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Lugulu Hospital: Three Years After
By Tom and Elizabeth Gates

Our arrival in January was in marked contrast to our initial coming five years ago. Then Lugulu had seemed a strange and exotic, even vaguely threatening place, as we began several months of a sometimes rocky adjustment to life in Kenya. This time, we felt as though we were returning home.

Everything seemed familiar and comfortable, and we were especially overwhelmed with the genuine affection and hospitality with which we were greeted by our Kenyan friends. The most frequent question asked of us that first day was, "Only two months--why can't you stay for two years like last time?"

In many ways, life in Lugulu had changed little in three years, and we quickly adapted to the hospital routine. Matt and Nathan, each three years older and more independent, spent their mornings doing school work, but in the afternoons were able to experience Kenyan life more directly, through pick-up soccer games or exploring the market.

Liz coordinated schooling for the boys, worked on statistics for the hospital, and continued her work helping Edith Ratcliff organize her memoirs. Tom spent most of his time in the hospital, where the patients and their diseases were familiar--but more numerous. Perhaps one small contribution we were able to make was time spent in "the ministry of listening."

Most of the hospital staff was known to us from before, and the opportunity to listen to their stories of hardship and share in their lives (often by visiting their homes for a meal) will provide us with perhaps the sweetest memories of our time in Kenya.

One significant change for the hospital is the absence of Dr. David Lugaria, who began a three-year surgical training program at the University of Nairobi in November 1996. Although he is greatly missed, his eventual return to Lugulu as a fully qualified surgeon promises to be a great asset to the hospital.

Dr. Damwanza, a Zairean national who has lived in Kenya for many years, has been named acting medical officer in charge. Dr. Jenna Omoto, a government doctor seconded to Lugulu, started a maternity leave in February, so Tom's presence was especially timely.

Another important change for the hospital was the purchase of a new Land Rover ambulance at the end of 1996. The need for a new vehicle has been critical for some time, as the old Land Rover approached 25 years of age. The hospital solicited help from various donor agencies, but in the end had to borrow money from the bank to pay for the vehicle. The loan payments of $1,200 a month represent a significant drain on hospital resources, but a reliable ambulance to transport critically ill patients over pooroads is absolutely essential to the mission of the hospital.

Compared to our previous time in Lugulu, the hospital is doing much more surgery--from 81 major cases in 1992 to 271 in 1996. Partly this is out of necessity, as the government hospitals are increasingly without resources to do emergency surgery. It is now common for the government hospital in Webuye (7 km away) to refer Caesarean sections and other emergency cases to Lugulu.

In addition to the increased surgical volume, we were struck by the increased number of AIDS cases, along with a drastic increase in tuberculosis. A study done in 1996 showed that over 20% of hospital admissions tested positive for HIV, and even among healthy blood donors, the rate of HIV infection approaches 15%. Unlike in America, even rudimentary medicines are unavailable in Kenya, and as a consequence very little can be done for AIDS victims.

The hospital's financial position, never very secure, now seems even more precarious, with large accumulated debts owed to our medicine pplier and other creditors. Because of lack of funds, the hospital staff now routinely receives their monthly salaries as much as two weeks late. Wages have not kept pace with the high rate of inflation over the past several years, and staff morale is understandably low.

The basic cause of these financial problems is clear: the level of medical care rendered by the hospital (rudimentary as it is by American standards) is nevertheless beyond what the local economy can afford. The hospital is almost entirely dependent on patient charges for its operating expenses, but is currently able to collect less than two-thirds of its billed charges.

Two examples may illustrate the kind of financial problems faced by the hospital and its patients. Lillian is a fifteen-year-old insulin-dependent diabetic who was a patient on the ward when we arrived in Lugulu in January. She had developed complications at home, including a serious foot infection, when her family could no longer afford to buy her insulin.

We feared that she would require an amputation of her big toe, but eventually the infection responded to antibiotics. However, as Lillian approached the time for discharge, her family disappeared, evidently because they knew they could not afford to pay her bill.

Seven weeks later, Lillian was still on the ward, still receiving daily blood tests and insulin injections, and still waiting for her family. As we prepared to leave Lugulu, her bill was approaching $1,000--well beyond what her family could possibly be expected to raise.

Lincy was a ten-month-old infant who was admitted to the hospital for gastroenteritis and chronic malnutrition. After six days, she had recovered sufficiently to be discharged, but her family could not immediately pay the hospital bill of 2600 shillings (about $50), so Lincy and her mother stayed on the ward while the family tried to raise the money. (The hospital has learned by hard experience that discharged patients will not return to pay their bills, so they are kept on the ward until the family comes with money.)

Three weeks after her discharge, still waiting for her family and with the bill continuing to increase, Lincy had to be readmitted, this time with severe malaria and anemia. After receiving an urgent blood transfusion, she began to have seizures-a manifestation of cerebral malaria. Tragically, Lincy died less than 12 hours after readmission, a victim of malaria she had contracted while waiting in the hospital for her family. Meanwhile, her total bill had more than tripled, to about $180, with little prospect that the family would be able to pay.

The deteriorating economy is only one example of the way in which larger forces within Kenyan society can affect the hospital. Transparency International's recent annual survey shows that the international business community now considers Kenya the third most corrupt country in the world, behind only Nigeria and Pakistan. This "culture of corruption" can have a very serious impact on institutions like Lugulu Hospital. One of the biggest financial constraints facing the hospital is the very low reimbursement it receives from the government's National Health Insurance Fund, which covers hospitalization expenses for teachers and civil servants.

The fund pays Lugulu Hospital 120 shillings per day, which represents only about 35% of daily charges (patients have to pay the rest). Because similar hospitals (including a nearby Catholic mission hospital) receive as much as 320 shillings per day from NHIF, insured patients often choose to go to other hospitals.

Lugulu has tried unsuccessfully for years to get an adjustment in its rate, but it now appears that without a bribe to encourage the responsible bureaucrats, there will be no increase. The hospital has taken the position that as a Christian organization, we cannot participate in this culture of corruption--but in the meantime, the government's inaction is putting the hospital's survival at risk.

Amidst all these problems, Friends Lugulu Hospital continues to minister to the physical and spiritual needs of sick patients. The hospital is blessed with a dedicated staff, who work harder and for less money than they could make in government hospitals. Despite financial problems, Lugulu has medicine in stock, as well as the capability of doing even emergency surgery. It has earned a reputation in the wider community as one of the few available sources of caring and competent medical care in all of Western Province.

However, we left Kenya in March quite concerned for the future of Friends Lugulu Hospital. It seemed to us like a fragile plant trying to grow in a hostile environment, with the outcome by no means assured.

Friends in Kenya are grateful for the support FUM has given to the hospital over the years, and ask for our continued prayers and financial support during these difficult times.

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