Day 12 in Kenya: Final Day at Fluorspar, Head Home

It’s our final day at Fluorspar and we begin as usual with rounds.  Two mothers are in the pediatric ward with their children.  Luckily both children seem to be stable and the clinic staff recommended a treatment strategy approved by Dr. Michael.  They have decided to withhold antibiotics as both cases appear to be viral and not bacterial.  Dr. Michael views this as progress as he has been trying to educate the staff on not over prescribing antibiotics so as not to promote antibiotic resistance. 

The mother of one of the sick children. 

We also saw another woman we’ve been following. She remained in the clinic for the last two nights.  She came to the clinic with a chronic cough that began one year ago.  She is HIV+ and Dr. Michael thought the cough was due to an infection she acquired due to her being off of her meds.  We had her CD4 count done again and in fact it is quite low, which means her HIV condition is under control.  She has stabilized and been put on oral antibiotics.   For now, she is sent home but will come back for follow-up and will be tracked via the Complex Case Care program. 

Dr. Michael advising staff on the treatment strategy for the woman who is HIV positive. 

A chicken walks in and out of your hospital room.

Dr. Michael demonstrates one final neo-natal exam in the perfectly healthy baby boy. 

We then had our wrap-up meeting.  Everyone gave a summary of their experience and observations of the week.  It was all really positive and full of insights on what our next steps will be.  We have accomplished quite a bit but we have so far to go.   

The good news is we are enjoying the process and I think in our small way making a difference with these two clinics.  And as I told the group, my overall sentiment is with every trip it just gets better and better.  More asking questions by the staff, more learning, more training and more services provided to their community.

This is sustainable change. 

When we leave, the clinic staff is able to provide a level of care that is higher than before we arrived.  That’s the goal.  But ahh…the elusive finish line.  When are we truly “finished” and go into maintenance mode?   Because the bigger picture would be to take this concept to more clinics in order to broaden the reach.

For now, we have our work cut out for us with these two clinics and we still have so much to learn.   But I’m more energized than ever that we are on to something.  A chronic disease management program as well as specialty services and training to address more urgent needs of the community.  So much to do!

So, our next trip is potentially planned for the last week of January and the first week of February.  We are contemplating taking a cardiologist and/or dermatologist with us next time.  And of course will continue with chronic disease and optometry.  So, until then, thank you so much for reading and supporting this important initiative.  We will continue to post on Instagramand Facebook as we have so many pictures and it would be a shame not to share them! 

The whole team (minus Dr. James). 

- Stacy

Day 11: Heartbreak & Celebration ... Our Last Full Day

Dr. Michael having an early run with the house dog Lucy. 

Our fifth day at Fluorspar and our last full day. We’re headed to the only outreach we’ll do on this particular trip.  We will be going to a new location for us and for the Fluorspar clinic staff. It’s up high in the mountains about a 30-minute drive from the clinic. We arrive to a group of young children and their teacher.   

The welcoming committee

The location of the outreach is in a church. 

The outreach will be held inside of the community church that also serves as the nursery school. The teacher gave us a tour of the outside area around the church.  First we see 2 pots boiling over a wood fire.

The teacher of the nursery school explains the cooking pots. One for rice and the other for beans. 

One pot was full of water that will be used to cook rice.  The other was full of boiling water and red beans.  Combining the beans and rice is a typical dish here.

Pot full of beans. 

I’m wondering why there is no maize in the pot in order to make their traditional dish, githeri.  I think I may have my answer when I am shown the storage area for keeping the maize and I see that it is empty. 

Storage space for maize. The structure is made of mud. 

It comes to my mind the lack of rains in August and that the price of food increases in the dry season, even more so when the rainy season never came.  For this population the meal will now consist only of beans and rice with no maize or greens.  Although they may not go hungry they are lacking the important nutrients that improve their immune systems and overall health.

Inside the church

The Fluorspar staff begin to setup for Dr. Michael and Rahema who will see children and adults and Dr. Sue who will conduct cervical cancer screening clinic alongside Samuel.  We will divide and conquer today with Dr. Sidiqa and Alex visiting the Fluorspar school doing vision screening and nutritional assessments and education.

Faith, the community health worker who we met earlier in the week, is here doing chronic disease screening.  All of the adults are given a sheet of paper with their blood pressure, age, whether they are diabetic, a smoker or drink alcohol.  We are thrilled to have her here screening patients and collecting data which continues to be compiled back on the computer at the clinic.

During this process, we were presented with a man complaining about a ulcer on the bottom of his foot.  Despite the fact he’s able to walk he is not able to feel his legs from the knee and below.  He is presenting as an end-stage diabetic who will likely need to have his foot amputated at some point.  He’s been instructed to go to the Fluorspar clinic to have a proper diagnosis and receive medication.  He will be educated on managing his diabetes both with medication and nutritional strategies.

We give him antibiotic to treat the foot and advise him that his infected foot is likely due to diabetes and that it’s essential that he comes to the clinic for treatment.  He promises to come and we pray he does to minimize any further preventable damage.

A son arrives carrying his father

One of the most heart-wrenching moments was when a son arrived carrying his father. The father suffered the effects of leprosy from years ago.  His foot had been amputated and was replaced with a wood peg.  And his toes on his other foot were also removed.  Although the leprosy had stabilized, he was now suspected of having tuberculosis.  He will need to come to the clinic to have a confirming diagnosis and begin his treatment.  His son assures us that he will get him there. 

The sight of him scooping up his father (who was arguably larger than the son), thanking us with such gratitude and then leaving with his father in his arms will simply never leave me.

Some of Dr. Michael's patients. 

Dr. Michael also saw 2 young girls, who are pictured above. The one on the left is 9 years (in yellow) and the one on the right is 5 years old (standing).  After taking a history and conducting a clinical examination Dr. Michael is suspecting syphillus.  Her father will bring her into the clinic to be tested and begin treatment.  Although it will not fix the damage that has been already done she will now begin to develop at a more normal rate.

Outside of the clinic in the church, you never know what you will find around the corner ... like the obstacles I encountered on the way to the outhouse. 

On my way to the outhouse, the white building. Needed to literally excuse myself around the chicken and the cow as they had no intention of moving. 

