Day 7: Farewell to Uganda

Jambo!

It’s hard to believe, but it is in fact our last full day at the hospital. It has been an incredibly productive visit with our new friends at Kambuga and we feel optimistic we can develop a program here that will benefit them.

We started the day with Dr. Rajiv doing a surgery in the OR with Vanessa and Dr. James as assistants, along with the other staff at the hospital. He removed a man’s enlarged prostate and was able to provide valuable training and insight on the procedure.

Dr. Michael did rounds in the pediatric ward. Very sadly a young 3 month old baby girl came in presenting with incessant cough and irritability. The diagnosis was whooping cough. The baby had 2 out of 3 of the required vaccinations, but with the vaccinations being incomplete she was at risk of contracting the disease. Dr. Michael measured her oxygen saturation and determined that the baby needed oxygen. Fortunately for the community in Kambuga, Dr. Michael has developed a technology that uses solar panels to power a condenser, turning air into pure oxygen. The solar panels also charge batteries so the condenser can be used at night. This allows the hospital to provide life-saving oxygen even when there are disruptions in the electricity, which is frequent.

 Solar panels installed on top of one of the buildings at the hospital. The panels provide energy to deliver oxygen to the patients.

Solar panels installed on top of one of the buildings at the hospital. The panels provide energy to deliver oxygen to the patients.

Dr. Sidiqa continued her training with Alex on the vision program. She is really happy with his eager to learn attitude and high level of ability. We only have so much time here, so it’s important to work with people that not only have the ability to learn, but the desire. Alex seems to have both. One of their patients was a burn victim. Hot milk spilled on his face five years ago leaving him with scarring on one side of his face affecting the eye as well. Fortunately he is able to see out of the eye, but he is unable to completely close his lid which causes many complications and increases his risk of infection. Dr. Sidiqa educates him on how to minimize the potential problems and discusses the issues with Alex as well so that he can continue to help the patient even after she leaves.

Dr. Michael also saw chronic disease patients in the outpatient ward. Based on the ability of the clinician he was working with and the medical records for these patients, he determined the hospital could benefit from some additional training. Our plan is to include education around chronic disease protocols in our program at the hospital.

 A chronic disease patient having his blood pressure taken.

A chronic disease patient having his blood pressure taken.

 Dr. Michael working with a nurse at the hospital while seeing a chronic disease patient.

Dr. Michael working with a nurse at the hospital while seeing a chronic disease patient.

For dinner we were invited to the home of John, who is an employee of Dr. Michael's here in Uganda and is the person who helped organize the Ugandan portion of our trip. It was a traditional Ugandan dinner prepared by 6 women. It was an impressive display of local food and I can only imagine a tremendous amount of work. The dinner included home grown vegetables such as cabbage, pumpkin, plantains and potatoes as well as meat stew and different soups. And of course the delicious pineapple and watermelon for dessert. Simply perfect. They were so gracious and kind and our group was immensely grateful to have been invited into their home. 

 A small part of all of the delicious dishes we were served!

A small part of all of the delicious dishes we were served!

 Dr. James and Dr. Rajiv with our host, John's father.

Dr. James and Dr. Rajiv with our host, John's father.

After 11 flights in 10 days, our trip has finally come to an end. We as a group feel like we’ve made considerable process on our initiatives and have even more ideas on how we can make an impact.

Once again, it has been a pleasure working with the members of the Naweza family. It is an incredible group and I’m so grateful for all of their hard work and commitment. Everyone who participates in this trip does so on a completely volunteer basis, taking precious vacation leave in order to come. Jen and Vanessa (my two “daughters” on the trip) are an absolute pleasure.  Always happy and smiling no matter the challenge. Their contribution to Naweza is year long and not limited to just the trips to Africa. They layer their Naweza duties on top of their daily work schedule at Medcan, and I know put in a huge amount of extra time. We are very lucky to have them.

Dr. Sidiqa, my dear friend at this point, has been a dedicated and loyal member of the Naweza family. Out of 7 Naweza trips, she has been on 5 of them. The vision clinics that we offer during our time at the clinics have provided amazing stories of people who are now eternally grateful for the gift of sight. She works tirelessly during our time at the clinics and hospitals providing training and education to the staff so that they can continue to care for their patients after we leave. I am immensely grateful to have her as part of our team.

