Its difficult to know how best to work on this problem of healthcare access among the poorest of the poor. Obviously the people should have some responsibility to pay for services but at the same time should the payment for the medical services cause their entire future livelihood to be mortaged and in the case of the masaai should they be forced to sell their future inheritances (cattle) just to pay for the hospital services. I know that I am on a tangent but the situation remains frustrating.
One extreme example is a young woman who came to the hospital with a ruptured ectopic pregnancy and was told to pay for all services beforehand. As you can imagine this created quite a stir among the doctors within the Internal medicine department but the problem is at the level of the hospital administration and must be modified so future problems like this don’t happen. On a daily basis a similar problem pervades, that all patients must pay for their hospital stay in full before being discharged…well this means that they are still charged for each additional day in the hospital (5000 shillings per day…about 2.50 dollars) while they are attempting to find the means for payment. Many of these situations have been frustrating and is one of the reasons why working in medicine among the poorest people presents such a challenge.