Lay care-takers inside the Kenyan hospitals, Is there a way forward?

Lay care-takers inside the Kenyan hospitals, Was there a way forward? Today we discuss lay care providers, popularly referred to as caretakers inside the public hospitals. Do they assist with care or usurp health professional’s caring work and cover staffing shortages?  Though they are to be found mainly in public health facilities, some private and mission hospitals in Kenya also had them. Here we are not referring home-based care, this we shall explore at a later date.

Usually, these care takers were relatives and friends or hired ‘caretakers’. This practice tended to have a gender bias component as it engaged the women’s time more than the men. Often, the role of caretaking was left in the hands of ill-prepared significant others.

Some disgruntled elements also made it their business to do it on behalf of others on brokering basis or ‘care-taker for hire basis’. This is a vibrant and unique characteristic of Kenya’s health care setting that most leaders in health care would rather assume it does not exist.

It had been variously noted that they posed a security risk as they were difficult to control. They could cause contamination and easily get infected as they carried out their chores in hospital. This long held African culture of caretaking has taken a new dimension that defies the danger involved.

Imagine what this happening in the era of Ebola threat. Care taking was a major issue as to why it was so hard to stop Ebola spreading between people and across borders. The recent cases reported in Uganda each had over 12 contacts in a very short time, each of the 4 cases was linked to attending to funeral rites of a relative in DRC Congo who had died of Ebola.

Were caretakers somehow filling up for the shortage of staff in some of our public hospitals?

It could be that the withholding of or failure to carry out all necessary care was due to lack of human resources and time.  Had such necessitated lay care givers to step in. It had been observed that in some instances in as much as they were lay persons, care givers were doing some element of ‘total care’ inside some public hospitals. They learned to do most of the procedures pertaining to their loved ones. How did they learn? That is for another day but any one can chip in or share their experience or view.

Which brings us to the next question. What standard of care do lay care-takers give? Is it a product of clinical decision making and clinical judgment that leads to the need to have them? Manyisa et al., 2017 published a literature review of factors affecting working conditions in public hospitals in general across the world. The presence or absence of a lay care provider in developing world had a predictive role in terms of patient management outcomes.  Kamau cited that the care takers influenced the registered nurses’ workload assignment while Mangare acknowledged that they were important as respondents in a research.

Why must we expect them? Interestingly, today some of the admission criteria (emphasis mine) questions in some hospitals included: Mtakaa na nani? Mko na nani? Nani atamchunga? In Swahili for ‘Who is staying in/rooming with you? You will be under whose custody?’

The picture below shows a typical market-like ward, a good proportion of the space taken up by caretakers often in squalid living conditions. With no personal space for anyone and minimal to no privacy. See my previous posting on beds and cots figures .

(Courtesy of NASCOP)

If and when a patient had no caretaker one might hear such a comment (and this could come from anyone including the staff) as in huyu hana mtu Swahili for ‘this one has no caretaker, or ‘is alone’. A neighbouring caretaker carefully observed, ‘it was not unusual that such unfortunate patients remained for days on end in the same clothes they came in. Whether they soiled or wet them, they were not removed’. Thus would it be excusable if a patient were unkempt or even neglected while in a hospital by …Who? Very crude question, but it needs to asked.

Seems to me that negative patient outcomes e.g. falls, pressure ulcers, nosocomial infections, near-misses and generally low-quality care was likely without these care givers. In quotes, it’s like – ‘Those who need proper care need someone to take care of them’.

One lady said ‘proper care means skin care, hygiene, feeding etc. We are the ones who give this not the staff. She added this concerning the fate of being left unattended ‘ukienda utamkuta vile ulimuacha’ Swahili for in case the caregiver were to be away the patient might be unattended during the stretch. “If the hospital staff could discharge their services as required, then there could be no need for us to have the caretakers,” a patient replied on why it was necessary to have one.

I look at another aspect of caretaking and the way forward next time.

 

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