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Doctors making a killing

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The Race: 9:33pm, June 24, 2018: From Nairobi, Dr Felix Wanjala texts on a work WhatsApp group: “Team, let’s ensure we don’t let the team down … let’s meet our target.”

Without context, this might appear like a harmless motivational speech from a boss to his subordinates. But here is the context: Dr Wanjala is the CEO of Nairobi Women’s Hospital (NWH). In the message immediately before that, he had forwarded a text listing the admission numbers across all the hospital’s branches in the country. “We have the numbers as follows at this hour,” the CEO wrote to his employees, and then listed admissions totalling 288 across the hospital group.

The target, and the context of the war cry not to let the rest of the team down, he went on, was to get 22 more admissions.

To do this, the CEO recommended that his team, based at the Nairobi Women’s Hospital Branch in Nakuru (called Nakuru Hyrax) should “start with looking for referrals”, not miss “any opportunity (to admit)”, and be “very vigilant in casualty”.

In multiple texts covering different days in 2018, the WhatsApp group resembles a trading floor, with Dr Wanjala and his Chief Operations Officer Eunice Munyingi pushing employees to work harder and increase admissions. On the first day of July, for example, Ms Munyingi wrote in response to the nurse in charge of the hospital chain: “Let us increase speed; two admissions against 13 discharges at this hour is not good.”

Two minutes later, the CEO added: “It’s our striking time. Let’s intensify our effort … replace all discharges by 6pm.” Five days later, at 7:28pm, the COO told the Nakuru branch staff to “get three admissions by 9pm”.

Interviews with whistle-blowers who shared the screenshots paint the picture of a corporate culture of being pushed to meet admission targets. “Although it was not said explicitly,” one former member of the NWH told this writer, “the implication was that doctors and nurses in particular had to find reasons to admit patients to meet the hourly and daily targets, even if those reasons were an absolute lie.”

Another added that there was a financial reward paid to clinical officers for each admission; and they had to write down why they were admitting each patient. This meant, several former staff members said, that they had to get creative to meet targets, both personal ones and those of their employer.

The Founder:

Founded two decades ago by Dr Sam Thenya, a young gynaecologist, Nairobi Women’s Hospital began with a unique specialisation. The focus of its first branch, in Hurlingham, was solely obstetrics and gynaecology services, meaning its primary clients were women. It particularly became known for its Gender Violence Recovery Centre, a charitable arm that serves survivors of sexual and domestic violence.

“I was working in a hospital and I had pitched this idea to the CEO of that hospital, but he wasn’t very keen on the idea of taking in abused women for free,” the hospital’s founder told the Business Daily in November 2016. “One time he told me that if I thought the idea would work then I should go ahead and open my own hospital because it wasn’t going to work at that hospital, and right there I thought to myself, ‘Why not?”

So at 31, Dr Sam Thenya followed his boss’s advice.

What drove him to start the hospital when he had no money, he told the interviewer, was a “certain trigger, madness or passion”. That singular focus to his goal, despite challenges almost as soon as he started, built one of the most familiar, respected private hospitals in the capital city.

In 2003, the hospital’s banker, Daima Bank, collapsed. Dr Thenya, still in the early years of his project, heard the devastating news while refuelling his vehicle at a petrol station. “We had just issued suppliers’ cheques,” he said in the interview.

Despite other challenges, Dr Thenya and the hospital he built surged on. In a scenario that exemplifies the fine line between private healthcare as a business and a service, Dr Thenya had to fight with politicians, including President Uhuru Kenyatta, and technocrats who demanded the release of patients over bills.

Once, he told the interviewer, the President called him and told him someone had sent him an email lamenting that the body of his or her mother was being held hostage by NWH over unpaid bills. “Sam, what do we do?” the President asked. “Your Excellency, the bill has to be paid,” Dr Thenya answered.

After the President said he would pay the bill, and asked the body be released while he did it, Dr Thenya replied: “I need some proof of payment. If you want me to release it today, then pay today.”

By the time this was happening, a lot had changed. Dr Thenya had transformed from a practising gynaecologist to an entrepreneur as the hospital grew. He had also sold it, and was on his way out as the founding CEO.

