Nipate
Forum => Kenya Discussion => Topic started by: RV Pundit on May 20, 2015, 02:49:02 PM
-
This lady Ms Nyokabi has done something quite simple and revolutionary. I think if medical field (that is dominated by old school MOH and religious bodies) like the education sector can embrace the fully use of ICT and MPESA type tech....we could easily solve many of our health issues.
http://www.nation.co.ke/lifestyle/money/Clinic-where-doctors-access-X-ray-reports-round-the-clock/-/435440/2723234/-/fofv00z/-/index.html
-
Some years ago, I travelled home from Graduate School and found a neighbor dying of ulcers. I rushed him to hospital and ran in to archaic doctors telling me Ulcer is an incurable distemper. I contacted my friends abroad who sent a prescription. I had some drugs airlifted. The man died however on the day the customs released the meds after a lot of "invisible" costs.
Needless to say a lot of good came out of it. I linked the local docs to others and several years later, some of those bozos are "experts" on the treatment of ulcers.
This lady Ms Nyokabi has done something quite simple and revolutionary. I think if medical field (that is dominated by old school MOH and religious bodies) like the education sector can embrace the fully use of ICT and MPESA type tech....we could easily solve many of our health issues.
http://www.nation.co.ke/lifestyle/money/Clinic-where-doctors-access-X-ray-reports-round-the-clock/-/435440/2723234/-/fofv00z/-/index.html
-
They need to fully embrace technology..now that internet is a google a way and they've all the tools for make e-medicine a reality. Just like Mpesa is transforming the lives of people in terms of financial access, I think medical and education field will be transformed in the next few yrs in ways we cannot even imagine.
Some years ago, I travelled home from Graduate School and found a neighbor dying of ulcers. I rushed him to hospital and ran in to archaic doctors telling me Ulcer is an incurable distemper. I contacted my friends abroad who sent a prescription. I had some drugs airlifted. The man died however on the day the customs released the meds after a lot of "invisible" costs.
Needless to say a lot of good came out of it. I linked the local docs to others and several years later, some of those bozos are "experts" on the treatment of ulcers.
-
As you already know I am familiar with Switzerland. I once took a short tour of their pharmaceutical industry. I thought I would find huge structures straddling the borders of various cantons. Nope! Nothing grand. Then I found out they invest more in technology and eliminate unnecessary human labour.
You may have missed this... but Ivory Coast opened it first Chocolate Plant (http://www.theguardian.com/world/2015/may/20/ivory-coast-president-tours-countrys-first-chocolate-factory) nearly 60 years after independence!
There is something seriously wrong with us. Nobody stopped Kenya from starting the Mobile Phone revolution in Africa. The fear that the opposition would use it dictated the way. FM radios are now being licensed at a time when the rest of the world is getting rid of FM - just think about it!
You have a guy like Dr. Ndemo pretending to be far sighted. Yet he works closely with Safaricom to keep mobile user costs high! I wondered aloud who he works for.
I think Kenyan doctors are used to how things are and do not want change.
They need to fully embrace technology..now that internet is a google a way and they've all the tools for make e-medicine a reality. Just like Mpesa is transforming the lives of people in terms of financial access, I think medical and education field will be transformed in the next few yrs in ways we cannot even imagine.
-
Its not embracing, rather someone whos willing to invest in change. Most docs may be used to the old system and they may also not be willing to change. It needs new thinking. A good example is KNH. It has an antiquated management system that will never change, so until its goes bankrupt it will stay the same. Youve got to change everyones attitude before things can change.
-
There is something seriously wrong with us. Nobody stopped Kenya from starting the Mobile Phone revolution in Africa. The fear that the opposition would use it dictated the way. FM radios are now being licensed at a time when the rest of the world is getting rid of FM - just think about it!
And what a change! For "sentimental reasons", I still have my father's old Short-Wave radio: a huge wooden Grunding, with the names of stations written on the face. It still works and always makes for a great conversation piece: the "older types" recall the "good old days", and the younger ones marvel at the idea of SW. Reminds me of the days when anyone who wanted to know what was rely happening in Kenya would tune into BBC World Service ...
But in these Amazing Days, in which people make their own "radio stations" on the internet---almost a decade old in places like Korea---one still finds places like Burundi, where a coup starts with an attack on the radio station. A different kind of "good old days", I suppose ...
Your comment on fear is an amusing one. Back in the day, my school had this expat British teacher who was into Morse Code---anyone remember that!---over radio. He was keen to teach some of us about that, and he duly ordered all the required equipment from the UK---long, fancy antennae and the like. It then took a year to get going because GoK (the military) was concerned about the guy might transmit ...
-
Its not embracing, rather someone whos willing to invest in change. Most docs may be used to the old system and they may also not be willing to change. It needs new thinking. A good example is KNH. It has an antiquated management system that will never change, so until its goes bankrupt it will stay the same. Youve got to change everyones attitude before things can change.
Kenyan hospitals need to first focus on some very basic things---such as cleanliness. Most public hospitals are filthy places that pose a great danger to the health of Kenyans: you might go in with one thing and come out with ten new ones.
After that would the sort of corruption that means that most "free" or "cheap" drugs that are supposedly in the hospitals actually have to be paid for in little nooks-and-crannies "pharmacies" near the hospitals.
-
MoonKi
It is the same solution. The reason most of these hospitals are filthy is simple: They still base all cleaning on human beings who still use the same old style and tools to clean.
Most modern hospitals from design to construction and equipping made to be easily cleaned using modern technology. Just about ten people can keep clean the entire Kenyatta National Hospital. As a student fresh from Kenya, I took up cleaning to make some extra cash. I had to take up a course in cleaning which basically trained me in operating the equipment to be used in cleaning. Once I mastered it, I could carry out tasks that would require 100 people in Kenya.
I have to add some caution: It is not that Kenyans are ignorant of this. No sir! The other reason technology is not embraced is that it interferes with "income generating activities" going on by the side. You may recall that Moi had to get rid of toll stations after those working there became instant millionaires.
If you eliminate mama kifagio in Nairobi and replace her with an advanced Street Cleansing Machine, you will run in to problems. The MCAs whose constituents are "Ghost" workers may even impeach you.
(http://www.tymco.com/images/home-banner-600-2013.jpg)
It doesn't even have to be advanced:
(http://outhouserag.typepad.com/photos/uncategorized/2007/10/26/streetcleaningmachine.jpg)
This street cleaner was spotted by tourists in Qinghuangdao city, Hebei province
Kenyan hospitals need to first focus on some very basic things---such as cleanliness. Most public hospitals are filthy places that pose a great danger to the health of Kenyans: you might go in with one thing and come out with ten new ones.
After that would the sort of corruption that means that most "free" or "cheap" drugs that are supposedly in the hospitals actually have to be paid for in little nooks-and-crannies "pharmacies" near the hospitals.
-
We need to take care of the basic things - like eliminating Cholera , which is threatening to become an epidemic. 30 visitors from Germany who were meant to visit us in Nakuru and Kisumu have cancelled their trip. They could not get travel insurance due to the security issue and cholera out breaks going on in Kenya.