And a special thank you to Dr. Rajiv and his wife Sandra who were willing to take a chance and come to Uganda with us and help assess the potential of a Naweza relationship with this hospital. The unknown is always a bit daunting, and we as a team really had little idea of what to expect with this hospital. We worked through some challenging times together and I am sincerely thankful that they were there to provide valuable insight into how we could improve the standards practiced at the hospital.

 Dr. Rajiv performing a prostate removal surgery and providing education and training to the hospital staff.

Dr. Rajiv performing a prostate removal surgery and providing education and training to the hospital staff.

Dr. Rajiv taught a CME to the staff on catheters as well as promoted themes around surgical safety procedures and streamlining pre-op care using a patient safety checklist. Most impressively, he performed multiple surgeries including a prostate removal as well as various pediatric urological procedures. These patients won the lottery of sorts as not only were they able to have their surgeries done at no cost, but the surgeries were performed by a surgeon of Dr. Rajiv’s caliber. I am sure they each feel incredibly blessed.

With Dr. Rajiv’s feedback, one of our ideas is to layer on to our SMS technology tool a screening test for prostate cancer which would be conducted by the Community Health Worker out in the field. Prostate cancer is one of the leading causes of cancer deaths in Africa.  The goal would be to do screening in order to identify those at higher risk of developing cancer. We would then bring a urologist with us once a year in order to do prostrate removal surgeries on those patients who do not have the financial means to pay for it themselves.

And a final big thank you to Dr. James and Dr. Michael, my fellow founding partners of Naweza. I feel very lucky to work with people who are at the top of their profession and who not only want to do something good in the world but want to have a good time doing it. We laugh our way through it all and with this spirit we have persevered since 2013 enduring many many challenges. But here we are now, beginning our own foundation with an innovative screening technology which enables Africans to identify conditions they are at risk for before that condition declares itself, thus resulting in better outcomes. There are countless applications for this technology, but our main focus at the moment remains screening for chronic disease. Our next step will be the Electronic Medical Record (EMR) which will allow the Community Health Workers and clinic/hospital to follow-up with those who have been identified as “at risk” in order to ensure that the patient is complying with their treatment strategy. Our goal is to have this ready by our next trip. Very exciting!

So, that’s a wrap! On behalf of the Naweza team, thank you for reading and for all of your support. Our next trip is planned for May 14th to 24th. So until then, make sure to keep following us on Instagram, Twitter and Facebook for updates on our programs. And we will continue to post photos from the trip throughout the year. We literally have hundreds and maybe thousands! Every moment is one you want to capture and remember always. We will be sure to share them with you!

 Our final charter flight back to Nairobi. Everyone passed out, except for (I hope) the pilots! Thanks for all of the hard work team! You have about 4 months to recover until the next one!

Our final charter flight back to Nairobi. Everyone passed out, except for (I hope) the pilots! Thanks for all of the hard work team! You have about 4 months to recover until the next one!

Keep well and best wishes,

Stacy

Day 5 & 6: Surgeries, training and a little miracle in Uganda

Jambo!

After 3 flights and (even worse) 5 security checks, we arrived in Uganda!

 On board the third flight taking us to Kahihi, Uganda, located on the western side of the country, bordering the Congo.

On board the third flight taking us to Kahihi, Uganda, located on the western side of the country, bordering the Congo.

We are so excited to be here. We are visiting a government hospital and evaluating whether we think Naweza could be of value here. And I’m happy to report we have been joined by Dr. Rajiv and Sandra and our team is now complete.

We made our way to our lodge which we chose because it is a two minute walk to the clinic (and also very cheap). The 35 minute drive to the lodge is beautiful. Rolling green hills and dusty dirt (and very bumpy) roads. There are people walking along the road everywhere, and from time to time a small town with loads of shops.

 The scene driving to the lodge.

The scene driving to the lodge.

We finally made it to our lodge at 5 PM and agreed we’d meet for dinner at 7 PM.  Dr. Michael and Dr. Rajiv went directly to the clinic to do pre-op on the patients Dr. Rajiv would be operating on the next morning. While they were there, a 3 year old arrived in the ER. He had been hit by a motorbike and had very bad head injuries, was unconscious and basically was not expected to make it through the night. Dr. Michael examined him and did what he could but his prognosis was grim. They left him with the mother and the nurse on duty and said that they’d be back tomorrow morning.

