The Problem with Health Care in Nairobi, Kenya, pt. 1

June 19th

I have not stepped inside of a hospital yet. I have not watched physicians practice, I have not spoken with patients or heard their stories, and I have not observed a health system at work. I have no idea what the problem with health care in Africa is.

But I have seen many other things that I would consider problems, though. For example, one of the ‘pedestrian walk’ signs in Nairobi’s city center is stuck on green. I was nearly run over yesterday because I had the gall to think that the sign was accurate and telling the truth. In other parts of town, police are needed throughout the entire day to direct traffic, because either the traffic lights aren’t working, or the intersection is jammed every day, and it is completely without any street lights or signage at all.

At the research facility where I work, it usually takes between 4 and 12 weeks to receive an internet account. That is a huge problem for a plugged-in, internet-needy American worker, and a problem that would never happen in America. A log-in name for a computer system?... as a freshman in the college of engineering, our first assignment was to setup an account at the computer lab; it took 5 minutes at UW-Madison.

The reason it takes so long to get an account here: because the IT director only signs the paperwork when he has a pile of 10 applications. I cannot begin to guess at the reasons for this, but it is a major problem, and resolving this problem could dramatically increase the productivity at the research facility. (The IT director is the former director of the Center for Traditional Medicine and Herbal Treatment Research at my facility, and I plan on being introduced to him before the end of my stay so I can talk with him about his old position. I will make sure to comment on what I find.)

Now, I want to discuss the general nature of problems, and I thought I would use these as examples. Using all the deep thinking I’m capable of (I’m really showing my cards here), I think that problems exist for two reasons:

1) They aren’t recognized as problems by a majority of people, and therefore cease to exist as problems. This is the case of the walk sign that was stuck on green. Pedestrians are expected to guard their lives with all their faculties, because cars absolutely have the right of way here, and therefore those on foot have no reason to pay attention to, worry about or heed any signs for pedestrians.

2) People recognize that a problem may exist, but have no incentive for making any effort towards resolving the problem. My advisor at the facility—a Infectious Disease fellow from the University of Washington—was removed from (kicked out of) the IT director’s office when he made an informal complaint to the director (i.e. he rose hell about the bush-league actions of the IT department). Obviously, the IT director must recognize that people are not happy with the way he runs things, and that there must be a problem with one of his processes. However, he clearly enjoys exercising some kind of power over the researchers at the facility, and has no real reason to change his practice.

There may be other confounding issues that aren’t considered in these two scenarios; for example, the IT director may have other reasons for delaying the approval of accounts, such as limited memory allotted for personal space on the accounts (that’s the only shitty reason I can think of right now). But setting those aside—which is, of course, a very important ‘but’—I think the only reason that these problems can persist is a lack of motivation mediated by a lack of incentive.

Shit. I realize where this is going. I’ve read too many WHO reports, seen too many articles on system engineering, and I’ve just broke into the systems vernacular with ‘motivation’ and ‘incentive’. So please, let me proceed informally.

People do good work because they’re either rewarded for it, or because they’re motivated internally for some reason. Here in Africa, people don’t have a whole lot of stuff. (And as the saying goes, if you have nothing, you have nothing to lose. No real point to that, just a good saying.) Furthermore, people aren’t paid very much money here, and are expected to live on very little (especially when compared to their counterparts in the States). So I can understand how people can become obsessed with how little their lives produce, reward-wise, and therefore see no reason to do good work.

I think the people that have the internal motivation have the gift of idealism. Does that not simply and beautifully explain the visions and dreams of a person who hopes to achieve a personal goal? But I want to know, who gets this gift? Has there ever been a poll on idealism? What are the demographics? What’s the distribution like across the map? I think it’s safe to say that more youth in America are idealistic than youth in Africa. It’s an opportunity thing, where the young stay young longer in America (extended adolescence nationwide), while children in Uganda are being abducted and recruited for armies (similar to the US, only 5-6 incredibly important adolescent years earlier). Being an idealist allows a person to work for very little reward, because they have the ability to dream of something greater than the real, terrible and gross world that we actually live in (oooh, I wonder what the demographics on cynicism are).

In conclusion, it’s the same shit in a different place. I think I see problems that need fixing. The only question, is whether or not they are actually problems. And if they are, what needs to be done to solve the problems. Something to meditate on for a few decades.