Tuesday, May 28, 2013

Medical negligence reports grossly exaggerated

By Lukoye Atwoli
Sunday Nation 26 May 2013

Last week, a local newspaper carried a series of stories whose thrust was that medical malpractice was rife in the country and was causing untold suffering and loss of lives in our hospitals. An opinion piece carried during the series indicated that “doctors, pathologists and medical industry players concur that misdiagnosis is running at almost 30 per cent of cases, across both public and private hospitals”.

It was claimed that one in ten patients who suffer medical malpractice die. The writer further made the sensational claim that: “Doctors, it seems, are killing more of us, all the time, than our police and all our criminals put together ever have.”

In my view, the opinion piece did not do justice to a complex problem in the health sector, and only served to increase negative sentiment towards many doctors who are already burdened with an inefficient system.

First, the claim that 30 per cent of all patients are misdiagnosed is not only unsupported by evidence, but is also impossible to ascertain. Not all patients who go to hospital end up dead, and not all patients who die undergo an autopsy. In fact, only difficult cases, or cases where there was no diagnosis or a wrong diagnosis, are likely to end up at a pathologist’s table. It would therefore not be very surprising if there is a higher rate of “misdiagnosis” in this setting. 

Physical exam

Majority of patients visiting our health facilities suffer from conditions that probably do not need any investigation beyond a proper history and physical exam. It is preposterous to claim that when one goes to hospital with a common cold they could be misdiagnosed and end up maimed or dead. All the patients diagnosed with depression or anxiety, and are treated with psychotherapy and medication, are unlikely to end up at a pathologist’s table for an autopsy.

Secondly, the allegation that a tenth of those that suffer malpractice die is premised on the assumption that all those that suffer malpractice are known, and have an opportunity to get a second opinion when still alive, or undergo autopsy if they die. This is simply not true. The author of the piece asserts rather sensationally that there are no statistics in our hospitals, or even at the Medical Board, on such cases. Where she gets her own statistics is therefore suspect.

Sadly, the Saturday Nation also carried an alarmist story about a purported link between a life-saving vaccine against mumps, measles and rubella (MMR) and a pervasive developmental disorder also known as autism. The story was based on discredited research by Andrew Wakefield, whose publication has already been retracted by a prestigious medical journal.

After reading these pieces, a group of my non-doctor friends confronted me and asked me to convince them why they should ever go to hospital again. My answer was simple. 

Risk of dying

Not going to hospital when you’re sick definitely elevates the risk of dying from whatever it is that is bothering you.

Secondly, most doctors you see at hospitals know enough medicine to take care of a majority of the commonest ailments in your vicinity. One is therefore safer taking chances with the doctor than with the untreated illness.

Finally, we must take medical opinions proferred by non-medical personnel with a healthy dose of salt. 

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at the Moi University’s School of Medicine lukoye@gmail.com; Twitter @LukoyeAtwoli

Thursday, May 23, 2013

Mental patients: Media could have done better

By Lukoye Atwoli
Sunday Nation, 19 May 2013

“Kenyan patients escape from Nairobi’s Mathari hospital,” the BBC reported on its website some time last week. The Daily Nation reported that “40 mental patients escaped from Mathari Hospital”. And “Nine escaped mentally ill patients return to Mathari Hospital”, reported The Star.

This narrative was repeated in all news outlets last week when mentally ill patients absconded from the country’s national psychiatric referral and teaching hospital. The Daily Nation editorial on Thursday stated: “... all indications are that the escape was pre-planned and meticulously executed. People who are deranged cannot have the capacity to do that ...”

This same thinking was widely reflected on social media, with many deriding mentally ill people as being zombies, always sedated, incapable of independent thought, “mentally challenged”, or just outright stupid to the extent that any intelligible thing they do should be considered a sign of wellness or conspiracy.

From these examples, it is clear that many view mental illnesses as exotic stuff that only happens to others, never to oneself or to loved ones. They are also viewed as conditions that always result in grossly deranged behaviour, and many people believe that they would recognise a mentally ill person on sight if they met one.

Stereotypes have been created that view making fun of mentally ill people as being a harmless pastime, and everyone, including politicians, refers to their opponents as being mentally ill. The problem, of course, is that this public perception is completely misguided.

First, mental illnesses are not a homogenous condition that can be discussed collectively. Depending on the classification system one uses, there are dozens of different mental disorders, many of which do not share any common symptoms. They range from mild anxiety disorders to the more severely disabling disorganised type of schizophrenia. Painting every mental illness with the same brush is akin to saying that illnesses as diverse as malaria and hypertension are actually the same condition.

Secondly, not all mental illnesses disrupt an individual’s ability to think, plan or organise their own lives. The vast majority of people with mental illness are not in hospital, and are going about their lives oblivious of the fact that the difficulties they are encountering may be due to a mental illness that is amenable to treatment.
They are our politicians, our businesspeople, our health workers, industrialists, drivers and street people. A mental illness is not necessarily a disability.

Thirdly, mentally ill people are not criminals by virtue of being mentally ill, and mental hospitals are not prisons. It is therefore inappropriate to refer to them as having “escaped” whenever they leave the hospital before being officially discharged. In all medical settings, whenever a patient leaves the hospital in this manner, they are said to have absconded. Why it suddenly becomes “escape” in the case of mental illness is beyond me.

Finally, mentally ill patients do not suddenly lose their humanity and become fair game for dehumanising treatment. The Constitution of Kenya guarantees them the right to equality and freedom from discrimination, the right to privacy and the right to be treated with dignity.

