Day 10 - Reflecting on outcomes, and living/working on our the edge of our comfort zone

Jumbo!

Our final day with Lewa has finally come.  It really has been a fabulous week and very productive, including the following outcomes: 

  • 2 mornings full of lectures on topics the clinicians requested training on. 
  • We've provided clinical training on chronic disease, communicable diseases, pediatrics, optometry and dermatology
  • We’ve seen hundreds of patients both at the clinic and on outreach
  • We’ve provided a 'Chronic Disease Kit' and more training to Community Health Worker Emily so that she is better able to educate and manage her chronic disease patients in her village
  • We’ve conducted 21 cataract surgeries, all with good prognosis for their 2-week post op follow-up
  • We’ve begun training Lydia on how to use the auto-refractor enabling her to conduct a weekly vision screening clinicThis initiative will be supported by the country ophthalmologist who will come to the clinic once a month in order to continue Lydia’s training (cost sponsored by Naweza)
  • We’ve donated a cryotherapy machine, which will allow the clinic staff to run cervical cancer outreaches on a monthly basis.  This initiative will be supported by a county gynecologist who will attend the outreaches in order to continue the training on identifying abnormal lesions and proper removal of those lesions (also sponsored by Naweza).
  • We’ve conducted fungal and scabies screening on over 300 kids and administered drugs for treatment and education to aid prevention.

We managed to squeeze in a couple of games drives too!  Sadly the lion and cheetah never showed up.  Next time :) 

As is tradition at Lewa, we had a special ceremony where we all offered feedback on the week and thanks for each other. 

Their thanking us for coming and our thanking them for making us feel so welcome.  We then participated in a cake cutting ceremony where we all put our hands on the knife and cut the first piece together, symbolizing unity.  The next part involved us being paired up with the person who we had been partners with for the week and then feeding him/her a small piece of cake, signifying a binding between Lewa and Naweza.  And as we would feed each other one by one everyone would chant “Naweza” or “Lewa” in unison.  And then of course lots of Masala tea (my personal favourite, with loads of sugar).  The entire ceremony was so touching.  It was evident they value the relationship and hope it continues into perpetuity.  The ingredients of the cake coming together as one was supposed to represent that Lewa and Naweza were now one.  The symbolism was everywhere!  The request for us to come more often was heard too many times.  And we would respond always with, we will try our best.  But for sure our next visit will be around January next year.  And we’ll continue with our bi-weekly call keeping us in consistent contact with them, helping them navigate complicated case files as well as us tracking the progress of the Chronic Disease program.

The journey is long, especially given a finish line that is as elusive as this one.  So you must enjoy the process and the people you are with.  

I want to thank the amazing group that worked with me on this trip.  Dr. Ed, his wife Denise, Dr. Paul and his partner Cheryl, Dr. Sidiqa, Vanessa and Dr. Michael (who has been on every trip with me from inception and is the mind behind many of these initiatives).  Everyone worked incredibly hard, in very difficult conditions, for many many hours a day and into the night.  But we always managed to have a good time. 

I tell everyone who comes on this trip, your coping mechanism for stress must be laughter, otherwise it may not be for you…because it can be very stressful and very uncomfortable.  I read recently “A comfort zone is a beautiful place, but nothing ever grows there.” I can of course only speak for myself, but I have been forever altered by the encounters I’ve had through Naweza. The strength of character and resiliency of the Kenyan people have made a deep impression on me and I think of them often when I’m going about my regular day.  

I’m equally affected by everyone who works with me on Naweza, whether it be the people who come with me on the trip or the many more who help me from the Medcan office in Toronto.  All of the “staff” do so on a completely volunteer basis.  They give time on top of their regular duties in order to support these 2 clinics in rural Kenya.  It is a true act of humanity and I’m grateful for their generous spirit and sense of responsibility to help those in need.

So, I think that’s about it for now.  Thanks for all of your support and time it took to read some of my way too long entries.  Our next planned trip is end of January and we are exploring the idea of adding a clinic in Uganda.  It should be interesting if nothing else!

Make sure to follow us on Instagram https://www.instagram.com/medcannaweza/ and Facebook https://www.facebook.com/medcannaweza/ to keep current on our initiatives and goings on.  And we’ll continue to share photos from this trip throughout the year.  We literally have hundreds as you can imagine. 

Until January, I wish you a final lala salama.

Stacy

Day 9 - Long lines, long patient walks and reflecting on four-year professional relationships

 Rush hour during our daily commute

Rush hour during our daily commute

Jumbo!

It is our day of outreach and we are all most eager to get there.  But not before a brief stop at the clinic to see patients from the previous day for follow-up.

 A beautiful patient at the clinic

A beautiful patient at the clinic

Dr. Sidiqa was up extra early and left for the hospital in order to check on the cataract surgeries.  While we were driving to the outreach she was making her way to the clinic in order to see 20 patients who had not been seen the day before.  They all very much want to be seen by her because Naweza has agreed to pay for glasses prescriptions for those who are prescribed the glasses this week. 

We have identified a local supplier in Nairobi who will provide high quality frames and lenses for $16 including delivery to the clinic.  We are hoping to begin a donation scheme whereby people can either offer to purchase glasses for a Kenyan or donate old frames which will lower the price per pair.  In partnership with the clinics we now share the prices of the glasses if the Kenyan is not in a position to pay for it themselves.

 Dr. Ed and Hagai saying goodbye to each other. They had been partners all week and Hagai would be staying behind manning the clinic while we went to the outreach. 

Dr. Ed and Hagai saying goodbye to each other. They had been partners all week and Hagai would be staying behind manning the clinic while we went to the outreach. 

We arrive at the outreach which is being held at one of Lewa’s four clinics, Ngare Ndare.  This clinic sees about 450 patients a month and services a community of about 20,000 with the support of the Lewa Clinic.  On this day, we have about 200 patients to see, representing just about half of what they’d see in a month!  We decided to employ a triaging strategy whereby the “easy” patients would be seen by the Ngare Ndare head nurse in order to free up Naweza docs for the more complicated cases.  This would help us move through the lines more quickly.

 On our way to outreach!

