Bronchitis

The receptionist at the Nairobi health clinic sits behind a commanding desk that confronts me as soon as I walk inside. It would be intimidating except for her friendly smile. Chairs ring the perimeter of the room, which is combination lobby, waiting room, and central access for the consultation rooms. The tile floor is polished to a mirror finish, and there are about a dozen people waiting to see the doctor. There’s also a pharmacy counter in the waiting room, something I’ve never seen in an American clinic.

I hand the receptionist my passport and inform her in a hoarse, croaking voice that I’d like to see a doctor. She asks me if I have an appointment. I say no, and she tells me it’s no problem. She takes my passport and enters me into her computer. When she is done, she looks at me apologetically.

“I have to inform you that the consultation fee is one thousand five hundred shillings, which you can kindly pay to me here.”

1,500 shillings is about $15. I hand her two bills which she takes to a cashier. She asks me to wait. Five minutes pass. There’s a small alcove in the corner hidden behind a thick blue drape marked “Observation Room.” The curtain parts and a young man in a medical uniform calls my name. He has an enormous crooked smile. He holds the curtain open and I squeeze into the alcove, which has a tiny desk, a computer, and a well-used bathroom scale. He uses a worn cuff to check my blood pressure, then clamps a state-of-the-art blood oxygen sensor on my finger. He pulls out a glass thermometer, the kind with the silver mercury bulb just like the one my mom used on me back in the 1960s. He gives it a cursory wipe with a cotton ball and presents it to me. For a moment I think he wants me to put it under my tongue, but he’s aiming for my underarm instead.

He asks me the normal questions: are you allergic to anything, do you have chronic diseases, do you smoke or drink. When I say I don’t smoke or drink, he says “Then you are a very good boy!” Unlike an American doctor’s office, there is absolutely no paperwork.

The medical assistant is very soft spoken, and after a week in the country I’m still struggling to understand the Kenyan accent. He is patient with me, repeating himself when it’s obvious I don’t understand.

He’s collected my vitals, and I’m sent back to the waiting area. It’s not long until I hear my voice called from one of the consultation rooms. I look up but can’t figure out from which room the voice came. As I stand there, confused, every single patient in the waiting area points in unison, as if they’ve practiced the motion beforehand.

The doctor is a tall with an authoritative bearing. She wears an immaculate lab coat. I thank her for seeing me without an appointment and she scowls at my hoarse voice. I try to joke with her but she fails to see the humor in the situation. She listens to my lungs, looks down my throat and in my ears, makes a clucking noise, and tells me I have a bad infection. She then furiously types on her computer, so fast that her fingers blur. When I act amazed at her dexterity, I finally elicit a smile.

The doctor sends me to the pharmacy counter where I collect a fantastic assortment of drugs and potions to treat my ailments. The pharmacist packages each set of pills in a small credit-card sized paper envelope on which she writes the dosage instructions. She lays them on the counter like a deck of cards and announces each drug’s purpose: antibiotic, antihistamine, pain killers, cough suppressant, disinfecting gargle, steroid, etc. At home in the USA my doctor would have prescribed an antibiotic and given me a paper prescription, which I would have them taken to a pharmacy. All the other drugs I would purchase on my own.

The total cost for the entire event, including the doctor visit and all the medicine, was about $35, less than a quarter of what it would have been for similar-quality services and products in the USA.