Can you imagine only paying $3.00 for an x-ray? How about $12.00 for a CT csan? Well, that’s the US equivalent price for those imaging studies here at Tenwek. We found that out when Emily went for an xray of her foot on Sunday. It was still giving her a lot of trouble so we decided, for fun, to just see if she had a fracture. The ortho docs and her PT husband, Mark, had all said it wouldn’t change the current course of treatment due to where the fracture would probably be, but we were still curious because of all the swelling and sharp pains she was having three days after the sprain. Good news – no broken bones! She is actually doing much better today and has been off crutches since yesterday. Mark also turned his ankle playing raquet ball the other day, so I’ve learned to not play sports with the Gibsons. They are intense! It’s also different for me to not be the sickly and injured one and I plan on keeping it that way here in Kenya.
As you can see by the prices I gave above, the health care system is very different from the United States. However, we also have to take into account the different customs and lifestyle here in Kenya. While that x-ray may be equal to only 3 US dollars, it is around 285 shillings (current exchange rate $1=95 shillings) for the people of Kenya and that amount may not be so easy to come by for everyone. One thing I have learned is that money is handled very differently here. Most people in America have cash, checking accounts, savings account, and credit cards through which they spend money. The people of Kenya do not hold on to money here. Their belief system is that money (and commodities) will be used or spent as soon as they are available. If they personally cannot use them immediately, they know that someone else such as family or friends can. They consider holding onto such resources to be hoarding and this is unsocial. We also learned that if, for example, a patient cannot pay their hospital bill upfront, they will hand over something of personal value to the hospital until they come up with the money. These valued items can be things such as a deed to their house or farmland. Try that at an American hospital (or moreso, with the insurance company) and see what happens!
The only type of insurance we have come across here at Tenwek has been NHIF, which stands for National Hospital Insurance Fund. From what I understand in talking to some of the medical staff, the NHIF is an optional insurance into which Kenyans can pay a yearly fee to have and it will cover any hospital stays they may have during that year. It does not cover any clinical visits or check-ups or the outpatient labs/tests. The hospital submits a claim on behalf of the patient once they have been discharged, but unfortunately the claim can be rejected just as in America. This is the one similarity I have found – you must submit all of the vital information when it comes to the patient’s care! We did encounter this type of situation with one patient we saw who refused to leave the hospital because she did not believe we were helping her. (She was 35 weeks pregnant and not in any labor or pain, but she thought she was 43 weeks pregnant and needed to deliver. The doctor diagnosed her with TOBP: tired of being pregnant.) Once we mentioned that the NHIF would not cover her stay (because there was no medical reason to hold her), she decided it was okay to leave. However, she was only one of very few patients we have seen with NHIF. Most people pay upfront, stay around the hospital until someone can bring the amount they need, or leave something of value until they can return with the money in order to cover their bill.
As I stated earlier, the equivalent amount in US dollars seems so cheap, but to these people I am sure it is not as simple. I am not sure of the average income, especially for the patients we see here at Tenwek who mostly come from rural areas and very far distances, but I am sure it is a far cry from what most of us are used to. I can’t imagine what it may take sometimes to get the amount of shillings these people need to cover their health expenses. They are a tough, hard-working group of people whom I have a tremendous amount of respect for. Emily and I have both stated that we feel bad “haggling” with them over the cost of souvenirs sometimes, but it’s what they expect. They name a price, such as 4000 shillings for several different items, and then we are to say what we think we should pay. That is roughly only $42 and they are all hand-crafted, beautiful items! We are pretty sure we have helped James, a local seller here at the hospital, put his kids through college because we have bought so much from him. He gives us such great rates since we’ve been so many times that we don’t feel the need to haggle anymore. He is just so happy to sell to us and the price to us is reasonable as is.
I am loving all that I am learning from this culture and I know I will continue to learn for the next four weeks. I think we have all started to take to heart the lifestyle of these people and have a great respect for them. Mark donated blood last week for a patient needing surgery and today, Emily was led to donate for another patient needing surgery. Since I can’t donate blood (due to the fact I don’t weigh enough, go ahead and insert your tiny person joke here!), I am waiting to find where I will most be of service. For some reason I believe that moment is not too far away as I am starting my Pediatric rotation on Monday – the rotation I have been waiting for since we started school! These kids will pull at my heartstrings before I can even blink and I can’t wait to see how God uses me there as well as how He uses the kids to teach me. Oooh, excitement!
God Bless everyone!
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