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Published on August 3rd, 2015 | by KNUN

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KNUN AND NNAK REPORT ON AKICHELESIT DISPENSARY ALLEGED INJECTIONS

FINDINGS OF THE ALLEGED INJECTION ASSOCIATED NEURITIS IN CHILDREN AT AKICHELESIT DISPENSARY.
Report Released to:
The Cabinet Secretary,
Ministry of Health,
P.O Box 30016-00100,
Nairobi

The County Executive Committee – Member
Health Services,
Busia County Government
P.O Box PRIVATE BAG 50400
Busia.

The Chairperson
Parliamentary Committee on Health
National Assembly
11th Parliament
Nairobi

The Chair,
Senate Committee on Health
Nairobi

1.0 INTRODUCTION
(1.1) About Kenya National Union of Nurses (KNUN).
The Kenya National Union of Nurses is a duly registered trade Union in Kenya. The union was registered in accordance with the provisions of the Labor Relations Act. No. 14 of 2007 Laws of Kenya. The sole purpose of the union is to be a world class Union of Choice for all nurses working in Kenya. The union endeavors to deliberately regulate terms and conditions of employment for all nurses both in the Private and the Public Sectors.
The union aims at establishing a democratic platform upon which nurses shall express their feelings by engaging their employers in dialogue and employment agreements, with an aim of improving nurses working conditions and as a result improving the quality of nursing care to the public.
(1.2). About National Nurses Association of Kenya (NNAK)
National Nurses Association of Kenya (NNAK) is a professional body representing all cadres of nurses in Kenya duly exempt from registration under the society’s act Cap 108 of the laws of Kenya. NNAK is a member of ICN and ICM a federation of nursing organization’s whose objectives is to empower nurses to speak with one voice in order to influence social and health policy.
NNAK exist to promote excellence in nursing and midwifery practice through lobbying and advocating for sound health and social policies while promoting competence, motivation and satisfaction among our membership.
(1.3). About Akichelesit Dispensary
Akichelesit dispensary is located north of Teso, Busia County. It is a public Health facility that serves a total population of 10,251 people, with a monthly workload of 4500 cases on average and a daily attendance of 150, malaria is the leading condition among out-patient morbidities. They conduct 4 deliveries on average every month, with an average ante-natal attendance of 70 clients. The main source of drug supply is KEMSA while other sources include revolving fund pharmacy run by AMPATH. The dispensary is managed by 3 nurses and 1 lab technician.
2.0 THE REPORT
This report has been compiled from actual visits, interview with various stakeholders and meetings with different levels of County Health Management
Meeting with the County Health Executive.
Through our branch networks at the county level the two organizations were made aware of the incidents and immediately embarked on a fact finding mission from 23rd July 2015 to 25th July 2015. Where different health facilities were visited and various issues discussed with the nursing fraternity. The mission entailed a meeting with the County Executive for Health (Dr. Maurice Siminyu), the County Director of Medical Services (Dr. Lutomia) and the County Director of Nursing Services (Ms. Assumpta Matekwa).
During the meeting several issues were discussed to include a feedback on observations made by the team from visiting some of the health facilities in Busiathe issues raised include:
(2.1) In-secure working environment: where in one of the facilities a nurse was attacked by villagers while attending to her duties at the facility and sustained a head injury and has since not received the required medical attention to include CT scan and MRI. Her condition was worsening by the day.
(2.2) Un conducive practice environment that does not support the practice of nurses as professionals:
(i)High workload due to poor nurse patient ratios that lowers patient safety, increases average length of stay for patient’s and leading to preventable deaths.
(ii)Nurses being subjected to non-nursing duties for instance a facility where the nurse was cleaning dressing instruments instead of attending to his nursing obligations.
(iii)Lack of instruments and crucial equipment’s to ensure quality services are offered for example a facility that had a broken down autoclave machine and no suction machine makes it difficult for the nurse to assure infection prevention.
(2.3) Lack of acceptable human resource workplace standards that ensures adequate personnel with the right skill mix,
(i)Case at hand where in one of the facilities visited the nurse was working on a night duty shift alone in a hospital that has 1 medical officer, 6 clinical officers, 3 pharmacy personnel and 3 laboratory technicians, yet the nurse was required to fill in all the above positions at night in addition to the nursing obligations that were present.
(ii) Due to poor staffing ratios the non-skilled personnel treating and offering clinical services meant to be offered by qualified personnel.
(2.4) Failed administrative systems and structures are blamed on the nurses by the community this is due to community’s lack of understanding on the role of nurses in health service delivery,
(i)Case in point: in one of the facilities the nurses invoked the wrath of the community when the ambulance delayed in referring their patient, they are also accused of misappropriation of hospital funds yet the nurses are never involved in prioritization and execution of health related projects.
(ii)Poor management of referral system and lack of a referral protocol that explicitly stipulates roles and responsibilities of each health provider involved across the referral system.
(iii)Poor prioritization of projects by the County Health Committee is blamed on the nurses. This is because the health workers are not involved in identifying, designing, planning and executing of the health projects.
(2.5) Our investigations further revealed that there was poor relationship between the community and the health providers.
(2.6) Political interference with the running of the health facility and mis-information of the public about the role of nurses in health care management.
3.0 AKICHELESIT
The findings
The team established that:
(3.1). From 17th December to 25th June 2015, a total of 18 childrenwere reported to have developed injection related neuritis and foot-drop, 17 of them reported to have supposedly received the injection at Akichelesit dispensary, 1 had been treated at Angurai health center, 1 from Moding Health Center while the other from St Mary’s Chelelemu Mission Hospital however Two of the children had received treatment for bone infection in the year 2013 at a different health facility namely Angurai dispensary.
(3.2). All the affected children hailed from one village (Ketebat), they alleged to have received the injections at different points between December 2014 and June 2015. They alleged to have received the offending injection from a particular nurse and not the other two.
(3.3). The nurses offer clinical services and nursing services to include clerking, injecting dispensing of drugs, report writing and reproductive health services.
(3.4) The investigations revealed that nurses in this dispensary rotate in different departments on a weekly basis.
(3.5). The offensive drug (quinine) was out of stock during that period of administration, which necessitated the relatives to purchase from private chemists.
(3.6). The nursing officer in charge of the dispensary had earlierinformed her two junior nurses ,that one of the support staff was stealing drugs hence they were instructed to be locking the doors at all times when they were not in the pharmacy further the nurse who is alleged to have injected the children was then one who had been directed by the officer in charge to call a meeting of all the support staffs and inform them that they aware of the person stealing the drugs and the person was warned by the suspected nurse not to continue with the vice, since they knew the culprit.
(3.7). It was further established that the suspected support staff who was stealing the drugs was treating patients from her home over the weekends, and she hails from the affected village.
4.0 CONCLUSION:
It is beyond reasonable doubt that there is more than meet the eye considering the following findings:
(4.1) The nurses who is alleged to have injected all the children does not hail from the community.
(4.2) Remaining two nurses who are not suspects, one hails from the community while the other is married in the community.
(4.3) The support staff suspected of stealing drugs and treating patients in her house over the weekend, hails from the same community and the affected village.
(4.4) Three of the affected children were not injected at Akichelesit dispensary rather they were injected from three different facilities yet they are from the affected village.
(4.5) That the affected children hailing from the same village received the injections at different points in time yet they alleged to have been injected by one particular nurse in all these occasion.