-
This is the same argument we had when computers and mobile phones were being introduced. That we should focus on basic things. Like food and ending starvation. But now look at what Mpesa is doing and what mobile phone has done.Technology will eliminate cholera...and the need to go to hospital or clean one.
That lady with a few radiologist...can give us world class radiology service...at a fraction of the cost.
Now If we had more of that....we wouldn't need to overcrowd in KNH...
We need to take care of the basic things - like eliminating Cholera , which is threatening to become an epidemic. 30 visitors from Germany who were meant to visit us in Nakuru and Kisumu have cancelled their trip. They could not get travel insurance due to the security issue and cholera out breaks going on in Kenya.
-
I believe another area of potential growth is medical coding. Medical insurances live and die by it in the US.
-
Right. Telemedicine out to be work here. Like Mpesa there is no competitor or comparator..considering the lack of real hospitals out there. Even if telemedicine or e-medicine is not as good as see jakoyo in person...it better than what we most have here.
All you need are agents [business for someone] with basic equipment that can do blood test, do some scans, mris and perhaps manned by a nurse and clinian...then linked to somewhere in Nairobi....where real doctors...sit round the clock.
Why travel all the way to KNH only to be seen by doctor for less than 20mins...in two rounds every day?
All it takes is for someone of Safaricom like clout to try it out...with well known hospital brand.
I believe another area of potential growth is medical coding. Medical insurances live and die by it in the US.
-
Right. Telemedicine out to be work here. Like Mpesa there is no competitor or comparator..considering the lack of real hospitals out there. Even if telemedicine or e-medicine is not as good as see jakoyo in person...it better than what we most have here.
All you need are agents [business for someone] with basic equipment that can do blood test, do some scans, mris and perhaps manned by a nurse and clinian...then linked to somewhere in Nairobi....where real doctors...sit round the clock.
Why travel all the way to KNH only to be seen by doctor for less than 20mins...in two rounds every day?
All it takes is for someone of Safaricom like clout to try it out...with well known hospital brand.
I believe another area of potential growth is medical coding. Medical insurances live and die by it in the US.
Ok. That is different from what I am thinking. But a good idea nevertheless.
I was thinking along the lines of processing ICD codes. A regular doctor's visit, a diagnosis and creating a digital record of the same using ICD codes in the states, I believe Read codes in the UK.
The doctor's office normally does not handle that process, but they outsource it to specialists. The specialists convert the doctor's notes into a code that can be used to bill the insurance company.
I was thinking coding specialists could be based out of Kenya.
-
Yes I understood. There is certainly scope for that here. If it will help for instance reduce fraud in billing..that will be helpful.
I was thinking along the lines of processing ICD codes. A regular doctor's visit, a diagnosis and creating a digital record of the same using ICD codes in the states, I believe Read codes in the UK.
The doctor's office normally does not handle that process, but they outsource it to specialists. The specialists convert the doctor's notes into a code that can be used to bill the insurance company.
I was thinking coding specialists could be based out of Kenya.
-
Technology can certainly help, but first it requires that the government spend more money on health. As far as I can tell, spending health, taken as a % of budget or GDP, has been going down for quite some time. This article, from not-too-long ago, summarizes the grim picture:
http://www.standardmedia.co.ke/article/2000086000/kenya-s-2013-14-health-budget-cuts-threaten-to-cripple-sector?articleID=2000086000&story_title=kenya-s-2013-14-health-budget-cuts-threaten-to-cripple-sector&pageNo=1
Even more alarming is that quite a bit of that money apparently does not go where it is supposed to go.
This (from the same article) is alarming, if true:
But even worse, at least 40 per cent of the total budget allocation is lost through corruption, questionable procurement and misappropriation of funds. “We lose 20 to 40 per cent as has been documented in a World Health Organisation report,” said Dr Boniface Chitayi, the former secretary general of the doctors union
Omollo:
I would not have problems with Mama Kifagios if they actually did what they were paid to do; as it is, there are too many idlers-on-the-job. In the particular case of hospitals, I have seen much that could easily be done with just a small number of people armed with mops, detergents, etc.; at the same time I have observed the "workers" out basking in the sun or busily engaged in chit-chat. Go take a look at "Russia", for example.
Speaking of "Russia", I have just had a rude reminder of the state of such hospitals. I am in the process of getting a relative transferred from there to a private facility. He was admitted last night, no doctors with time to see him until the morning, and given the choice of sharing a bed with another person (apparently standard practice there) or sitting on the floor until the morning as he waited for a doctor.
-
Technology can certainly help, but first it requires that the government spend more money on health. As far as I can tell, spending health, taken as a % of budget or GDP, has been going down for quite some time. This article, from not-too-long ago, summarizes the grim picture:
http://www.standardmedia.co.ke/article/2000086000/kenya-s-2013-14-health-budget-cuts-threaten-to-cripple-sector?articleID=2000086000&story_title=kenya-s-2013-14-health-budget-cuts-threaten-to-cripple-sector&pageNo=1 (http://www.standardmedia.co.ke/article/2000086000/kenya-s-2013-14-health-budget-cuts-threaten-to-cripple-sector?articleID=2000086000&story_title=kenya-s-2013-14-health-budget-cuts-threaten-to-cripple-sector&pageNo=1)
Even more alarming is that quite a bit of that money apparently does not go where it is supposed to go.
This (from the same article) is alarming, if true:
But even worse, at least 40 per cent of the total budget allocation is lost through corruption, questionable procurement and misappropriation of funds. “We lose 20 to 40 per cent as has been documented in a World Health Organisation report,” said Dr Boniface Chitayi, the former secretary general of the doctors union
Omollo:
I would not have problems with Mama Kifagios if they actually did what they were paid to do; as it is, there are too many idlers-on-the-job. In the particular case of hospitals, I have seen much that could easily be done with just a small number of people armed with mops, detergents, etc.; at the same time I have observed the "workers" out basking in the sun or busily engaged in chit-chat. Go take a look at "Russia", for example.
Speaking of "Russia", I have just had a rude reminder of the state of such hospitals. I am in the process of getting a relative transferred from there to a private facility. He was admitted last night, no doctors with time to see him until the morning, and given the choice of sharing a bed with another person or sitting on the floor until the morning as he waited for a doctor.
Those are disastrous numbers for corruption. That is almost half the budget. It is just possible that the mama vifagios and general staff are poorly motivated.
It can happen in an environment where year in year out a Mama Ngilu to pick a perfectly random example moves from one rewarding public post to another, the trail of destruction and controversy that follows her notwithstanding.
-
Ok. That is different from what I am thinking. But a good idea nevertheless.
I was thinking along the lines of processing ICD codes. A regular doctor's visit, a diagnosis and creating a digital record of the same using ICD codes in the states, I believe Read codes in the UK.
The doctor's office normally does not handle that process, but they outsource it to specialists. The specialists convert the doctor's notes into a code that can be used to bill the insurance company.
