Kijabe Hospital & Access to Health Care

Kijabe Hospital  has 365 beds, including an ICU, operating theater, men's & women's wards, pediatric, ob-gyn, ENT, Infectious Diseases/HIV, and outpatient services.  The hospital is part of a larger network of outlying clinics, draws from a large geographic catchment zone, and offers pathology referral services - a critical and severely understaffed area of medicine in Kenya. We see about 3500 pathology cases every year. The last few weeks have been complicated by a national strike among doctors and nurses in public hospitals.
NPR - Doctor's Strike in Kenyan Public Hospitals

Okay: the hospital here provides important services to a large number of people.  But how hard is it to get here? 

When I walk into work every day, I pass through patient waiting areas.  This morning I was pulled aside by a young man, about my age (early-to-mid 30s), who was here with his wife and young son.  The man was able to explain that his son had "water in his head" (hydrocephalus).  The patient is a 2 month old, former 34 week permature infant with a birth complicated by NICU stay and hydrocephalus. This is apparently a common problem here due to folate & B12 deficiency.

The boy had been evaluated in the emergency room overnight, but the family was still waiting. The father asked for help getting seen by the doctors as he was understandably worried about his son and concerned that "nothing had been done for [the boy]." We talked for a few minutes. I established that the boy had already been evaluated, which meant there wasn't an acute emergency. The father politely responded that, to him as the boy's father, this was an emergency. I did my best to reassure him that the doctors would be out after their morning rounds, probably about 0900, and that I would check back around 0930 or 1000 to see if he had been seen at that point. I shared that I was new here, and mostly worked in the labs, but would do what little I could.

As I talked with the man in the waiting area, I was struck by his and his family's patience. They had traveled 9hrs to get to the hospital and slept in the ED. They have no car and transportation can be expensive.

Travel Time: Kenya vs US and other high-income countries
American hospitals also have long ED wait times and, for many rural communities, access to specialized or tertiary care centers is a major challenge. Nine hours struck me as an almost inconceivable amount of time for the majority of areas in the developed world. At home, we have systems of ambulances, helicopters, and learjets to transport critically ill patients. So how does this family's experience compare to the average travel time to tertiary care centers in the US & other high-income countries?

In North England, median travel time was ~28min with outliers out to 90-120min.  Most travel was by private car.  Ref 1

In the US, ~80% of patients live within 1h of access to an institution that can provide cardiac catheterization (PCI) in the event of a heart attack. Ref 2, 2006 data

As of 2001 data, ~86% of Americans traveled by car (or private vehicle) for their >5 BILLION yearly medical & dental trips. For all visits, rural trips averaged 27 min (17.5 miles) compared to 20.7 min (8.3 miles) for urban residents.  ~8% of US patients traveled more than 30miles and 28.5% of trips took >= 30min.  Not surprisingly, the burden fell overwhelmingly on rural residents. Although other patterns of inequity in access to care were also observed - non-white patients were >5x more likely to rely on public transit/walking; African Americans had on average 50% greater travel times than whites (29min vs 20min) - but these are discussions for a different post.

Further reading on rural care, methods, and access in Idaho (which has some of the lowest numbers of practicing physicians) see this article.