On our way to outreach!

About 40 minutes into the outreach Ezekiel, the clinic manager from the Lewa Clinic came to me and said that the patients who are being triaged to the local clinic nurse are upset.  They want to be seen by the “mzungu” doctor (white doctor).  Despite the fact they have minor issues which might include prescription refills, minor aches, requests for multi-vitamins…they want to see the doctors from the west.  Understanding the situation, we promised to see them but we were going to take very little time with each and focus on the most complicated cases.

A sad case was a woman who arrived with her 1 year old baby.   After taking a history and conducting a full examination we sadly diagnosed the baby as having cerebral palsy.  What we observed and suspected was, despite the fact the mother had previous tests completed on her son, nobody had bothered to sit down with her to manage her expectations on his delayed development.  Nor did they give her strategies on how she can cope with a baby who is severely delayed.  Having a child with cerebral palsy would be enormously difficult back at home in Canada.  Can you imagine managing the condition with no resources and no guidance in a tiny rural village deep in Kenya?  On top of this, the woman is a single parent.  Fortunately her mother was with her and was providing emotional support.  The woman was visibly shaken with the news we were sharing with her as if it were the first time she had heard of it.  Incredibly sad but I think she appreciated the time we took and the honesty of the conversation.  We gave her a few strategies and places to contact that might help, at least a small plan to get her started on a very long and difficult journey.

Dr. Sidiqa meanwhile had finally made it to the outreach after seeing 40 patients (and turning away 20!) at the clinic.  She had another 40 patients waiting for her at the outreach and they would have been enormously upset if she hadn’t come.  She, Ezekiel and Lydia devised a plan to get through the numbers, with Ezekiel doing vision acuity testing (using the eyechart) and Dr. Sidiqa and Lydia examining patients who were complaining about various eye conditions.  It was also an opportunity for her to provide training to Lydia so that she will be able to begin to manage on her own when we leave.

Dr. Paul saw 40 kids from the local school and said that 30% had fungal infections.  They were distributed medication and advised on treatment.  And also given counsel on proper hygiene so as not to re-infect themselves or infect others.

Dr. Paul and Faith made a fantastic team today.  A success story is when Faith, the nurse completed her first lump excision after observing Dr. Paul remove a painful cyst of another patient.  Her eagerness to learn and willingness to grow and go outside of her comfort zone is such a great demonstration of the kind of attitude that will enable the Lewa Clinic to go to another level of care they provide to their community.  Dr. Paul was quite proud of his student, and she was just as pleased with herself, and I think rightly so!  By the way, Lydia’s excision was a sliver of a branch that has been stuck in the patient’s leg for 20 years and has always caused her pain!  She could not have been more delighted to have it removed and how great it was that it was a Lewa nurse who did the procedure.

Finally at 6:30 we were finished.  And just in time as the sun was setting given that Kenya does not follow daylight savings time.  The clinicians and we were all in a good mood, taking photos/selfies, hugging, laughing, sharing stories from the day…..despite the absolute exhaustion we all were feeling.  It was a great effort.  We had seen over 200 patients and had provided as much training as time would allow.  It was now time to go home, have the delicious dinner we knew was waiting for us followed by a good night sleep.   

Tomorrow is our last day.  We will say goodbye to Dr. Paul and Cheryl in the morning as they are heading off on safari.  And the rest of us will head to the clinic for our closing meeting where we discuss the week, what worked and areas for improvement.  Then a short game drive in search of the lions and cheetahs.  Our faithful driver James says he’s hopeful we will spot them.  Fingers crossed!

Until then….lala salama and thanks for reading!

Stacy

 

Day 8 - Complex care patients, cataract surgeries, and maternal health challenges

Jumbo!

Well, I’m not sure how your day started but mine was watching a gheko run into my bathroom from the hallway and me searching everywhere to find him.  Not so much to do anything with him really, just wanted to know where he was.  I mean, I certainly didn’t want to step on the little fella, especially as he’s been quite good at eating all of the spiders in my room.  I even was witness to a kill.  Actually gave out a little cheer after he got that scary black spider.  In fact this gheko has been in my room since I arrived.  I’ve decided that he’s actually the one who lives here and I’m the intruder.  Luckily we’ve even developed a bit of a friendship.  Sometimes we play the staring game.  Me from my bed (while I’m writing this) and him from the wall.  Or we play chase…with me always the one chasing him.  We even play hide and seek, sort of like this morning in the bathroom.  Despite the fact he always seems to be the winner, it never takes away from the “fun”.  I guess we’ve struck an unsaid agreement of sorts.  That is, as long as I don’t tell the staff that they need to get rid of this tiny squatter in my room, he’ll continue to eat the spiders that usually crawl on my walls (which absolutely creeps me out more).  We’ve learned to coexist despite our very different backgrounds and actually have become quite good roommates.   I’m going to miss the little guy when I leave and (believe it or not) hope to see him again when I return.

 Herd of elephants walking by dining room

Herd of elephants walking by dining room

Anyways, on to more serious things, like the mass of patients that were waiting for us at the clinic.  But today was different.  We had a plan!  Vanessa with the help of a clinician triaged the patients, most seeing more than one physician.  We also ranked the severity of the conditions and had one of their clinicians examine the “easy” ones and our doctors would focus on the complex cases.  A much better system!

  Dr. Michael and John having a light moment

Dr. Michael and John having a light moment

We shortened our lectures and began treating patients by about 10:30.  By lunchtime we had seen many patients presenting with a myriad of issues.  Dr. Paul had one patient with vitiligo and another with  neurofibromatoses, a rare genetic condition where the patients grow multiple skin lesions on their face and body and develop other more serious associated complications.

Dr. Sidiqa spent the morning at the hospital ensuring the screening was going as planned on the second group of cataract patients and also did post-op on the patients who had the surgery yesterday.  Overall she was happy with the results.  Three of the patients were asked to stay one more night in the hospital for observation.  Dr. Sidiqa will head back tomorrow morning to check on the post-ops from today’s surgery before heading back to the clinic to see more patients. 

By the time she reached the clinic today she had 34 patients waiting for her.  So her afternoon was full!

