Short version

Mr. Otieno’s journey through the local healthcare system began in a manner Kafka himself might have penned. After battling shortness of breath, chest tightness, and fatigue—Google-worthy symptoms that scream “seek immediate medical attention”—he was finally convinced by his neighbor, Kamau, to visit the hospital. But getting there was an obstacle course in itself.

Kamau’s old truck, a relic from a time long forgotten, required a hearty shove to rouse its engine. With a bit of help, Kamau managed to get it going while Mr. Otieno watched, too weak to assist. With a sputter loud enough to wake the dead, the truck jolted to life, coughing its way toward the county hospital. As they pulled away, Mr. Otieno couldn’t help but notice a raven perched ominously on a nearby tree, its dark eyes tracking them as they left.

“Hold on tight,” Kamau grinned as they bounced along the pothole-riddled road, the truck’s rattling drowning out any hope of conversation. “She’s old, but she’s got character!”

Catherine, his wife, was tied up with farm duties, the harvest beckoning, leaving Kamau to play chauffeur. Mr. Otieno had initially resisted the idea of going to the hospital—he didn’t want to be a bother—but Kamau wouldn’t take no for an answer.

At the hospital, Kamau led Mr. Otieno through the chaos, his grip firm, his presence reassuring. “We’ll get you sorted,” Kamau said, though the concern in his eyes belied his steady tone.

They found a seat in the packed waiting area, where the hustle and bustle of the overcrowded hospital provided a grim soundtrack. A weary nurse brushed past them, her exhaustion visible in every step. “How long is the wait?” Mr. Otieno asked, anxiety creeping into his voice.

“Could be a while,” she replied, barely slowing down.

Time dragged on, each minute feeling like an eternity, until a doctor finally called for Mr. Otieno. Kamau offered a few encouraging words before the doctor, clearly running on autopilot after endless shifts, began his examination. Despite his fatigue, the doctor moved with a purposeful air, as though some deep-seated duty still drove him.

After the consultation, Mr. Otieno was admitted, finding himself in a bed shared with a stranger—because nothing says “patient-centered care” like enforced intimacy. The Ward was a relic, its peeling paint and broken equipment casting shadows that seemed to stretch ominously into the corners. The raven, now perched on a telephone wire outside his window, continued to watch him, its presence unnerving in ways Mr. Otieno couldn’t quite grasp.

The staff’s exhaustion was evident in their every move, and the attending physician looked as if he hadn’t had a day off since medical school. He approached Mr. Otieno’s bed, taking the time to listen carefully to his heart with a furrowed brow. Holding Mr. Otieno’s X-ray film against the dim light, he scribbled notes onto Mr. Otieno’s treatment sheet. Just as his pager beeped urgently, the doctor paused to say, “You have a weak heart, Mr. Otieno. This happens when your high blood pressure and diabetes aren’t well controlled. We’ll help you get better. We’ll do an ultrasound and some blood tests to guide your treatment.” With that, he vanished, leaving Mr. Otieno alone with his thoughts in the dimly lit ward.

A clattering food cart interrupted his reverie, but the sight of the bland, beige meal trays only deepened his unease. “They call this food?” grumbled the man in the next bed, poking at his tray.

“To think I’m on a salt-free diet,” Mr. Otieno replied with a weak smile.

Adding to the bleakness, a recent strike had left the hospital even more short-staffed. The young boy sharing his bed — heads at opposite ends — mentioned doctors sleeping outside the Ministry of Health, waiting for posting letters. The boy, full of youthful bravado, asked if Mr. Otieno thought the finance bill would survive Parliament.

Despite himself, Mr. Otieno chuckled at the boy’s spirit. He couldn’t help but think of his family, imagining the strain his illness was causing them — financially, emotionally, in every possible way. He had heard that a WhatsApp group had been set up to collect contributions for his treatment — an act of kindness that brought as much shame as it did relief.

The sounds of city life outside the hospital felt distant, almost foreign. The gray sky cast a pall over everything, deepening the gloom that permeated the hospital. When he noticed the raven had moved closer, now perched on the windowsill, its gaze unnerved him.

What was supposed to be a short visit stretched into weeks. The days blurred together, marked only by occasional visits from Catherine, who brought fresh clothes and a comforting smile, though worry was etched deeply on her face. Mr. Otieno watched as the woman who once saw him as a pillar of strength now had to watch him wither away.

One day, his son, the unemployed teacher, came to visit, bringing a newspaper and a book in an effort to lift his father’s spirits. The “Gen Z” sharing Mr. Otieno’s bed struck up a conversation. “What was it like on the streets? Did you get hit with tear gas?”

