Updating the Blog on Kenyan Time…3 weeks late

So yeah, I know, I haven’t posted a blog in about 3 weeks but I am back to give an update on what has been going on with my Kenyan life since my last update as well as what is going on as we wrap up our Heston Summer Experience this week.

So the last week of June I thought I was going to be going around Western Nyanza Province visiting hospitals visiting clinical officers and physicians that the MUMs program had trained in May before my arrival in Kenya. However, I thought wrong. The visitations being conducted were centered more on administrative meetings that did not pertain to what I was doing at KMET so that was a bit stressful because I had spent the week before getting excited to see some hospitals in Kenya and see a different side of healthcare than what I had been seeing in the clinic. However, the week was not wasted as I continued to perform ultrasounds in the main Corkran clinic and began more intense research on my project idea that the Heston grant money would be used for. So then after that week of initial disappointment I was told that the following week MUMs would be conducting a maternal ultrasound training for some clinic officers from South Sudan. With the violence and lack of stable economy and funds available, many of the medical school and clinic officer schools in South Sudan shut down and therefore many of these students actually came to Kisumu to try and continue their education.
So Monday July 2nd I came to the clinic and met up with Moses, the head clinical officer here at KMET and Liddy, the director of MUMs. We gathered 3 ultrasounds from the storeroom and hopped on a matatu to the New Nyanza Provincial General Hospital (AKA Russia AKA NNPGH) which is conveniently located right down the road from KMET.
SIDE NOTE AND DESCRIPTION OF NNPGH: The reason “Russia” is also a nickname of the provincial hospital and oddly enough how a majority of locals know it, is because the USSR erected it as a gift to Kenya many years ago. It is a large hospital even by western standards containing everything from in patient care, out-patient clinics, casualty (emergency) department, laboratory, radiology department, and other smaller departments like a plaster service (for casts). The structure is made of cement blocks and looks like something that would have been erected during the times around the Cold War. The wards are separated by men and women. The men’s ward had multiple men sometimes crammed into one tiny room whereas the women’s ward had multiple mothers and their children all crammed onto as many beds as possible. In the little bit I walked around the hospital I RARELY saw one bed inhabited by just one person…it was always one bed inhabited by many people. In the women’s ward the children often filled the beds and women were expected to lay on the floor or find a corner to sit in. If someone needs a healthcare service provided they generally go to local healthcare providers – such as KMET or a sub-district hospital. If these facilities can’t give the necessary care, maybe the patient needs more advanced medication or surgery or difficult birth is often seen, then the patient is referred to a District hospital. If the District hospital can’t provide proper care then the patient is referred at the Provincial hospital. The Provincial hospital in Kisumu has things like surgeries, X-ray, and even MRI. If something is too much for even a Provincial hospital and a sub-specialty surgery or care is needed (cardiothoracic, neurosurgery) then patients (if they can afford it) are referred to more modern hospitals in Nairobi. The primary care for the patient is given by relatives, completing tasks like feeding, giving water, changing linens and clothes, etc. The only care the medical staff gives is medical treatment and medications and supplies like bandages and ointments and IV fluids. If a patient finds they can no longer afford the care, then the care immediately stops. Once the patient gets enough money to pay for their care, medical treatment can resume. However, patients are not allowed to leave the hospital until they have enough money to pay for all the care they received up front at the hospital payment desk. So a patient who cannot pay for care is still stuck in the hospital, raking in more bills for renting out the bed in the ward while they try to get enough money to pay for the care that they previously ran out of money to pay for. So seeing all of that was definitely different than what I was used to seeing in the United States and learning about how hospitals, especially government run hospitals operate, was an eye opener.
Ok so now I am back from the rant about the Provincial hospital. So we arrived at the hospital and were directed to the Maternal and Child Health ward which is a large building located directly adjacent to the main hospital building. Once inside we sat for a little bit because, like most experiences I have had here, the people on the hospital side who were supposed to organize a room for us to use…had not organized a room for us to use. So after a little downtime they announced that they had prepared a room for us so I was elated…for like 30 seconds. I realized walking down to the room they had setup for us was located in the TB ward. And yeah it was nice to see stickers everywhere advocating for opening windows and avoiding enclosed spaces, but in a hospital designed by the USSR, large open windows and proper ventilation didn’t seem to be high on their priority list. Luckily we were towards the back of the ward in our own room. So we crammed 9 people into a room of comparable size to my freshman dorm room (Stine 208) and setup two ultrasound machines next to two strategically placed beds. Moses handed out these little booklets that the clinic officers were to use to record all the data collected during the examination such as presence of fetus, position, fetal heart rate, amniotic fluid index, placenta position, is there previa, etc. They had to search for the same things Moses had taught me too look for while doing ultrasounds during my first week at KMET. So we split up the 6 clinic officers into two groups and each group worked together on