For dinner, we were joined by some of the Ugandans who had helped organize the trip.  It was already evident they had worked really hard to bring it all together and they were very appreciative of us being there.

 Enjoying our first dinner in Uganda with our new friends.

Enjoying our first dinner in Uganda with our new friends.

 Dr. Rajiv and I working on our blogs together after dinner.

Dr. Rajiv and I working on our blogs together after dinner.

After a good sleep and big breakfast we made our way to the hospital the next day.  Our plan for the day was:

  • Dr. Rajiv – perform three surgeries and give a CME in the afternoon
  • Dr. Sidiqa – work with the nurse dedicated to optometry and train on the auto refractor and trial lens kit
  • Dr. James – work with clinicians in the outpatient ward and train on chronic disease
  • Dr. Michael – do rounds in the paediatric ward and see patients in the paediatric outpatient clinic.
 The 3 year old child who had been hit by a motorbike and who made a miraculous recovery overnight.

The 3 year old child who had been hit by a motorbike and who made a miraculous recovery overnight.

First of all, I must share that the 3 year old not only made it through the night but was actually sitting up and eating bread and watermelon! It was truly a miracle that he pulled through, let alone so quickly! They will continue to monitor him, but certainly it appeared that he was on the road to full recovery.

During rounds we were joined by the hospital staff as well as about 20 nursing students who are in the last few months of their 2½ year program. They all huddled around Dr. Michael as he examined the patients and provided rich training and education. The cases that we saw included a patient who is suffering from congestive heart failure due to undetected rheumatic fever and a 2 year old who has cerebral palsy.

Dr. James had a good session with his clinician in the outpatient ward. His major observation is that some of the staff are actually quite well trained around chronic disease in terms of diagnosis and treatment. However, the hospital lacks resources and specific equipment. A model that may emerge out of our visit would be to focus our energy less on training and more on investing in pieces of equipment which would support the chronic disease program. We would continue to screen for chronic disease patients using the Community Health Worker program and then use the hospital as a referral center.  We also would like to identify a nearby clinic where we could provide training on chronic disease and then only send patients who are at risk to the hospital.

Vanessa met with a Community Health Worker and trained him on the chronic disease educational material that she prepared and gave to the Community Health Workers in Fluorspar and Lewa. It was our first time meeting him and we are quite optimistic that he will be a great addition to the team.

 Vanessa sitting with our new Community Health Worker and training him on chronic disease.

Vanessa sitting with our new Community Health Worker and training him on chronic disease.

Dr. Rajiv and Vanessa had a good day in the OR. He performed multiple pediatric urology surgeries on children and provided training to the hospital surgical staff while in the operating room. His main observation is that the staff are qualified, however the hospital would benefit from better surgical safety procedures. The hospital lacks adequate safety protocols before, during, and after surgery, which inevitably results in less than optimal results. He later gave a CME to the hospital staff which included a presentation on exactly this topic, highlighting to them that this is an area they need to improve.

 Dr. Rajiv and Vanessa after surgery.

Dr. Rajiv and Vanessa after surgery.

Dr. Sidiqa worked with Alex, the nurse at the hospital who is dedicated to optometry. She was quite happy and even relieved to find that Alex was very engaged and easy to teach. We had taken a bit of a chance because we moved the auto refractor, trial lens kit and ophthalmoscope from Fluorspar to this hospital in Uganda. This is an example of how we believe a model of providing equipment and training around that equipment will be beneficial given the higher level of health professionals here. 

Dr. Sidiqa and Alex saw about 20 patients, which allowed Alex to practice on the equipment as well as ask Dr. Sidiqa many questions. This will enable him to conduct vision clinics for the community, including assessing visual acuity and general eye health.

We finished the day with a CME lecture presented by Dr. Rajiv. He spoke to the hospital staff and nursing students about catheters and having proper safety standards for conducting safe surgeries.

 Dr. Rajiv speaking at the CME.

Dr. Rajiv speaking at the CME.

Finally it was the end of a very packed day and we were all very tired. Dinner was at a restaurant back at the airstrip, about 35 mins away. It was a great night, and again we were joined by the Ugandans. It was lovely.

