01 December 2010
Nairobi’s National Spinal Injury Hospital struggles to survive by reinventing itself.
By Denis Gathanju
To many people with spinal injuries, the desolate-looking facility off Lenana Road in Nairobi’s leafy Kilimani suburbs is the only thing that stands between hope and despair. For many, it ought to be the first frontier towards reclaiming their lives after devastating injuries, but it has most often been the last port of call in the desperate journey toward rehabilitation. Many have come full of hope, but have left with their heads hanging and staring death in the eye.
Though it is the only medical facility of its kind in all of East and Central Africa and only one of three specialized medical institutions in Africa beside ones in Cairo, Egypt and Cape Town, South Africa, the facility has been starved of cash over the years and operates on a dilapidated infrastructure several decades old while the medical equipment at the facility has remained deplorable. Add under-staffed, poorly trained and ill-equipped medical personnel to the equation and you have a critical medical institution desperately clinging for survival on its own death bed.
At least that is how the situation has stood until recently.
Expansion and Modernization Plans
With new plans to modernize and expand the facility, things may be looking up for the medical facility. The Nairobi Spinal Injury Hospital (NSIH), though faced with massive challenges since it was established as a rehabilitation center for wounded World War II soldiers is putting a brave face towards expansion and improving its medical service to shed the negative image it has had to carry over the last four decades of its existence.
According to the NSIH Medical Superintendent Dr. Soren Otieno, the first steps towards transforming the medical facility will be changing the role it plays in its quest to help spinal injury patients in the country. According to Dr. Otieno, there is an urgent need to change the facility’s functions if it is to play a bigger role in helping spinal injury patients get back on their feet and out into the community. The facility, notes Dr. Otieno, is currently in the process of transforming itself from a rehabilitation institution into a full-fledged spinal hospital.
Cumbersome Admission Process
Says Dr. Otieno: “This is very critical for this institution because we are currently operating only as a referral medical facility. That means that patients cannot be rushed to the hospital immediately after they have their injuries from traffic or other accidents and they have to go through a cumbersome, and often, life-threatening medical process that is bureaucratic and offers spinal injury patients little chance for recovery.
“That means that a spinal injury patient has to be taken to the district hospitals and onwards to the provincial hospitals and then to either the Kenyatta National Hospital in Nairobi or the Moi Teaching and Referral Hospital in Eldoret before they can finally be referred to the NSIH for treatment,” explains Dr. Otieno.
The process takes anywhere between six to nine months or more. “When the patients finally arrive here,” notes Dr. Otieno, “they have so many complications and other infections such as bed sores, urinary tract infections and anemia, that the healing process becomes a long and painful experience. This is because of a lack of specialized medical care and personnel at the district and provincial general hospitals.”
However, getting a referral to the NSIH is no guarantee that a spinal injury patient would get an admission and treatment to the spinal facility. The facility has an overwhelming number of spinal injury patients on its waiting list and admission to the facility is on a first-come, first-served basis. Its small ward can only accommodate 40 beds, making it impossible to accommodate more than a few patients at any given time.
“In any given year, there are more than 100 patients on the NSIH waiting list, with most of them receiving little or no treatment whatsoever in district and provincial general hospitals across the country because this facility can only take 20 per cent of them,” explains Dr. Otieno.
Thanks to the cumbersome admission process, some of these patients die even before they gain admission to the NSIH while others are resigned to their fate and waste away slowly in their homes before they eventually succumb to their injuries and resultant complications. But for those who are lucky enough to get an admission, there is only a flicker of hope for them to better manage their conditions as they can only get physiotherapy and occupational therapy at the facility.
Acute Wing
“We can do more with an expanded facility and better equipment under the planned transformation of the facility from a rehabilitation center into a fully fledged spinal hospital,” Dr. Otiengo says. “These are the factors that have influenced our decision. We need to expand the wards so that we can accommodate more patients and we need better, specialized medical equipment to provide better care for spinal injury patients in Kenya.”
The proposed erection of an Acute Wing would enable the institution to be better placed to handle patients without going through the cumbersome (and often gruesome) medical admissions process in place that requires a patient to be shuttled through the district and provincial general hospitals.
“Our research indicates that about 50 per cent of spinal injuries are not complete, however, the injury is completed or further complicated at the initial point of contact where untrained personnel handle the injured patient,” notes Dr. Otieno. “This causes further damage to the spine and therefore greatly reduces the chances of a spinal injury patient to walk again. If such injuries are operated on within eight to 24 hours, such patients have a higher chance at making a full recovery. The proposed Acute Wing at the NSIH would be equipped to receive injured patients and thereby increase their chances of making a full recovery,” explains Dr. Otieno.
According to Dr. Otieno, the Acute Wing would be a 30-bed facility with a casualty, an Intensive Care Unit (ICU), a High Dependency Unity (HDU) and a well-equipped operating theatre. However, the biggest challenge that NSIH faces towards the realization of its planned expansion program is exactly what the facility has been lacking in its more than 40 years of existence: funds and equipment.
According to Dr. Otieno, the Acute Wing alone would require more than Kenya Shillings (Kes.) 100 million (US$1.25 million) for the construction of a one-story building fully equipped with modern medical equipment, an ICU, an HDU and an operating theatre. That is an awesome amount of money that the facility cannot afford as it has been surviving on cash and assistance from well wishers under the banner of Friends of the Nairobi Spinal Injury Hospital (FoNSIH) who have been instrumental in keeping the facility on its feet. FoNSIH are currently helping rehabilitate the wards at an estimated cost of about Kes. 25 million (US$ 312,500) but have so far managed to raise only Kes. 15 million (US$187,500) and the rehabilitation work has stalled as they continue to fundraise.
According to Dr. Otieno, the limited resources the facility gets from the Kenyan government through the Ministry of Health, only goes towards meeting the administrative needs of the facility and are insufficient to develop the facility or buy expensive medical equipment.
For now, the hospital can only rely on private donations from individuals and corporations within and without Kenya for survival hoping that it will be the first port of call for injured spinal patients, in the years to come, and not the last, as is currently the case.
For more information about the hospital, you can write to Dr, Soren Otieno, National Spinal Injury Hospital, P.O. Box 20906, Nairobi 00200, Kenya , or call 011-254 20 2723158 (Nairobi is seven hours ahead of New York/Eastern Time).
Denis Gathanju (www.gathanju.com/) is a free-lance journalist who lives in Nakuru, Kenya.