In 2013, Debra Adhiambo, 35, then four weeks pregnant, booked an appointment with a popular gynaecologist based at one of the private hospitals in Nairobi. He had been highly recommended by several friends, and since she wanted to get the best treatment, she decided to consult him.
“A couple of months before this, I had suffered a miscarriage, so the abdominal pain I was experiencing worried me. I called his clinic and was given an appointment for 1.45pm,” she explained.
When she arrived at the clinic, she found it packed with women waiting to see the doctor, and was surprised to be informed that patients saw this doctor on a first-come, first-served basis. She decided to wait anyway, even though she questioned why she had been given an appointment in the first place. And wait she did. Until about 7pm.
“By then I was so frustrated, I had made my displeasure known to the doctor’s secretary and could not wait to give the doctor a piece of my mind,” she said.
When she finally got into his consulting room, however, she could not help noticing how utterly exhausted he looked, and decided to swallow her angry words.
“I patiently explained how I was feeling and I recall him asking me to rate the pain I was feeling on a scale of one to 10, which I found odd,” said Ms Adhiambo.
Eventually, the doctor, whom she had informed of her history of miscarriage, concluded that she was just anxious, that the pain was psychological. She said he did not recommend any tests, and after paying a consultation fee of Sh4,000, he sent her home with the advise to “take it easy.”
Several days later, the pain intensified.
“I remember this day because it was on March 4, 2013, the day the General Election was held. After voting, I decided to go to hospital, the same hospital the gynaecologist I had consulted had a private clinic, but this time round, I went to the outpatient area.”
She was seen by a general practitioner, who, after she described the symptoms, informed her that he suspected a urinary tract infection, but to be sure, recommended a test.
“It turned out that the GP was right – I had a UTI infection, which had travelled to one of my kidneys, hence the excruciating pain.”
The test also revealed that the kidney was swollen, and she was put on antibiotics to clear the infection.
“That incident made me lose faith in what I like to call celebrity doctors – the least that experienced doctor could have done was recommend several tests, one of which would have hopefully pinpointed the problem, but I guess exhaustion had got the better of him,” she concluded.
Ms Adhiambo is eight months pregnant with her second child, and attends antenatal clinics at a private hospital in Nairobi, where she is seen by either of two gynaecologists.
Kenyan mothers, especially those who live in Nairobi and can afford the consultation fees of between 3,000 and Sh4,500 a visit most private gynaecologists charge, will tell you that long queues and hours upon hours of waiting at their doctors’ clinics is the norm, rather than the exception, a frustrating inconvenience they grudgingly put up with in search of reliable medical care.
Currently, Kenya has only 349 obstetrician/gynaecologists and just one obstetrician-oncologist registered with the Kenya Medical Practitioners and Dentists Board (KMPDB). There were 948,351 births in 2017, according to data from the Statistical Abstract 2017.
These figures show the crisis Kenya is facing in maternal health care – there just aren’t enough obstetricians/gynaecologists to care for all the women in need of their services every day. And so Kenyan women continue to die of birth-related complications that could have easily been prevented had these women had access to a specialist, and one they could afford, for that matter.
According to the United Nations Populations Fund, UNFPA Kenya, the maternal mortality ratio, the number of women dying of pregnancy-related causes, stands at 488 deaths per 100,000 live births. This ranks Kenya among the 10 most dangerous countries for a woman to give birth in the world. Limited use of skilled care, inadequate skills among health care providers and low health facility coverage are the main reasons for this high number.
Dr Kigen Barmasai, an obstetrician/gynaecologist and a former head of Obstetricians and Gynaecologists in Kenya, says that in a day, a single obstetrician/gynaecologist in a public hospital can see as many as 20 patients, sometimes more, while one in private practice generally attends to between 10 and 15 patients a day. These are the ordinary ones, the celebrity doctors see many more.
“Worth noting is that these doctors do not just attend to patients, they are also involved in research, some are studying, while others also teach in our institutions – it is a tough balancing act – in a nutshell, these specialists are overworked,” Says Dr Kigen, who is currently the head of the National AIDS and STIs Control Programme, NASCOP.
Most of the mothers we spoke to talked of waiting for between three and six hours, sometimes longer, to see their gynaecologists for every antenatal visit, visits that increase to every one or two weeks as the pregnancy progresses.
“When I have an appointment, I normally work in the morning and then take the afternoon off work because from experience, I know that I cannot just dash in and out of my doctor’s clinic, which is always packed,” said June Mwangi, who is 32 weeks pregnant with her second child.
The experience was the same with her first. Her doctor is a popular gynaecologist who has a clinic in Upper Hill.
Another mother, Mary Muroki, once waited for a doctor who had been recommended by a friend for close to three hours, only to be informed that he was attending to “an emergency” and would therefore not come in. Keen on an opinion about a medical matter that had been bothering her for some time, she eventually consulted him via Skype, the video call app.
“I paid the same consultation fee of Sh4, 000 I would have paid had I seen him in person,” she said.
Beatrice Kemunto has a sad story of a friend who lost her baby during labour three years ago after maternity staff at a private hospital failed to reach her doctor, who treated her throughout her pregnancy.
“They tried to reach him by phone for over two hours but could not. The medical personnel were hesitant to oversee the birth, and by the time they decided to step in, the baby had already died,” she said.
To get a feel of what expecting mothers go through in search of specialist care, the Nation visited a number of clinics run by popular gynaecologists in the city, specialists with years of experience under their belts. The clinics are packed with patients most days of the week.