A Heart of Flesh II-By Edward Maroncha

(Continued from A Heart of Flesh I)

Rosemary asks Nurse Anne to give her a spatula, and the nurse quickly complies. The CO pries Mark’s mouth open and notes with satisfaction that the tongue is still in place. She then takes a stethoscope and listens to the boy’s chest.

“His breathing is regular, but his chest is congested.  I will give him an injection that will clear his chest for a while, but he needs a proper evaluation so that we can tell what is ailing him. That should be done by a doctor, not me. I would have admitted him here but we do not have the capacity to give him the attention he needs. I will refer you to Maniani Mission Hospital.”

“Thank you daktari,” Hilda says.

Rosemary smiles. She is a clinical officer but in the eyes of the local population, she is a doctor. Anybody who treats them is a doctor. She instructs the nurse to go to the pharmacy to get her a syringe and the drug she will inject Mark with, while she starts looking for a vein in Mark’s hand. But the nurse come back empty handed.

“The pharmacy does not have the drug,” she tells Rosemary. “They don’t even have syringes. The only thing they have is painkillers.”

Rosemary feels like screaming, but she remains calm. There is no point of making the patient’s mother and uncle panic.

“It is okay, Anne. Get me Ronald. Tell him to get the ambulance. We are taking a patient at Maniani right away.”

Anne leaves once again, but she returns once again without positive news.

“Ronald says that the ambulance doesn’t have fuel.”

“Tell him I will pay for the fuel.”

Anne dashes out and comes back a minute later.

“He says the engine has a problem and he cannot risk driving it.”

“Why didn’t he say that before?” Rosemary snaps. She is getting irritated.

“I asked him that, and he said he told Dr. Makali two weeks ago but it has not been fixed.”

“But I saw him driving that ambulance yesterday, even though there was no patient aboard.”

“I think Ronald just doesn’t want to take the patient to hospital. I found him preparing to go home.”

“Let him be. We’ll go in my car. You have completed your shift as well Anne, haven’t you?”

“Yes, I have. But I am the only nurse here. Fancy and Meshack have left, and the night shift people are yet to arrive. Gideon is on leave. If I leave the place will be left unattended.”

“But we don’t have any patients in the wards, do we?”

“No we don’t. Kagwaci was the only inpatient we had.”

Rosemary had been forced to discharge the old man called Kagwaci earlier in the day because the health centre was doing him more harm than good. The man was admitted with tuberculosis, which should have been a routine disease to treat, but the health centre does not have drugs. As if that is not enough, the health centre doesn’t even have food, and the old man was staying hungry until he informed Rosemary. Since then Rosemary and Anne have been taking turns to bring him food from their houses. When it became obvious that TB medicine would not be procured, Rosemary discharged him and told him to seek help from the much larger County Referral Hospital or at Maniani Mission. She could have referred him directly to the County hospital and have him taken there by the ambulance, but that would have attracted unnecessary drama in her life, because the boss expects all patients to be referred to his clinic. Besides, getting that ambulance to move is proving to be another headache.

There are so many things that frustrate Rosemary at Kanyenje Health Centre. The attitude of her colleagues and bosses, the lack of medicine…the heath centre doesn’t even have basic things like food for patients, syringes or adequate surgical gloves. Everything about this place is demoralizing. But things have not always been this way. Under former Governor Silas Gitonga, the county’s health care system was the finest in the country. The Governor had made it clear in his campaigns that health care would be his priority, and he entrusted his Deputy, Irene Nyaga, with the health care role. She delivered. The county referral hospital was revamped and in the ten years that Silas and Irene were Governor and DG, it emerged as the best in the country. But they didn’t stop there. Instead of expanding the hospital at the central location, they constructed satellite health centers in every ward. That way, the hospital’s services would be closer to the people.

Kanyenje Health Centre was among the first to be constructed. Like all the other Health Centers in the County, it was well equipped and was actually a model facility. It has male ward with five beds, and female ward with five beds and a maternity wing with five beds. It also has a minor theatre. Anybody requiring a major surgery, including giving birth by CS, would be taken to the County Referral Hospital using the ambulance assigned to the health centre. It was adequately staffed. There are two doctors, including its superintendent, three clinical officers and eight nurses. There is a sonographer, two pharmacy assistants, two laboratory technicians, three midwives and a host of support staff.