I was thinking coding specialists could be based out of Kenya.
ICD 9 or upcoming 10's most important function is billing for services provided by clinicians. That is its most basic function, so that physicians are not making up things and billing fraudulently for service not provided. Actually most clinicians are now coding as they see patients, and if they are too busy, they write them down and a medical biller enters it on the template for Medicare/Insurance payments systems..I fail to see how such a service can benefit a country that lacks the most basic of services such as Kenya. It doesn't cost much to provided basic services, and clinical officers can provided such services all over Kenya if lack of physicians is the issue.
Growing up there were dispensaries in almost every estate that provided basic medical care including childhood immunizations so that kids are not dying for no reason. All these can be accomplished by basic assessments and a few tests that are provided on site. Kenya can afford to have such clinics in almost every corner of the country if they were serious about health care in the first place.Computerized healthcare will be important in communicating findings with other providers, ie specialists in in other locations.
The only thing that is outsourced are radiology services, where they send pictures (x-rays, CT scan, MRI's) to a different location, the radiologist reads them and sends his result to the provider. There aren't that many radiologists around so this is a much more efficient way to still provide the services. Kenya could benefit from this particular technological advancement.
-
Ok. That is different from what I am thinking. But a good idea nevertheless.
I was thinking along the lines of processing ICD codes. A regular doctor's visit, a diagnosis and creating a digital record of the same using ICD codes in the states, I believe Read codes in the UK.
The doctor's office normally does not handle that process, but they outsource it to specialists. The specialists convert the doctor's notes into a code that can be used to bill the insurance company.
I was thinking coding specialists could be based out of Kenya.
ICD 9 or upcoming 10's most important function is billing for services provided by clinicians. That is its most basic function, so that physicians are not making up things and billing fraudulently for service not provided. Actually most clinicians are now coding as they see patients, and if they are too busy, they write them down and a medical biller enters it on the template for Medicare/Insurance payments systems..I fail to see how such a service can benefit a country that lacks the most basic of services such as Kenya. It doesn't cost much to provided basic services, and clinical officers can provided such services all over Kenya if lack of physicians is the issue.
Growing up there were dispensaries in almost every estate that provided basic medical care including childhood immunizations so that kids are not dying for no reason. All these can be accomplished by basic assessments and a few tests that are provided on site. Kenya can afford to have such clinics in almost every corner of the country if they were serious about health care in the first place.Computerized healthcare will be important in communicating findings with other providers, ie specialists in in other locations.
The only thing that is outsourced are radiology services, where they send pictures (x-rays, CT scan, MRI's) to a different location, the radiologist reads them and sends his result to the provider. There aren't that many radiologists around so this is a much more efficient way to still provide the services. Kenya could benefit from this particular technological advancement.
mya88,
My idea was for the coding part to be done by Kenyans, rather than to be incorporated into the Kenyan system. Hence the outsourcing bit. A service by Kenyans for others if you will
-
Ok. That is different from what I am thinking. But a good idea nevertheless.
I was thinking along the lines of processing ICD codes. A regular doctor's visit, a diagnosis and creating a digital record of the same using ICD codes in the states, I believe Read codes in the UK.
The doctor's office normally does not handle that process, but they outsource it to specialists. The specialists convert the doctor's notes into a code that can be used to bill the insurance company.
I was thinking coding specialists could be based out of Kenya.
ICD 9 or upcoming 10's most important function is billing for services provided by clinicians. That is its most basic function, so that physicians are not making up things and billing fraudulently for service not provided. Actually most clinicians are now coding as they see patients, and if they are too busy, they write them down and a medical biller enters it on the template for Medicare/Insurance payments systems..I fail to see how such a service can benefit a country that lacks the most basic of services such as Kenya. It doesn't cost much to provided basic services, and clinical officers can provided such services all over Kenya if lack of physicians is the issue.
Growing up there were dispensaries in almost every estate that provided basic medical care including childhood immunizations so that kids are not dying for no reason. All these can be accomplished by basic assessments and a few tests that are provided on site. Kenya can afford to have such clinics in almost every corner of the country if they were serious about health care in the first place.Computerized healthcare will be important in communicating findings with other providers, ie specialists in in other locations.
The only thing that is outsourced are radiology services, where they send pictures (x-rays, CT scan, MRI's) to a different location, the radiologist reads them and sends his result to the provider. There aren't that many radiologists around so this is a much more efficient way to still provide the services. Kenya could benefit from this particular technological advancement.
mya88,
My idea was for the coding part to be done by Kenyans, rather than to be incorporated into the Kenyan system. Hence the outsourcing bit. A service by Kenyans for others if you will
Ok, Maybe I got lost in translation somewhere....... service for Kenyans by Kenyans is always good. But would that make our health system any better than it currently is?
-
Ok. That is different from what I am thinking. But a good idea nevertheless.
I was thinking along the lines of processing ICD codes. A regular doctor's visit, a diagnosis and creating a digital record of the same using ICD codes in the states, I believe Read codes in the UK.
The doctor's office normally does not handle that process, but they outsource it to specialists. The specialists convert the doctor's notes into a code that can be used to bill the insurance company.
I was thinking coding specialists could be based out of Kenya.
ICD 9 or upcoming 10's most important function is billing for services provided by clinicians. That is its most basic function, so that physicians are not making up things and billing fraudulently for service not provided. Actually most clinicians are now coding as they see patients, and if they are too busy, they write them down and a medical biller enters it on the template for Medicare/Insurance payments systems..I fail to see how such a service can benefit a country that lacks the most basic of services such as Kenya. It doesn't cost much to provided basic services, and clinical officers can provided such services all over Kenya if lack of physicians is the issue.
Growing up there were dispensaries in almost every estate that provided basic medical care including childhood immunizations so that kids are not dying for no reason. All these can be accomplished by basic assessments and a few tests that are provided on site. Kenya can afford to have such clinics in almost every corner of the country if they were serious about health care in the first place.Computerized healthcare will be important in communicating findings with other providers, ie specialists in in other locations.
The only thing that is outsourced are radiology services, where they send pictures (x-rays, CT scan, MRI's) to a different location, the radiologist reads them and sends his result to the provider. There aren't that many radiologists around so this is a much more efficient way to still provide the services. Kenya could benefit from this particular technological advancement.
mya88,
My idea was for the coding part to be done by Kenyans, rather than to be incorporated into the Kenyan system. Hence the outsourcing bit. A service by Kenyans for others if you will
Ok, Maybe I got lost in translation somewhere....... service for Kenyans by Kenyans is always good. But would that make our health system any better than it currently is?
No. They would not be working for the Kenyan system at all. Mwananchi healthcare would continue to remain dire(or improve) in this particular scenario.
Think in terms of the guy who answers your phone from India asking you if watched the Cubs vs Whitesox game when you call to complain that cable is not working in the first place.
The Kenyans would be working as outsourced resources; as coders. This particular angle is not about Kenyan healthcare itself at all. I am not sure it makes sense anymore if the clinicians are doing the coding themselves though.