conducting and analyzing the ultrasounds. Moses monitored one group while I monitored the other. These students had previously had 10 months of classroom training that included maternal ultrasound logic but this was their first time actually doing a maternal ultrasound so the first day was a learning experience for them. They seemed to know pretty well what to look for and mainly had questions on specifics like proper orientation of the skull for measuring the biparietal diameter or if the waves produced when in” M mode” (a mode the ultrasound can be set to in order to measure fetal heart rate accurately) were defined enough to yield and accurate fetal heart rate. The next day I was pleased to find that we were switching rooms to be further away from the TB area. That was exciting. We moved to a much smaller room though so we still had 9 people in a tiny room but this time had only one machine and one examination table setup. By the end of the second day the students had really picked up on how to read ultrasounds and explain to the patient what was going on and what they were looking at on the screen. By this time I realized that I was a bit less useful (since Moses could watch over just one machine by himself) and very much just taking up space in the crowded room so I decided to spend the next two days at the Corkran clinic instead to do any ultrasounds that came in there. I did that all day Thursday and then Friday Emily, Ludi, and I went to visit the CDC building located adjacent NNPGH to hear from Andrea Davis who heads the Global HIV/AIDS program for the CDC here in Kenya. Andrea gave us a rundown of her job which included overseeing all operations and where they money given by the CDC for the program specifically goes to. She took us on a tour of the facility which was comprised of an administrative building, a health clinic, a laboratory, and a new research center being setup for an upcoming TB study being done in Kisumu.
That Friday we were supposed to go to Nairobi but the bus transport ended up not working out as planned. We went to the stage where the buses gather that are going to places like Nairobi to see if we could find a bus leaving at 7. We found a guy who said his bus was leaving at 7 for Nairobi but that didn’t happen. We forgot that just because they say they are leaving at 7 means they will really leave a few hours later than that because in Kenya, or at least Kisumu, transport won’t leave until the bus or matatu is completely packed full of people. We got on the bus around 6:30 and once 9:45 came around we decided it was no longer worth it or safe to make the 5-7 hour bumpy bus ride to Nairobi only to arrive at 3am when no hostels are open and no transport would be available. So we got off the bus 600Ksh poorer and retreated to the rooftop bar Duke of Breeze to hangout for a bit before heading home to sleep. The next day we decided to go hike some rock formations outside of Kisumu. I can’t spell the name of the place but if you picture a lot of big boulders oddly stacked on top of one another providing awesome views of the Kenyan landscape below…then there is no need to know what is was called. We hiked about 4 miles to get there because we jumped off our matatu early to explore other random rock formations we saw in the distance from the roadside. It was really fun to explore like that because I got to see a new rural side of the Kisumu area that I had not seen before so close to town. Mud huts sparsely placed all over the landscape surrounded by fields of maize, beans, and other vegetables.
The next week was a normal week of working in the clinic and doing more research for my grant proposal. Looking up specific BMUs in the area and what I wanted the grant money to be used for. Then that Friday morning we headed out on a 3 day safari to Masai Mara. It was awesome. Before even entering the park we saw zebras and giraffes. On our first game drive into the park we saw a cheetah feeding on an impala that it had just taken down which was really cool to see. We saw elephants, water buffalo, gazelle, impala, wildebeest, and so many other animals on our first drive. The next day we saw two male lions right as we entered the park and got up very close to them which was really cool to see. Then we decided to go through a giant mud puddle and our safari van almost tipped and felt like it went up on two wheels before slamming back down spraying mud everywhere and leaving us stuck. We waited about 10 minutes before another safari van came along and was able to tow us out but we then discovered we had a small leak in the tire. We decided we could last the whole day and change the tire later. We were wrong. About 20 minutes later the tired was much lower and we pulled over to change it but for some reason our driver decided we could still make it. We were wrong again. About 5 minutes after that our tire was completely flat and almost off the rim. It just so happened it went completely flat in the middle of a high grassy field down in a little valley so no other vans could really see us in the middle of nowhere. The ground was uneven so we spent about 2 hours total digging, ripping grass up, and maneuvering the ghetto car jack and a large rock to lift the car up so we could switch the tires out. After that experience we were on our way again. But after an hour or so maybe, we heard a weird noise from under the van. We got out and discovered that our fuel tank had partially fallen off the vehicle. So that was exciting. The tank was then tied back on using some rope and random copper wires lying around the vehicle to hold until we made it back to camp. Our driver, Rafael, felt bad that our day was a bust so we got up very early the next morning and headed out to the Mara River. We got to visit the Tanzania-Kenya border and jump back and forth from Tanzania to Kenya. I don’t think we were supposed to do that and I am unaware if admitting that is something that I could be prosecuted for later on but it’s worth it. So then we went to the Mara River and saw the areas where the wildebeest cross during their annual migration which was just starting during the time we were there. We saw lots of hippos and a few crocodiles.