Dermatologists in high demand in rural community

We also notice several skin conditions today.  Our plan is to bring a dermatologist with us on the next trip.  The clinic claims that skin diseases are the second most common ailment, just behind upper respiratory tract infections.  We see a myriad of conditions today and I am making a list and taking photos so that I can share with our dermatologists.  Eastern Africa has many skin conditions specific to its region and we want to make sure the dermatologist will be familiar with the unique issues.  

Cases included one that had begun to scab and showed signs of squamous cell carcinoma; one child had symptoms of ringworm; and a young girl had an advanced-stage fungal infection on her head.  The conditions are not easy to look at and are not what we are used to seeing back home.  But these are the very real issues that many rural communities in Africa deal with every day.  It is our goal to provide education to the staff so that they are better prepared to care for their community.

Nutrition Q & A with Dietitian Alex

Alex had an opportunity to speak to the children at Fluorspar primary school.  She gave them a nutritional talk and answered all of their questions.  She also had a chance to speak with the chef who prepares the food for the students many of whom are boarders.

The menu includes very typical dishes of the area including githeri, ugali and a treat on Sunday mornings, mandazi.  We notice that vegetables are listed every day which is not common in the public school system.  Fluorspar does a far better job than most of the schools with a more balanced and healthy diet.  Still, Alex will be making some recommendations to make it even better.  Likely her first suggestion will be to cut down on sugar.  The traditional tea that is served has a lot of sugar in it.  It’s absolutely delicious!  Having tea is one of my favourite parts of being in Kenya.  But my team reminds me that having 2 or 3 cups of it likely puts me over my daily allowance of sugar.  There is that much sugar in it!  So the recommendation will be to reduce the sugar and to reset the taste buds.  Apparently it takes 3 weeks to readjust our palettes so that we are satisfied with less sugar or salt, etc.   So this will be first on our list.  Perhaps it will be easier to suggest taking something away vs adding to the overall cost of the food program. 

Vision Screening at Schools

Dr. Sidiqa began vision screening at the schools.  She was working with Jemimah and Noah on how to do the screening properly so that they will continue when she is gone.  The goal will be to screen all of the children by the time we return by February and then move on to other schools in the community.  Any children requiring glasses will come to the clinic to be examined by the auto-refractor and prescribed and provided glasses.

Staff Party

We all headed back to the guest house to prepare for dinner as we were having the clinic staff over for a little party.  We had so much fun speaking with them on a more personal level, learning about their families, their culture, and, of course, their music!  I’ve already downloaded three albums which are amazing.  It’s a little part of Kenya that I can carry with me wherever I go and think back to this amazing group of people who care so much for their community.

Tomorrow is our last day.  Hard to believe it has finally come! Check back tomorrow for the last post!

- Stacy

Day 10: “I can see a mzungu”

We’ve had 2 intense days of cervical cancer screening, cataract surgeries and classroom training at the clinic.  The Fluorspar staff and the Naweza team are definitely feeling the effects of the stress of trying to fit as much into our short time together.  But still, we have an agenda and we persevered.

The female cataract patients sit together.

We began with removing the eye patches from the cataract patients who had their surgery yesterday.  The process is to remove the patch, then clean the eye area with warm water and then place steroid/antibiotic drops into the eye.  They then ask if they can see.  I was standing in front of one patient when they asked him, “What can you see?” and he responded, “I can see a mzungu.”  He was referring to me as mzungu actually means white person in swahili.  It was quite funny and everyone laughed.  And of course we were all most happy that he could see!

The cataract patient who said he could see a mzungu when his patch was removed.

It was an incredible experience to see the expressions on their faces when the patches were removed and they could see.  We pray that the patients follow the post op care that has been explained to them and are cautiously optimistic that the surgeries will be judged a success at the critical 6 week mark. The patients are transported back to their communities in the backs of trucks and told to come back in 2 weeks for a post-op followup to ensure proper healing.

Cataract patients who are being transported home after the surgery and overnight stay to ensure proper post op care.

The cataract team together with some of the cataract patients. 

Dr. Sue provided didactic training on obstetric emergencies and common gynecological disorders.  She provided several techniques on how to maneuver a baby who is difficult to deliver and the staff was highly engaged.   With 12 deliveries last month alone one can understand their interest.  As well, recently, the clinic suffered the death of a baby at birth due to the cord being wrapped around the baby’s neck.  It was devastating for the family as well as the clinic and surrounding community.  Our goal is to provide training and education in order to minimize these occurrences. 

We then had to say goodbye to Dr. James who will be going on to a John’s Hopkins Medicine International Partners Forum 2015 in Brazil where he will present an abstract on our innovative 2 way mHealth sms application to screen community members for chronic disease.   We will very much miss him and his sense of humour which has kept us laughing since our arrival in Nairobi!

Our last moments with Dr. James .

The end of a long day ...

That’s all for now.  Tomorrow, outreach!

Thanks for reading.

- Stac

Day 9: Third day at Fluorspar Started with Post-Op Check-Ups for Cataract Patients

Another busy day planned with the Fluorspar team.  Most important on the morning agenda is post-op on the cataract patients who were operated on yesterday.  They’ve all stayed the night at the clinic and a nearby facility to ensure next day follow-up.  In fact, the surgery itself is only the half the journey.  The patients must be measured the day after, at 2 weeks and at 6 weeks for visual acuity.  Only at 6 weeks when we measure each patient’s visual acuity will we know for sure if the surgeries have been an overall success.

Cataract surgery patients lined up waiting to have their post-op check-up. 

The patients were lined up outside, given a seat and some water while they are educated on proper post-op care.  A demonstration is done on one of the patients to ensure they know how to put in the drops correctly and proper hygiene.  It can’t be stressed enough the importance of the post-op protocol and the health workers take their time explaining and answering questions from the patients.

Wilson, the doctor assistant, gives a lesson to the patients on self-care and post-op care. 

One of the patients then requested to lead the group in prayer. It is a very powerful and most touching moment watching these humble people pray for their blessings.  I find myself praying that they follow their instructions for following the post-op procedure so that they regain and maintain their improved eyesight.

A cataract patient leads a prayer giving thanks for all of their blessings. 

Dr. Sidiqa then measures their vision and will compare it to what it was prior to the procedure.  She will also compare what it is at 2 weeks and 6 weeks.  Only then will we know if this initiative is a success.  If it does prove to be successful, then we will continue the program in a community we visit often on outreach and know that the people have a prevalence of cataracts.  They live in the mountains are unable to come to the clinic.  So the plan would be to do the screening in their community and then do the actual procedure at the clinic and provide the transportation to ensure safe travel.