-
MoonKi
It is one mysteriously ignored fact that the MOH is one of the Most Corrupt Ministries (if not The Most Corrupt). The days when former Health ministers would go around bars begging for beer are gone. Now you have smart millionaires like Anyang Nyong'o, Charity Ngilu, etc. Amukowa Anangwe ran in to trouble with a cartel and got fired over paltry ambulances before he could dip his hand in the real honey. We now have Macharia who wants to rob county governments in broad daylight. Take note of it because it is another Anglo Leasing case in the waiting. GoK has signed a contract which would have to be paid - eventually!
That said, part of the corruption in the hospitals arises because of weak systems. These weak systems can only be corrected by investing in technology. We are not investing in technology so we are bound to remain with weak systems. There you have your vicious cycle.
What you describe is the poor work ethic we are discussing in another thread. Note that there are other factors contributing to the poor work ethic. There is absenteeism caused by illness, bad habits (alcohol), poor transport, bad infrastructure, weather etc. In decent countries the ministry of labor, Health and Transport ensure that this information is thoroughly collected and analysed.
One of the reasons hospitals opt to use technology to clean as opposed to people is exactly that the cleaners become a liability to the very mission of the hospital (no need to expound on it). Machines cover a larger area, reduce the human traffic and improve the quality of cleanliness.
Note that even in the best hospitals on earth one still needs mama or baba kifagio to clean the corners and the patients rooms. But you can't find them in corridors leaning on their brooms and gossipping.
Russia hospital was ruined by the Kenyatta regime with support from the Brits. It was a state of the art hospital at inception and could easily have rivaled Kenyatta National Hospital. History and geopolitics aside, it suffers from the same mismanagement that is killing other hospitals.
We need a minister who will be devoted to improving service in hospitals not rent seekers on a mission to build the Campaign War Chest.
-
This particular angle is not about Kenyan healthcare itself at all. I am not sure it makes sense anymore if the clinicians are doing the coding themselves though.
I get it now, you had lost me back there....but yes, it would not make any sense since now clinicians are doing it or are at least required to do it.
-
Omollo,
Why are we not blaming county gov who have taken over health. Health is devolved except for I think KNH. Counties have completely failed. The only exception is Machakos where Mutua has ensured hospitals in there are spotlessly clean, well stocked and ambulances are on stand up. Not 1 or 12 like in Bomet but 70 ambulances.
We need to focus our energies on holding county gov on this. If they succeed, there will be a case to devolve more sensitive functions in the future; education and security.
Of course Macharia 36B nonsense of equipment is an attempt to undermine counties while stealing tax payers money.
If every governor was half as serious as Mutua has been...some of health issues (like dirty hospitals, absentee nurses, lack of ambulance)..would have long been sorted out.
MoonKi
It is one mysteriously ignored fact that the MOH is one of the Most Corrupt Ministries (if not The Most Corrupt). The days when former Health ministers would go around bars begging for beer are gone. Now you have smart millionaires like Anyang Nyong'o, Charity Ngilu, etc. Amukowa Anangwe ran in to trouble with a cartel and got fired over paltry ambulances before he could dip his hand in the real honey. We now have Macharia who wants to rob county governments in broad daylight. Take note of it because it is another Anglo Leasing case in the waiting. GoK has signed a contract which would have to be paid - eventually!
That said, part of the corruption in the hospitals arises because of weak systems. These weak systems can only be corrected by investing in technology. We are not investing in technology so we are bound to remain with weak systems. There you have your vicious cycle.
What you describe is the poor work ethic we are discussing in another thread. Note that there are other factors contributing to the poor work ethic. There is absenteeism caused by illness, bad habits (alcohol), poor transport, bad infrastructure, weather etc. In decent countries the ministry of labor, Health and Transport ensure that this information is thoroughly collected and analysed.
One of the reasons hospitals opt to use technology to clean as opposed to people is exactly that the cleaners become a liability to the very mission of the hospital (no need to expound on it). Machines cover a larger area, reduce the human traffic and improve the quality of cleanliness.
Note that even in the best hospitals on earth one still needs mama or baba kifagio to clean the corners and the patients rooms. But you can't find them in corridors leaning on their brooms and gossipping.
Russia hospital was ruined by the Kenyatta regime with support from the Brits. It was a state of the art hospital at inception and could easily have rivaled Kenyatta National Hospital. History and geopolitics aside, it suffers from the same mismanagement that is killing other hospitals.
We need a minister who will be devoted to improving service in hospitals not rent seekers on a mission to build the Campaign War Chest.
-
Omollo,
Why are we not blaming county gov who have taken over health. Health is devolved except for I think KNH. Counties have completely failed. The only exception is Machakos where Mutua has ensured hospitals in there are spotlessly clean, well stocked and ambulances are on stand up. Not 1 or 12 like in Bomet but 70 ambulances.
We need to focus our energies on holding county gov on this. If they succeed, there will be a case to devolve more sensitive functions in the future; education and security.
Of course Macharia 36B nonsense of equipment is an attempt to undermine counties while stealing tax payers money.
If every governor was half as serious as Mutua has been...some of health issues (like dirty hospitals, absentee nurses, lack of ambulance)..would have long been sorted out.
Pundit
County governments have teething problems. They need plenty of help. I have no idea how it is arranged but I assume the Director of Medical services still calls the shots as concerns quality and service delivery. If this is not the case then we have to amend the law. Get me right, I am all for devolution but not at the expense of quality.
My problem with Mutua is he, like PLO is a born spin doctor. You can never know what is real and what is "Chap Chap". I have treated his every pronouncement with a sack of the best sea salt, since his chap chap road peeled off in his wake as he drove back to town with a sea of journalists.
That said, have you undertaken a brief analysis of the qualifications of our so called governors? How many bought degrees in a hurry to contest? Is it only Joho? Most of these guys were what you can call functionally illiterate. Until there is a proper electoral and campaign finance reform to introduce PR (and avoid the recent UK debacle of re-electing a man you don't want), we shall continue to have this problem.
Education makes a major difference. Take the Police. Those countries that set very high educational admission requirements for their police and proceed to demand a long training period in college also have the most professional police force with limited cases of brutality and corruption. Kenya and the US fall in the same category.
-
Think in terms of the guy who answers your phone from India asking you if watched the Cubs vs Whitesox game when you call to complain that cable is not working in the first place.
The Kenyans would be working as outsourced resources; as coders. This particular angle is not about Kenyan healthcare itself at all. I am not sure it makes sense anymore if the clinicians are doing the coding themselves though.
Tough to imagine; medicine is---and probably right to---a different ball-game.
I imagine most of the work would come from places with reasonably functional health systems and with a lot of work. That would be the "richer" countries. But those countries have the most stringent legal regulations, including on privacy and the transfer of medical information. (I recall a long-running skirmish between the EU and the USA on whether medical records could be transferred from the latter to the former unless the USA strengthened its privacy regulations.) Just think of Americans' readiness to go for malpractice suits, and you will find all sorts of issues in the "chain".