What this did was that it decongested the County Referral Hospital, and it made it easier for residents to get services, even in remote areas. When Gitonga completed his term, Irene should have been a shoo in Governor. But things didn’t work out that way. There were many people who were not happy with the Gitonga administration. Top amongst them were the owners of private hospitals and clinics in the county who were now struggling to get patients. Many tenderpreneurs who had gotten wealthy through shady deals with previous administrations were now struggling because the Gitonga administration was corruption free.

They sponsored a female MCA, Fancy, to run against Irene. They pumped cash into her campaign, most of which was used to bribe voters. The first sign of trouble came in the party nominations. Even with the massive voter bribery, Irene was the clear favorite to clinch the party ticket. And she did get the majority of the votes. But it appears that the President and the national politicians, who had been uncomfortable with Gitonga all along, did not want Irene as Governor. She was rigged out, forcing her to vie as an independent. The same happened to Gitonga, who was seeking the party’s ticket for the Senate seat. What followed were months of intimidation, bullying and voter bribery. It wouldn’t have been enough, were it not for massive ballot stuffing across all polling stations.

Both Irene and Gitonga ‘lost’, but they filed petitions in the High Court. They won in court, but Fancy and John, the latter being Gitonga’s competitor for the senatorial seat, appealed. The cases are still in the court of appeal. In the meantime, Fancy was sworn in as the County Governor, and John as the County Senator. The new governor is as corrupt as they come, and is responsible for the mess that the county health care system is in today. Dr. Benjamin Makali, the head of Kanyenje Health Centre, is the current governor’s husband. She had actually proposed him as the CEC for health, but MCAs rejected him and threatened to impeach the governor. Fancy made him the medical superintendent of the County Referral Hospital, and this time MCAs made good their threat and filed a motion to impeach her. The President intervened and brokered a truce. The Governor quietly brought her husband to this remote health centre, which he has been looting dry.


Makali was a junior doctor at the county referral hospital when his wife became a nominated MCA. But within a month of his wife becoming Governor, he was promoted and made the head this health centre, a move that made many other doctors very unhappy. There were many more qualified doctors ahead of him. Makali also opened a clinic and within three years it has grown into a level three facility. Medicines meant for the county health care system are diverted and taken there. Makali uses county staff members at his clinic and only pays them a token amount as motivation, knowing that their full salaries are paid by the county.


There are supposed to be two clinical officers during the day shift and one in the night shift. Rosemary knows that Joseph and Grace spent the day at Makali’s private clinic. That is why Joseph didn’t show up during the day and that is also why Grace is late for the night shift. Anne is also the only nurse at the clinic because the others are either working at Makali’s clinic, or they are resting after completing their shift there. Gideon, the only other nurse who refused to work for Makali, is on leave.

“Let’s go Anne. We have completed our shifts and there are no patients who need our immediate attention, except Mark. Let us take him to the mission hospital. I want you to come with me just in case his situation gets worse before we get there. Two heads are better than one when dealing with emergencies.”

Mark’s uncle carries the boy in his arms and takes him to Rosemary’s car. He sits at the back with the boy still in his arms, and Anne joins them there. Hilda sits at the front with Rosemary.

“Thank you for doing this for my son, daktari,” Hilda says as they get onto the tarmac. This road was also tarmacked by former Governor Gitonga.

“It is my job, Hilda. I have to do everything to make sure that Mark is okay.”

They are still talking when Rosemary’s phone rings. She checks it and sees that it is Dr. Makali calling.

“Rosemary what is this I am hearing that you have abandoned your post?”

“I have completed my shift sir. In fact I have stayed there for two hours after my shift ended.”

“You are supposed to stay there until your replacement comes.”

“I called Grace and she wasn’t picking up. With all due respect sir, I think your quarrel should be with Joseph, who didn’t show up at work at all today and Grace, who is late for her shift.”

“I assigned them other duties. But I will not argue with you on the phone. Just bring that boy to the clinic as I decide what to do with you.”

“I am sorry sir, but I am not bringing Mark to your clinic. His mother cannot afford it. I am taking him to the mission hospital.”

“If that boy doesn’t come to this clinic, consider yourself fired,” Makali snarls and then hangs up.

(To be continued on Tuesday)

Image by Anna from Pixabay:


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