Healthcare for the poorest

“Tom” after treatment

We are always grateful for contributions to the website from those who are working at Kisiizi. Here Anna Jones tells the story of “Tom” and the effects of poverty on his health and on his prospects for survival. This article and the accompanying photograph are published with his family’s consent.

Kisiizi serves an incredibly poor population, but it cannot afford to give all care free of charge. Patients can recover only to be faced with unmanageable bills. The Kisiizi insurance scheme helps to manage this, greatly reducing the bills of those who have paid their annual subscription. Recently we were reminded of how important this work is.

A couple of weeks ago, a very unwell 14 year-old boy (let’s call him Tom) arrived in Kisiizi. His face, limbs and tummy were swollen, he was struggling to breath and he looked terrified. He had been increasingly unwell for five months and had been taken to traditional healers who had cut him repeatedly, but had not had any effective medical care.

We diagnosed him with heart failure, secondary to rheumatic heart disease. Rheumatic heart disease happens after rheumatic fever as the body equips itself to attack the bacteria and then mistakes the heart valves for the bacteria and attacks them as well. When the valves are damaged, the heart has to squeeze harder to force blood through and to work harder as much of the blood goes backwards. We used to have a lot of rheumatic fever in the UK but it has disappeared as living conditions have improved.

Tom responded well to our treatment – the swelling went down and his breathing improved; but his valves will always be bad and he will need to stay on treatment for the rest of his life or he will become swollen and breathless again. We said he could go home and emphasized the importance of him taking his medications and returning to clinic.

But Tom couldn’t simply go. He is not on the insurance scheme and the hospital bill his mother was presented with totalled over £60. Tom is one of six children. His father is unable to work, his mother brings up the children and earns money by digging – just over 80p for a hard day’s work; this has to feed a family of eight. Tom’s condition is a disease of poverty and, having improved his health in the short term, it looked like our care was set to tip him and his family into even worse poverty. What is more, if treatment proved so financially damaging to his family, would they seek help again if needed? Would they pay for his much-needed medication?

Unfortunately, the Good Samaritan Fund did not have the funds to assist him at this point. Luckily, there are volunteers at Kisiizi who felt able to pay off most of the bill. There is a slim chance that Tom’s valves could be improved by surgery (which a charity here would pay for); meanwhile we hope his medications control his heart failure for as long as possible.

Tom’s stay would have ended very differently if he was on the Kisiizi insurance scheme. We hope that, as the scheme’s uptake increases, fewer family’s find themselves in the position of Tom’s family.