After lunch the crowd seemed to intensify again. There were still patients in line to be registered but the staff was holding off until we were able to work through the current registrants.

One of the patients was part of our complex case care program, whereby the most complicated cases get reviewed on a bi-weekly basis by our doctors in Canada.  This poor woman has severe blistering erosions and ulcers of the mouth.  We’ve been following her for a year and her condition has perplexed Medcan’s global network of specialists.  When we saw her today the condition had improved but apparently it seems to follow a pattern of improvement and worsening.  We took our own biopsy which we’re hoping will reveal the answer or provide more clues.  The procedure was excruciating to watch.  A touching moment was when Vanessa asked the woman if she wanted to squeeze her hand.  The woman hesitated for a moment and then took her hand, not letting go until long after the procedure. 

Another case involved a woman who had 5 children, all separate pregnancies.  The first died after 4 days.  One can’t walk and is blind.  Two can’t walk or talk.   And one is severely delayed and is the one that brings her here today.  She has come with symptoms of puffiness which we did some lab work on and were awaiting the results.  The family situation was, as difficult as this is to fathom, devastatingly, the father of the children actually wanted to kill them as they were too much of a burden.  At that point the mother took the children away and is caring for them on her own.  A strong and feisty woman as you can imagine.  When she said goodbye to us she thanked us again and again and I just looked at her in amazement.  I thought to myself this is one of the most selfless, courageous people I’ve ever met.  I can’t imagine what her typical day is like caring for 4 children in such need, on her own, in this challenging environment.  And yet she does.  Because that’s what keeps humanity going, we care for those who can’t care for themselves.  But I simply can’t imagine how she endures day after day.  It is yet another experience here that will stay with me forever. 

Tomorrow is outreach.  Dr. Sidiqa will be splitting her time between the hospital monitoring the cataract patients as well as the Lewa clinic and then the outreach.  Busy busy!!

The rest of the docs will see a few patients for follow-up and then make their way to the outreach.

But until then, a good night sleep as it will be a full day again tomorrow!

Thanks for reading,

Stacy

 

 

Day 7 - Escaping elephants and other emergencies

Jumbo from Lewa! 

Our second full day at Lewa was a busy one.  Dr. Sidiqa went with Lydia to the hospital to observe the cataract surgeries and help with ensuring proper follow-up instructions were being given to the patients.

And the other 3 docs gave presentations covering asthma, hypertension, fungal infections and scabies. 

 Some of the patients who are waiting to be seen

Some of the patients who are waiting to be seen

I was approached by John K., the manager who oversees the health clinic, that we need to aim to be finished by 5pm this evening.  Yesterday the patients who finished by 7:30 all still needed to walk across the conservancy in the dark.  This is actually not allowed and is not safe given the risk of encountering such things as lions and buffalo.  I thought a perfectly reasonable request!  He told me that while we had been conducting our morning lectures the clinic had already registered 100 patients to be seen today and the cutoff will be 120.  I warned him that # of patients did not mean # of patient visits as most of the patients will want to see multiple doctors.  This could result in over 200 patient visits easy. 

Our strategy would be to move as quickly along as possible and carefully select the cases that we believe to be rich learning experiences.  Those we would take longer with.  And we should take longer with, because our goal is not to see record numbers of patients.  That is not sustainable and only helps the patients we saw on that trip.  Our goal is to educate and train the clinicians so that they can operate at a higher level when we aren’t there.  That way the patients helped over the course of a year becomes exponential and is long sustaining.

 A young patient

A young patient

However, we still needed to contend with the fact that 120 patients needed to be seen today before 5pm.  So we began seeing patients straight away after the lectures and the obligatory tea at 11am. 

After a VERY quick lunch we arrived back at the clinic to literally a mob of people.  There is tension in the air with people yelling at others for skipping the line.  They are tired, frustrated and hungry.  You can’t blame them.  We in the west get upset if we need to wait 30 minutes to see the doctor.  Some of these people have been here since 8am and it was then 2pm.  Although they may have seen one doctor they are now in another line to see another one.  It’s a mass of people that never gets smaller and we only have until 5pm to get through it!  Can you imagine being turned away after waiting all day!? 

 A patient escaped 5 elephants but fell and hit his eye on a rock in the process. 

A patient escaped 5 elephants but fell and hit his eye on a rock in the process. 

An emergency case was a man who arrived with a laceration to his eye going into his tear duct.  He’s an employee of Lewa working in logistics.  He encountered 5 elephants and was forced to run from them.  Good news is, he got out of the way of the elephants but unfortunately he fell and his eye hit a rock. 

Dr. Sidiqa, our optometrist was at the hospital observing the cataract surgeries.  I contacted her, sent her photos of his eye for her opinion.  She was relieved to see that his eye looked fine, but he will likely have dry eyes and tearing issues if the laceration is not sutured properly.   We organized for transport to take him to the hospital and she was able to navigate him through the process to ensure he had immediate care.  They successfully sutured him and he will likely have no long term issues.

Another emergency case involved a 10-year-old boy who had come in contact with a euphorbia candelabra tree which secretes a milky sap that is highly irritating to the eye causing a conjunctivitis and swelling of the eyelids. The condition is quite painful but fortunately he will make a complete recovery.  It is in fact a common issue the clinic deals with all the time.

The brave little boy had actually walked himself to the clinic!   Luckily a neighbor of his happened to be at the clinic as well and was able to escort him safely home. 

One uplifting story is that a young girl arrived who we’ve been following for a year when she arrived with a heart issue.  We referred her to have an ECG which revealed that she had PDA, a whole in the heart.  The family was fortunate to have a donor from Lewa sponsor the required surgery and she is 100% cured!

Our day finally came to a forced end by 5:30 which allowed for the staff and community members to traverse the conservancy safely to their homes.  We turned away about 20 people but promised to see them first tomorrow.  Today we followed a first come first serve strategy.  Tomorrow it will be based on degree of need.  We saw many complicated cases that required more time and will be added to our complex case bi-weekly call we do from our office in Toronto back to Kenya.  However many others were minor or even “well patient” visits where the patients simply wanted to see a doctor from the West.  Although totally understandable, the worst case scenario is that the patients truly in need won’t be seen and given the counsel of our docs for proper disease management.  A triaging system will be implemented whereby Vanessa and one of the clinical officers will assess the seriousness of the condition and will queue them accordingly.  Let’s just say she is a brave soul!!