Born in Nyakihai, Murang’a, in 1968, a much younger Sam Thenya had wanted to be a pilot. But he became a doctor instead. As a young doctor in training, he led a strike at Nyeri Provincial General Hospital in the early 1990s. The issue, which was fixed because of the strike, was bad work conditions for medical practitioners.

“I am not one who stands by and watches things deteriorate,” he told an interviewer in 2011.

What finally drove him to ask his boss to start a wing for victims of sexual violence, and doing it himself when he was challenged, was meeting the victim of a brutal gang rape. Battered, violated and in need of urgent medical care, she did not have money to pay for admission.

“I paid for her admission and closely monitored her progress.”

The Past: As a young doctor on a mission in the early 2000s, Dr Thenya was unstoppable in his mission to build Nairobi Women’s Hospital. In October 2000, a facility called Hurlingham Hospital was being auctioned off for unpaid debts. Dr Thenya approached the auctioneers with a promise to buy the hospital. It was an attractive deal for both sides: the auctioneers would get rid of an asset, and the young doctor would not have to start a hospital from scratch. But there was one problem, a big one. He had no money on him.

Nairobi Women’s Hospital Adams branch. PHOTO | JEFF ANGOTE| NATION MEDIA GROUP

The most he could raise was half a million shillings, which he did by selling his wife’s car. He needed Sh17 million more, so he got other investors to put in the money and take a share of the repainted hospital’s ownership.

In the world of modern finance, this seemingly brilliant financing strategy has a name. It is called a leveraged buyout (LBO). It works exactly how Dr Thenya did it: You buy a company by taking in debt and giving up equity, which means you do not need a single coin to start whatever enterprise you want to start.

The most famous LBO in the world is the hostile takeover of American company RJR Nabisco. In 1989, the executives of the conglomerate, which sold tobacco and food, started an unstoppable process to acquire the entire company at $75 a share.

The events that followed that ignition are covered in Barbarians at the Gate: The Fall of RJR Nabisco, a book by two American journalists that later became a movie. It covers the executives’ plan to buy out other shareholders, and the marathon that began when other groups of people joined in on the sudden race to acquire one of the biggest companies in the world. One of them finally won, by offering a price higher, by $15, than the management team’s offer.

But the best part of this story is that none of them, even the executives who wanted to buy a company for $25 billion, actually had the money, and they didn’t need to.

The gist is to start what is called, in modern finance, a fundless fund. Simply, a corporate body that on the one hand promises to and negotiates to buy something, while asking for money from those who have it to complete the deal. For investors with vast amounts of money, this is an investment for which they expect to see profits.

Dr Thenya gave up 40 per cent of NWH’s ownership to the investors who gave him Sh50 million to buy the assets of Hurlingham Hospital and rebuild it anew as Nairobi Women’s Hospital. As the hospital grew, on the back of its reputation as a niche healthcare provider, Dr Thenya bought out the investors, and by the late 2000s, owned the entire thing.

In 2009, he acquired Masaba Hospital in Adams Arcade, and turned it into the second Nairobi Women’s Hospital branch. By the end of the next decade, there would be a total of nine branches of Nairobi Women’s Hospital: four in the capital city and the metropolis; two in Nakuru; and one each in Naivasha, Meru and Mombasa.

From a single hospital in Hurlingham, Nairobi Women’s Hospital was one of the fastest-growing hospital chains in Kenya by the mid-2010s. But things had changed. In the first decade, Dr Thenya had quit practising to concentrate on the business side of his hospital.

“I realised that I was not giving my patients full attention because I was often caught up in strategy meetings,” he said, “(so) I had to choose between expanding the hospital and practising.”

And in several transactions beginning in 2010, he had progressively sold his ownership stake in the hospital to the successor of leveraged buyouts in modern finance; a similar but differently named structure called a private equity fund.

The Present:

A private equity (PE) firm is a leveraged buyout by any other name. Simply, you get money from wealthy individuals and organisations and invest it in attractive companies. Then you restructure the company by cutting costs and expanding as fast as possible, and then you sell the now bigger company for a profit.

The basis of this model of financing is to buy and sell, as opposed to keeping an investment in perpetuity. So PE firms strip their new companies of any sellable assets, change the management, reduce costs by firing professionals and employing cheaper labour, pay executives bonuses for meeting targets, and once the company is attractive enough on paper, sell it to someone else. That new buyer is often just another PE firm.