Tomorrow we have a similar day planned, with rounds and surgeries in the morning and then outpatient clinics and CME in the afternoon. And of course Dr. Sidiqa will continue training with Alex.

But for now, a good night’s sleep!

Thanks for reading!

Stacy

Day 4: Come rain or shine, it's outreach day!

Jambo!

Day 4 was our outreach day and we were told it would be busy.  It was a Saturday and everyone was available to come in to benefit from the western doctors.  In fact, what we have found from doing many outreaches now is that people come in with complaints about issues they’ve experienced their entire life but were never able to ask a doctor. Can you imagine being a doctor and asking your patient, "When did this pain begin?" and having the patient answer, "45 years ago"?!  This is actually not that uncommon of a response and so we do what we can do, for as many people as possible.

 A baby giraffe on the way to the clinic. We've been told the mother left it about two weeks ago and has not come back. They assure us the baby is safe as this particular area is wired off and the lions can't get to it.

A baby giraffe on the way to the clinic. We've been told the mother left it about two weeks ago and has not come back. They assure us the baby is safe as this particular area is wired off and the lions can't get to it.

 My outhouse buddy!

My outhouse buddy!

The outreach was held at a school and we used the classrooms as our clinic examination space.  We arrived to a scene of dozens of kids playing soccer and running around in the field.   The community members were already lined up outside of the classrooms waiting for the outreach to begin.  We were then told that there would be many more coming later and that it would likely be a long day. Better get started! As always, the patients were triaged according to their ailment, however many of them would see multiple doctors given this rare opportunity.

I have a conversation with one of the nurses who works in the nearby district hospital. The Kenyan doctors are on day 57 of a strike. They currently make around $12,000 USD per year and are asking for a 300% pay increase. The government offered 40% but they turned them down, so the nurses at the hospitals are working double time as they take over many of the duties of the doctor. However, there are plenty of things that the nurses are not trained to do and ultimately it is the patients who suffer.  Nurses here are paid around $6,000 USD per year and I wonder to myself if they will be next to strike after the doctors negotiate their deal, thus continuing the struggle for the patient.

About midway through the outreach the rains come.  And do they ever come.  So we allow as many Kenyans inside as we can fit in order to keep them dry.  Let’s just say patients aren't as worried about confidentiality here.  People are literally on top of each other and peering in the windows openly listening to each other’s conversations with the doctors.  Nobody seems to mind.  It is so counter to what we are used to and we can’t help but feel a need to do something.  We try putting up a screen at one point, only to have the people peeking around it.  Then I ask Ezekiel, the clinic manager to ask the crowd to step back, only to have them creep even closer after 10 minutes.  So again, we do what we can do and accept that we only have so much control in this challenging environment.

All in all, our final numbers for patients seen were:

  • Vision Clinic: 35
  • Adults: 45
  • Children: 41
 A rather tame portion of the ride home allowing me to take a photo.

A rather tame portion of the ride home allowing me to take a photo.

It was now time to go home and unfortunately the rains caused the earth to become very soft and the air to become cold. The ride home is thankfully only 15 minutes long. But let’s just say, in Canadian terms, it was like driving on a few inches of snow with no snow tires in an open jeep, fishtailing all the way home. Everyone (except for maybe me) quite enjoyed the thrilling ride and thought it added to the adventure of the trip.

We were told that one of the locals said that they thought we brought the village blessings in that not only did we bring doctors but we also brought the rain. It has been otherwise quite dry and the vegetation has suffered. The rains are a much welcomed event and hopefully the people will benefit from Mother Nature’s will.

We say our goodbyes at the outreach as we will be leaving for Uganda on an 8 AM charter flight the next morning.  In our 3 full days with the Lewa staff we have achieved quite a bit. Most significantly, we’ve decided to hire a full-time person dedicated to Naweza who will work out of the Lewa clinic. This person will run our Chronic Disease Program, vision clinic, bi-weekly call, Complex Case program, manage the Community Health Workers and other Naweza initiatives at both Lewa and Fluorspar. Ezekiel is going to identify the person and manage the process for us. 

We’ve been told by many organizations who have programs in remote settings that ultimately it is key to have a local dedicated person who is running your program. With all of the initiatives that we’ve begun it has also become a bit of an issue at the clinic trying to manage the workload of the staff. I think Ezekiel is a bit relieved to hear our plans to hire someone, taking pressure off of his already fully busy staff.