Dr. Sidiqa conducting a post-op vision check on a patient. This man has done quite well with much improved eye sight. 

After the post-op examination of the patients who had the procedure yesterday, the surgeons began the second day of cataract surgeries.  Another 11 are planned for today.  Those patients will sleep here and will be monitored and re-examined tomorrow to again, make sure all is okay. 

Cervical Cancer Screening

Dr. Sue worked again with Rahema and Samuel in the cervical cancer screening room.  They saw 26 patients today with one minor abnormality.  They used the cryotherapy unit and the lesion was successfully removed.  The plan is for Rahema and Samuel to take a course at a government clinic nearby and receive proper training on the cryo unit. 

Women lined up for cervical cancer screening. 

As in the case of Lewa, we’ll bring a new donated cryotherapy unit for them on our next trip so that they will continue these outreaches and be able to treat the minor lesions at the time of diagnosis.

Dr. Sue teaching a class on cervical cancer screening. 

She also gives a talk to the cervical cancer team on how to identify cervical lesions that require treatment.  She shows them a series of slides of different cervixes and they must tell her whether it’s normal, requires cryo, or must be referred for more advanced treatment.  Many of the examples look like they may be abnormal but in fact do not require treatment.  She stresses that it is just as important to know when not to cryo as it carries its own risks.

Helping Babies Breathe

Dr. Michael did his course on Helping Babies Breathe.   Everyone is asked to be at the lecture as the clinic does about 10 deliveries a month and any one of the staff could be the nurse or clinical officer on duty.  He starts with a pre-test to get a base level of knowledge. 

A fun moment with clinical officers Julius and Noah who are holding the baby prop for the Helping Babies Breathe course. 

The Fluorspar staff taking a pre-test for the Helping Babies Breathe course taught by Dr. Michael.

Dr. Michael teaching a course on Helping Babies Breathe to the Fluorspar staff. 

He then begins the course with a bit of theory and then moves on to the practical.  He uses two dolls as props and is able to demonstrate the proper procedure for resuscitation.  During the demonstration he discovers that the oxygen mask that the clinic has in stock will be too small for most babies.  They’ve been advised to buy a smaller one so that it provides an adequate suction on the baby’s face.

Lung Disease

Dr. James did a talk on Chronic Obstructive Pulmonary Disease (COPD), a progressive lung disease that makes it difficult to breathe. 

Dr. James teaching a class on COPD, a chronic lung disease that makes it difficult to breathe. 

In Kenya, the leading causer of COPD is smoke.  The smoke may come from cigarettes, firewood from cooking in the house with an open fire, industries and burning of charcoal.  It is a very big issue here and the staff has requested more training on how to identify it, differentiate between asthma and treatment strategies.

The Gift of Sight
And that’s the end of another day here at Fluorspar.  It was not only full of learning but also a lot of emotion.  The cataract surgeries have been an incredible experience for everyone at the clinic.  To see someone regain their eyesight is simply amazing and we are very fortunate to be a part of it.

Tomorrow we will be conducting post-op on the cataract patients who were operated on today as well as seeing patients who are part of Naweza’s Complex Case Care program.  These cases are the most complicated ones that we discuss on our bi-weekly call with the clinics and we’ve asked Fluorspar if they can bring those patients in to the clinic  to be seen by the doctors.

That’s all for now…and thanks for reading!

- Stacy

Day 7 & 8: Cross-Discipline Health Agenda for Fluorspar Community

After a quick flight, we have arrived at Fluorspar, our other sister clinic in Kenya. 

We have a packed agenda for the week including:

• cataract surgeries
• cervical cancer screening
• community health worker evaluation
• chronic disease program review
• didactic training on requested topics
• nutrition counseling
• women’s health
• eye health
• outreach
• peadiatrics

Rahema, a clinical officer at the clinic, during our first day of rounds. 

Yesterday we arrived at the clinic to a warm welcome from the staff.  It was so good to see them again and hear all that has been happening in their community.  We quickly reviewed the itinerary for the week and Alex gave an overview of nutrition and how she planned to support the doctors throughout the next few days.  We then immediately saw patients for the next hour that provided excellent teaching points for the clinicians.  Nothing like getting right back in there and wasting no time.

The Fluorspar clinic team presenting a case to Naweza doctors. 

Patient Rounds
So today we began with rounds as always at Fluorspar.  Different from Lewa, Fluorspar is an in-patient clinic and always seems to have patients who have stayed the night.  Since yesterday, we’ve seen several patients including type 1 and 2 diabetics, a pregnant woman with abdominal cramps, a woman who just delivered a healthy baby as well as a 9-day old baby with neo-natal sepsis.  Neo-natal sepsis is a life threatening infection in a baby occurring within the first month of life.

This baby is 9 days old and suffering from neo-natal sepsis. Dr. Michael is providing training on prevention, diagnosis and treatment for this life threatening condition. 

The mother was holding vigil over her baby when we came in and seemed to be intently listening to everything Dr. Michael was saying in hopes that he could help.  Although the baby seems to be improving with the intravenous antibiotic, there’s a risk of delayed development, seizure disorder and hearing loss.

Cataract Surgeries

Dr. Sidiqa, Jemimah and Noah discussing how the cataract surgeries will work tomorrow. It was also an opportunity to review how the weekly vision clinic is going. 

The optometry team had a debrief yesterday in anticipation for the cataract surgeries scheduled for today and tomorrow. We’ve sponsored 2 surgeons and 2 assistants to do the screening and the actual cataract surgeries.  Last week they screened 327 people and found 50 who are eligible for the procedure.  Today they did 30 surgeries and tomorrow another 20.  It’s the first time cataract surgeries have been done at Fluorspar and the staff seems very excited. 

Cataract surgeries being conducted at the Fluorspar Clinic. They will perform 40 surgeries in 2 days. 

I had the opportunity to observe an actual surgery today.  Really incredible.  And remarkable they are able to do this here.  The surgeons are working side by side while the assistants are prepping the patients in an adjacent room.  They are extremely professional and super cool under pressure.  The staff at the clinic are assisting with the surgeries which is an amazing opportunity for them.  They will also learn about post-op follow-up which is crucial to the success of the surgery.