Dr Sam Thenya founded Nairobi Women’s Hospital with a unique specialisation. The focus of its first branch, in Hurlingham, was solely obstetrics and gynaecology services, meaning its primary clients were women. PHOTO | FILE | NATION MEDIA GROUP

In the complicated structures of global commerce, private equity funds are used to finance rapid expansion, which increases the value of the assets. Investors, who include funds of funds — where one investment fund invests in another investment fund — expect a return on investment. And investment funds get money by promising exactly that.

PE funds make money in two ways: by charging an annual management fee of the money they have been trusted with, calculated as a percentage, and by taking a cut of the profits they make when they sell the companies they buy. So their primary motivation is to get more investor money, and to restructure companies as fast as possible to attract a higher price than they bought it for.

by nation.co.le


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Health

Comedian Flaqo opens up on rare condition he has been battling

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Popular Kenyan comedian, Flaqo born Erastus Ayieko Otieno has for the first time spoken about a rare condition that he has been struggling with for some time.

Turns out that despite the funny man the Kenyan audience and beyond has grown to know as Flaqo Raz, he has his fair share of battles behind the cameras.

Flaqo opens up

The Internet sensation shared a photo showing red, itchy welts like a form of skin reaction on certain parts of his body.

Depending on the reactions, the welts appear and fade repeatedly and vary in size.

The YouTuber shared his condition with fans in the hope that maybe one or two can relate to what he has been going through and maybe work out a solution on the same.

“Anyone with this condition, how do you go about it?” he posed.

Comedian Flaqo rare skin condition

“Sometimes I have to postpone my shoots because they are unbearable. Zangu zilipotea for 6 months straight. Now they are back…” he replied to a fan who shared a similar experience.

Funny enough, soon as he had put up the post, he got so much feedback, with so many individuals able to relate to his skin condition, to his amazement.

“So far: try staying in the sun for a bit, bathe with warm water after taking antihistamines. To understand your condition better, make a point of seeing a dermatologist,” Flaqo shared with fans battling a similar condition, after gathering responses from his fan base.

Wrapping up urging fellow victims to take plenty of water, work out more often and avoid proteins since hives get triggered by things like particular foods, medication and stress.

By Ghafla.com


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Health

MP’s battle with Covid-19 at home

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On November 2, Nakuru Town West MP Samuel Arama drove to Naivasha to attend the Building Bridges Initiative (BBI) meeting.

Earlier, Mr Arama had taken a Covid-19 test at a health facility in Nakuru after he experienced chills at night.

However, on arrival at the hotel where he was to spend the night, he started experiencing chills again and developed fever, pain in the joints and nausea.

Soon he started experiencing shortness of breath.

He informed his colleagues that he was feeling unwell, and they quickly planned to take him to Nairobi for treatment.

Not able to walk

“When I booked into my room, my body temperature was high and I had chills. It was at that time that I received a phone call from health officials that I had tested positive for Covid-19. I had gone for the test before travelling to Naivasha,” he recalled.

But when he informed the department of health about his plan to travel to Nairobi for treatment, he was counselled and advised by the County Chief Officer of Public Health Samuel King’ori to self-isolate in his house where he would be monitored by medics.

Inside an isolation room in his house, he was put on supplemental oxygen and fed through tubes, with doctors examining him in the morning, afternoon and at night.

“For the past several weeks, I have kept off the public because I was not able to walk, talk or eat after being diagnosed with Covid-19,” said Arama.

After 15 days, he began to feed normally and later tested negative for coronavirus.

“God has been merciful to me. Gasping for air and feeding through tubes was the most trying moment in my life. Actually, this was my first time to feed through tubes and get oxygen support,” he said.

The MP plans to work with community health volunteers, the police and youth to sensitise locals on Covid-19 preventive measures.

He wants to buy at least 20,000 masks to distribute to the needy through local administrators and nyumba kumi members.

Prior to being diagnosed with Covid-19, Arama used to hold a meeting with constituents.

Initially, he used to criticise police whenever they arrested people for contravening Covid-19 protocols.

