Abstract.

The following report was prepared after a visit to the Kiambu District Hospital, the main purpose for the
research conducted was to establish the state of the hospital and the dynamics that have been in the
hospital since it was opened, the challenges from implementation of government and international
policies such as the structural adjustment programs (SAPs) and also asses the relevance and importance
of the hospital. The data collected was mostly collected through primary means of data collection.
 KIAMBU DISTRICT HOSPITAL REPORT

Introduction

The world that we live in today is a globalized world that has become so interconnected such that an
action on one corner of the world affects people on the other side of the world, with focus to the
International Monetary Fund (IMF) and the World Bank (WB), a case in point of how their policies
Structural Adjustment Programs (SAPs) affected the health care system in Kenya, a visit to Kiambu
District Hospital was organized and conducted to assess the state of affairs, then from the visit the
following report was compiled.

As part of partial fulfillment of the course work in the Field Study class, a class excursion to Kiambu
District Hospital was organized on the 28 th of January 2012. The objective of the visit to the District
Hospital was to collect information, mainly in the form of primary data, and analyze that data into more
meaningful information as relates to how policies formulated in the international arena by the
international community, mainly the hegemonic concerns penetrate to affect third world countries at
the grassroots level.

Kiambu District Hospital is located in Kiambu East District, and in Kiambaa Division opposite the Kiambu
law courts and is owned by the Ministry of Health, thus a government hospital.

On the day of the visit, after arriving at the Kiambu District Hospital at 10:00am and we had to wait
inside the hospital compound as our course instructor, Dr. Abel Kenyoru was making the final
arrangements to ensure that the t’s were crossed and the I’s doted. We waited for close to half an hour
as our instructor was being referred from one hospital official to another, a clear indication that the
organization at the hospital is not optimal or the hospital is understaffed and the staffs are demoralized.

Meanwhile, while inside the hospital compound, we could not help but notice that there were billboards
displaying the services offered at the hospital, such as

a) Antenatal g)  Immunization

b)  Basic Emergency Obstetric Care h)   Prevention of Mother to Child

transmission of HIV 
c) Curative Outpatient Services
i)  Tuberculosis Labs
d) Family Planning
j)   Tuberculosis Treatments
e) Growth Monitoring and Promotion 

f) HIV Counseling and Testing

And also the expected waiting time before being served or how long each service would take and the
charges the patient would incur.
The above observation, drawing from the negative picture usually painted about public hospitals, would
serve as a plus and if one was to make a generalization, it would imply an improvement in the mode of
service delivery associated with government hospitals in Kenya, which is usually poor.

After verification of all details, our instructor introduced us to the hospital staff who would take us
round the hospital; we were divided into two groups. I was on the group led by Philip Njema, a clinical
officer in the Hospial.

The first stop was the antenatal centre, a section of the hospital dedicated to dealing with children who
are ages 0-5. This section of the hospital is responsible for immunization services such as against polio
and Measles. We were informed that the vaccines in this area are stored in a freezer from where they
are moved to a cold box when about to be used because they are sensitive, and that by virtue of being a
government hospital, the immunization services were free for all patients.

The antenatal section was also very noisy because of the many babies crying, but this was a normal
phenomenon to expect even in private hospitals, and we were also informed that on Fridays services
usually take longer, an average of thirty minutes.

The average time from seeing a doctor to getting medication we were told average forty five minutes.

Other services offered in the antenatal section and as listed on the billboards on the hospital compound
are Family Planning and Growth Monitoring and Promotion 

Our next stop was the HIV counseling and testing centre, a section that we were informed was
performing quite well and was receiving funding from many donors and still from the government, it
had one of the highest success rates in the hospital. Among the key donors was USAID, ICAP and Nairobi
University

This section was a comprehensive care centre as it included testing of the HIV/AIDS virus, Antiretroviral
Drugs (ARVs) and also checking of other Sexually Transmitted Infections (STI’s). We gathered from this
section that STI’s were on the decline.

This HIV centre also deals with tuberculosis, and treatment of tuberculosis is free or government
sponsored just like HIV/AIDS is.

After visiting this section, our guide, Mr. Philip brought up the subject of nutrition, and asked where the
hospital gets the food it feed the patients on, he informed us that it has a kitchen garden from where it
gets most of the food, which also ensures that the food provided by the hospital is fresh produce.

