Sunday, August 19, 2012

A Medical Perspective

Upon first recognizing just how overwhelmed we were when taking on the roles of the medical advisors for the Kenya trip, Andi and I were glad at all the help we received.  The pre-camp proved to us both just how generous Canadians are.  We both stared in amazement at the piles of medications, dressings, toiletries, glasses, safety equipment and much more, trying to find a way to keep it all organized.  I think we ended up with about 20 duffle bags each weighing 50lbs filled with medical gear.  Special thanks go out to everyone who took the time to gather the donations, including the donations.

The first hurdle passed, we finally arrived in Nairobi without losing a single bag!  Customs weren’t an issue and we made it all the way to Shiru with everything.  We knew the priority was to build the ward building, but Andi and I had our minds elsewhere.  First of all, we were making sure 17 contingent members stayed healthy, and we had our hearts set on helping out at the clinic.  Fate was against us, as we were all living in very close quarters and a stomach illness passed through a number of team members-some requiring a small dose of antibiotics.  A few others developed stuffy noses and cold symptoms, but we all pulled through by helping each other.  We were very proud to see the group coming together and helping those that were under the weather by bringing them food and taking on their chores.

While the team began work on the foundation, AndI and I began going through the mounds and mounds of medication with the Shiru pharmacist Acquilynne.  She and Eluid, the clinic’s manager, were so overwhelmed by the sheer volume of donations, most of the unpacking was put on hold, as there was clearly not enough shelf space for any of it.  While Eluid took on the job of finding someone to build new shelving units, Andi and I spent some time getting to know Scrita, the head nurse at the clinic.  She’s been working there for about 16 years.  She basically runs the show.  Always smiling, she truly made us welcome, giving us Keswahili names “Khamede” for Andi and “Nakhuminja” for Jen.  She was to become our Shiru mom.

She showed us around the clinic.  Our minds were blown.  A triage room, a small makeshift treatment room with no running water and the door is always wide open so a HIV tests and Hepatitis and TB tests decide the patient’s fate in fifteen or so minutes.  In another building, small rooms for expectant mothers, family planning and immunizations help the community learn and grow towards a healthier future.  The Shiru Health Clinic is one of the leading HIV-AIDS prevention clinics in the country.  I truly believe it is because of the wonderful staff who get to know their patients and help them make better decisions in life.

The third building is a maternity ward.  They deliver babies almost every other day.  Unfortunately, the whole time we were in Shiru, we were never at the clinic when one of the expectant mothers went into labour.  The birthing room is stark and has semblance of sterility.  We didn’t touch anything.  What an eye-opener.  Dora, another nurse, and Scrita  both stay in houses on the clinic grounds, so if someone needs help, they are there 24/7.  The clinic is currently a level 3 out of 6 on the Kenyan Hospital scale.  With our help, the new building where people will be able to stay on site will help to bring it up to a level 4 facility.  When the building is complete and the clinic can acquire an ultra sound and x-ray machine, they will be able to employ a physician 24/7.  As of now, nurses and clinicians run the clinic, diagnosing treating and prescribing.

During our stay, Andi and I took part in 3 separate outreach clinics.  On each outing, members of the contingent went along to help and get their hands dirty in a different way.  Florence, who is the community relations nurse, and Scrita regularly go out to outlying villages to see patients who cannot travel all the way to Shiru.  They usually take what little medication the MOH and government send to them-mainly anti-malarials, generic painkillers and amoxicillin.  They do referrals and check expectant mothers while immunizing those who need immunizing.  We had no idea what we were getting into.

The word spread that the Canadians had arrived and had brought medications.  We had to pack the bags based on what the staff asked for.  We had zero experience with tropical diseases, such as Malaria,Thyphoid, and Dengue, never mind the more heartwrenching commonalities such as malnutrition and lack of hygiene.  We set out on our first outreach at Makuchi with Ashley to help us with medications.

Driving way off the main road, through never-ending dropped jaws, as Mzungus were very rarely seen off the beaten path.  We made our way to a small power-less Salvation army church.  Many children smiled and waved at us as we approached.  We set up a treatment area and were introduced to our interpreters.  It seemed fairly calm, about 30-40 people sat in the pews, as Scrita welcomed everyone.

The day began slowly and Andi and I soon realized there was a pattern starting.  Many, many people were suffering from upper respiratory infections-August is their cold and flu season, as it rains at night and the temperature drops.  The regular treatment is antibiotics and painkillers.  We were told to give each of these patients Amoxicillin and Ibuprofen.  Andi and I looked to each other and tentatively moved through patient after patient, realizing we were taking much too much time with each patient.  We were checking pulses, blood pressures, temperatures, and blood sugars, all while trying desperately to assimilate to the rural Kenyan treatment style, all while retaining as much of our own style as possible.

