The World Bank published a brief essay titled, Cured Into Destitution: The Risk of Financial Catastrophe After Surgery, a quick, informative read.
Surgery has been called the “Neglected Stepchild of Global Health,” which I addressed in detail in an essay published last year, and the World Bank is rightly advocating for support on a global level.
I would like to add several clarifications to the World Bank article as they relate to Kijabe. Maybe they are obvious, but sometimes it is important to restate the obvious.
Lack of Access to Quality Surgery is an Impossible Barrier
“Five billion people—two-thirds of the world’s population—lack access to safe, timely, and affordable surgical, anesthesia, and obstetric (SAO) care.”Access to surgical care is an impossible luxury for most people in the developing world, particularly sub-Saharan Africa. To say that “over 2 billion people cannot afford surgery if they needed it today,” paints the picture that the issue is merely financial.
Yes, on some level financial barriers are true, but the reality is that lack of access predicates the financial barriers. “Over half the global population cannot access the treatment they need should they, for example, haemorrhage after childbirth, suffer a burn, or develop cancer.”
To say a herdsman in Samburu doesn’t have financial resources for surgery might be true. But he also doesn’t have access to a hospital. If he were to fracture a femur, no amount of money could stop the bleeding in time. He needs medical access.
It’s not just Samburu, the problem is just as acute in Nairobi.
Lack of timely access to quality surgery is an impossible barrier for the vast majority of the world, particularly in emergency situations.
The Most Compassionate Action is to Provide Healing, No Matter the Cost
“Impoverishment is a side effect of surgery.” Shouldn’t we fight against this side effect?Yes, absolutely, but we should not neglect the cure for fear of the side effect. The most compassionate action a health care system can take is to heal a person completely. Another way to say it, healing is a higher good than financial stability. The more ethical choice is to give a person the surgery they need. If, after a vehicular accident, I was given the choice of a double-amputation or selling all I possess to save my legs, which would I choose? Absolutely, I would choose my legs. I would not hesitate. Neither would you.
The most devastating situation is impoverishment due to surgery done incorrectly. A person spends all the money they have at another facility and they are not healed, arrive Kijabe destitute and desperate, and require much more complex intervention to correct the improper healing. Therefore, we must not just talk about access and affordability when we discuss global surgery, we MUST consider quality. Are patients actually being healed in a proper, timely manner?
Only 46% of Kenyans are at Risk?
The interactive map in The W.H.O. article is helpful, but without context could be misleading. To see Kenya (46%) versus the Democratic Republic of Congo (86%), Uganda (74 %) and Tanzania (61%) might lead you to the conclusion that investment in surgical access might be better spent elsewhere. A better way to frame the reality is, out of the 300 patients at Kijabe hospital right now, 138 are at risk of being impoverished by their treatment. This is serious.
Let’s Play Dominoes
The World Bank advocates for high-level policy change, as they should. Because of their work toward Sustainable Development Goals, Universal Health Coverage has been at the forefront of Kenyan President Kenyatta’s agenda. The majority of patient funding at Kijabe Hospital must and will continue to come through National Health Insurance coverage, individual insurance policies, and individual funding.
But as director of Friends of Kijabe, I advocate for individual involvement, because I have seen that real people, giving generously, can solve these issues within our context. The solution is not to throw endless amounts of money at the problems, the solution is to play dominoes. Which domino, if pushed, causes the others to fall?
Starting mid-2018, the Friends of Kijabe donated generously to grow the Kijabe Hospital operating theatre complex from 8 to 15 rooms. The project will be revenue-positive almost immediately, increase utilization of the surgical workforce, and reduce the actual cost-of-care in trauma surgery because of shorter wait-times before treatment. Residents and anesthesia trainees will have room to learn. The months-long backlog for elective cases will diminish. The hospital will make a massive step toward internal sustainability. Multiple positive effects from one strategic investment, this is the goal.
The Friends of Kijabe board will meet again in early February to discuss which dominoes to knock over next. Please keep this time in your prayers, that we might make wise decisions on how to provide the best Access + Affordability + Quality in medical and surgical care available in East Africa. This an exciting time, when needs are great and opportunities greater.
David, E.D. Friends of Kijabe