Kenyans and the media should should respect the rights of these vulnerable members of our society. 

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association, and a senior lecturer at the Moi University’s school of medicine lukoye@gmail.com; Twitter @LukoyeAtwoli

Monday, May 13, 2013

Let MPs inject decorum in their disagreements

By Lukoye Atwoli
Sunday Nation 12 May 2013

The past couple of weeks have not been particularly encouraging for those Kenyans who look up to our elected representatives for leadership. Members of Parliament have been raucously demanding salary increments while threatening the Salaries and Remuneration Commission (SRC) with disbandment if its members do not accede to their demands. One even went as far as calling the Kenyan voter “a greedy thief”.
The MPs have also engaged in vigorous disagreements on the floor of the House, trading insults and engaging in tantrums that do not serve to move debate forward. This culminated in a walkout by the parliamentary minority, arguing that they were not being accorded a fair hearing by the Speaker of the National Assembly. The bone of contention centred on the composition and leadership of key watchdog committees.
It is important to remind our politicians that there are young people in this country who look up to (at least some) them as role models. The youth are imbibing leadership lessons from their elected leaders, and as they transition into leadership positions themselves, they are likely to model their behaviour on those they have observed on the national stage.
Live broadcast of parliamentary proceedings dominate evening news on all television channels, resulting in children and young adults being fed on a staple of conflict and uncouth behaviour at the apex of the legislative arm of government. Additionally, the audience for our disgraceful parliamentary show has now gone international due to our TV stations’ online presence.
I do not think that any of the MPs shown on TV uttering unprintable stuff would be comfortable watching the resulting coverage in the evening with their own children and relatives. One wonders why they would then subject Kenyans to that kind of tripe and expect to retain the respect of even the most indulgent among us.
There are civilised ways of solving disputes among leaders in any society. On the matter of salaries, our MPs have been advised that if they feel aggrieved by the SRC decision, they should seek redress in court. Should it turn out that the Commission broke the law in reducing their salaries and perks, the courts have the power to reverse the decision and appropriately compensate the MPs.
Fulminating on the floor of Parliament and making threats will obviously not solve the problem.
The disagreement on the leadership and composition of parliamentary watchdog committees is much easier to resolve, in my view. In a presidential system of government, any relationship between the party in charge of the Executive and that in charge of the Legislature is purely accidental. 
Situations will arise where the same party forms the parliamentary majority and also produces the president of the republic, but this is not always the case. In a future election, Kenyans may elect a president from one political formation while giving a parliamentary majority to an opposing group. In the event that the minority controls watchdog committees after that election, the same conundrum will arise.
In my view, the parliamentary minority should strategise to improve their parliamentary strength and develop strategies to effectively check the Eexecutive both within and outside Parliament.
But overall, my plea to parliamentarians is that they need to go about their business with a little more decorum, even if they disagree on principle.
Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at the Moi University’s School of Medicine. lukoye@gmail.com; Twitter @LukoyeAtwoli

Thursday, May 9, 2013

Counties deliberately underfunding health sector

By Lukoye Atwoli
Sunday Nation 05 May 2013
County governments across the country have in the past weeks been putting out press advertisements calling for applications and informing the public about budgeting and other policy initiatives. This is a good thing, and is encouraged and even demanded by our Constitution. Kenyans have also had the opportunity to listen to governors outline their budgetary allocations to the various sectors within their mandate.
Having interrogated a few county budgets presented to the public in the past couple of weeks, one would conclude that many governors are unaware of the important roles assigned to them by the Constitution. For instance, the Elgeyo Marakwet County government proposes to spend about Sh3.1 billion on the various functions mandated to it by law.
As part of expenditure, the governor has allocated Sh50 million to the health department. With the addition of sewerage and veterinary services, the allocation rises to Sh68.3 million, or 2.2 per cent of the entire budgetary allocation. We must remember that according to the Transition Authority, this county will be running the Iten District Hospital as well as the many dispensaries, health centres and hospitals in the county. The Constitution further requires the county government to address ambulance services and primary health care, among other health functions.
One wonders how the county government will deliver on its constitutional responsibilities with this paltry allocation to the health sector. The same budget allocates over Sh250 million to buy vehicles and Sh120 million to renovate offices, demonstrating the importance attached to various other services.
It is note-worthy that the situation in Elgeyo Marakwet is not unique. I would challenge all citizens to interrogate their county budgets to see what percentage is allocated to the health sector. Most county budgets have not taken into consideration the immensity of their responsibilities as far as health is concerned.
We must take the opportunity to remind government at all levels that we signed an agreement in Abuja to ensure that not less than 15 per cent of budgetary allocation is used on the health sector. This commitment cannot be said to bind the national government alone. Because of the extensive devolution of health services in our Constitution, it follows that this agreement binds any level of government involved in budgeting for health.
One may wonder why those of us in the health sector keep harping on about these resource allocation shortcomings. Is it driven by the self-interest of health workers, or is it informed by public interest?
I would argue that both perspectives are correct. Health workers are fighting for increased allocations to the health sector in order to improve the working environment. This would mean more health facilities that are properly equipped and staffed, as well as improved preventive, promotive and rehabilitative services in all our counties.
As a result of this improved health working environment, service delivery would improve, making health services available to all in the manner envisaged by the Constitution. Increased investment in the health sector is therefore of direct benefit to all citizens.
It is the responsibility of every Kenyan to agitate for proper funding of the health sector, given that only a healthy population can handle the numerous challenges facing our nation.
Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s school of medicine lukoye@gmail.com; Twitter @LukoyeAtwoli