The cataract patients lined up waiting to be prepped for the procedure. 

Cervical Cancer Screenings  

Dr. Sue is working with Samuel and Rahema doing cervical cancer screening.  They’ve seen 21 women and luckily all had normal results.  Usually you would expect to see about 10% of abnormalities but this group is luckily healthy. 

Two members of the Fluorspar staff prepare supplies for the cervical cancer screening. 

It actually proved to be a good opportunity to discuss how certain “normals” can look abnormal and knowing how to distinguish between the two so that you don’t treat the lesion unnecessarily.

Nutrition Awareness
Alex had an opportunity to speak with several patients about their diets and give her recommendations.  She also met with the chef of the clinic to better understand the food that is served at the clinic.  She asked what his recipes were but he said that he doesn’t follow any.  So she has decided to work alongside him tomorrow so that she can see how and what he prepares.

Helen and Faith, two of the three community health workers we've hired at Fluorspar Clinic in order to support the chronic disease program. 

Chronic Disease Program
e also had the opportunity to meet with 2 of the 3 community health workers we’ve hired for the chronic disease program.  Helen was the original hire who did an incredible job organizing a strategy on how to collect data on all of the people in her community who are over 40.  She has almost collected data on 450 people, which represents about 90% of her community. 

Helen's notes on who to follow up with for the chronic disease program. 

Helen's work went way beyond our expectations.  So we’ve decided to continue the relationship and she will now train all of the new health workers.  We’ve already had her train Faith who has collected data on about 200 people.  And we just hired a male health worker named Alan.  Helen will train him as well. 

Helen and Faith share their record books on their chronic disease patients with Dr. James and Dr. Michael. 

The cost of a health worker is about 10,000 ksh/month or about $100 USD.  If you get a good one, like Helen, they are worth their weight in gold.    Her next step after she has collected the data is to follow-up with all of the patients who scored non-green.  The ultimate goal is to find those people at risk of chronic disease and provide the treatment to them before a cardiac event occurs.  Again, these are patients who are asymptomatic and have no idea they are at an elevated risk.

Highly Productive First Day

It was a highly productive first day and tomorrow will be much of the same with more cataract surgeries and cervical cancer screening.  The patients who had their surgeries today are actually sleeping at the clinic to be checked first thing in the morning.  It will be very exciting taking their patches off tomorrow and seeing their reactions when they are hopefully able to see again!

That’s all for now….thanks for reading!

- Stacy

Day 5: Over 350 patients seen and treated

This will be our fourth full day at Lewa and today we’re on to our second outreach clinic. Given our past three days, we were all anticipating a busy day. This is an underserved community and outreach is rarely done here.  This is in fact Lewa’s first time at this location so we are not sure what to expect.

Wildlife grazing as we make our way to the second outreach at Lewa.

Cecilia, the county nurse who is helping with cervical cancer screening, gave a talk to the community before we begin the outreach.  She informs them that it will be like a hospital with many services available and they are allowed to use all of them.

Cecilia (at centre) giving a talk to the community prior to the start of the outreach. She is informing them of who we are and what services will be available to them. You can see Dr. Aw's back in the right foreground.

These community members will have access to:

• Cervical Cancer Screening

And services, support and care in the following areas:

• Optometry
• OB/GYN
• Chronic Disease
• Peadiatrics
• Global infectious diseases including HIV and Malaria
• Nutrition

A meeting of the Medcan Naweza staff to discuss crowd control. There will be over 300 visits today and managing the queues will be a logistical challenge.
 

The first part of the outreach involves a meeting with everyone to determine how we will manage the crowd.  By 9 a.m. there were more than one hundred people in line with more arriving every minute.  Each of these people will likely see at least 2 doctors and quite probably more.  It will be a logistical challenge, but we are also blown away about how many lives we will help with our pop-up clinic.

Security & Order at the Outreach

Rose, our "bouncer" for the day. She has made a list of names in the order of each patient's arrival in order to manage the anticipated chaos.

We’ve got a tiny Kenyan named Rose who has been designated our "bouncer".  Despite her size she is completely in control.  Our only issues arise when she occasionally mysteriously disappears and the hall fills with people.  It’s a constant battle to manage the crowd.  But you can’t blame them.  Having medical care, especially western doctors with modern equipment is a rare occurrence and they don’t want to miss the opportunity.

Cervical cancer screenings, Obstetrics and Gynecology

The cervical cancer screening team preparing for the day.

Dr. Sue and the cervical cancer team performed 50 screenings with 1 abnormal result.  Luckily we have the cryotherapy unit and can remove the lesion immediately.  Faith is working with the county nurse Cecelina who is kind enough to help train the Lewa staff under the supervision of Dr. Sue.  We are hopeful that the relationship between Lewa and Cecelina will develop so that Lewa will continue the cervical cancer screening outreaches when we leave.  Naweza has agreed to sponsor the cost as long as Lewa supplies the labour.  They are quite happy with this deal, as are we. 

With the HPV vaccination too expensive at $300 per person, the next best option is to conduct screening on as many people as possible in order to have early detection.  The fact that we have the cryo unit and can remove the lesions immediately has the added insurance that the patient will have a positive outcome.

Dr. Michael, Dr. Sue and Dr. James consulting with each other and the Lewa staff to diagnose a patient.

Dr. Sue had an interesting case where a woman presented with extremely swollen legs and feet.  It was a fantastic moment where she, Dr. Michael and Dr. Aw consulted with each other alongside the Lewa staff to make a diagnosis of heart failure.  This transaction was a great example for the staff to see how consulting with each other is a great resource.  It is in fact a sign of strength to know when to seek the advice of others and to use all of the resources that you have available.  

Pediatrics

A little patient of Dr. Michael's. What an angelic little face.

Dr. Michael is working with John in the pediatrics station.  They have many cases and therefore many learning opportunities.  With every case Dr. Michael challenges John with questions on how he would treat the patient.  It’s basically using real patients and scenarios to create protocols for diagnosis and treatment out in the field.  We have found this to be an enormously effective teaching strategy.

Chronic Disease

A man who is suffering from COPD, a chronic lung disease, which causes a wasting away of the body.  Very hard to see.