This past week I really kicked into gear putting the finishing touches on my grant proposal and moving into action. My goal with the mini-grant proposal was to figure out a way to fulfill KMETs dream of providing a “floating health clinic” to those populations living on the Kenyan shores and islands of Lake Victoria. To do this, I did research on beach management units (BMUs) that populate the Kenyan shores and islands on Lake Victoria. Beach management units are organizations of fisherman that are official bodies recognized by the Kenyan government and Ministry of Fisheries. In order to be considered an official BMU, these communities must be comprised of at least 30 boats used for fishing by the community and have a solid infrastructure being composed of a BMU chairperson, an executive committee, and various sub-committees as well. I also discovered that the BMUs in Kenya are considered MARPs or most-at-risk populations for HIV/AIDS and other diseases like TB and malaria that often lead to the high mortality rates in these areas. I realized I had hit a gold mine for my project; a BMU was exactly what I needed to jump start this floating clinic. Utilizing a BMU in the area was reassuring because the BMUs already had to have a legitimate infrastructure in order to be considered an official BMU by the Kenyan government. Therefore, the chances of this pilot program succeeding and being able to be used in other BMUs in Kenya on Lake Victoria drastically increased. The goal of my project is to provide health services and education to a most-at-risk population that is an integral part of the surrounding Kisumu life. These populations are the ones that get the fish and are able to provide it to those in the area and all throughout Nyanza Province and Kenya and so I wanted to provide them with an opportunity to better their lives so that they could continue providing the important goods and services that Kisumu and Kenya as a whole have relied on them to do for so long. So my project goal is to find a way for KMET to obtain a boat. It just so happens that a staff member at KMET heard of old Kenyan government boats (previously used to carry healthcare supplies) that had been abandoned on the shores of Lake Victoria. This past week we have been trying to set up meetings with someone who has rights over one of the boats to see if they would donate the vessel to KMET so that KMET could repair it and utilize it as the centerpiece for their floating health clinic. Once obtaining a boat my goal is to use the $200 grant to hire someone from the pilot program BMU to refurbish the boat. The sustainability part comes from what the money would used to refurbish the boat would do. After refurbishing the boat my program is setup to find someone in the BMU that would oversee the boat and serve as a liaison between KMET health outreach teams and the Dunga BMU community. The boat would only be used by KMET during health outreaches and all other times the community would be able to utilize the boat for fishing – maybe for someone whose boat is being repaired or someone who has no boat – which would provide a job for someone to now earn a living themselves to provide for their family and to invest in their community. When someone would use the boat, they would be “renting” it from the community and would pay a small fee for use of the boat from whatever fish sales they have. Whatever is left would be their own profit. The funds raised by the rental fee could then be used to pay for boat upkeep and maintenance. This way once the initial refurbishing of the boat is done it will allow for the community to have a new fishing vessel which will create more jobs and allow more profit to come into the community. Simultaneously, having the boat there would allow for KMET to be able to come once a month or maybe more if there is demand and provide health outreach services and education to islands and beaches of the Dunga BMU. My timeline is for 6 months because I decided that 6 health outreaches would give KMET a good indicator if they were having an impact on community health in that area and if the floating clinic is as effective as we hope it will be. I see that I mentioned Dunga BMU in the rant above and you are probably asking “what the hell is a Dunga BMU.” I wrote my grant proposal and planned to find a reliable BMU in the area that could serve as the pilot program site for the floating health clinic. Luckily, Agnes was able to find some contacts who led us to a place called Dunga BMU which is located outside of town, right on the lake. This BMU was voted the 2nd best BMU in all of Kisumu last year (they have a trophy just like we used to get after baseball season to prove it, they showed me). Last Thursday, July 19 Agnes, another volunteer Ann, and I went to visit Dunga and meet with the executive committee. We told them what KMET was about and what my vision was and they were very excited. They had tons of ideas on how to mobilize their community like offering boat races on the lake during an outreach and even offered us an old abandoned room that used to house a Red Cross office for use during health outreach programs. They even said if we wanted KMET could setup a permanent health clinic there and that they had already purchased some land that would serve as a health clinic site if they ever found a donor or NGO that wanted to help make that happen. Although it is way too soon to decide all of that it was really great to hear how excited they were and how receptive they said the community would be to these outreaches. HIV/AIDS and other diseases like TB and malaria are known to have high prevalence in this area and they seemed very willing to work with us so that we could help them, help themselves.

For now we are just waiting to hear back from the board about what specific services they want offered in their community and when we could setup a meeting where department heads of KMET could attend a Dunga BMU community meeting to explain what they do and how they could empower the Dunga community and answer any questions or concerns. With only one week left…actually less than that now…there is still lots of work to do but it is nice to be so busy and working with so many enthusiastic people. At first I wasn’t sure if my project would really amount to anything but with the cooperation of everyone involved thus far it really made me think that this could blow up to be the amazing innovation that myself and KMET thought it could be. We will see how these last 3 days go and I can’t wait for updates on the program once I am finally home and KMET starts doing outreaches in Dunga.

So yeah, sorry again I missed out on these last few weeks but it was nice to be busy and experiencing Kenya. None of this would have ever happened if it wasn’t for the Heston Experience program so I am very happy and grateful that I had the opportunity to be a part of this once-in-a-lifetime experience.

Note: The pictures below are from our safari and our day excursion to the rock formations that we hiked around.

Masai_mara_035_-_copyMasai_mara_099Masai_mara_117Kenya_3_045Kenya_3_075Kenya_3_074

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