to fix the software, even though the hospital signed a 5-year service contract. Such callous medical profiteering made my blood boil.
“This is absurd,” I ranted. “Your goal is to save lives. Their goal is to make money. You are the customer and they should be serving you!”
We devised a plan. If we could get these images off the Imaging PC that was on lockdown (no one could change anything or access the real OS) – then they might be able to use a free and superior 3D reconstruction program developed by NIH scientists (ImageJ), saving money while improving medical care. At the moment, a million dollar piece of equipment sat idle while Phillips or it’s local service partner cashes in on a service contract they’d violated for over a month.
Dr. Betty was also upset. “It’s not just this machine. We also bought a Phillips X-ray that was a waste, and Kenyatta Hospital bought a million-dollar catheter insertion machine, all of which go unrepaired. Their machines are too delicate. I will never buy Phillips again!”
There are only 5 places one can go for heart surgery in East Africa. Kenyatta’s cardiac doctors have been sitting idle for over 2 years, all because of a broken Phillips catheter machine.
It was surreal. Here I am, just some guy who’s studied rats in a lab, telling the CEO and a team of doctors how to wrestle with a shady corporate medical equipment provider. That WAS one thing I’d become an expert in – finagling salesmen into selling us what we wanted, and not what THEY wanted, no strings attached. In retrospect, ALL of my headaches from grad school and my post doc were related to dodgy biomedical equipment salesmen.
If you want to understand why hospitals pay more for less, this story captures it in a microcosm. The profit-hungry corporation sells a product that shines at first, then holds these medical-outcomes-oriented hospitals for ransom with fine print, expired licenses, and deadbeat service contracts. In Kenya, that seriously impairs the cash-poor hospitals, who must do without. And forget litigation – Kenyan courts would only tie their hands just like the members of parliament tie up the constitution in legalistic knots. Now I see how a weakened judiciary can directly result in people dying unnecessarily, and it angers me enough to publicize this, consequenses be damned.
If I don’t say something, who will?
If Phillips should hear about this, I should hope they’ll fix the problem and apologize to the hospital. But there’s always a chance they’ll do the opposite, try to punish the messenger and stonewall against better medical outcomes. Stay tuned.