The interpreters were great.  They became used to our questions and were able to explain our findings very well by the end.  That was the easy part.  As the day progressed we began to realize our impact.  Hundreds of people flooded to the church.  Andi and I tried to keep up.  Scrita was checking pregnant patients on a makeshift bed of two side-by-side benches.  Florence spent the day immunizing.  The mood of the day began to change as Ashley started warning us that we were running out of medications-she was running back and forth and was the saving grace of the day.  Without her, the number of patients we saw would have been cut in half.

Along with the dwindling supplies, the number of patients was increasing and it began to rain.  Our lunch consisted of sodas and cookies and when we returned to treating patients the church was so dark we had to work by flashlight.  Any light coming in through the few windows was blocked by the sheer volume of people pushing forward, surrounding us to be seen.  It was almost impossible to work, until finally Scrita and Florence told everyone we were done for the day.

Mentally and physically exhausted, we were smiling on the inside and out.  Ashley, Andi and myself directly helped almost 200 people.  From respiratory infections, to very seriously infected wounds, from long term illnesses, to new concerns like diabetes or high blood pressure.  We saw it all.  People with Malaria and Chiggers showed us how important our Malarone and hygiene were while traveling through the country.  We left the church feeling different.  Alive.  Our jaws were dropped this time, but we smiled and yelled “Jambo” back to all the waving kids.

Our second clinic was only a couple days later.  They had not given the village advance notice of this outreach like they were able to with the first clinic; however, to our surprise, there were still many people waiting outside as we pulled up to the church.  We were in the village of Cheptulu for this clinic, in a church on the main road through Shiru.  Due to the volume of patients at the first outreach clinic we decided to take 3 contingent members along with us to help; Kiki, Post and Nash (Kristin, Eric and Michael respectively).  At the last minute, Kevin decided he wanted to tag along as well for some photo ops as well as lend a hand where needed. 

The day started out much slower than the first, with only one significant glitch; there was only one interpreter.  With Jenn on her way treating patients using Scrita’s cousin as her interpreter, Kevin went outside to the queue of patients and asked if anyone could speak English well and would care to help.  A man named Solomon came forward and offered his assistance.  After a short introduction and treating Solomon first to ensure that he was seen, we began to see other patients.  Jenn and I saw more of the same issues we had at the previous clinic.  The pace of the day picked up quickly and while it wasn’t as busy as the first outreach, everyone still have a job to do.  Jenn and I were seeing and treating patients while Scrita, Beatrice (another nurse from Shiru) and Florence dealt with expectant mothers and child wellness.  Kiki, Post and Nash ran for medications as we needed them (sometimes even listening in to our treatment so as to have them ready ahead of time-they did a great job).  They even assisted with blood pressures and pulse checks when needed.  Kevin had double duty; official photographer as well as the responsibility of registering every patient seen at the outreach that day.

I had a chance to speak to Solomon during our ‘biscuit and soda’ lunch and learned that he had spent much of his 50+ years working in hospitals or hotels.  Having dealt with many Canadians in these past positions, he had nothing but flattering things to say about all of the Canadians he had encountered and expressed his thanks and appreciation for our help in the community.  Later in the day, we had the pleasure of meeting a very proud 96 year old Kenyan Scout who offered a salute and a handshake to any of us that he met.  He wore his scout badge proudly on his lapel.

The day went by fairly smoothly and without incident.  Assessing and treating 196 patients between Jenn and I alone.  Kiki, Post, and Nash were busy grabbing medications for not only Jenn and me, but also for Scrita, Florence and Beatrice as well.  As the day was coming to an end I noticed that Solomon was no longer in the church.  Worried that he had slipped out quietly, I ran to the door to catch him, and thankfully did.  I called his name and he came running back to meet me, filled with apologies for leaving without word.  We spoke briefly as I thanked him for his kindness and selflessness in staying to help and sacrificing his entire day for the sake of us and his neighbours.  I pinned a Canadian flag on his lapel; he was so appreciative for the gift and for us coming to help.  We said good bye and he walked away quietly, having never asked for anything in return for his assistance.  So many could learn from a man like him.

As I went back into the church to help finish up, Jenn was still with the same patient.  I could tell from her face when she looked up at me that it was a significant illness.  She later explained that the woman had stepped on a nail, having it tear through her foot leaving a serious open and infected wound that the woman had not yet had treated.  Another situation that reminded us of how different the living conditions are here in Kenya.  We finished clearing up the clinic and said good bye to the people of the village that stayed around to see us off, including the 96 year old scout.  With another salute and handshake we departed.

