Discharge in

“Every day many not be good… but there’s something good in every day”.

I have been working on the same ward for several months now. Many patients come and go just like hospitals in the States. However, if you do not have insurance or have the money to pay your hospital bills you cannot leave the hospital until you pay. We use the term “discharge in” to describe these patients. Every day you are a “discharge in” the bill continues to accumulate to cover the cost of your bed and food. Also, if you are a discharge in and you relapse, you will not be treated until you have cleared your previous bill. It’s a completely unethical way to address the situation, and, from what I have seen the hospital seems to lose more money by keeping patients hostage. Sometimes I see patients suffer right in front of my eyes because of this policy.

Because of this policy I have one patient I have grown very close to. Herin was admitted to my ward over three months ago for a massive wound to the left upper leg. I still don’t have a good history, but, when I asked her how it happened she said “it just did”. Look at the picture, wounds like this don’t just happen. We treated her for about a month, but, because the wound was still too large for a skin graft, we discharged her with instructions to go to her nearby clinic and receive alternate daily dressings. With no insurance, days pass and her family is nowhere to be found. She just tells me she doesn’t have money. I also come to learn her husband left her for another women because she is sick. Because she is a discharge in, all antibiotics, cleanings, and medication are stopped. She complains of pain and her dressing is soaked in puss. Finally, after a very intense conversation with the administration she is allowed to have ibuprofen, and receives alternate daily dressings. She continues to stay in my ward the next two months, her wound slowly heals.

About two weeks ago I noticed the lower part of her leg was swollen, hot and tender.  I begin to think abscess. Once again, I bring it to the doctor’s attention, but because she is a discharge in he says we can’t do anything. The doctor and I both try talking to the administration but they say no, “she must find money”.

Her wound continues to slowly heal, but I’m frustrated because a wound like this can take over a year to heal without grafting. Her abscess continues to be neglected.  Then, about a week ago an Italian surgeon came to visit Tabaka. Immediately, I showed him this patient and discussed her serious need for grafting. I asked him if he could speak with his Italian collages about this patient. Maybe he would be willing to do the surgery for free, and we could only charge her for the medication, and materials used. Success!!!! Italians have a good pull with each other. Herin received the surgery the same week.

Herin is still not well enough to go home but I can’t even begin to explain how happy I am for her. My job is full of so many sad moments that sometimes I need to take a step back and look at the positive. As if Herin finally getting a skin graft wasn’t good enough, the other day she told me something that meant the world to me. She told me thank you so much. I told her welcome and don’t worry about it. She then proceeded to say how she appreciates how I have taken care of her the last three months. Once again I tell her it’s no problem, I’m only doing my job. Lastly, she tells me I’m the one who helped her get the surgery she needed and without me the doctor would not have understood her financial problems.

Having a patient be so appreciative and express how much my actions meant to them is pretty special. I almost lost all hope for treatment, but, this just shows you can never lose hope, for you never know what the next day holds. This situation just shows the importance of advocating for your patients, even if it’s next to impossible to be heard… like it is in Kenya. Although, I feel like I was just doing my job, I know having someone stand up for her means more to her than I could ever comprehend. I can tell she now has hope for her future health. I’m so happy and blessed to be a part of her treatment.

 

 Warning graphic pictures below.

 

 

 

 

 

 

 

Herins wound 2 plus months ago

Post skin graft last week

 

Herin and I post skin graft