Dr. James and Geoffrey are busy seeing chronic disease patients.  This one particular patient is suspected of having COPD, chronic lung disease.  One of the signs of COPD is a wasting away of the body due to the increased metabolism from the chronic inflammation.

Nutrition

Alex had conducted a talk on healthy eating with about 30 people in the community.  The group was full of questions from how to reduce uric acid, how much sugar, salt and fat they should eat.  Her overall message is to eat less starch and more vegetables and protein.  The common food here is either ugali (ground maize made into a paste) or githeri (maize with beans).

She found that the meals are frequently comprised of too much starch, made with either potatoes or rice.  As well,  the people suffer from acid reflux as they usually eat 1 or 2 large meals and simply eat too much too fast.  She is providing education on trying to eat less starch, more vegetables and smaller portions.

Optometry and Vision Care

Dr. Sidiqa is working with Ezekiel to conduct eye examinations.  She begins with a vision clinic for the school children.  Any child who is suspected of requiring glasses is referred to the clinic where they will be examined with the auto-refractor in order to get an exact prescription.  We’ve identified a local supplier who will provide the glasses at affordable prices.  Naweza will fund the glasses that are as a result of this outreach.

Outreach Outcomes

Over 350 visits by the patients, fully utilizing all of the services available to them.  It’s our last full day at Lewa and we definitely feel like it was the grande finale!  The turnout was fantastic and we and the Lewa staff feel like we gave it our all to help this lovely community.

Tomorrow we depart Lewa and head to Fluorspar.  It will be a busy day of saying goodbye to the Lewa team, then an hour flight to Fluorspar.  We are super excited to see the Fluorspar team again and look forward to a productive week together.

That’s all for now.  Thanks for reading!

- Stacy

(P.S. No snake or bat updates, thankfully!)

Day 4: Medcan Naweza Draws a Crowd

Today was another full day. The community has heard that doctors from the West are in town and so the crowd has grown. The clinic was also full of patients we had referred from the outreach clinic the day before, including children to be seen by Dr. Sidiqa for vision examinations and chronic disease. 

Dr. Sue began the didactic training with a talk on urinary tract infections.  She spoke about the protocols for prevention, diagnosis and treatment that the staff can follow.  She specifically spoke about the importance of treating pregnant women due to the fact they run the risk of pre-term labour if untreated.  Also, a very common natural treatment for UTIs is cranberry juice but cranberry juice is not available here. There is no natural alternative available here, another reminder how this is a challenging setting where options easily accessed in the west are simply not options here. 

Dr. Sue giving a talk on Urinary Tract Infections, one of the topics requested by the Lewa staff. 

Dr. Sue also informed the team that new findings recommend that the length of treatment on antibiotic is now 3 days instead of 7, which will help reduce unnecessary usage,expenditure on expensive antibiotics and the spread of antibiotic resistance.

We will provide written protocols for the team so that they can begin to utilize a systematic approach to diagnosis and treatment in order to improve outcomes.

Alex working alongside some new friends. 

Neo-Natal Resuscitation Education

Dr. Michael led a 2 hour course on neo-natal resuscitation called Helping Babies Breathe.

John, Faith, Joy and Lydia were present and taking lots of notes.  Dr. Michael made the course quite interactive posing questions throughout the session.  The staff was taking turns reading out loud and answering questions, as well as posing their own on past cases.  He reviewed the supplies the clinic currently has including their oxygen unit.  After evaluating the equipment it was discovered that the plug was missing, the mask was not inflated and it was too big for most babies. 

Dr. Michael demonstrating the proper usage of the oxygen unit. 

One of the key messages of the Helping Babies Breathe program, is the “golden minute”, the window of opportunity to save lives at birth.

Dr. Michael stressed the importance of having the unit absolutely ready at all times because when there is an emergency and a baby is born “flat” the last thing you want to have happen is that your machine is not ready. 

Children's Vision Care

Dr. Sidiqa worked with Geoffrey and Ezekiel on training of the auto refractor and trial lens kit. 

Dr. Sidiqa with Ezekiel and Geoffrey training on the auto-refractor. 

Once they had a base level of knowledge she invited the school children she examined yesterday and had referred to the clinic for a full examination.  Out of the 50 she examined yesterday and the 10 that were referred from that screening, 4 actually require glasses, which will be provided by Naweza.

A little boy being measured for prescription glasses. We screened 50 children during a school vision clinic and identified 4 that required glasses. Naweza will provide the glasses for the children. Lewa and Naweza will continue to do the school screenings and will partner in funding any eye wear required. 

It was a long day of training but she believes they will have enough skills to continue the eye clinic in order to bring consistent care to their community after we leave.

Chronic Disease

Dr. James saw patients during the morning alongside Duncan. Many of the patients are from the clinic yesterday who were referred to the clinic for the chronic disease program. One patient was a 42-year-old man who had suffered a stroke. He has semi-paralysis on his left side and used a cane to walk. 

He is an example of why we want to implement the chronic disease program here at Lewa. His stroke was likely preventable. 

If he had been screened for chronic disease he would have received a risk score of at least orange given that he has high blood pressure, and is a drinker and a smoker.  He would have been put on medication and counseled on lifestyle and nutrition strategies.  His outcome could have been different.  The goal now is to prevent him from having another stroke or other cardiac event by putting him on medication.

Dr. James working alongside Duncan to provide training on chronic disease. 

He also provided training on doing a proper knee examination on an older woman who has severe knee pain with swelling. The diagnosis was to be put on anti-inflammatory for a week and then re-examine her. The additional learning was determining the right medication given that she has high blood pressure. The drug combinations can be dangerous and should be determined carefully.

Preventing Illness Through Nutrition

Alex had an opportunity to visit with around 100 of the Lewa Wildlife Conservancy's security personnel, which represents the largest portion of the Lewa staff. We’ve learned that they often suffer from illnesses as they work deep in the rural area and cook for themselves. The symptoms of these illnesses suggest nutritional deficiencies. We’ve been asked to assess their diet to determine what is missing and how they can fill in those gaps. 

One solution suggested was to build gardens near their outposts enabling them to grow vegetables that are lacking in their diets.  The security guards would maintain the gardens providing a sustainable approach to improving their diets and health. 

