Dear Nairobi Hospital (Dr Cleopa Mailu, CEO - above):
I would like the following 2 staff investigated for competency and patient handling skills;
1. A&E covering Doctor (Waki/Weki not sure), who was on duty on Saturday, 9th November from 8PM to Sunday, 10th November 3AM.
2. A&E Nurse, called Anita, who was on duty on Sunday, 10th November from 10AM to about Midday.
Chronology of events leading to mismanagement
I came into your hospital on Saturday, 9th at about 8pm with my daughter XXX who is 3.5 yrs old child, with complaint of running tummy, fever and dizzy spells. Visible signs included being sleepy, cranky and kept “jerking””, like someone who has just touched something very cold. The history given to the doctor was that the child had seen her doctor earlier in the day, been given medication with a caution to keep a keen eye for deterioration since she clearly did not seem well (at least her doctor knows her well to know when she’s not good).
I even advised him to call her Dr. David Githang’a, but I don’t think this was done. The covering doctor at A&E run a battery of tests which cost over Sh10,000, prompting your finance staff to get authorisation from the patient’s insurance for clearance. I think his name is Waki/Weki (sorry I don’t recall the name but am sure you can pull it off your records). After all that we were cleared to go home at almost midnight with some extra meds. We went home hoping that all is well.
However, on Sunday, 10th November at 2.30AM, we were back again to hospital with my daughter running a fever of 40C, which I gave bruffen to control as we left the house in Kileleshwa and removed all clothes, carried her in a shuka. Her personal dr (Dr David Githang’a) advised that she should be investigated as an in-patient.
Upon reaching hospital, I checked into finance and asked the lady there to process admission forms and presented all the relevant insurance forms. This was done as we waited to see the same doctor who we had seen earlier. When it came to our turn, of course the fever had subsided but not the other symptoms pointing that the child was clearly not well.
I told him what her doctor had said and he said he’ll call Dr Githang’a to discuss and he left the room. He also took time to review the APA Doctors panel and informed me that Dr Githang’a was not on it. But I explained to him, my cover had exemptions on paediatric and gynecologist doctors, whereby the patient is allowed to use their preferred doctor.
When he came back, he advised that they had discussed with daktari and he (the A&E doctor) had advised Dr. Githang’a that the child is well enough and no need to admit and gave us a battery of reasons why.
So I went back to Finance and withdrew the admission with APA insurance. No medication was given and we were advised to go home and continue with the meds given earlier. At that hour of the night we (my husband and I, did not have the energy to argue with him, considering that we had not slept since we left hospital at midnight). Thankfully, the fever had come down.
Sunday, 10th November 10.00AM, I arrived at with my daughter who was not clearly well and went straight to the A&E paediatric unit and spoke with the nurse there by the name Anita. I explained to her that we need to urgently see the dr and that dr Githang’a wants to speak to the covering Dr ASAP. This was prompted by the fact that I told the dr Githang’a (who was out of town) that despite my daughter’s fever being low, she was now vomiting and now her watery stool had streaks of blood and was very weak.
The nurse (Anita) promptly informed me that there was a line and that I should follow it. I repeated my story with my daughter in tow, but she would not listen to me – almost becoming confrontational. (What I read is that she had a queue to clear and how she does it is her business) I informed her, that my daughter’s case is an admission case and that am proceeding to process the admission as I await my turn after 5 or so patients to clear.
She had the audacity to tell me that “no admission will be accepted until the A&E doctor certifies it” as she waved me off. I proceeded to admissions and completed the process in excellent time. Meanwhile, my child is getting weaker and weaker.
Upon returning to paediatric A&E, I went to the nurse and told her I was back informing her that the child was now very sick. She said “pls wait, I called and you were not here so wait your turn”. My daughter told me she wanted to lie down and slept on the waiting seat. I informed Dr. Githang’a of the treatment were getting here and asked him to intervene.
When we were finally called in by the attending Dr Mbugua, the child was so weak; I had trouble getting her of the seat. So by the time we got to the cubicle the dr was already moving on to the next patient. However, she stopped and took an interest in my daughter. I explained the story and clearly she was very concerned and put a call through to Dr. Githang’a.
But as they spoke, my daughter seemed to go into shock and I had to get her back into our cubicle. Upon checking her, her vitals were not good, pulse was low, pupils dilated, child was hallucinating, veins were near collapse. The one she got could not draw blood at all.
Now it became an emergency. She was put in the treatment room and emergency treatment started. I know my daughter had to be given “bolus”, that is the direct of fluid with glucose into the vein, then some injection to stop vomiting. By this time, my daughter did not even know who I was, when she was asked by the doctor “who is this” and just kept hallucinating/talking to people who were not there e.g. her friends in school.
After a while, they tried the blood again, and this time the only option was to “bleed” her and also take her entire diaper to the lab. She was then moved to the observation room across the building, as this doctor kept updating her doctorr on management.
Eventually we ended up in the scan room and then to the ward. Which was made easier by my pro-activeness, and we were discharged yesterday, 13th November. I have two medical covers, and I used admitted her using my UAP cover, so clearly the ability to settle bills did not arise. Meanwhile the patient line which was so important to clear, had grown quite long.
Questions I need answered
Aren’t your staff trained to pick a child who is clearly very unwell? (I know my daughter is quite healthy, weight wise, but that doesn’t mean she can’t go down like a skinny child)
Are the staff in Nairobi hospital pediatric section trained to adhere to processes, so much that saving human life and eventual costs is secondary?
At what point do the staff listen to patients issues/mothers? It’s not every day that I walk in there trying to cut the line, in fact I NEVER, I prefer seeing her personal dr. Neither do I like my child in the ward, I know they pick all sorts of germs from there.
Who will pay for the emotional trauma that I suffered as your staff attempted to resolve a problem they created?
Nurse Anita, should be relieved of her duties immediately. Due to her management, how many other children deteriorate under her watch?
Dr. Weli/Waki (the evening dr), needs to go back to medical school to get the basics of patient assessment. Secondly, insurance payments are not his business, it’s the finance office to resolve. If he has aspirations to join the insurance sector am sure his resignation at this juncture will be in order.
I look forward to getting your prompt response on the matter above. Regards,
Cofek: We are very sorry for Susan's experience and especially her daughter (whose name we have deliberately removed) for the bad experience. We will be ready to publish Nairobi Hospital response. We hope they will not need to rush to a legal firm to claim frivolous libelous damage. Meanwhile, we are referring this complaints to the Kenya Medical Practitioners and Dentists Board for further investigations. Patients with more complaints on Nairobi Hospital or any other hospital are requested to send their complaints to be discussed at the Cofek Health Sector Unit