Our day tomorrow will include the second round of cataract surgeries as well as the removal of the patches of the first set of patients.  Back at the clinic we’ll again begin with lectures which we will likely shorten given the large numbers of patients who need to be seen.  The rest of the day will be examining patients.  Hopefully the numbers will be manageable and we will end on a positive note, and by 5pm!

We ended the evening with a lovely dinner full of stories of the day as well as lots of sharing about family.  We have all been without our loved ones for quite sometime and we are all very much missing them.  It makes us feel a little better (even if just a little bit) to at least talk about them.  But for sure most of the meeting is spent laughing.  This is one of the funniest groups I’ve had the pleasure of bringing over and I will miss them very much when the trip comes to an end.  

Until then…..lala salama!

And thanks for reading….as always!

Stacy

Day 6 - Medical training and managing expectations

Jumbo!

Our first full day at Lewa was amazing.  After a ridiculously beautiful and delicious breakfast at Ngiri House, we left for the clinic.   I must say this is the one time that the commute to work is a highlight of the day.  Even a form of therapy.  The feeling of peace and serenity is so wonderfully abundant.  The animals, the landscape, the air...fills you...energizes you…and you arrive at “work” ready.

We were greeted warmly by the staff with smiles and handshakes and a promise of a productive day.  The morning was dedicated to didactic training by all 4 docs.  The topics were chosen by the clinic and the doctors had planned accordingly.  The training took place in the lovely outdoor area where they have a projector screen which the doctors use for their presentations.  Each of the docs taught the material in an interactive way involving the clinicians by asking questions and answering theirs.  The staff seemed very engaged and eager to learn.  A very good sign!

We then went back to our lodge, had a very quick lunch and headed back to the clinic within an hour.  We had about 70 patients waiting to be seen, many of them seeing multiple doctors, given the rare opportunity to see a Western doc.  We anticipated a long afternoon.

The doctors saw patients with a myriad of issues.  One sad case involved a 38-year-old woman who had experienced a stroke 3 years ago due to atrial fibrillation, a heart arrhythmia.  She came today in order to be seen by a “mzungu” doctor (white doctor) to get an opinion on whether she would get better.  The stroke resulted in paralysis on her right side and speech aphasia.  At this point she has regained her speech and most of the use of her right side, however, it is still very weak. We’ve given her a prescription for anti-coagulant to prevent future stroke and propranolol to control the heart rate.  However, the main issue is that she requires a valve replacement which is highly unlikely given the expense of it.  Without it she risks another stroke or other life threatening issue.  But we do what we can do in this limited resource environment.

These happy faces of local children who were seen at the clinic are so welcoming to capture. 

I think this is the most challenging part for the Naweza doctors.  They are accustomed to diagnosing a condition, prescribing the treatment and in turn that patient receiving the treatment.  Although that treatment may not necessarily result in a positive outcome, the patient at least has a chance.  In this setting, the patient many times does not have that chance due to the lack of resources.  A Western doc who is used to making the sick better with all of the resources available, whether it be diagnostic testing, abundant drug choices and surgical interventions, feels at times powerless.  And this can be emotionally demoralizing to a person who has chosen a profession to make people better.

 Vanessa training community health workers on chronic disease

Vanessa training community health workers on chronic disease

Vanessa spent the second part of the day with the Community Health Worker, Emily.  They took the clinic ambulance to the local church where Emily had organized for members of the community to assemble.

This was to be Vanessa’s opportunity to explain the Community Health Worker Kit which will serve as an educational tool for Emily when trying to educate her people on chronic disease.  It was also a chance for Vanessa to observe how Emily interacts with her community so that we can provide guidance on the advice she offers them.  Vanessa will do a separate write-up describing her experience.

A funny story that happened was when a cheeky little monkey ran over and stole food out of a person’s hand and then ran up a tree.  He proceeded to peel of the wrapper and eat it tossing the wrapper away after he finished.  As the wrapper was falling to the ground hitting branches along the way, the Kenyans were all laughing hysterically.  I think the monkey was too!!

We were finally finished.  The doctors had worked without a break from 2 p.m. until 7:30 p.m. without as much as a bathroom break.  Their commitment and passion to help those in need was never more apparent and Naweza and this Kenyan community are most grateful.   We then headed back to the lodge for tea/dinner/and maybe some wine, feeling very satisfied from a most productive day.

Tomorrow we will do cataract surgeries at the hospital.  Dr. Sidiqa and Lydia will go to the hospital to observe the procedures and keep informed on each patient file so as to ensure proper follow-up, especially in the event of complications.

The other 3 docs will lead the didactic training in the morning and see patients in the afternoon.  It is the same formula we used today and we were very happy with the flow.

Until then...lala salama and thanks for reading!

 Stacy

Day 5 - Solving a mysterious infection among school children; getting to know Helen; the impact of the mining economy on the Fluorspar clinic; flying to Lewa

Jumbo!  My post today will be a combination of our day of outreach at Simit and our closing day at Fluorspar and arrival at Lewa.  

A magical moment again watching the cataract patients regain their eyesight.  Overall we’re quite happy with the results.  We did 27 surgeries over two days and all but two patients showed improved vision.  We’re hopeful that through proper follow-up treatment those two will improve.  At two weeks Jemimah will perform a vision test on the patients to assess their improvement.  Only then will we know whether the surgeries were a success.  Given our current results we are cautiously optimistic :) 

Let’s just say Simit never fails to deliver amazing experiences.  Some funny, and others heart wrenching.  You are emotionally and physically spent by the end of the day.  The ride there is 39 minutes (we timed it) up the mountain on unimaginably poor roads.  At one point our bus driver actually stopped as he was too afraid to go further.  We waited for another driver to arrive and we proceeded along with great trepidation.

We arrive to this scenic hilltop village.  We are surrounded by green lush hills with waterfalls and a river running through.  It is beautiful.