His son sighed deeply. The air had been thick with tear gas, choking the breath from his lungs as he pushed through the surging crowd. Shouts of anger and fear mingled with the sharp crack of batons against shields, the clatter of debris hurled by desperate hands, and the relentless thud of boots on pavement. It was a cacophony of violence and resistance—a scene seared into his memory, impossible to forget.

“It was tough,” he finally said, “but we had to do it.”

The boy’s eyes widened with admiration. “I want to do that one day, but my lungs need to be ready.” he said, his youthful bravado shining through.

Then came the governor’s visit, a spectacle so absurd it could have been plucked from a satirical novel. The hospital, which had resembled a warzone, suddenly underwent a miraculous transformation. The floors gleamed, the patients, including Mr. Otieno, were draped in crisp linens, and the air reeked of disinfectant—more than he had ever seen or smelled since his admission. Even the bedridden patient by the window, who had been in the same position for days, was scrubbed clean.

A nurse, who had previously been too busy to notice him, appeared at his bedside, adjusting his sheets with a forced smile. “Everything looking good, Mr. Otieno?”

“For now,” he replied, raising an eyebrow at the sudden change in treatment.

For the first time, he laid eyes on the hospital managers, previously as elusive as a good blood pressure reading. As the governor and his entourage paraded through the ward, nodding as if they had personally overseen the recovery of every patient, Mr. Otieno’s head throbbed—not from his heart failure, but from the sheer absurdity of it all. The next day, as he read about the visit in the newspaper, he noted with mild amusement that the governor had promised to upgrade the hospital to match the state-of-the-art facility he had seen on a recent benchmarking trip to the U.S. The name of the place was to later escape him, but it had reminded him of sandwiches.

Despite the surrounding chaos, Mr. Otieno found solace in small acts of kindness that pierced through the dysfunction. A pair of intern doctors, though visibly worn out, made it a point to check on him with a smile and a few comforting words. In another unexpected moment, a young visitor to the patient in the next bed took it upon himself to swat away the flies that occasionally found their way to Mr. Otieno’s porridge. The boy’s bright red shirt was a striking contrast against the drab, colorless surroundings—a burst of vibrancy in an otherwise bleak environment. While the gesture was small, it reminded Mr. Otieno that even in the most trying circumstances, tiny acts of care could make a profound difference. A janitor, noticing his discomfort, took the time to adjust his bed, and a padre on his rounds invited him to attend mass at the small chapel on the hospital grounds. However, the thought of dragging his urinary catheter and bag across the hospital was far from appealing. The promise of a spiritual experience was overshadowed by the very real concern that the leak in his catheter, which had yet to be properly fixed, might choose to reveal itself during the sermon. Mr. Otieno politely declined, deciding it was wiser to keep his devotions within the safety of his bed, where any mishaps would be confined to a familiar space. As the padre left, Mr. Otieno noticed the raven again, now perched just outside the chapel window—a constant reminder of the shadows that lingered.

Gradually, the swelling in his feet improved, as did his breathing. The staff’s vigilance, despite their exhaustion, brought about a tentative improvement in his condition.

When the time came for him to be discharged, a process that took longer than most marriages, Catherine arrived to take him home. She carried his small wash basin and the belongings he had brought on the first day—items that now seemed heavier, both in weight and in the emotional toll they represented. As they left the hospital, Mr. Otieno felt a mix of relief and apprehension.

Kamau was waiting outside in his beaten old truck, smiling broadly. “Ready to go home?” he called out, his voice full of warmth.

“Let’s hope I don’t have to come back,” Mr. Otieno said to the nurse who handed him his discharge papers.

“Take care, Mr. Otieno. But you know where to find us,” she replied with a weak smile.

Back home, Mr. Otieno initially seemed to be on the mend. Over the next few days, he regained some strength, moving about his home with cautious optimism. Determined to return to his daily routines, he decided to inspect his farm. Walking the familiar rows, he took in the sight of the ripe maize, his thoughts focused on ensuring everything was in order. For a brief moment, life seemed to be returning to normal.

But this sense of normalcy was cruelly fleeting. As he finished his inspection, a sudden, severe pain tore through his chest. His vision blurred, and he felt lightheaded. Collapsing to the ground, his last conscious thought was of the farm and the harvest he might never see.

When he opened his eyes again, he was back in the hospital, staring up at the familiar ceiling of his old Ward cubicle. The nightmare, it seemed, was just beginning.

Back on his farm, the raven perched on a maize stalk, its dark silhouette a harbinger of the trials yet to come.

