District Hospital

The medical system is Kenya is based on a hierarchical system of health centers. There are clinics and dispensaries that provide basic care to more remote settings. Then there are referral hospitals: district hospitals (level 4), provincial hospitals (level 5), and national teaching hospitals (level 6). Tenwek is a private hospital and doesn't fall into any of the above categories, although it's sort of a level 5/6. We get lots of patients referred to us from lower level hospitals, and sometimes will refer to the national hospitals in Nairobi and Eldoret for specialist care, dialysis, etc.

After almost 2 yrs here in Kenya, we had never really been inside a government hospital, just some dispensaries and other missions hospitals. A former intern was working at Longisa DH just down the road and invited us over for a tour, so we jumped at the chance. We get many patients referred to us from Longisa (20-30 min east of us on good roads) for a variety of reasons. A primary one that I see is for a C-section...reasons listed for referral being among the following: no anesthesia, no doctor, theatre being remodeled, no blood, no IV fluid, higher level care needed...etc. We were curious at the functionality of the hospital.

It was a very enjoyable trip. Ronald met us at the door--he is not only a former intern but is now starting in Tenwek's family medicine program, so Eric has spent a good bit of time with him. The head matron and a supervisor also came with us for the tour, which was an honor. Longisa is pretty new (built within the last 15 years) and looks very nice--wide corridors, clean, no overcrowding, new lab equipment. It has been well kept up. Obviously not every service must be available, since patients are frequently referred to Tenwek, but when it is available it is much more affordable for the patients since care is subsidized by the government.
Our favorite part of the tour was actually the price lists painted on the walls! It was interesting to see what was charged for what procedure. Many things are free for patients. As a point of reference, Longisa charges 4500 shillings for surgeries, and at Tenwek it is probably closer to 20,000 shillings (still a deal compared to US costs at an exchange rate of 90 shillings to the dollar, but pricey none the less for our patients).
The surgery price list. Note that a C/S is only allotted 20 minutes. Speedy. :)

This gives us another good point of reference to working in Burundi, where the hospital setup will be far different than what we have at Tenwek. Anything we can learn in advance is appreciated.

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