 Helen, the community health worker extraordinaire in Simit. Showing us her kitchen where she prepared the masala tea and mandazi

Helen, the community health worker extraordinaire in Simit. Showing us her kitchen where she prepared the masala tea and mandazi

Our first point of contact is Helen, the community health worker we’ve hired in Simit. Helen begins by offering us sweet masala tea and mandazi, a fried sweet dough.  It is delicious and warm and we are revived and ready to go after the treacherous ride.

Very typical at Simit, the outreach starts slow and then reaches complete chaos with a slow burn to the end with last minute walk-ins trickling in until nightfall.  You feel compelled to stay until you’ve seen everyone as it is their rare chance to be seen by our western docs. 

 Dr. Ed and Dr. Paul with the village chief whose house we are using to see patients. 

Dr. Ed and Dr. Paul with the village chief whose house we are using to see patients. 

Dr. Paul, our dermatologist begins by doing a skin condition clinic on school kids who have been brought in from the primary school.  Around 70% of the kids revealed fungal infections on their heads and were asked to stand in a line so that they would receive medication to treat it.  The incidence was so high that our clinical officer went to the school and asked if all of the kids could walk to the outreach in order to be checked. 

About an hour later another 120 kids showed up and they received both a vision screening and derm screening. 

Due to the high incidence of fungal we asked if they could locate the village barber.  About 20 minutes later he showed up. 

 The town barber speaking with doctors about how to prevent fungal infections 

The town barber speaking with doctors about how to prevent fungal infections 

Dr. Paul informed him of the fungal infections and then counseled him on proper hygiene and the importance of sterilizing his razor after each child.  We sent him off with a solution used to sterilize and hoped he would heed our advice.

If not diagnosed, fungal infections can lead to scarring and permanent hair loss and other serious infections.

Through the vision clinic we also identified a 14 year old who had developed a cataract due to trauma.  She has already been added to our list for when we come back in January.

One very difficult case was a woman who came in with an abscessed foot.  Unfortunately the clinic doesn’t have anesthetic to freeze the local area.  But the woman’s abscess was too advanced to not address it immediately.  Dr. Ed was forced to lance the woman’s foot with no freezing.  Despite the obvious enormous pain she was in as he performed the procedure, which required people to hold her down, she never once made a noise.  Plenty of tears rolled down her face but without a peep.  It was agonizing to watch, I can only imagine what she was enduring.   She was treated with antibiotic and will be monitored by Helen the community health worker.    

On a light note, we were very amused by an elderly gentleman who proved to be quite a good dancer.  The local “hotel” (a house with “Hotel” painted on it.  And as an aside, when I asked Helen who stays at the hotel, she just looked down and giggled.  I took that as a hint not to pursue any further), but anyways, the local hotel was playing music which came through the windows.  So the gentleman seized the moment and freely began to dance.  A picture of youthful disregard for what people might think. It made me happy to watch him. 

At one point I ask Helen, the CHW for Simit, where I might use the loo.  She walks me around the corner, points to an outhouse, I say thank you thinking that’s it.  But she suggests we take a walk to her house and have a general tour of the hood.  So we proceed to walk though lots of overgrown brush. Simit is very lush at the moment.  The maize crops look healthy and the community is hopeful for a good harvest.  We arrive at her house which is a round tin structure which when I look at it can only think how bloody hot inside it would be during the day.  

 Helen showing me her home and garden. She lives in one and the other 4 remain empty

Helen showing me her home and garden. She lives in one and the other 4 remain empty

There are 5 of these structures in her area but none of them are currently occupied.  She is alone.  In fact, all alone at the moment.  She has been a single mother for 10 years with two daughters age 11 and 24.  The 24 year old is at nursing school and the 10 year old is away at school too.  It costs her about $700 usd a year for school fees.  Her main form of employment at the moment is the work she does for us as a community health worker.  We pay her about $100 usd/month, the going rate.  She told me how appreciative she was for the job and that when we hired her she was able to pay off her children’s school fees. 

In addition to the CHW salary, she makes modest income from her garden that surrounds her home, planted in a haphazard sort of way.   There are greens, beetroots, pumpkin, squash, an avocado tree, a papaya tree, maize and bunch of sugar cane.  To give you an idea of the economy, she can sell a large papaya for 50 cents.  The small one for 20 cents.  One can see how thankful she was to have our job offer.

She proceeds to go to the sugarcane and well…basically...manhandle one  of the stalks.  This tiny woman rips it down, breaks it in half, peels it back and hands it to me.  She said, “try it”.  And so, not to be rude, I took a big bite of it, sucked all the sweet juice out of it and then kept chewing…..and chewing….until she finally said that I needed to spit the chewy part out.  Not to swallow it.  Relieved, as I had no idea how I was going to get this down, I spit it out (in the most elegant way possible) and told her how delicious it way.  It was so good in fact I continued to eat it while she kept talking.

 Helen taking down the stalk of sugarcane

Helen taking down the stalk of sugarcane

 Helen walking back to the outreach with the 3 sugarcane stalks

Helen walking back to the outreach with the 3 sugarcane stalks

As she continued to talk (and me eat) she ripped down 2 more stalks, told me to hold her 2 writing pens and then took the 3 stalks and carried them on her shoulders through the overgrown bush back to the outreach.  I quickly and obediently followed behind struggling through the same bush (with her 2 pens) that she was navigating with agility and ease (with 3 sugarcane stalks), she sometimes glancing back at me giggling at my complete awkwardness in dealing with the brush hitting my face and the muddy ground.  Helen is an incredible woman with an enormous inner strength and level of intelligence that has enabled her to systematically identify people in her community who are at risk of chronic disease.  She has self initiative and a very big heart.

 Helen showing Vanessa and me her self made chronic disease posters that she uses when travelling in her community identifying people at risk for chronic diseas 

Helen showing Vanessa and me her self made chronic disease posters that she uses when travelling in her community identifying people at risk for chronic diseas 

Vanessa had the opportunity to walk with Helen and visit some homes in her community.  Together they are testing out a Community Health Worker kit that Helen requested and Vanessa has developed.  The kit will allow Helen to better educate and inform her people on chronic disease and strategies for prevention.  I’ve asked Vanessa to write up her own entry on her experience so that you can hear first hand an afternoon that I’m sure was a memorable one.