Mr. Otieno’s journey through the local healthcare system began in a manner that Kafka himself might have penned. After battling shortness of breath, chest tightness, and fatigue—symptoms that practically begged for immediate medical attention—he was finally convinced by his neighbor, Kamau, to visit the hospital. But even getting there proved to be an obstacle course.

Kamau’s old truck, a relic from a bygone era, needed a hearty shove to rouse its engine. With a bit of help, Kamau managed to get it going while Mr. Otieno watched, too weak to assist. With a sputter loud enough to wake the dead, the truck jolted to life, coughing its way toward the county hospital. As they pulled away, Mr. Otieno couldn’t help but notice a raven perched ominously on a nearby tree, its dark eyes tracking them as they left.

“Hold on tight,” Kamau grinned as they bounced along the pothole-riddled road, the truck’s rattling drowning out any hope of conversation. “She’s old, but she’s got character!”

Catherine, his wife, was tied up with farm duties, the harvest beckoning, leaving Kamau to play chauffeur. Mr. Otieno had initially resisted the idea of going to the hospital—he didn’t want to be a bother—but Kamau wouldn’t take no for an answer.

At the hospital, Kamau led Mr. Otieno through the chaos, his grip firm, his presence reassuring. “We’ll get you sorted,” Kamau said, though the concern in his eyes belied his steady tone.

They found a seat in the packed waiting area, where the hustle and bustle of the overcrowded hospital provided a grim soundtrack. A weary nurse brushed past them, her exhaustion visible in every step. “How long is the wait?” Mr. Otieno asked, anxiety creeping into his voice.

“Could be a while,” she replied, barely slowing down.

Time dragged on, each minute feeling like an eternity, until a doctor finally called for Mr. Otieno. Kamau offered a few encouraging words before the doctor, clearly running on autopilot after endless shifts, began his examination. Despite his fatigue, the doctor moved with a purposeful air, driven by a deep-seated sense of duty.

After the consultation, Mr. Otieno was admitted, finding himself in a bed shared with a stranger—because nothing says “patient-centered care” like enforced intimacy. The ward was a relic, its peeling paint and broken equipment casting shadows that seemed to stretch ominously into the corners. The raven, now perched on a telephone wire outside his window, continued to watch him, its presence unnerving in ways Mr. Otieno couldn’t quite grasp.

The staff’s exhaustion was evident in their every move, and the attending physician looked as if he hadn’t had a day off since medical school. He approached Mr. Otieno’s bed, taking the time to listen carefully to his heart with a furrowed brow. Holding Mr. Otieno’s X-ray film against the dim light, he scribbled notes onto Mr. Otieno’s treatment sheet. Just as his pager beeped urgently, the doctor paused to say, “You have a weak heart, Mr. Otieno. This happens when your high blood pressure and diabetes aren’t well controlled. We’ll help you get better. We’ll run a couple of tests to guide your treatment.” With that, he vanished, leaving Mr. Otieno alone with his thoughts in the dimly lit ward.

Mr. Otieno’s experience with the hospital’s record-keeping was like being caught in an endless loop of misdirection, where each misplaced document added another layer to his frustration. His medical records, as elusive as a breeze on a still day, would vanish and reappear with the inconsistency of a fickle lover, leaving Mr. Otieno to wonder if he was the subject of some cruel joke. When finally referred to a larger hospital for more tests, his previous results, predictably, were nowhere to be found. This meant the joy of enduring each test all over again, as if there was something particularly exhilarating about being pricked and prodded repeatedly. The inefficiencies were so ingrained that Mr. Otieno began to suspect the system was devised by a committee more adept at creating chaos than providing care. The persistent hum of fluorescent lights overhead, punctuated by the occasional crash of a dropped tray, only added to the surreal atmosphere. As his palpitations worsened with each passing hour, and the looming threat of yet another insulin injection hung over him, Mr. Otieno’s mind drifted back to his farm—his worries about whether the rains would last long enough for the maize to be harvested never far from his thoughts.

A clattering food cart interrupted his reverie, but the sight of the bland, beige meal trays only deepened his unease. “They call this food?” grumbled the man in the next bed, poking at his tray.

“To think I’m on a salt-free diet,” Mr. Otieno replied with a weak smile.

