When a Boy Doesn’t Need to Die
Some days we public health specialists are hell-bent on improving quality of care and reducing medical errors. Other days we wring our hands about the lack of access to health services, turning our focus to affordability and outreach. In reality, quality and access are two sides of the same medical care coin. But this presumes that the coin is within our grasp, not rolling down an embankment and into a muddy river.
On this particular day, my team’s goal was quality improvement. In rural Kenya, doctors are scarcer than sunscreen, so nurses have to act as frontline health providers. Our task was to observe and rate nurses as they diagnosed and treated sick children at two government health facilities about two hours from Vihiga town and three hours from the nearest city. The protocol was for us to assess a nurse’s management of six sick children — enough to observe a range of ailments.
The team I was leading consisted of eight Kenyan clinical supervisors and assessors from several cities. A supervisor would first document how the nurse handled each young patient. Then, in a separate room, an assessor would perform a “gold star” re-examination to determine if the nurse had made any errors. It was a painstaking process. The nurses, understandably nervous in the face of such close scrutiny, took 20–30 minutes with each child, rather than the usual five to seven.