Finally, the end of the outreach.  After seeing a couple hundred plus patients, we pack up and head back to Fluorspar.  The staff back at the main house have prepared tea and a selection of beer and wine.  We are so appreciative.

The next morning we have our wrap-up meeting with the clinic staff.  Our main concern at the moment is the future of the clinic.  Unfortunately the mining industry is in a downturn and the competitive climate has changed with new entrants offering Fluorspar at lower prices.  The mine has been forced to close down and the clinic’s future is uncertain.  The staff has begun to quit leaving only 4 now.  They are working hard to compensate for the shortage of staff and it is taking a bit of a toll on morale.  We suggest some strategies in stretching the people resources, one being perhaps they may need to only be an outpatient clinic at this point.  They are reticent to scale back as they know the community relies on them to be available 24/7.  But I think they are at the tipping point and this is something they need to consider.

 Jemimah and Dr. Sidiqa saying a sad goodbye. They've worked together very closely over the last 2 years as Jemimah was being trained by Sidiqa to be the "optometrist" at the clinic. 

Jemimah and Dr. Sidiqa saying a sad goodbye. They've worked together very closely over the last 2 years as Jemimah was being trained by Sidiqa to be the "optometrist" at the clinic. 

We say our goodbyes, lots of hugs and photos, and promise to see them in January.  I think deep down we all know it’s not a sure bet.  But we feel compelled to keep the faith that the mine will recover as it always has and everything will return as normal.  The next few months will reveal a lot and we’ll be sure to keep you posted on the progress.

 With the clinic staff. Saying goodbye

With the clinic staff. Saying goodbye

Next stop…..Lewa.  We board our charter flight at 11:30 a.m. and arrive at Lewa airstrip at 12:15 p.m.  Imagine arriving in the middle of an African safari with giraffes, elephants, zebras…in the distance.  Surreal. 

 Vanessa moments after seeing her first elephant in the wild

Vanessa moments after seeing her first elephant in the wild

We are greeted by the clinic manager of Lewa clinic, Ezekiel.  We dropped our things at Ngiri House, our lodging for the week.  We have a beautiful lunch overlooking vast terrain with all sorts of animals off in the distance as well as up close.  It is totally normal to have monkeys, impala, warthogs walk by.  We were then told that the clinic staff were in a meeting that went long and they asked if we wouldn’t mind going on a game drive before heading to the clinic.  We were like, uh, no problem?!  So off we went in our jeep and saw elephants, giraffes, rhinos, impalas, zebras, monkeys, baboons, buffalo,…and the list goes on.  Really incredible.

Finally it was time to go to the clinic.  Ezekiel and his staff had an incredible presentation and introduction and were full of suggestions on how the week together would work best.  We made some adjustments to the schedule, had a tour of the facility for the newcomers and were on our way back home. 

Tomorrow we begin at 8:30 a.m. at the clinic.  The morning will include 4 presentations from our docs in the morning followed by clinics of chronic disease and pediatrics in the afternoon.  Dr. Paul will be doing a lumps and bumps clinic as well. 

We are super excited at the potential of this week.  The clinic staff is full of positive energy and seem to be eager to learn and take advantage of this opportunity. 

There are countless more stories to tell but you’ll just have to talk to us in person to hear the rest.  We all would love to share for those who are willing to listen.

 Until tomorrow…..lala salama!

 Stacy

Day 4 - Cross-cultural psychology conversation and post-op eye surgery celebration

Jumbo from Kenya!  Another fantastic day at the clinic.

I’m relieved to report that the patient who ingested the toxin has improved quite a bit.  She is conscious and alert although is still unable to sit up.  She is experiencing chest pain due to aspirating when she expelled the toxin and is being treated with antibiotic.  She should make a recovery with hopefully not many long-term physical effects.  The more important issue at the moment is her mental state.  She is still very sad and will require counseling.  The clinic staff is unfortunately accustomed to this issue.  They have up to five attempted suicides a month and the staff does an unbelievable job considering their limited training and resources.  We are exploring the idea of bringing a psychologist with us on a future trip although are sensitive to the cultural differences and the challenges this will bring when counseling someone from a different country.  But the issue remains they have a high incidence of depression and anxiety and we’d like to give the staff tools when trying to help their patients.

 Dr. Sidiqa removing bandages post-surgery

Dr. Sidiqa removing bandages post-surgery

 Patches being removed and drops administered to the patients

Patches being removed and drops administered to the patients

An exciting part of the morning was removing the patches of the cataract patients’ eyes.  A very moving experience with lots of smiles.  Dr. Sidiqa and Jemimah conducted post-op eye examinations assessing the patients’ visual acuity to determine whether the surgery was a success.

 Dixon after his surgery. He was soooo happy!

Dixon after his surgery. He was soooo happy!

We are pleased with the results with 15 out of the 16 showing visual improvement.  The one remaining was unchanged but through vigilant follow-up we are optimistic that their eyesight will improve as well. 

 David explaining to cataract patients proper follow up care. With cataract surgeries the care you receive after the surgery is critical to the success. 

David explaining to cataract patients proper follow up care. With cataract surgeries the care you receive after the surgery is critical to the success. 

We also conducted 12 more surgeries today.  A few were tougher than the others, but overall they went very well. The patients will stay overnight and be administered drops every four hours and monitored for any complications.  Tomorrow will prove to be another exciting morning when the patients have their patches removed.  Will be sure to share more photos!

 Julius with a happy family wearing stickers complements of Dr. Paul

Julius with a happy family wearing stickers complements of Dr. Paul

 Dr. Paul with local children

Dr. Paul with local children

Dr. Paul was busy with many patients with a myriad of issues.  He also performed several cyst removals on patients including one of the chefs from the main house where we lodge.  He had a benign cyst on the back of his neck which had been bothering him for years.  Dr. Paul was able to remove it easily today and the chef couldn’t have been happier!