After finally securing a diagnosis of heart failure—no small feat in itself—Mr. Otieno was handed a regimen of medications that could have filled a pharmacy’s inventory. But, as luck would have it, the hospital pharmacy had everything except what he needed. Instead of life-saving drugs, Mr. Otieno received a prescription and a polite suggestion to try his luck at a private pharmacy, where the prices soared as high as his blood pressure. It was like going to the supermarket for bread only to be directed to a boutique bakery, where the cost was double. Despite being enrolled in the NHIF, Mr. Otieno’s brief brush with financial relief was fleeting. Just as he thought he was out of the woods, he was informed that his NHIF card was inactive—quite a feat considering his consistent payments. Since he was confined to the hospital bed, Kamau had to trek to the NHIF head office on his behalf, his truck stalled by the roadside. The office, as reported by Kamau, was a hub of chaos that could rival any rush-hour traffic jam. After hours of waiting in line, filling out forms, and explaining the situation to a series of increasingly indifferent clerks, the card was finally reactivated.

But Mr. Otieno’s optimism was quickly dashed when he discovered that the NHIF didn’t cover everything—in fact, it seemed to cover exactly what he didn’t need at that moment. The hospital was out of the necessary drugs, and the equipment required for his tests was also missing in action. The NHIF coverage, it seemed, was as effective as a band-aid on a broken leg. As he reflected on the absurdity of it all, he couldn’t help but think that health insurance in Kenya was more like a lottery—with the odds decidedly not in his favor. As his family scrambled to gather the necessary funds, Mr. Otieno overheard that a WhatsApp group had been created to collect contributions for his treatment—an act of generosity that brought as much shame as it did relief. The dim, yellow glow from the bedside lamp did little to chase away the shadows that seemed to stretch longer with each passing hour.

Then there was the salt-free diet he had been prescribed; each bland bite was a bitter reminder of the small pleasures he had once taken for granted. He longed for the rich, red stew his wife used to prepare for him back on the farm—before his world had shrunk to this hospital bed. Outside, the distant rumble of thunder hinted at the approaching rains, a cruel reminder of the harvest he might miss. As he lay there, a lone crow perched on the windowsill caught his eye, its ominous caw slicing through the hospital’s din, sending a shiver down his spine. The bird’s jet-black feathers stood in stark contrast to the pale, sterile surroundings, a stark reminder of the dark cloud that loomed over his entire experience.

Adding to the bleakness, a recent strike had left the hospital even more short-staffed. The young boy sharing his bed — heads at opposite ends — mentioned doctors sleeping outside the Ministry of Health, waiting for posting letters. The boy, full of youthful bravado, asked if Mr. Otieno thought the finance bill would survive Parliament.

Despite himself, Mr. Otieno chuckled at the boy’s spirit. He couldn’t help but think of his family, imagining the strain his illness was causing them—financially, emotionally, in every possible way.

What was supposed to be a short visit stretched into weeks. The days blurred together, marked only by occasional visits from Catherine, who brought fresh clothes and a comforting smile, though worry was etched deeply on her face. Mr. Otieno watched as the woman who once saw him as a pillar of strength now had to watch him wither away. The sounds of city life outside the hospital felt distant, almost foreign. The grey sky cast a pall over everything, deepening the gloom that permeated the hospital. When he noticed the raven had moved closer, now perched on the windowsill, its gaze unnerved him.

One day, his son, the unemployed teacher, came to visit, bringing a newspaper and a book in an effort to lift his father’s spirits. The “Gen Z” sharing Mr. Otieno’s bed struck up a conversation. “What was it like on the streets? Did you get hit with tear gas?”

His son sighed deeply. The air had been thick with tear gas, choking the breath from his lungs as he pushed through the surging crowd. Shouts of anger and fear mingled with the sharp crack of batons against shields, the clatter of debris hurled by desperate hands, and the relentless thud of boots on pavement. It was a cacophony of violence and resistance—a scene seared into his memory, impossible to forget.

“It was tough,” he finally said, his voice low and heavy with emotion, “but we had to do it.”The boy’s eyes widened with admiration. “I want to do that one day, but my lungs need to be ready,” he said, his youthful confidence unmistakable.

Then came the governor’s visit, a spectacle so absurd it could have been plucked from a satirical novel. The hospital, which had resembled a war zone, suddenly underwent a miraculous transformation. The floors gleamed, the patients, including Mr. Otieno, were draped in crisp linens, and the air reeked of disinfectant—more than he had ever seen or smelled since his admission. Even the bedridden patient by the corner, who had been in the same position for days, was scrubbed clean.

A nurse, who had previously been too busy to notice him, appeared at his bedside, adjusting his sheets with a forced smile. “Everything looking good, Mr. Otieno?”

“For now,” he replied, raising an eyebrow at the sudden change in treatment.