Complex Case Care Program Review

Dr. Michael and Dr. James also had an opportunity to see patients that are part of the Naweza Complex Case Care program whereby every other Tuesday Naweza doctors in Canada use Skype to connect with the clinical officers in Kenya in order to discuss the difficult cases.  The cases presented are ones that are complex in nature and on-going.  The Canadian doctors are able to access their professional networks to get more specialized opinions.  One of the cases involves a young girl with juvenile rheumatoid arthritis. 

A young girl who suffers from juvenile rheumatoid arthritis. She is part of Naweza's Complex Case Care program whereby the doctors in Canada can discuss complex cases on a bi-weekly basis with the clinical officers in Kenya.

Naweza doctors have been following this case for a few months now.  We are at a point where she has been diagnosed and stabilized and are now working with a physiotherapist who is recommending strategies for feeding and dressing herself.  Her mother has told us that she gets very tired when she is writing at school.  We will consult with specialists at home to give strategies on how she can function for effectively at school.

Minor Surgery, Major Relief

A large splinter was removed from the side of a young boy's head by Dr. Sue at the clinic. It required a small incision and 2 stitches. 

We ended the day with Dr. Sue removing a large splinter (a total understatement) from the side of a little boy’s face.  Dr. Sue injected him with Novocain and proceeded to cut an incision to remove the particle.   Apparently thorns and large splinters frequently get lodged in people’s skin and eyes.  Children many times lose eyesight because an acacia thorn gets stuck in the eye.  The acacia tree is common in this area and the thorn is what the elephants and giraffes eat.

The young patient needed to have a large splinter removed. His wound was treated and stitched by Dr. Sue. 

Back at the Lodge: Snack Check, Check!

So back to the lodge we went.  I decided to work on the blog in my room before dinner.  Did the quick snake check in my bathroom and it was all clear.  The toilet paper still stuck in the hole.  Phew.  So I relaxed and sat on my bed, sipped my tea and typed away.  After about 30 minutes I just happened to look up only to find a small little black bat! 

A friendly black bat keeping me company in my room. 

Once again the Kenyan staff came to the rescue and swatted it out of the room with a long stick.  And I must say I felt a tiny bit better when they too screamed a little when the bat would swoop down in the room while they were trying to guide it out.  However, ultimately they were far braver than I evidenced by hiding behind the door every time the bat flew across the room.   The Kenyans are tough people who endure a life much harder than we can imagine in our world.  This story paling in comparison to other issues that we’ve witnessed in our short time here. 

Tomorrow is another outreach and we’ve been told it will be busier than the first.  So a good night's sleep is in order and everyone retires early in anticipation of the large crowds.  I myself have resorted to not only using my mosquito net which of course is mandatory but now tucking it under around my bed to minimize the chance of any other “friends” keeping me company while I sleep.  Fingers crossed for a quiet night.

Until tomorrow…and thanks for reading!

- Stacy

Day 3: Cervical Cancer Screenings, Cryo Procedures, Chronic Disease Assessments, Vision Care, Nutrition and more...

Day 3 began with a full schedule of reaching out to communities with our partners. Sit down, because this is going to be a long entry! 

On our way to the outreach in Ntumburi. That's Mount Kenya in the background. 

We started the day in Ntumburi, a village about 30 minutes from Lewa Clinic.  When we arrived, people were already lined up. And patients continued to arrive as the day progressed. Final patient tally: 104.

Arriving at Ntumburi. Patients wait in line. They arrived early before the clinic even opened. 

On today's agenda:

Cervical Cancer Screening and Cryotherapy Procedure

Dr. Sue worked with Faith and Cecilia, another nurse from a government clinic, who assisted in the cervical cancer screenings. 

Cervical cancer is a major concern in the developing world and with the vaccine being exorbitantly expensive ($300/patient), we have decided to incorporate training on the next best thing, screening. 

Dr. Seth Berkley, CEO of GAVI, the vaccine alliance, says, “Of the 275,000 women who die of cervical cancer annually, 85% live in the world’s poorest countries.  Cervical cancer is one of the leading cancer killers of women in the developing world.”  

We’ve been told that a woman who is diagnosed with a small lesion and is told to go to the county hospital to receive treatment simply won’t go.  Therefore it’s essential that if we find a minor lesion we must treat it if possible during the same visit.  Otherwise the woman runs the risk of having the minor lesion progress into cervical cancer. 

Dr. Sue and Cecilia, the government nurse, standing next to the cryotherapy unit, which is used to remove minor lesions on the cervix. 

A cryotherapy unit is used to treat minor abnormalities.  We bought one for the clinic prior to our trip but unfortunately it was back ordered and didn’t arrive in time.  Luckily we’ve been able to use a second unit from the county hospital for usage during our trip.  A clinical officer from the county hospital has also joined us and is able to receive further training on proper screening from Dr. Sue.  It will hopefully prove to be a good partnership going forward.    

Supplies for the cervical cancer screening including homemade cotton swabs and household vinegar. 

At this particular outreach we did 21 screenings and discovered one abnormality. Dr. Sue and her Kenyan team were able to successfully remove the lesion with the cryo unit.   This literally could save this woman’s life by having early detection with immediate treatment.

General Medicine and Chronic Disease

Dr. James worked with Geoffrey at the general medicine/chronic disease station.  The conditions that were presented included potential kidney stones, metabolic syndrome (pre-diabetes) and diabetes.  One of our observations is that as we are beginning to screen for chronic disease, the drug formulary (an official list giving details of medicines that may be prescribed) will need to change accordingly.  Many times we found that the drugs that were brought from the Lewa pharmacy were inadequate for treating chronic disease illnesses.  Our recommendations will include a model formulary and proper stock levels to ensure drugs are available at the time of need.

Dr. James and Geoffrey seeing a patient at the outreach clinic. 

Emily, our new community health worker was here collecting data on chronic disease patients.  Using her smartphone, she was able to digitally collect data on 70 patients. 

Community Health Worker Emily records the blood pressure of a patient at the outreach clinic. 

The high-risk patients (see photo below) were instructed to go see Dr. James and Geoffrey, who will begin a treatment plan that will be a combination of nutritional and lifestyle counseling and medication depending on their individual score.  This was an excellent start to the program.  Emily has kindly agreed to join us again on Wednesday when we open our second outreach clinic.

An alarming blood pressure taken at the outreach clinic. A normal score is around 120 over 80. This patient had no idea and felt relatively fine. The issue with chronic disease is that it is asymptomatic - so people don't know they are at risk of stroke, diabetes or other cardiac event. Through the screening program, this patient will receive treatment before such an outcome occurs. Preventive health at its best. 