Going beyond mere data coding, a company such as Nyokabi's would get very little business from a place like the USA, even though there is plenty of such work that needs to be done there. India tried that market and did not get very far. From a few years ago:
About fifteen (15) Indian radiologists currently read U.S. images. This number is unlikely to expand much in the near future. When U.S. images are offshored to other countries, the typical reader is a U.S. radiologist living abroad.
And that is because:
To demonstrate competence - to be allowed to legally read images generated in the United States - a radiologist must have completed his/her medical residency in a U.S. program, passed U.S. medical board examinations, be licensed in the state where the image was taken and have privileges in the hospital where the image was taken.
http://dusp.mit.edu/sites/dusp.mit.edu/files/attachments/publications/levy_indian_rad.pdf
-
Think in terms of the guy who answers your phone from India asking you if watched the Cubs vs Whitesox game when you call to complain that cable is not working in the first place.
The Kenyans would be working as outsourced resources; as coders. This particular angle is not about Kenyan healthcare itself at all. I am not sure it makes sense anymore if the clinicians are doing the coding themselves though.
Tough to imagine; medicine is---and probably right to---a different ball-game.
I imagine most of the work would come from places with reasonably functional health systems and with a lot of work. That would be the "richer" countries. But those countries have the most stringent legal regulations, including on privacy and the transfer of medical information. (I recall a long-running skirmish between the EU and the USA on whether medical records could be transferred from the latter to the former unless the USA strengthened its privacy regulations.) Just think of Americans' readiness to go for lawsuits, and you will find all sorts of issues in the "chain".
Going beyond mere data coding, a company such as Nyokabi's would get very little business from a place like the USA, even though there is plenty of such work that needs to be done there. India tried that market and did not get very far. From a few years ago:
About fifteen (15) Indian radiologists currently read U.S. images. This number is unlikely to expand much in the near future. When U.S. images are offshored to other countries, the typical reader is a U.S. radiologist living abroad.
And that is because:
To demonstrate competence - to be allowed to legally read images generated in the United States - a radiologist must have completed his/her medical residency in a U.S. program, passed U.S. medical board examinations, be licensed in the state where the image was taken and have privileges in the hospital where the image was taken.
http://dusp.mit.edu/sites/dusp.mit.edu/files/attachments/publications/levy_indian_rad.pdf
The whole "tele-medicine" business seems to be full of all sorts of legal (and medical) "minefields" that generate much discussion but without any clear resolutions. In places like Kenya, with the fondness for short-cuts and easy money, my first worry would be whether the person reading the "outsourced" image was really qualified or whether it would be the boss's nephew holding the image in one hand and a medical textbook in the other. But, of course, Nyokabi's is an excellent initiative, and one hopes there will be more of that sort
-
Mutua is working. Whatever he did as Gov Spokesman for me is history. I admire his leadership at Machakos County. Not fools like Isaac Ruto.
Pundit
County governments have teething problems. They need plenty of help. I have no idea how it is arranged but I assume the Director of Medical services still calls the shots as concerns quality and service delivery. If this is not the case then we have to amend the law. Get me right, I am all for devolution but not at the expense of quality.
My problem with Mutua is he, like PLO is a born spin doctor. You can never know what is real and what is "Chap Chap". I have treated his every pronouncement with a sack of the best sea salt, since his chap chap road peeled off in his wake as he drove back to town with a sea of journalists.
That said, have you undertaken a brief analysis of the qualifications of our so called governors? How many bought degrees in a hurry to contest? Is it only Joho? Most of these guys were what you can call functionally illiterate. Until there is a proper electoral and campaign finance reform to introduce PR (and avoid the recent UK debacle of re-electing a man you don't want), we shall continue to have this problem.
Education makes a major difference. Take the Police. Those countries that set very high educational admission requirements for their police and proceed to demand a long training period in college also have the most professional police force with limited cases of brutality and corruption. Kenya and the US fall in the same category.
-
The counties don't necessarily have it easy. USAID has been a funding a project to help with some of the issues, and here are some statements from its January 2015 summary report:
Services and resources were devolved rapidly, but a number of outstanding questions and concerns remain for the Kenyan health system.
Unsurprisingly, significant capacity gaps are common within county political and management structures. When resources were devolved, few counties possessed the administrative capability to absorb the available funding or plan for its use. Although the national government was concerned about these capacity gaps, it had not outlined training and mentoring plans for the counties, as it expected to use the full three-year transition period originally allowed by law.
These issues reflect some of the political and technical challenges associated with devolution. Counties sought to expand the scope of resources transferred from the national government, increase their authority over services, and reduce national government restrictions. However, the national government fought to retain centralized control.
MOH civil servants, seeking to preserve their positions in Nairobi, have tried to limit health worker transfers to CHMTs or health facilities. They fear that certain counties will have poor social services and infrastructure, that they will lose political power outside of Nairobi, and that their work will be subject to greater political interference.
The national MOH has also been slow to restructure. Without adequate political will, it is unlikely that MOH headquarters staff will be reassigned to assist CHMTs or provide health services as originally envisioned.
http://www.healthpolicyproject.com/pubs/719_KenyaDevolutionBrief.pdf
-
Unless we have proper managers and strict accountability and disciplinary process - everything esle is wishful thinking. The greatest hinderance to improved health care in kenya are the doctors and nurses employed by these institutions. Drs in public hospitals in Kenya are a law unto themselves. They are accountable to no one. They abscond work. They are rude. Same with nurses.
Patients are treated as a bother , with alot of dis respect.
Now spare me this BS that medical dstaff work under stress and difficult conditions. Medical staff should reflect on their performance under the circumstances while continually holding the govt to account.
Most radiaology services in public hospital are sabotage by the same Dr and technicians so that patients can be refered where they Drs earn kick backs.
Drugs are looted from pharmcy so that Dr can write private prescriptions and get kick backs.
Operating theatre are sabotaged so that patients can have their operations in private clinics.
Forensic auditors to investigate these illegal activities and punish the greedy Drs are urgently needed.
But more importantly - Dr and Nurses must be ready to be sincere and work from within to improve the quality of health service.
Drs , managers and nurses who engaged in corrupt activities , abscond duties , neglect patients should be sacked and charged in court if their offences are criminal in nature.
With that in place the health care workers can have the moral grounds to blame the govt of its failures
Enough of my rant. :D
-
That said, part of the corruption in the hospitals arises because of weak systems. These weak systems can only be corrected by investing in technology. We are not investing in technology so we are bound to remain with weak systems. There you have your vicious cycle.
I don't completely buy this argument, which I have also heard in relation to how the national government does some of its business. Technology of itself will never be a solution to what is, essentially, a fundamental "national character-flaw". All it will do is make things slightly more difficult and necessitate more creativity in looting.
Look at it this way: at the bottom of whatever technological system one has in place to supposedly prevent theft, there is something as simple as just entering data into some computer system. As long as the person doing that can be bought, the system is not of much use.
There are way too many people in Kenya who have no problems with public theft. What's more they know they can get away with it and so have little incentive to stop. As long as that is the case, the theft will continue.
