The Lecture

So I gave a lecture at the University of Nairobi, College of Health Sciences. I was invited to talk on the issue of Clinical Pharmacy and the role of the clinical pharamcist as a member of the healthcare team. The title of my talk: Current and Emerging Trends in Clinical Pharmacy: Integration of the Pharmacist as Health Team Member. In the audience were professors from the various healthcare disciplines, noted names in their various fields in Kenya, including highly respected professors of pharmacy, representatives from the Kenyan Ministry of Health, and the Kenyan Poisons and Pharmacy Board (the Kenyan FDA equivalent), and what seemed to be the entire student body of the University of Nairobi school of pharmacy. All of these individuals want to make a difference in health care in Kenya and all strive to bring pharmacy to the forefront of that paradigm shift in Kenyan healthcare. Further, it seems to be the concensus that the University of Nairobi, College of Health Sciences should be among the leaders of advancing healthcare in this country, if not the leader. So there I was, presenting my views on where the profession of pharmacy could go in Kenya, and how the profession can bring about meaningful change in Kenyan healthcare. The Gospel according to Neil...:>). or maybe an Epistle, 21st century style, by powerpoint. Of course my tongue is planted firmly in my cheek; I was humbled by the experience.

In any case, Kenyan training in the healthsciences is, in many if not most cases, more advanced than some U.S. schools of the healthsciences. Their thinking is quite progressive, their attitudes are very positive, their overall position is that we, as healthcare scientists, particularly pharmacists, have a rightful place among the healthcare elite of this country, and it is our obligation to be the authors of change,.... for all Kenyans. But, in this country of approximately 40 million, there is rampant HIV/AIDS, epidemic malaria, particularly in coastal areas, nutritional problems abound, with hunger, starvation and dehydration leading the causes of death in children. The issues of poverty as the primary factor in all of these circumstances is huge with most working individuals livng on $1.00 per day. So why is it that in a country of such forward thinking health professionals, AIDS and its accompanying deaths, exists at record prevalance, dehydrated children die routinely, malaria still kills the most vulnerable, and in its most remote areas, there are no physicians, no pharmacists, no medications and almost nothing that bears the slightest resemblance to regularly administered modern healthcare.

Several years ago, while walking on a gravelly/dirt path towards the main road, in a small Kenyan village, I asked my host, "What happens when someone gets sick back here". He smiled the kind of smile usually given to someone who has asked the most nieve of questions,..and replied simply," they die." Over the years, in other remote areas of Kenya, I've asked the same question, and the answer has always been the same,...."they die,...,of the simplest malady,... "they die." Of the most uncomplicated respiratory or cardiovascular disorder,..."they die". But wait a minute,... we have forward thinking health professionals,.. people who boldly state their intention to innovatively treat disease. People with uncomplicated disease are not supposed to die prematurely.

The universal tragedy is that this is not a story unique to Kenya. In many of our "developed" countries, there are those who die, needlessly, because "innovative healthcare" is not synonomous with the term "equally available healthcare", and even with U.S. healthcare reform, and the availability of insurance for an additional 32 million individuals, we are left questioning if that insurance will provide innovative healthcare to all. My mother who may have been diagnosed with cancer may not be offered state of the art treatments without the appropriate insurance, and what's even more tragic, is that investigations required to render an accurate diagnosis, may not even be ordered until the cancer is in its late stages,... because my mother may not have an insurance program that will pay for state of the art diagnosis and treatment, ...y'know,... the treatments that are seen on Fox Chase Cancer Hospital commercials. Or, my mother, because of the color of her skin, or perceived social background, may be seen as not worthy of elite care that would be offered to others of higher social or economic background. So, I wouldn't get too overjoyed about the new U.S. healthcare proposals until we have a sense of how the new legislation incorporates, in very specific terms, the dignity that one human being affords another,... or until the newly enacted laws state how we should relate to each other as the community that we really are. So, of course, Kenya doesn't have a monoply on poorly and unequally disseminated healthcare. We all share pieces of this tragedy.

Nevertheless, I incorporated some of this in my talk last week, calling on those in the audience to truly advocate for adequate and evenly distributaed healthcare for all Kenyans (especially those in the slums where we've often treated patients). It seemed very well received, and judging from the optimistic views of the students, their overall idealism as well as ambitious thoughts on healthcare provision, there is abundant reason to be hopeful that in future generations this change will come about. These Kenyans seem more than committed to the meet the challenges and engage in the difficult work that change will require. Their dedication to this could allow them to make the difference in providing healthcare for all Kenyans, in a way that affords uplifting the human spirit, allowing human dignity to flourish and dispenses hope along with medication. Now if that hope and committment for equality in healthcare reaches the world, the term Universal Health Care could take on its true meaning. Archeologist have said that civilization began in East Africa. Maybe the rebirth we need for global equally disseminated healthcare will begin in East Africa as well.