Peadiatrics

Dr. Michael worked with Lydia in the pediatrics area.  A few cases involved children complaining of red/itchy eyes. 

A little boy whose eyes are suffering from the smoke effects of having an open wood fire used for cooking in the house. 

The likely cause after taking a history of the patients was that the red eyes are due to smoke in the house as it is quite common in this region to use an open wood fire when cooking.  Many times the only exit for the smoke is the window that the fire is positioned next to resulting in eye irritations in the family. 

Dr. Michael seeing patients at the outreach clinic. 

The only treatment is education on proper ventilation.  Unfortunately easier said than done when trying to change behaviour that is so embedded in the culture as well as limited resources.

Vision and Nutrition

While some of the Medcan Naweza crew were seeing patients at Ntumburi, Dr. Sidiqa and Alex were at a school to conduct vision screenings, teach health literacy sessions and perform nutritional assessments. 

Dr. Sidiqa and Ezekiel worked until dark to examine patients. Rather difficult to do vision screening when only using a flashlight, but it would be worse to turn them away after waiting hours (all day for some) to be seen by the doctor. 

Dr. Sidiqa had the opportunity to work with Ezekiel to continue training on general eye health explaining the difference between various eye infections.  As well, she trained him to use eye charts so that they are able to determine if the child needs to come to the clinic for a full examination.  Today the team screened 50 children. Ten kids likely require glasses.  They’ll come to the clinic tomorrow to be examined using the auto-refractor and trial lens kit to determine their prescriptions for eyeglasses of which Naweza will provide.

Dr. Sidiqa also educated the children on proper hydration and its importance for healthy eyes, especially in this very dusty environment.  She gave them water bottles and had each of them write their name on the bottle.  She instructed that each must refill the bottle at the school tap at least once during the day to ensure proper hydration.

Alex providing dietary advice to a patient. This consult was virtually done in the dark with the only light provided was from my camera flash. 

Alex had the opportunity to meet with the children and hear what they eat in typical day. The school actually had its own garden!  The kids all have a role in maintaining the garden, which supplies the lunches for both the children and teachers.  For lunch at the school that day was maize and beans with no greens.  In comparison, interestingly, the teachers' bowls all contained greens. 

She also had a chance to visit a market and see first hand what the Kenyans are buying and the cost of the food. 

A sweet moment when this little boy, who had befriended Alex, jumped in the jeep with us when we were leaving. His mom eventually got him out of the jeep with the help of a lollipop we gave him. 

Tomorrow will be another day of capacity building and training at the clinic.  We’ll also have a chance to see patients who are more complex in nature.  These patients are the ones we review on our bi-weekly call with the clinic when we are in Toronto, so the doctors are most eager to see them face to face.

That’s it for now!  Thanks for reading.  Be sure to check us out on Instagram and Facebook for more photos from the day.

- Stacy

Day 2: Another great day with the Lewa Team

Day 2 began with Dr. James giving a talk about chronic disease, including the World Health Organization’s guidelines for assessing risk for prevention of cardiac disease. 

Dr. James giving a talk on chronic disease, which included a review of the World Health Organization's guidelines. 

We also had an opportunity to meet our new community health worker Emily who will help assess the risk of members of her own community.  She’ll be using her cell phone to input 5 pieces of data on each person, including blood pressure, gender, whether they smoke, drink and/or a diabetic.

Emily, the community health worker, practising taking blood pressure on Dr. James Aw. 

She inputs the data in her phone and then transmits the data to a computer residing at our other sister clinic Fluorspar.  An SMS message is sent back to her indicating a risk score for cardiac disease.  The score is either a green (no need for treatment) or yellow, orange or red indicating the person must go to the clinic to begin treatment.  We’ve been using the community health worker program successfully at Fluorspar and are really excited for the potential at Lewa.  Emily will be joining us tomorrow as well at our outreach working alongside Dr. James in order to begin the screening program.

Geoffrey, one of Lewa's nurses asking Dr. Michael a question. 

Next, Dr. Michael had a talk on respiratory infectious disease for babies mostly focused on pneumonia and cough/cold.  The clinic was quite engaged with lots of questions.  One of the main goals was to provide training on when a patient requires antibiotics.  Most of the time when an infant comes to the clinic with a respiratory issue, the infection is viral and not bacterial and therefore doesn’t require antibiotics.  The tendency in the developing world is to overprescribe antibiotics and this unfortunately promotes antibiotic resistance -- a problem being dealt with worldwide, even in Canada and the U.S.  However in low-income and low-resource countries like Kenya it is exacerbated by the fact the mothers or patients walk so far to come to the clinic and don’t want to go home empty handed.  We discussed strategies on how to minimize overprescribing including following proper protocols when diagnosing in order to determine if the infection is bacterial or viral, as well as providing education to the patient on why they are not receiving antibiotics and guidelines on when it is recommended to come back to the clinic for another examination.

Dr. Sidiqa began training with Ezekiel on eye health and vision screening.  The skills she’ll be teaching will enable him to better diagnose eye infections, conduct vision screening and operate the auto-refractor and trial lense kit in order to determine the prescription for glasses as well as readers.  The ultimate goal is for him to begin a weekly vision clinic at Lewa whereby he’ll see patients from the community who require care.  We’ve also identified a local supplier who will provide the glasses at affordable rates for the local residents.  Naweza will also support the program by supplying readers throughout the year and glasses for programs we run while here.

The view from our lodge. 

We went back to our lodge for lunch and picked up the last member of our team, Dr. Sue (our OB/Gyn) who had just arrived at Lewa airstrip an hour before.   We enjoyed a beautiful lunch in a stunning setting.  And even had a special visit by a friendly tortoise.

A friendly tortoise joined us for lunch.

Despite being completely jet lagged (such a trooper as she showed no signs of it!) she was the first on after lunch for a didactic session on Pelvic Inflammatory Disease (PID).  The staff had several questions as they treat women for this sort of issue frequently. 

Dr. Sue leading a talk on Pelvic Inflammatory Disease, one of the topics requested by the Lewa staff. 