To my mind, the best way to deal with corruption is Lee Kwan Yew's Singapore way: no matter how small or how big, punishment is quick and painful---literally when it includes caning.
If, on the other hand, by technology you mean mechanizing more things so that there are fewer people employed who can steal, then the problem still remains: the procurement, servicing, replacement, etc. of the technology will be the vehicles for theft.
The people who do the big-time stealing have the means and opportunity to get around any system. In fact, it is they who will oversee the setting-up and use of any system that is supposed to stop them from stealing.
Russia hospital was ruined by the Kenyatta regime with support from the Brits. It was a state of the art hospital at inception and could easily have rivaled Kenyatta National Hospital. History and geopolitics aside, it suffers from the same mismanagement that is killing other hospitals.
That could be so. I don't know exactly how Kenyatta and the British ruined the hospital; so I can't comment on that. But I note that both have been long-gone, and it has been the local management f**king-up for years on end; it is they that I am more concerned about right now. And knowing that other public hospitals are similarly messed up does not give me much cheer: because of what one might call "historical" or "cultural" reasons, I have "extra" interest in that particular hospital.
P.S.: My relative that I mentioned earlier has now moved from "Russia"---but not without a final bit of unpleasantness. A doctor eventually came to see him, and it went something like this: "Yes, you are seriously ill. Vey much so. From this and that. We need to give you injections of A, B, and C. That will cost so much, and we require payment before a syringe is even pulled out."
-
:32:
Freaking scary stuff.
you should secretly record some of these consultations and shame these quacks on FB and twitter. kwani ?
My relative that I mentioned earlier has now moved from "Russia"---but not without a final bit of unpleasantness. A doctor eventually came to see him, and it went something like this: "Yes, you are seriously ill. Vey much so. From this and that. We need to give you injections of A, B, and C. That will cost so much, and we require payment before a syringe is even pulled out."
-
The hospital was put up by the Russians. Most of the technology was Russian - meaning equipment, even the wiring. The facilities were firm, long lasting and made for multiple usage without dagamage (to give a general description). Even the lights were from Russia.
Flat roofs were vetoed by serikali mandarins who had received bribes from the asbesto cartel to use the poison - againt Russian objections.
Now came the maintenance. Under the agreement withb the Russians, spareparts would be provided for an indefinite period. All the hospåital had to do was prepare a list and dispatch to Moscow and the parts would be sent.
This was not to be. I heard the first person to send the list was arrested and questioned for his communist links. So rather than get spares, the hospital slowly became a graveyard of Russian equipment that could easily be repaired. The staff - educated elsewhere and returning with a heavy dose of anti-Sovietism - bad mouthed the hospital and set about changing everything. I know the son of the contractor who had to remove all the "Russian" electrical units and replace them with poor quality British type shiet.
Now if you have lived on mainland Europe, you know what most europeans think of British Electrical systems - those three rectangular holes and very silly solutions. These were preferred to better quality Russian equipment.
That could be so. I don't know exactly how Kenyatta and the British ruined the hospital; so I can't comment on that. But I note that both have been long-gone, and it has been the local management f**king-up for years on end; it is they that I am more concerned about right now. And knowing that other public hospitals are similarly messed up does not give me much cheer: because of what one might call "historical" or "cultural" reasons, I have "extra" interest in that particular hospital.
P.S.: My relative that I mentioned earlier has now moved from "Russia"---but not without a final bit of unpleasantness. A doctor eventually came to see him, and it went something like this: "Yes, you are seriously ill. Vey much so. From this and that. We need to give you injections of A, B, and C. That will cost so much, and we require payment before a syringe is even pulled out."
-
Two Kitui MCAs have accused Kitui County Referral Hospital staff of demanding bribes from patients.
The county assembly Health Committee chairperson Joyce Mutemi and member Mary Mbandi say some of the staff demand bribes to serve the patients.
Mutemi said she went for an ultrasound scan and a hospital staffer demanded Sh1,000, which he pocketed without giving an official receipt.
She said when she became adamant, the staffer disappeared.
Mbandi said she had a leg condition but was told there was no X-ray film in an apparent bid to “extort money from me”.
When the hospital staff realised she is an MCA, a health officer intervened and the X-ray was done immediately.
The duo said their experience reflects what patients undergo in the hands of dishonest staff at the hospital.
They demanded that the hospital management fire corrupt staff.
The MCAs spoke when the assembly’s Health Committee visited the hospital’s medical superintendent Dr Allan Owino.
They asked Owino to crack the whip on the wayward hospital staff.
Owino admitted there are cases of staff fleecing patients out of money.
He said the introduction of computers is meant to bring down the vice and discourage thieving staff.
Owino said the cases involving staff and students from Kenya Medical Training Collage Kitui have been discovered and disciplinary action will be taken.
He urged the patients to ask for receipts for any payment at the hospital.
Owino said the county government should give the hospital more money for hiring more staff.
He said the hospital requires at least 175 nurses but has only 105.
- See more at: http://www.the-star.co.ke/news/kitui-hospital-staff-ask-bribes-two-mcas#sthash.gtw4G27z.dpuf
-
The hospital was put up by the Russians. Most of the technology was Russian - meaning equipment, even the wiring. The facilities were firm, long lasting and made for multiple usage without dagamage (to give a general description). Even the lights were from Russia.
Flat roofs were vetoed by serikali mandarins who had received bribes from the asbesto cartel to use the poison - againt Russian objections.
Now came the maintenance. Under the agreement withb the Russians, spareparts would be provided for an indefinite period. All the hospåital had to do was prepare a list and dispatch to Moscow and the parts would be sent.
This was not to be. I heard the first person to send the list was arrested and questioned for his communist links. So rather than get spares, the hospital slowly became a graveyard of Russian equipment that could easily be repaired. The staff - educated elsewhere and returning with a heavy dose of anti-Sovietism - bad mouthed the hospital and set about changing everything. I know the son of the contractor who had to remove all the "Russian" electrical units and replace them with poor quality British type shiet.
Now if you have lived on mainland Europe, you know what most europeans think of British Electrical systems - those three rectangular holes and very silly solutions. These were preferred to better quality Russian equipment.
I think I missed something. I'm trying to get a line on how Kenyatta No. 1 and the Brits messed it up and why the local management has since then been f**king up.
I can't comment on the merits of the British electrical system vs. those of Europe and the rest of the world. But Kenya, as a consequence of its history, still works on the "British type shiet". And it doesn't look like it will change any time soon; so common sense would suggest that one be mindful of that.
I know why it's called "Russia", as well as the rabid anti-communism of the time. In fact, you'd be probably surprised at how well I know the place. One significant point I've noted is the growth of myths and tales about the place, its history, and its fortunes---no, I don't mean yours. But:
* If there are no doctors doing their rounds in the hospitals, then from my personal interactions, I have a good idea---from when I am there on vacation---of which bar or nightclub they are busy in. And when they wake up, with their hang-overs, the private clinic (serious money) comes first.