“At times I would rush to the police station whenever I heard that someone had been arrested, but now I support the police to fully enforce the set containment measures. It is through discipline that we will save the society,” he said.

He said during meetings with constituents he never thought he would contract the virus.

“I take this opportunity to thank God for giving me this second chance to serve Him and the people of Nakuru Town West,” he said.

His message to the public is to wear masks, wash hands with soap and water and avoid crowds.

“We need everyone to put on masks, wash hands with soap and water and avoid gatherings. This is the only way to contain the spread of this virus,” said the MP.

Dedication and courage

Arama applauded health workers in Nakuru, for their dedication and courage in the fight against Covid-19.

“I can confirm to you that Nakuru County has the best health facilities, equipment and qualified medical personnel. I spent two weeks on oxygen support machine, intensive treatment and consistent checkups,” he said.

Health records indicate that the attack rate in Nakuru is 169.2 out of 100,000 population, with a case fatality of 2.2 per cent.

Although the MP was reluctant to reveal the cost of his treatment, a source at the local department of health told The Standard he incurred a bill of Sh51,684 per day because he required supplemental oxygen and his condition was critical.

By Standardmedia.co.ke


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Health

Close friend, carrier of deadly disease

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Dog has always been mans best friend, but without responsible ownership, they are turning to I be the worst man’s enemy bet cause of rabies.

J The deadly virus spread to people from the saliva of infected animals, usually through a bite. Warm-blooded animals serve as reservoirs for rabies, with unvaccinated dogs as the main reservoir worldwide.

Florence Ndinda from Makueni county is one of those who can’t stand a dog’s presence after her two granddaughters, who she is taking care of, were bitten by her own dog, which was rabid.

She remembers vividly how two years ago one of her granddaughters, Florence Mbithe [then eight], was bitten by one of her puppies. Mbithe was playing with other children outside their house when a puppy came running to her. Before Florence could rescue Mbithe, the puppy had already bitten her.

Confused without knowing what to do, Ndinda took her granddaughter to the nearby dispensary for first aid. After receiving help, she was connected to the Makueni Rabies Surveillance team who came and took samples from that dog and the result showed it was rabid. They were also referred to Makueni Level Five hospital for Mbithe’s treatment.

“I was advised to isolate the dog for 10 days as the rest were getting the vaccine, but I didn’t. I felt that since it was a puppy it won’t harm any other person,” she says.

Since she couldn’t manage to go to Makueni hospital that same day, she had to go there the following day. While away, the same puppy attacked her youngest granddaughter Abigael Ndinda then aged four. With no Post-Exposure rabies Prophylaxis [PEP] vaccine at the hospital, she was forced to buy it from the nearby pharmacy.

It was not easy to get the required five doses per person for both her granddaughters. With a dose going for Sh950, she only managed to buy them three doses each. She also vowed to never ever keep dogs in her compound and even her neighbor’s dogs are always chased away when spotted in her compound.

“PEP is compulsory if you are bitten by a dog, cat, or another animal that is rabid or is suspected to be infected with rabies. An exposed person who has never been vaccinated against rabies should get four doses of the vaccine and another shot called Rabies Immune Globulin [RIG]. A previously vaccinated person should get two doses of the vaccine. They do not need RIG. Always, make sure you complete the dose,” says Dr Emily Mudoga, Animals Campaign Manager at World Animal Protection.

The vaccine is made up of the dead rabies virus. When it is injected into the body, the immune system immediately starts to produce antibodies to fight off the perceived infection. Multiple shots ensure the levels of antibodies remain elevated so that even if the live virus is already in your system, the antibodies will neutralise it.

Besides humans, rabid dogs attack livestock. Makueni county alone lost 300 livestock in the last five years. The number, however, is suspected to be higher since most cases go unreported.

Jane Nduku is one of the residents who lost her cow after it was attacked by a rabid dog. It took some days before she realised the cow had been bitten. She only found when she called the veterinary to report that the cow was suffering from foot and mouth disease as it couldn’t swallow anything. The veterinary confirmed otherwise.

“When the veterinary visited us, the dog that had attacked the cow had started showing rabid signs, but hadn’t gone crazy. So after taking samples and the result turned positive, we were advised to kill both the cow and the dog. That is exactly what we did,” says Nduku.

