Thoughts

Tenwek Hospital functions as a tertiary care referral center in Kenya. We provide some of the most specialized medical care in the country including ICU care. This week, a 16 year old girl was admitted in a very critical condition. She had severe pneumonia and ARDS (acute respiratory distress syndrome) and had an oxygen saturation of only 70% (normal is >92%) on the maximum amount of oxygen without a ventilator. We decided to intubate her and place her on a ventilator. She required two medications to keep her blood pressure close to normal (it was very low due to septic shock). She had labs checked frequently and received one blood transfusion. We gave her three different IV antibiotics and IV fluids. Her condition waxed and waned over the course of the week with her oxygen level and blood pressure improving and then worsening. Yesterday her neurologic condition worsened – she no longer needed sedation on the ventilator as she did not wake up or move – we suspected brain death. Today, she died.

I wonder; did we help this girl and her family? If she had not come to us but had stayed at home or in a district hospital, she would have died 5 days ago. Instead she died 5 days later with a huge hospital bill from 5 days of extensive ICU care. Few Kenyans in this area have health insurance. Her parents are subsistence farmers and will likely have to sell some land to pay her bill as almost no one has a savings account here. Just because we can offer this specialized level of care, does that mean we should? I believe God is sovereign and had a purpose for this child and her family but I also want to be a good steward of the resources He has given me – the medical knowledge and the medications, treatments, etc. The ethical issues are a bit different here when people live in significant poverty and must pay out of their own pocket for anything I order as a physician. Anyways, these are just a few thoughts about difficult aspects of practicing medicine in a developing country beyond different medication choices and learning tropical medicine.