 Vanessa and Michael working with Bernard (at the head) at the M-Health Study meeting.  Joseph on the right was the driver who drove Bernard to the meeting (9 hrs one way!)

Vanessa and Michael working with Bernard (at the head) at the M-Health Study meeting.  Joseph on the right was the driver who drove Bernard to the meeting (9 hrs one way!)

The day didn’t end at the clinic.  Vanessa and Dr. Michael had a meeting on our M-Health Study with Bernard Ochieng, principal investigator on the study.  Naweza is studying the effectiveness of using SMS technology, which is used by the Community Health Workers to identify patients who are potentially at high risk for cardiovascular disease in order to facilitate early intervention.

 A young patient smiling after care. Another family including a mother and her infant were treated for dehydration. 

A young patient smiling after care. Another family including a mother and her infant were treated for dehydration. 

Tomorrow is outreach at Simit.  It’s our favourite day as the village is in a beautiful setting about 30 minutes up the mountain.  The people are lovely and always so appreciative of us coming.  We will be offering pediatrics, general medicine, optometry and dermatology.  We will also have our Community Health Workers along with us and will be training them on using a sugar monitor to more accurately determine if the people they are identifying in their community for being at risk of chronic disease are diabetic.

 A hungry chicken looking for leftovers

A hungry chicken looking for leftovers

So, it will be a full day.  And it’s hard to believe it is our last full day at Fluorspar.  We have learned a lot on this trip and are already planning our agenda for the next one in January.  So much more to do! But for now, a good night's sleep is in order.  Will be sure to share lots of photos tomorrow of Simit. 

Stacy

Day 3: Eye surgery; recognizing the need for support & counselling; and the anticipated arrival of a Medcan dermatologist

 Patients being screened for cataract surgery

Patients being screened for cataract surgery

Jumbo!

Another great day at Fluorspar.  Dr. Sidiqa and Vanessa arrived early at the clinic in order to set up for the cataract surgeries.   16 surgeries were completed and the patients will stay overnight to be monitored and administered drops in order to optimize results.

A challenge we are now dealing with is that the public has heard that we are providing free cataract surgeries and are showing up literally as walk-ins asking if they are able to have their cataracts removed.  The issue is that we have planned for 25 to 30 surgeries in total over the two day period as that is a reasonable number of surgeries to perform safely by one surgeon.   We’ve promised them that we’ll be back in January and they can participate in the program then.

As well, in order to mitigate the risks of doing surgeries in such a remote setting, we conducted a 2 part screening process so as to ensure that the patients we were undertaking were low risk and had a high chance of success. 

 Jemimah and Sidiqa doing an eye exam

Jemimah and Sidiqa doing an eye exam

 Cataract surgery. Vanessa helping

Cataract surgery. Vanessa helping

One of our goals is to have zero cases whereby the surgery actually made their eyesight worse due to secondary conditions to the cataracts!  Those patients we advised to go to another cataract surgery initiative being conducted at Moi University in Eldoret next week where they actually have the resources to deal with difficult cases and complications.

A very sad case involved a woman who tried to commit suicide and was rushed to the clinic by a neighbour who found her unconscious. Apparently she had an argument with a relative with regard to her positive HIV status, which resulted in her ingesting some sort of toxin.  The challenge was trying to determine what toxin she actually ingested so that she could be treated properly. 

Dr. Michael, Dr. Ed and Julius (the clinic manager) were quickly researching online what the possible substance could have been given her presenting symptoms and what she would have available to her.  They deduced that it was likely a tick pesticide used for cattle.  They treated her with that assumption and she has improved but is not out of the woods yet.  She is still experiencing respiratory distress, which is the leading cause of death with this particular substance. 

This case is yet another example of the need for a support and counselling in the community.   Drug and alcohol use as well as depression are common here and there is no apparent program available to them.  We are considering bringing with us a mental health expert on the next trip in order to help give the staff strategies on how to deal with stress, anxiety and depression.

 Dr. Paul with Dr. Michael and Dr. Ed with Julius, the clinic manager, and a dermatology patient

Dr. Paul with Dr. Michael and Dr. Ed with Julius, the clinic manager, and a dermatology patient

I’m happy to report that Dr. Paul our dermatologist has arrived safely!  He had a great afternoon working alongside Dr. Michael and Dr. Ed, Julius and Samuel (another clinical officer).  They saw several patients with skin ailments who were brought in specially because Dr. Paul was here.  They saw a myriad of issues including scabies in an adult, severe hair loss in a woman and a woman with keloids from piercing her ears.

Each patient provides a great learning opportunity resulting in a rich discussion on treatment strategies and protocols for proper diagnosis.

Tomorrow we will do the second half of cataract surgeries with another 10 planned.  We will also assess the patients who received their surgeries today.  It is always an incredible experience to witness when someone who hasn’t been able to see for years finally regains their eyesight.  We will be sure to share many photos!

Dr. Paul will be conducting a lumps and bumps clinic and continue educating and training the clinical officers.

And of course we’ll begin with checking on the woman who ingested the poison.  Her vitals were all much better before we left this evening and we are very hopeful she will make a recovery. 

Until tomorrow...thanks for reading and lala salama from Kenya.

Stacy

Day 2: From Tragedy to Resilience, Community Health Workers See All

 Vanessa Churchill, Dr. Ed Bekeris and Dr. Michael Hawkes meeting with Community Health Workers

Vanessa Churchill, Dr. Ed Bekeris and Dr. Michael Hawkes meeting with Community Health Workers

Jumbo everyone!

We had a great first full day at Fluorspar.  So good to be back here.  After a lovely breakfast at the main house we left for the clinic.  The morning began as always with medical rounds.

One of the cases was a mother of two-month old twins who were quite ill.  While on the way to the clinic one of the twins died.  A heartbreaking outcome to say the very least.   And my main observation was how stoic the mother was during the examination of her surviving baby.  No emotion and even managed a smile at one point.  I think a testament to the strength of character and resiliency of the Kenyan people.

The surviving twin was diagnosed with possible sepsis, which is a life-threatening condition with neonatal babies.   He will be treated with very strong antibiotic and will be monitored closely over the next 2 weeks.  Dr. Michael is cautiously optimistic for a full recovery.