Richard Muteti, a veterinary who also doubles up as a field officer for rabies surveillance for Kenya Medical Research Institute in Makueni county, says some cases go unreported because livestock owners confuse rabies with foot-and-mouth disease, hemorrhagic septicaemia or choking.

Disease surveillance To ensure farmers are able to differentiate rabies from the above, he says they have been creating awareness about rabies and advising farmers to report if a dog attacks their animals. Because of these, reported cases of livestock being bitten by dogs have increased unlike before when people used not to report.

“At Makueni sub-county alone, we have been getting about 12 cases of dog or animal bites weekly. Since not all dog/animal bites are rabid about 20 cases turns positive annually,” says Muteti.

Currently, over 70 per cent of the county is now reporting any dog /animal bite witnessed. Muteti reveals they are targeting 90 per cent.

To make sure all bite cases have been captured at the county level, Dr Daniel Ksee, Acting Director, Veterinary Services in the county, says they are set to unveil an Integrated Bite Case Management [IBCM], an approach for rabies surveillance that directly and formally links workers in public health and veterinary sectors to assess risk of rabies among animal bite patients and biting animals, respectively.

“This approach will help us with contact tracing, and we will be able to come up with concrete data about rabies in the county. We hope this approach will be embraced by other counties,” says Ksee.

Apart from this approach, Ksee says other initiatives in place include: annaul mass dog vaccination, that have seen about 300,000 dogs vaccinated; and training the community and teachers about responsible dog ownership.

He says most farmers don’t know the importance of vaccinating their dogs. Farmers have been focusing on animals that generate some income such as cows, goats, pigs and donkeys.

“We decided to use teachers because they can easily reach the students. They have been integrating responsible dog ownership topics in their programmes and we have recorded a decrease of stray dogs across the county,” adds Ksee.

It is recommended for puppies to get the vaccination at three months for the first time, followed at nine months, and then yearly boosters. In some cases, the first vaccination can be given as early as two months, but with precaution. For adult dogs, the first vaccination should be given as soon as possible, and a local veterinarian

should be consulted.

In Kenya alone, about 2,000 people die annually because of rabies yet it is 100 per cent vaccine-preventable. The World Health Organisation says rabies is estimated to cause 59,000 human deaths annually in over 150 countries, with 95 per cent of cases occurring in Africa and Asia. Due to widespread underreporting and uncertain estimates, it is likely this is a gross underestimate of the true burden of disease.

“In Kenya, domesticated dogs are responsible for transmission of over 98 per cent of all human rabies cases. Apart from dog bites, the virus can also be transmitted when saliva enters any open wound or mucus membrane,” says Mudoga.

Although the campaign to make Kenya a rabies-free country has been running for the last 100 years, we are yet to eliminate the virus because, according to Mudoga, there is lac” political goodwill.

“Rabies vaccine has not been prioritised by counties despite that it is easier to vaccinate than to treat. The government needs to make this vaccine mandatory, put more resources for the campaign, and bring communities on board. With all that done, it will be possible to have zero human deaths from dog-mediated rabies by 2030,” adds Mudoga.

Survival chances

Generally, it takes between 30 to 50 days for rabies symptoms to develop. They appear once the virus reaches the spinal cord or brain. However, in some cases, symptoms can appear in just 10 days or it even over a year The duration depends on factors such as location of virus entry and viral load. Initial symptoms are flu, difficulty swallowing followed by fever, a headache and vomiting.

“Currently there is no cure for raibes. If you are bitten, you should visit your doctor right away. The incubation period can be as little as five days, so don’t assume you can wait for a week to see if the animal that bit you is unwell before seeking medical attention. The chances of survival are extremely low once the patient becomes symptomatic,” adds Mudoga.

And what should one do if bitten by an animal?

M udoga says the most effective first-aid treatment against rabies is to wash and flush the wound immediately with soap and water for 10-15 minutes. If soap is not available, flushing it with water alone is also acceptable.

MANAGEMENT

• Extensive washing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure.

• A course of potent and effective rabies vaccine that meets WHO standards. • The administration of rabies immunoglobulin (RIG), if indicated.

by PD.co.ke


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