5.0 OUR POSITION:
(5.1) We the Kenyan nurses are ranked the best in provision of nursing services and our services are sought after globally.
(5.2) Our nursing services are used by governments in sub-Saharan Africa to bench mark their own nursing services.
(5.3) We therefore dismiss the notion that all the affected children at Ketebat village were injected by the alleged nurse and it is our firm belief that the injection trauma was caused by unqualified personnel masquerading as a health care professional.
(5.4) We shall therefore take legal action to any person who attempts to continue linking the paralysis to the alleged nurse.
(5.5) We agree, empathize and hold hands with the affected parents and childrento strongly urge the county government to take full responsibility and ensure that the children are provided with the best medical care to facilitate speedy recovery.

6.0 RECOMMENDATIONS:
(6.1). Recognizing that, nurses have a right to practice in a manner that fulfills their obligations to society and to those who receive nursing care we therefore recommend that:
(a) Nurses be involved in health care planning and prioritization for speedy implementation and efficient execution of health priorities within their practice setting, this will prevent pilferage, misuse and disuse of public resources. It will also prevent unnecessary delays in responding to emergencies.
(b) The county government undertakes to employ adequate nursing personnel to meet the needs and the demands of communities.Research shows that adequate nurse ratios assures patient safety and positive patient outcomes with reduced length of stays and preventable deaths among the populace.
(c) Speedy deployment of other health personnel to attain the right skill mix for quality health service delivery this is to ensure that nurses do not perform non-nursing obligations.
(6.2) To maximize the contribution of nurses to society, it is necessary to protect their dignity, welfare and safety to this end:
(a) The nurses have a right to a work environment that is safe and free from physical assault, threatening behavior or verbal abuse for themselves and their patients
(b) The county government Must strive to provide security and ensure the safety of not just the nurses but, all of its workers and patients.
(6.3) Nurses have a right to practice in environment that allows them to act in accordance with professional standards and legally authorized scope of practice, it is necessary therefore that:
(a) The county government undertakes to provide the necessary supplies, equipment’s and instruments to enable the nurse deliver on their mandate of quality health care in an environment that supports and promotes professionals and professionalism and not quacks.
(b) The county health management Must ensure progressive and continuous medical education for all its staff, to assure seamless provision of quality health care in tandem with the current and ever changing technologies, emerging infectious and more virulent diseases and complications.
(6.4) Taking cognizance of the critical role politics play in shaping policies to include health, we recommend that;

(a)Politicians (MCAs) be part of the health management committee to ensure that their electorate are provided with the quality care and that they are able to lobby through the county assemblies for more allocation in health.
(b)The electorate should demand more and value for their taxes from the county government and the national government who are determinants of the county spending instead of blaming and harming innocent nurses and other health workers.
Signed for and on behalf of:
Kenya National Union of Nurses
General Secretary
Seth Panyako

National Treasurer
Agnes Munderu

Busia Branch Chairman
Isaiah W. Omondi

National Nurses Association of Kenya

National Chairperson
Winnie Shena

National Secretary
Alfred Obengo


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