The main discussion was about trying to determine whether the symptoms presented are PID or another condition.  In the absence of diagnostic tools such as an ultrasound the ability to make a diagnosis are limited.  This of course is always the problem here as the resources are in short supply.  It is a difficult situation.  The goal is to give them protocols and training so that when these patients present themselves they can make educated guesses and treat or triage accordingly.

Dr. Sue answering a question from Faith, who will be Dr. Sue's partner over the next few days during the cervical cancer screenings. 

Dr. Michael then did a talk on HIV.  In fact he did it alongside John, the clinic’s expert on HIV.   They were a perfect duo as Dr. Michael knows all of the prinicples of HIV and John knows the Kenyan guidelines on treatment. 

Dr. Michael and John conducting a talk on HIV together. 

One of the cases that came up by Lydia, a nurse at the clinic, regarded a member of the Maasai tribe who is HIV positive and refuses to go on meds due to the social stigma associated with HIV within the Maasai culture.   Apparently, whatever happens within the community is public knowledge and if she goes on meds, word will get out that she’s being treated for HIV.  She would rather succumb to HIV than have the community find out that she has the disease.  The worst and most devastating part is that she is pregnant and actually has an excellent chance of delivering an HIV-free baby if she receives treatment.  In fact, she has already had one baby who has died because she refused treatment.  The progression of the disease is much quicker with babies, with mortality occurring often within the first year.  It is truly heart breaking.  But I think is an example of how HIV is not just a medical problem but social one as well.

The rest of the day was spent seeing HIV patients, chronic disease patients, and preparing for our outreach tomorrow.  We have quite a bit planned for the outreach including, vision screening at a school, cervical cancer screening, chronic disease, pediatrics and nutrition. 

Alex, our dietician will also have an opportunity to speak with children at the school about nutrition as well as a nearby market to assess what foods are available here so that she can make relevant recommendations to them with regard to the nutrition program.

A friendly snake keeping warm in my bathroo.

So to finish this busy day off, I go home and use the washroom in my bedroom only to find a little “friend” waiting for me.  A cute little black snake! 

You truly never know what you’ll get here.  Fortunately the staff at the lodge managed to get him to go back down the tiny hole he came from and plugged it with some toilet paper! 

The Lewa Lodge staff pushing the snake back down the hole it came from. 

Let’s just say I’ve had more restful sleeps at Lewa Lodge!  But I will say, no matter what you might have been afraid of during the night, the beautiful mornings always more than make up for it.  It’s a special place with very special people.  We are most happy to be here and are looking forward to our outreach tomorrow when we can visit more with the broader Lewa community.

That’s it for now.  Will report back tomorrow with lots of photos from the outreach and stories from the day!

Thanks for reading!!

- Stacy

Outreach Visit #5 Begins

Jambo!

Team Naweza arrived in Kenya on October 2 but we've had trouble connecting with wifi. First stop, Lewa Downs, one of our two sister clinics in western Kenya.  This is our fifth medical trip to Kenya and we’ve got an incredible list of health professionals with us.  The team consists of:  Dr. Michael Hawkes to focus on pediatrics; Dr. James Aw, chief medical officer at Medcan who will lead chronic disease projects; Optometrist Dr. Sidiqa Rajani to lead eye health efforts; Gynecologist Dr. Sue Wong to focus on women's health and obstetrics; Registered Dietitian Alex Friel to focus on nutrition projects; and myself, as the team lead to make sure we make the most of our days here. 

(Left to right) Ezekiel, the head of the Lewa Clinic greets Dr. Michael Hawkes, Stacy Francis, Dr. Sidiqa Rajani, Alex Friel and Dr. James Aw. 

To bring you up to date since our trip last April, Lewa recently had theft issues within its clinic pharmacy and were forced to let go of its entire clinical staff.  Devastating for us to say the very least as our program is centered around medical training, education, and capacity building.  With the former staff, so went all our training. However, we have a partnership with Lewa, and as a true partner, we experience the highs and the lows of any new project.  We decided that as long as we had confidence in the new staff, we would continue the relationship.  This past July, I brought a group of doctors here to assess whether we should proceed.  I’m happy to say, after that visit we felt very optimistic that the new employees were going to be good partners.  They were motivated and receptive to all that we had to share and we felt hopeful that a long relationship was likely achievable.  So … fast forward 3 months … and here we are.  Ready to begin our fifth mission with a fantastic group of Canadian doctors who are ready to continue the work of providing training and expertise to this special clinic at Lewa Downs.

 Main objectives:

1. Continue developing the chronic disease program, our main focus of this initiative.
2. Provide training on pediatric issues, namely neonatal resuscitation and pneumonia.
3. Cervical cancer screening and training on first level of treatment.
4. Training on visual acuity including usage of an auto-refractor, which we’ve donated to the clinic.  This equipment enables the optometrist to measure eyeglass prescriptions.
5. Provide nutritional counselling training as it pertains to chronic disease, maternal health and malnutrition in children.

After travelling from Nairobi and having lunch at our lodge, we went to the clinic to meet the staff. Even on a Saturday, 10 employees were present with all hands were on deck.  We reviewed the itinerary for the week, heard their feedback and have come to a mutually agreed upon final draft of the week.  All of course with the caveat that we are most willing to change and amend the schedule at any point if they feel they need more of “this” or less of “that”.  We are only here for 4 full days. Our time is limited and we want to make sure we’re using it in a way that best provides training and strategies that will best enable them to operate at a higher level when we are not here.  That’s the goal.

Registered Dietitian Alex Friel speaks to clinic staff at Lewa Downs. 

 We ended the afternoon session with a talk by Alex, our registered dietitian, who explained how she would support the doctors throughout the week with nutrition strategies for prevention and treatment of disease and other conditions.  They were quite engaged and full of questions as they thought of their patients and how nutrition could play a valuable role in the treatment strategies they were using.  

One of the white rhinos we spotted on our way back to the lodge. A rare and spectacular sighting. 

While heading back to the lodge, our driver was kind enough to do a mini game drive.  For whatever reason the elephants and giraffes were no where to be seen.  However (!), we saw two rhinos in two different locations.  One with its baby!  Rare to say the least.  A real treat and a great way to end our first day.

 We’ll begin tomorrow morning at 9 a.m. with a full schedule.  Be sure to check back for a full report.  And please, don’t forget to check out photos on Instagram, Facebook and Twitter.

Thanks for reading!  

- Stacy