We were reminded today that to say most international residents of Nairobi have epidurals is unfair. Which made us realize how little we really shared about the hospital system of Nairobi. This gets confusing, but I’ll do my best.
First – there really is no set price for hospitals. Public hospitals are subsidized so much more standard in price (I think, that is the impression I got), but private hospitals set a fee based on the level of service. So to be in a private room in a hospital (for example Aga Kahn where we visited) is significantly more expensive than to be in a semi-private room. Additionally, Aga Kahn has a different cost for a maternity stay than Nairobi hospital (another private hospital) even when they are offering the exact same service.
Second – there really is no set price for physicians. The range of fee for a private physician is wide, one midwife guessed the costs could be anywhere from $30,000 Ksh to $100,000 Ksh (roughly US $300 – $1,000). I get the impression you are paying for prestige, which is not necessarily the same as skill or quality.
Third – there really is no set price for cesarean surgery. As one midwife estimated, the hospital fees alone can range from $20,000 Ksh at the “cheap” hospital to $120,000 Ksh at the top hospital.
Fourth – Nairobi is huge, with very busy roads and many hospitals. We are guessing the “nicer” hospitals are in the “nicer” regions of Nairobi. Some women have the funds to travel to differing districts for care. But other women are limited to what is in their region, not only in hospital but also in physician. It looks like the antenatal clinics are associated with a specific hospital, rather than one physician having admitting privileges at several hospitals as is done in the US.
So you put this all together and what you see in midwifery practice is that what is “normal” of the patients at one hospital is not the “normal” at another hospital. This made for a very interesting training as we tried to gauge what maternity care in Nairobi was like. Apparently, there is no consistency. So, while a midwife at one hospital may see all her international patients receiving epidurals, that may have more to do with the opinions of the referring physician at that hospital than the choices of the women.