* No drugs at the hospital, even when it should be fully supplied? I can tell you exactly which "pharma-shack" in Kondele or Manyatta is selling the hospital's supplies.
Moving to the broader picture, jakoyo is on the mark on many things that I may comment on later. But the essence is this: elitist arrogance in a corrupt "fuck-all" system is a recipe for disaster in something as important as health-care.
CUBA:
A great to be learned from the place ... for those who care.
-
:32:
Freaking scary stuff.
you should secretly record some of these consultations and shame these quacks on FB and twitter. kwani ?
Record? What for? Initially I was shocked, but I have since been assured that it's the way things are done there these days. Standard hospital policy or something. It appears that free government-provided health-care isn't free, and some of that is not actually corruption---just GoK not providing enough funding (or too much of it getting looted). He's now at some private clinic in Milimani where the owner works on a slightly better model: the muhindi owner---sorry, veritas---will treat & feed, but the security guard is to make sure that he doesn't even get out for a breath of fresh air unless his daily payments are up-to-date. And if the money keeps coming in, they want the patient to keep staying ...
-
Unless we have proper managers and strict accountability and disciplinary process - everything esle is wishful thinking. The greatest hinderance to improved health care in kenya are the doctors and nurses employed by these institutions. Drs in public hospitals in Kenya are a law unto themselves. They are accountable to no one. They abscond work. They are rude. Same with nurses.
Patients are treated as a bother , with alot of dis respect.
Now spare me this BS that medical dstaff work under stress and difficult conditions. Medical staff should reflect on their performance under the circumstances while continually holding the govt to account.
Most radiaology services in public hospital are sabotage by the same Dr and technicians so that patients can be refered where they Drs earn kick backs.
Drugs are looted from pharmcy so that Dr can write private prescriptions and get kick backs.
Operating theatre are sabotaged so that patients can have their operations in private clinics.
Forensic auditors to investigate these illegal activities and punish the greedy Drs are urgently needed.
But more importantly - Dr and Nurses must be ready to be sincere and work from within to improve the quality of health service.
Drs , managers and nurses who engaged in corrupt activities , abscond duties , neglect patients should be sacked and charged in court if their offences are criminal in nature.
With that in place the health care workers can have the moral grounds to blame the govt of its failures
Enough of my rant. :D
Jakoyo
what are you ranting on about…more importantly, what are you doing about the situation? The problem or the rot in Kenya starts from the top an trickles down. If the head is rotten, what do you think the body is going to look like? The sad part is that there is enough money being thrown around to provide such services......seem so basic but our mere existence depends largely on them....most kids dont make it past age 5 due to lack of these basics. Sometimes I wonder if these people at the top ever get sick? If so, how are they so blind or insensitive to the issue of healthcare.... It would be unfair to simply blame the workers, and yes despite what you thing, its the most stressful job you will ever come across (that applies to those who actually work)....after all peoples lives are on the line. Are they paid enough to care? Do they have supplies to provide the care?
-
Going beyond mere data coding, a company such as Nyokabi's would get very little business from a place like the USA, even though there is plenty of such work that needs to be done there. India tried that market and did not get very far. From a few years ago:
MOONKI
This is incorrect. Actually that is how business is done in the US. Most hospitals do not have Radiologists within the hospitals. They perform x-rays, CT scans and MRIs, then send the images to a radiologists who reads them and sends back the results electronically. So a company like Nyokabis is just catching up with what the US has been doing all along.
From my reading, I gather that she is herself a radiologist and not just a coder…… which helps a great deal with the actual translations. Some of those same radiologists are stationed in places like advanced radiology sites that take outpatient clients where they read the films in real time and still accepts to service local hospitals. Radiologists are highly paid and I am assuming that is why not many hospitals hire them in-house. This technology, combined with telemedicine are excellent resources because they help people get the treatment they need right at home without staying in the hospital.
-
MOONKI
This is incorrect. Actually that is how business is done in the US. Most hospitals do not have Radiologists within the hospitals. They perform x-rays, CT scans and MRIs, then send the images to a radiologists who reads them and sends back the results electronically. So a company like Nyokabis is just catching up with what the US has been doing all along.
Perhaps we are on two different lines here. Terminator is proposing that folks in Kenya be able to do all sorts of "outsourcy" stuff for people elsewhere. I also stated that I did not think Nyokabi could get much (outsourced) business from the USA, not in the USA.
From what I can tell, Nyokabi's business is in Kenya. And I'm saying that, as far as I understand American law, her company could not possibly do any/much work for an American hospital/clinic. The Indian Kings of Outsourcing have not had much success in that regard.
In fact---and please correct me, if I am wrong---even within the USA the legal matter of doctors "practicing across state lines" get very tricky. Last I looked---I'll have to find the report, which was some legal commentary---only a few states, like Montana (which themselves are already "backward & outsourced" from the rest of the USA) are free-and-easy with the practice of "telemedicine".
Anyway, just to go out on a limb here, I'm going to say that I don't see a US clinic/hospital sending work to Nyokabi in Nairobi. Not for a long, long, long time. I'd be keen to know why you disagree. From where I see it, the legal minefield is simply too huge; but, of course, I could be wrong.
-
most kids dont make it past age 5 due to lack of these basics. Sometimes I wonder if these people at the top ever get sick? If so, how are they so blind or insensitive to the issue of healthcare....
That's how it is. And when people come to vote for who will lead the country, it's all "our man!". Mission Impossible. You make your choice: laugh or cry.
-
Only radiologists whose qualifications are recognized by the American Board ( ie Board Certified) and registered to practice in America and have comprehensive medicolegal indemnity can be allowed to give a radiological report of persons recieving treatment in America.
Simply because they believe their standards are safer and superior to ours.
But inversly - most wealthy Kenyans prefer expert opinion from abroad.
-
I think I missed something. I'm trying to get a line on how Kenyatta No. 1 and the Brits messed it up and why the local management has since then been f**king up.
My assumption was that you will complete the dots.
You have inadvertently done so however with your mention of "anti-communism". Having such a hospital working and state of the art worked against the narrative. Need I specify the man who presided over this policy in Kenya?
-
MOONKI
This is incorrect. Actually that is how business is done in the US. Most hospitals do not have Radiologists within the hospitals. They perform x-rays, CT scans and MRIs, then send the images to a radiologists who reads them and sends back the results electronically. So a company like Nyokabis is just catching up with what the US has been doing all along.
Perhaps we are on two different lines here. Terminator is proposing that folks in Kenya be able to do all sorts of "outsourcy" stuff for people elsewhere. I also stated that I did not think Nyokabi could get much (outsourced) business from the USA, not in the USA.
From what I can tell, Nyokabi's business is in Kenya. And I'm saying that, as far as I understand American law, her company could not possibly do any/much work for an American hospital/clinic. The Indian Kings of Outsourcing have not had much success in that regard.