Dr. Sidiqa was busy with the final screening on the first 15 patients who will receive cataract surgeries tomorrow.  3 patients unfortunately were turned away as they had a secondary condition which would likely result in them having worse sight if we had done the surgery. 

Medcan Naweza donated to the clinic an opthalmoscope, which is used to look in the back of the eye and better enable them to provide general eye health examinations.

 Dr. Sidiqa training Noah and Jemimah on the ophthalmoscop 

Dr. Sidiqa training Noah and Jemimah on the ophthalmoscop 

Dr. Sidiqa began training Jemimah and Noah on the opthalmoscope as well as other general eye health.

Vanessa met with two community health workers (CHWs): Helen and Alan.  The afternoon was spent presenting the chronic disease kit that they will use to educate the community when they go door to door to assess their risk of chronic disease.  As a refresher, the CHWs are currently assessing the risk of chronic disease in their community by utilizing an SMS program that we’ve developed.  They input 5 data points into their phone and transmit the data to the computer that resides at the clinic.  Within 30 seconds the computer will send via an SMS message whether the patient is a green, yellow or red risk, each of which requires a different treatment strategy.

Now that we’ve identified the at-risk patients, our next step is to develop an electronic medical record (EMR), which will help us manage the patients that require treatment and follow-up.  We’ve met with the developer who helped us write the risk assessment program and he has now begun the development phase of the chronic disease management EMR.

We had an interesting discussion with the CHWs where they openly talked about the issues in their community.  A big challenge is motivating the children to go to school when they have friends who have already completed school but are not able to find a job.  They wonder why would they burden their family with paying for school fees when they won’t be able to be employed afterwards.  It’s a never-ending cycle perpetuating itself.

One funny story the CHW shared with us was when he went to a home of a community member who he was going to examine for the chronic disease program.  Apparently a popular yet illegal local brew is called Busaa.  The house in particular actually brews Busaa and sells it, an unofficial local bar of sorts.  In fact that is one of the reason the CHW went there as it would be full of people who may be at risk for chronic disease, exactly his target market!  As he was taking the blood pressure of one of the “customers” the police raided the house, and the woman whom he was measuring ran off with the blood pressure cuff still on her arm!  So he ran a ½ a kilometer to catch up to her to get his cuff back.  He had to convince her that the police weren’t chasing her anymore so that she’d stop running.

This particular CHW, Alan, is quite a resourceful guy and his community has nicknamed him “Google” as they are constantly asking him questions and he researches them and comes back with an answer.

It will be good citizens like him that will be critical to the success of our initiatives.  We’ve learned very quickly that we must go to the community and not wait for them to come to us in order to make an impact.

The next project will involve having the CHWs go door to door to identify HIV positive patients via a point of care diagnostic which reveals whether a person is positive within 20 minutes.  Alan has already tested 450 residents of his designated villages with 6 testing positive and 2 who were reconfirmed positive.

These patients will now be put on the life saving drugs that are provided for free by the Kenyan government.

Tomorrow, Dr. Paul our dermatologist arrives and will be working alongside Dr. Michael conducting a scabies clinic for children.  And the first of 2 days of cataract surgeries will begin.  A full day with lots more to report and stories to share.

Thanks for reading.

Stacy

Day 1: From Nairobi to Fluorspar

 The Medcan Naweza team including Dr. Michael Hawkes and Dr. Ed Bekeris and meets with the team at the Field Marsham Health Clinic during rounds

The Medcan Naweza team including Dr. Michael Hawkes and Dr. Ed Bekeris and meets with the team at the Field Marsham Health Clinic during rounds

Jumbo from Kenya!

After a restful couple of days at the Serena Hotel in Nairobi, the team has arrived refreshed and ready to go at Fluorspar Mines, the first of our 2 sister clinics we’ll be visiting on this trip.  It’s our 6th time here and we are eager to continue our work with our friends at the Field Marsham Health Clinic. 

The team this time round includes (more information on previous trips can be found here)

  • Dr. Michael -  founding father of Naweza who has been on every trip since the inception.  His background is pediatrics with specialties in HIV, malaria, global infectious disease and subtropical medicine.
  • Dr. Ed – General practitioner
  • Dr. Sidiqa – optometrist
  • Dr. Paul Cohen - dermatologist
  • Vanessa – nurse, heads up the complex care cases program we run remotely with the Kenyan clinics.  She’ll be working with the community health workers equipping them with a tool kit they’ll use when educating their community on the risks of chronic disease.

We have quite a bit packed in our 5 days here, including:

  • Didactic training and education focusing on chronic disease, peads, dermatology and optometry
  • Cataract surgeries
  • Lumps and bumps removals
  •  Further development of the Community Health Worker program
  • Outeach to Simit on Thursday

Tomorrow we’ll begin as usual with rounds.  Dr. Sidiqa will conduct the final screening for half of the cataract patients and begin training on the opthalmoscope which Naweza has donated to the clinic.

Vanessa will work with Helen and Allen, the Community Health Workers (CHWs).  She’ll be presenting the “tool kit” she’s developed - something created after the CHWs requested to help educate the community on chronic disease.  Later in the week she’ll be going with them into the community to test out the kit and further inform herself of the issues they are contending with.

We’ll also have the opportunity to conduct our bi-weekly Tuesday call between the Kenya clinic and Medcan in Toronto.  This will be the first time we will make the call with Medcan doctors in both Kenya and Toronto simultaneously.  The patients we’ll discuss are part of the Complex Care Case program whereby Naweza reviews and supports the Kenya clinicians on difficult cases.  Many times they are cases that require Medcan doctors to liaise with their global network of medical professionals to come up with diagnoses and treatment strategies.  It is a pathway for these clinics in rural Kenya to receive leading edge medical advice that they would never receive otherwise.  A huge opportunity for not only the Kenyan patient but, as well the clinician who will learn and thus help more Kenyans in the future. 

So, a busy day on tap for tomorrow.    But for now, a goodnight sleep is in order. 

Lala salama,

Stacy