By HENRY OWINO
Jermani Anyango’s loud voice cuts across the accounts offices as she asks about the strange M-pesa details in the message she has received. The accounts officer casually tells her to record it at the Mbagathi Hospital Customer Care Desk.
When asked what had happened she explains: “The M-Pesa paybill till number I was told to use belongs to a restaurant in South B Estate yet it is what I used to receive (medical) treatment. It is not my problem but it confirms theft happens here,” Anyango says as she heads back to her home in Kabiria Estate.
A nurse who asked to remain anonymous says the introduction of mobile money M-Pesa system for all payments at Mbagathi Hospital was meant to reduce corruption and extortion. Instead it has become a cash cow for a particular group of nurses and doctors who are well known to those who work there.
“Nurses and doctors are making good money here. They have also formulated a way that some patients get treated without going through the accounts office and do not queue but see them directly”.
Taking advantage of a situation where there is poor supervision of the healthcare system and no shop or booth offering M-Pesa services within the Hospital compound, the cartel use their own phone numbers to facilitate M-Pesa payments – at a price, the nurse claims. Many patients choose to pay the inflated cartel rates that includes a commission as well as withdrawal charges whereas the M-pesa till number has no extra charges.
“It is inhuman, dishonest and illegal to take advantage of a sick person, deceive or trick them by misrepresenting treatment procedures through fake designed payment system for personal gains,” says the nurse.
Initially built in 1950, Mbagathi County Hospital is one of the biggest healthcare facilities run by the County government of Nairobi. Sitting on the edge of Kibera slum the Hospital offers integrated health services to patients drawn from Kibra, Lang’ata, Madaraka, Starehe, Ongata Rongai and Dagoreti North and South sub-Counties – and even further away.
This catchment area serves about one million people many of them low income earners and heavily dependent on this public health facility.
Treatments offered here include many critical life-saving procedures, laboratory tests, radiology, maternal health services, eye clinic services, family planning options, nutritional education and health devices, oral health and community outreach programmes.
However, the important role of this healthcare facility is deliberately being sabotaged by dishonest staff, lack of regulation and poor supervision that has allowed corruption, inefficiency and callous unprofessional behaviour to become normal.
Notices posted around the reception, accounts office, indicate that all money must be paid electronically through M-Pesa till number 739700 while patient’s use their mobile phone number as an account number.
The MPESA messages that patients get back are supposed to be printed and used as a ticket to see the doctor although the phone message is also used.
Despite the ban on cash payments at the Hospital money does change hands and some patients are issued with dubious receipts. Doctors and other medical officers treating patients retain all receipts to ensure that each receipt is only used once. It also removes the evidence that such a cartel runs the hospital.
Alice Nibigira complains that she was asked directly for a bribe in the Radiology Department. She desperately needed the body examination and paid.
“The Radiologist asked me to pay Ksh 1,500/= in cash to receive his professional services and get results or go to (a private lab in the) city centre for the same. After realizing the extra expenses I would incur, I gave in,” Nibigira explains. “I had no option …… after queueing for four hours – just waiting – and in the end I am asked for money. Unfortunate!”
Similar stories are told throughout the Hospital, from the Nutrition Department to the Eye Clinic, laboratories and even the pediatric and maternal wards. Room 7 of casualty is notorious and has been blacklisted by patients for escalating corruption in this health facility.
Felix Otieno says he was denied services and turned away on 23 December 2019 for refusing to bribe a laboratory technician. Although he had the money in his M-pesa wallet, the laboratory technician insisted that the money be withdrawn and paid to him in cash. This is so as to leave no digital trail in case of complaints.
“I came here at 8: 30am, paid Ksh 100 registration fee through M-pesa to allow me see the lab technician. Surprisingly, I am told to pay Ksh 1,100 in cash for the diagnostic test services yet posters by management insist payment is through M-pesa only!” a shocked Otieno says. That, was after queuing for three hours.
The long hours of queuing are a deliberate ploy to breed frustration and desperation. Nurses wait until there is long queue stretching down the road towards waiting bay before they start attending to patients. Those who complain are earmarked, get harassed when their turn of receiving services reaches.
On 19 November, 2019 parents at the Pediatric Department were turned away and told doctors’ were absent and not available to attend to their infants and children. Mothers who parted with cash had their children treated despite the supposed absence of pediatricians while the rest were told to come back the next day.
A sympathetic pediatrician explained that the go slow was meant to push desperate mothers to part with illicit payment. “Patients who do not understand Mbagathi Hospital’s corruption systems are forever frustrated.”
There is no communication or queue management system and patients are randomly called up for treatment using criteria that suggests a sub-culture of favoritism and bribes for treatment. Some patients faint due to fatigue of waiting, others revert to their homes.
I (Journalist) saw nurses wearing civilian outfits to conceal their identity from patients and then change quickly into uniform to offer medical services to select patients before changing back into civilian garb again.
At the newly created Customer Care Desk located at the main entrance, the black record book is full of patients’ grievances. However, little has changed over the three months of observation. Patients lodge complaintsthat nobody listens to or cares about.
In this void the patient complaints get worse as staff turn more callous. Who would rescue the situation at Mbagathi hospital, is the question.
James Papoi recently took his expectant wife for delivery at Mbagathi Hospital. Ultrasound readings done at a private hospital showed she was expecting twins. After a successful caesarian section, Mrs. Papoi asked for the babies to be brought to her and was told it was not a twin birth – they only found one baby.
Hysterical and screaming Mrs Papoi was ordered out of the hospital bed. She pleaded with the other midwives and says she remembers the nurse in charge shouting at her, “Sitaki kujua! Ulichagua Mbagathi ukijua. Toka ama nikusukume chini,” (I don’t want to know! You chose Mbagathi yourself. Get out or I will push you down!) the midwife shouted. Despite her recent delivery and complaints of painful legs and backache, the unsympathetic midwife ejected Papoi from the Hospital.
Despite a trail of emails, phone calls and physical visits, efforts to get a comment from Mbagathi Hospital Medical Superintendent and the County Executive Committee member for Health in Nairobi County bore no fruits. I (media) was asked to channel requests through the ICT and Media Department at City Hall but after regular follow-up for two months, including delivery of the list of questions to be asked, nothing came of it.
In April 2019 at a press conference with doctors, the Chief Executive Officer of the Kenya Medical Practitioners and Dentist Board, Daniel Yumbya admitted that the attitude of some medical practitioners in the country is worrying.
He said the Board received many complaints related to practitioners’ attitude and has suspended dozens of doctors’ licenses, ordered others to go for retraining and deregistered a few.
Yumbya however urged Kenyans not to blanket all medical practitioners and deal with individual practitioners by lodging complaints with the Board for investigation.
Demand for services at the Hospital is growing. The number of outpatients rose from 98,471 in June 2017 to 113,916 in 2019 and is projected to touch 200,000 patients by the end of 2020 as new facilities to upgrade and expand Mbagathi to a 250 bed facility come online.
However, service delivery at Mbagathi Hospital is a total betrayal of the health goal of the Big 4 Agenda promoted by the Jubilee Government with the aim of providing affordable health care for all.
Without improving health services, the goal can never be achieved and it must begin by strengthening supervision and making sure that all staff delivers services as they are supposed to.
(The names of Mbagathi Hospital staff have been withheld at their request).