In fact---and please correct me, if I am wrong---even within the USA the legal matter of doctors "practicing across state lines" get very tricky. Last I looked---I'll have to find the report, which was some legal commentary---only a few states, like Montana (which themselves are already "backward & outsourced" from the rest of the USA) are free-and-easy with the practice of "telemedicine".
Anyway, just to go out on a limb here, I'm going to say that I don't see a US clinic/hospital sending work to Nyokabi in Nairobi. Not for a long, long, long time. I'd be keen to know why you disagree. From where I see it, the legal minefield is simply too huge; but, of course, I could be wrong.
Ok, I see, we were making arguments for two totally different point of views. It took me a minute to realize that Termi was actually making an argument about outsourcing such delicate services to Kenya, a country were laws exist only in books, and no one really pays attention to them….or can disregard them for the right fee. That is a never event.... I don’t think it will ever happen, for the mere reasons that you mentioned earlier, the sensitivity of such tests and lawsuits notwithstanding.
I was looking at Nyokabi's business from a Kenyan point of view…as far as the Kenyan or at least East African market is concerned. Actually compared to those neighboring countries, I think we have the better education system and out doctors are highly trained (or used to be highly trained. Not sure how it is now).She would make tones’ of money by having local rural and regional hospitals that do not have such capabilities sending images to her for translation. It would allow rural doctors to treat patient’s right where they are after getting the exact diagnosis from such tests. It would speed up treatment instead of waiting or having to travel far away to get those services. Of course there is still the issue of equipping those rural hospitals with the technology itself.
As far as physicians crossing state lines, I don’t think there is much of an issue and especially not concerning lawsuits, unless I am not understanding your question. Like most careers here, the states regulate licensing and if you move to another state, you simply register with the respective body. Once a physician, always a physician and you can practice anywhere in the US, of course after taking care of the necessary paperwork if needed. You can actually start practicing immediately even as you wait for the switch. Now if you are practicing in two states at the same time especially at the borders then you have to be certified by both states. Lawsuits can happen regardless of where you practice, and they will carry on if you move to another state.
-
As far as physicians crossing state lines, I don’t think there is much of an issue and especially not concerning lawsuits, unless I am not understanding your question. Like most careers here, the states regulate licensing and if you move to another state, you simply register with the respective body. Once a physician, always a physician and you can practice anywhere in the US, of course after taking care of the necessary paperwork if needed. You can actually start practicing immediately even as you wait for the switch. Now if you are practicing in two states at the same time especially at the borders then you have to be certified by both states. Lawsuits can happen regardless of where you practice, and they will carry on if you move to another state.
What I was referring to is that most law will define the "location of practice" as where the patient is, not where the doctor is. In most cases that is not a problem because they are in the same place. But it is different once you come to anything that could be considered "telemedicine: say you have a patient in a hospital in State X and a doctor in State Y but not licensed to practice in State X.
What a place like Montana has done is to allow Dr. Y to get a special, limited-purpose "telemedicine license" that would allow him/her to "work by remote in Montana".
-
kudos Nyokabi ... we need more cost friendly private sector, NGOist, church based service providers alternative .... KPMDU - bright doctors and nurses educated by taxes should seek funding to offer innovative health services instead of always complaining of salaries...it is very easy to overrun govt pathetic services and this needs to happen now that most of public services are irreedeemable ...how can we peg our hope on dead machines at KNH and MTRH .... looks like african govt need to be left with regulation/taxation role only......Mutua can only be 1 guy - maybe he can also open Machakos county govt health facilities in other counties as part of Machakos county income generating options.... we need all sort of experiments
-
My doctor cousin is busy buying plots; Instead of investing in his area of specialization. This is the problem with us wafrika. We are still traditionally minded.Most doctors would rather invest in real estate and not in starting their own high tech clinics. So we all end up complaining...from patient to the doctor.
kudos Nyokabi ... we need more cost friendly private sector, NGOist, church based service providers alternative .... KPMDU - bright doctors and nurses educated by taxes should seek funding to offer innovative health services instead of always complaining of salaries...it is very easy to overrun govt pathetic services and this needs to happen now that most of public services are irreedeemable ...how can we peg our hope on dead machines at KNH and MTRH .... looks like african govt need to be left with regulation/taxation role only......Mutua can only be 1 guy - maybe he can also open Machakos county govt health facilities in other counties as part of Machakos county income generating options.... we need all sort of experiments
-
My doctor cousin is busy buying plots; Instead of investing in his area of specialization. This is the problem with us wafrika. We are still traditionally minded.Most doctors would rather invest in real estate and not in starting their own high tech clinics. So we all end up complaining...from patient to the doctor.
This is funny but true.
Many years ago I recall a lecturer telling us that land is a primitive factor of production in that it requires the least mental input; buy-hold, buy-develop. And of course he explained how bahindis since 1900s fared well without a fat appetite for shambas.
There is no problem with going real but if that is the biggest preoccupation of an economy, we have a problem.
-
As far as physicians crossing state lines, I don’t think there is much of an issue and especially not concerning lawsuits, unless I am not understanding your question. Like most careers here, the states regulate licensing and if you move to another state, you simply register with the respective body. Once a physician, always a physician and you can practice anywhere in the US, of course after taking care of the necessary paperwork if needed. You can actually start practicing immediately even as you wait for the switch. Now if you are practicing in two states at the same time especially at the borders then you have to be certified by both states. Lawsuits can happen regardless of where you practice, and they will carry on if you move to another state.
What I was referring to is that most law will define the "location of practice" as where the patient is, not where the doctor is. In most cases that is not a problem because they are in the same place. But it is different once you come to anything that could be considered "telemedicine: say you have a patient in a hospital in State X and a doctor in State Y but not licensed to practice in State X.
What a place like Montana has done is to allow Dr. Y to get a special, limited-purpose "telemedicine license" that would allow him/her to "work by remote in Montana".
You are right about "location of practice" being defined as the patients' location. When it comes to telemedicine, I think there are enough clinicians in each state to go around which minimizes the need for inter-state practice, except in instances where renowned specialists services are required, or in states that do not have enough specialists. The provision of such licensing may be available in other states if need be (haven't really looked into it).
I personally think the success of Telemedicine will depend on how well patients' are able to interface with providers and receive care right there in their homes without office visit's or inpatient admissions. This will be even more important in rural communities that are not near any hospitals. Doctors can call or Skype with patients, provide consultations, view still images of xrays, ct's; send electronic prescription to pharmacy, and have pharmacy deliver the medicine right at their doorsteps. Patients can provide parameters for things like BP to determine the effectiveness of medications etc. This is going to reduce the costs of healthcare tremendously.
-
jakoyo:
In the case I was referring to, I was told---I have not confirmed it---that even in a hospital these days one pays for the service before it is rendered. Apparently, how ill one might be at the time is irrelevant.
That aside, veryone is eating chicken in Kenya. Even in hospitals:
Owino admitted there are cases of staff fleecing patients out of money.
...
He urged the patients to ask for receipts for any payment at the hospital.
http://www.the-star.co.ke/news/kitui-hospital-staff-ask-bribes-two-mcas#sthash.ymGoicW7.dpbs