When I asked about the general or average feeding habits of most patients who visit the hospital, Philip
informed us that malnutrition, especially in children was very high, leading to stunting and that stunting
is an irreversible process, and this issue was a major concern that the Kenya police, had reduced the
height required for recruitment because of so many cases of stuntation.
From the HIV counseling and testing centre we visited the triage desk next. At the triage desk, we were
informed that it is where all patients arrive once they come at the hospital and that it is from here that
they are divided according to their needs so as to make the process of attending to them easier and
faster. At this stage, they are divided according to those who are to see a clinical officer, those to go for
minor surgery, those to go for nursing and those to visit the casualty area.

While we were at the triage desk, our guide told us that during the post election violence time they
experienced a spillover effect in that section it was always congested.

When asked about the issue of inadequate staff, Philip confirmed that the hospital was understaffed,
with a shortage of two hundred nurses and still, even during the opening of the Mama Lucy Kibaki
Hospital, an new government hospital that was opened recently though not officially, the Kiambu
District Hospital had to release three nurses, to be working in the new hospital, and that replacement
was still pending.

The last place to visit was the casualty. The casualty is the unit designated fro emergency services. It was
pretty small for a hospital as big as the Kiambu District Hospital and another observation we made at
this section was that it was crowded and not aside from the main hospital as happens in many hospitals.

Philip explained to use that that was a major concern. There was no emergency door in this section
hence this meant that casually patients had to share the same entrance as non-casualty patients. This
was quite inconveniencing and usually led to congestion and made it difficult to manage the crowd.
What the hospital was doing to ameliorate the situation was to train its staff on crowd control and
usually used to color code the emergency cases and also put up a police line that people were not
allowed to cross so as to ensure efficacy when moving patients to the casualty department.

The visit to the casualty department marked our last department to visit at the Kiambu District Hospital.
Asked about how the visit advanced my abilities to achieve my field study course objectives, I would say
that it has sharpened my observation skills and also social skills as in some instances we went out of our
way to ask the patients questions to corroborate what our guide was telling us. It also promoted higher
order thinking and critical thinking in me as in most cases I did not accept what we were being told as
the gospel truth.

As of how the visit contributed to my understanding and appreciation to the study of development and
conflict issues, to be highlighted is that the nature of the visit provided us with an opportunity to get
firsthand or primary data that was not biased. The environment was natural and I was able to relate how
decisions made at the international level get to affect the common man negatively, a form of structural
violence. The people at the grassroots level may have no idea or the decision makers and foreign policy
formulators may just enter into agreements without involving the common man who gets to be affected
the most. I understood that once cannot also be able to separate development and conflict, they are
interconnected; underdevelopment is synonymous to conflict and vice versa.

During the course of the study, we were also plagued by various challenges. We were delayed at the
Hospital entrance as the hospital management deliberated on whether they would be able to have
someone take us round or that we would be divided into two groups whereby one would be taken
round the hospital on the appointed date and the other group which would be taken on a later date.
However this issue was resolved.

A second challenge was the ventilation of the hospital, the place was quite stuffy and poorly ventilated,
the environment inside was not as pleasing as anticipated, but we were able to cope up.

Crowd control in the hospital was also an issue of grave concern as the hospital staff was not able to
manage crowds effectively, especially in the casualty area.

Having assessed the situation in Kiambu District Hospital and also articulating the challenges, this report
would not be complete without stating the recommendations, basically what ought to be done or not
done in order to make the situation better.

On a first point, I would like to commend the hospital staff for their dedication and enthusiasm to serve
the common Kenyans despite the fact that they are actually being overworked and underpaid in
comparison to the guidelines stated by the United Nations and also as agreed upon by other relevant
organizations in health matters. However, it would be appreciated if the government served to motivate
the hospital staff and also increase employment so that no one is overworked and simultaneously the
issue of unemployment is solved.

An upgrading of the Kiambu District Hospital would also be appreciated since the premises on which the
hospital rests on are old (pre-colonial) and therefore cannot be able to suit the dynamic demands of the
contemporary society such as increased population. Notice that in the report it is mentioned that in the
casualty department there is no door for an ambulance and casualties have to be taken a long way and
through crowds before they arrive to the casualty area.

It is hoped that this paper, a humble attempt to asses on the situation at Kiambu District Hospital and
relate what happens at the grassroots level to the decisions and policies adopted at the international
arena, has achieved its objective in assessing the situation at Kiambu District Hospital and relating it to
government decisions on policy making.