For the first time, he laid eyes on the hospital managers, previously as elusive as a good blood pressure reading. As the governor and his entourage paraded through the ward, nodding as if they had personally overseen the recovery of every patient, Mr. Otieno’s head throbbed—not from his heart failure, but from the sheer absurdity of it all. The next day, as he read about the visit in the newspaper, he noted with mild amusement that the governor had promised to upgrade the hospital to match the state-of-the-art facility he had seen on a recent benchmarking trip to the U.S. The name of the place was to later escape him, but it had reminded him of sandwiches. In a corner of his mind that still basked in the faint light of irony, Mr. Otieno could almost picture the governor, clad in tattered hospital gowns, climbing into the creaking bed next to him.

Despite the surrounding chaos, Mr. Otieno found solace in small acts of kindness that pierced through the dysfunction. A pair of intern doctors, though visibly worn out, made it a point to check on him with a smile and a few comforting words. In another unexpected moment, a young visitor to the patient in the next bed took it upon himself to swat away the flies that occasionally found their way to Mr. Otieno’s porridge. The boy’s bright red shirt was a striking contrast against the drab, colourless surroundings—a burst of vibrancy in an otherwise bleak environment. While the gesture was small, it reminded Mr. Otieno that even in the most trying circumstances, tiny acts of care could make a profound difference. A janitor, noticing his discomfort, took the time to adjust his bed, and a padre on his rounds invited him to attend mass at the small chapel on the hospital grounds. However, the thought of dragging his urine bag across the hospital was far from appealing. The promise of a spiritual experience was overshadowed by the very real concern that the leak in his catheter, which had yet to be properly fixed, might choose to reveal itself during the sermon. Mr. Otieno politely declined, deciding it was wiser to keep his devotions within the safety of his bed, where any mishaps would be confined to a familiar space. As the padre left, Mr. Otieno noticed the raven again, now perched just outside the chapel window—a constant reminder of the shadows that lingered.

From the moment Mr. Otieno stepped into the hospital, it became glaringly evident that the system was running—or more accurately, stumbling—on autopilot. Mr. Otieno often wondered if there was a covert competition among hospital administrators to see who could reach the pinnacle of inefficiency. And through it all, his thoughts kept drifting back to his family and the farm. Would his sons manage without him? Was his wife coping, or was the stress of his illness taking its toll on her health as well?

At his lowest, when the weight of his illness and the hospital’s inefficiencies threatened to overwhelm him, Mr. Otieno’s old friend, Engineer Mutua, dropped by. He came bearing stories from their younger days and a much-needed dose of humour to lift his spirits. Between shared laughs about their youth, Engineer Mutua provided the latest update on their elusive pension funds. “Still missing in action, those files,” he said with a smirk. “It’s like they’ve fallen into some black hole in the system’s circuit—no trace, no output. But the good news is, we’re scheduled to go back in six months to see if they’ve managed to reboot the system and find them. Or maybe they’ll suggest we check behind the filing cabinet this time.”

The news wasn’t surprising—just another chapter in the epic saga of chasing their retirement money—but it drew a chuckle from Mr. Otieno. The absurdity of waiting for a pension felt almost as Kafkaesque as the hospital itself.

Gradually, the swelling in his feet improved, as did his breathing. The staff’s vigilance, despite their exhaustion, brought about a tentative improvement in his condition.

When the time came for him to be discharged—a process that took longer than most marriages—Catherine arrived to take him home. She carried his small wash basin and the belongings he had brought on the first day—items that now seemed heavier, both in weight and in the emotional toll they represented. As they left the hospital, Mr. Otieno felt a mix of relief and apprehension.

Kamau was waiting outside in his beaten old truck, smiling broadly. “Ready to go home?” he called out, his voice full of warmth.

“Let’s hope I don’t have to come back,” Mr. Otieno said to the nurse who handed him his discharge papers.

“Take care, Mr. Otieno. But you know where to find us,” she replied with a weak smile.

Back home, Mr. Otieno initially seemed to be on the mend. Over the next few days, he regained some strength, moving about his home with cautious optimism. Determined to return to his daily routines, he decided to inspect his farm. Walking the familiar rows, he took in the sight of the ripe maize, his thoughts focused on ensuring everything was in order. For a brief moment, life seemed to be returning to normal.

But this sense of normalcy was cruelly fleeting. As he finished his inspection, a sudden, severe pain tore through his chest. His vision blurred, and he felt lightheaded. Collapsing to the ground, his last conscious thought was of the farm and the harvest he might never see.

When he opened his eyes again, he was back in the hospital, staring up at the familiar ceiling of his old ward cubicle. The nightmare, it seemed, was just beginning.

Back on his farm, the raven perched on a maize stalk, its dark silhouette a harbinger of the trials yet to come.