There were a number of days between the second and third clinics, which gave the two of us the time we needed to organize the donated medications and supplies in the stock room on the newly built shelves.  This took quite some time, but in the end all the shelves and cupboards in the room were full and organized!  During this time we also did some follow up with some of the patients we had referred to Shiru for eyeglasses.  Over the entire time spent in Shiru, we fit almost two dozen people with glasses-mostly for  reading.  It was nothing short of amazing to witness what Jenn and I referred to as the “Eureka moment”.  This was the moment when, after trying a number of pairs of glasses without any success, all the frustration and disappointment melts away from their faces and is replaced with a smile and excitement as they begin to read what the couldn’t only moments before…Eureka!

Our final clinic was in another church; the smallest of the three.  Although the church was not far from the Shiru Health Center, it was a fair distance off the main highway in a small village.  We had a different group with us this time.  Scrita was busy today, so we had Florence, Millie and Victoria with us from the clinic and Jamie, Hannes, Caitlind and Michael (one of the Kenyan Rovers).  As the ladies from the clinic arranged for people to wait outside (which proved to be the better way) and got their stuff together for the clinic, Jamie, Hannes and Caitlind did a great job of organizing and arranging the medications to make things easier as the day got busier.  They also helped us move benches and chairs to create a make-shift clinic.  Interpreters were difficult to find that day, so we were immediately thankful to have taken Michael along.  He sat beside Jenn and spent the day interpreting for every patient she saw.  We found one of the local health community workers to help interpret for me.  It was evident that the communication barrier was still significant, but we learned how to work with each other and made it work well.  Even though Jenn and I found communicating difficult at times, we will be forever grateful to those who took the time and patience to help us by interpreting.

The day was going along as we had expected by this point.  Assessing, diagnosing, treating and prescribing patients as we had in the previous two clinics.  The day was hot and while we sat under the quasi skylight for our biscuit and soda lunch, we were especially aware of it.  Florence, Mille and Victoria were very polite in telling us that we needed to increase our pace to clear the queue of those waiting to be treated.  This didn’t come as a surprise to us, as we knew already that we were much slower than our Kenyan counterparts.

After lunch we tried very diligently to pick up our pace as the number of patients waiting outside increased.  During our time with the outreach clinics there were countless times when Jenn and I would refer to one another for a second opinion or even just for confirmation.  Often calling each other over to have a look at the patient in question.  During the afternoon, while I was just finishing up with my own patient, Jenn called me over.  I could tell immediately it wasn’t a second opinion or confirmation type of thing…it was different.  With the number of people around us, I couldn’t see her patient until I was done with mine and walked over to her.  Neither of us were prepared for what we saw.  A woman holding her young baby in her arms sat in Jenn’s patient chair.  Words alone cannot accurately describe the condition of this poor baby girl.  Extreme malnutrition, open wounds over her entire body and face, swollen and edematous extremities, her left eye swollen shut and her left ear completely enveloped with infection.  To say the child was next to death was a troubling but true fact.  Holding back tears, we tried to explain to the woman that if she did not take her child to the hospital right now that her child would most likely die.  She had already been referred to the hospital in Kapsebet to get medical care for the child, but didn’t go due to lack of funds.  Jenn asked the woman if she would go right now if we gave her the money; the woman agreed.  Jamie handed over the 200KSh that likely saved this child’s life.  The money was given to one of the village elders to drive the woman and her child to the hospital.  Immediately after she left, was an intensely surreal moment and more than a few tears shed for the condition and fate of that baby girl.  The rest of the clinic was quite somber and our minds were elsewhere, but we pushed on trying to treat as many patients as we could in the time we had left.  We did our very best, but at the end of the clinic there were still patients pushing into the church, waving their medical report books in our faces trying desperately to get us to treat them.  Sadly, we could not help them all.  We packed up the clinic supplies and carried the bags out past the people, who were walking away slowly and somewhat disappointed, but still they had smiles for us and waived their good byes as we drove away. 

We learned and experienced a lot in our time at the Shiru Health Clinic and even more while at the outreach clinics.  We had happy moments and sad moments, but at the end of the day we consider ourselves honoured to have gotten to know the amazing, wonderful and happy people of Kenya and the culture that came with them.  The people we encountered and our experience working, treating and interacting with them have changed our lives for the better and we will never forget them.

by Jenn and Andi

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