Tomorrow will be a very big travel day: it will take no less than 3 flights to get to our final destination in Uganda! We will also finally meet up with Dr. Rajiv and his wife Sandra. Dr. Rajiv is a urologist who will be performing surgeries and training, and Sandra is a Registered Dietitian who will provide nutrition support to the doctors.  It will be nice to finally have the whole team together as we embark on the last leg of our journey!

That’s all for now.  I’ve attached below a loop of some photos of the kids who were watching me with curiosity when I was working on the blog. They love to have their photo taken as you’ll see from their faces. I hope you enjoy the photos as much as I did taking them!

Stacy

Day 3: The importance of dedicating time to training

Jambo!

Another fantastic day here at Lewa! After a visit by the monkeys and a delicious breakfast of sausage, eggs, fresh local fruit and homemade bread prepared by the lovely staff at Ngiri house, we head for the clinic.  

 A giraffe on the way to the clinic!

A giraffe on the way to the clinic!

 Dr. Michael and Dr. James working on their presentations after breakfast.

Dr. Michael and Dr. James working on their presentations after breakfast.

We can’t complain about the commute in. In fact, it may be the only example of a drive to work that you hope doesn’t end! Between the impala, giraffe, zebras, and other animals, it is simply beautiful. It exudes a peaceful tranquillity that I don’t experience anywhere else. After seven trips here, I can honestly say the beauty never gets lost on me.

We arrived to a warm welcome from the staff and the patients waiting to see us. But first we had planned a morning of teaching, which included more training on:

  • approach and management of diabetes and hyperglycemic emergencies in remote areas
  • approach and management of pyrexia of unknown origin in pediatrics
  • pediatric gastrointestinal emergencies and disorder management in remote areas
 An open and interactive discussion on diabetes and hypertension. The staff have an opportunity to talk about specific complex cases that they've encountered and are able to obtain valuable insight by the doctors.

An open and interactive discussion on diabetes and hypertension. The staff have an opportunity to talk about specific complex cases that they've encountered and are able to obtain valuable insight by the doctors.

 Dr. James giving a talk on the management of hyperglycemic emergencies.

Dr. James giving a talk on the management of hyperglycemic emergencies.

I think it’s important to point out that these topics were requested directly from the clinic. As much as our goal is to implement our chronic disease program, we want the clinic to know that we are their partner and want to address the issues that they are contending with on a daily basis. It’s a bit of a balance, but we believe that the best approach is one where we build trust with them, assuring them that we are here to help them on the topics that are affecting them most and not simply imposing our own program oblivious to their areas of urgent need.

 Vanessa and Jen working on a presentation together.

Vanessa and Jen working on a presentation together.

The second half of the day is reserved for seeing patients. Dr. Michael to see the children, Dr. James to see the adults and Dr. Sidiqa continued the training with Lydia on the auto refractor. Vanessa brought out her stickers for the younger patients and kids gathered at the clinic.

One of the issues we’ve encountered is within the vision program. After the last trip we decided to fund an ophthalmologist to come to the clinic on a monthly basis in order to continue the training with Lydia on the vision equipment and eye care.  Unfortunately, as it goes when trying to implement things remotely, it didn’t go exactly to plan. Basically, the ophthalmologist was providing a weekly vision clinic without providing any training to Lydia. Although it’s good that the community was receiving eye examinations once a month, Naweza’s goal is to build capacity at the clinic so that they can conduct the eye clinic themselves. Dr. Sidiqa and I had a meeting with Ezekiel, the clinic manager, Stephen, the county ophthalmologist, and Lydia, the clinical officer, on our thoughts on how to move forward. I told them that this wasn’t about outsourcing the eye program. Naweza’s goal is to provide education and training to the clinic so that they can operate at a higher level without external help. Overall it was a positive meeting. I believe our expectations were well understood and appreciated and I’m hopeful we’ll now continue on the right track. We shall see….

 Dr. Sidiqa and Lydia (wearing an "eye chart" t-shirt we gave to her).

Dr. Sidiqa and Lydia (wearing an "eye chart" t-shirt we gave to her).

Dr. Sidiqa and Lydia had a solid day of training in the vision clinic.  Lydia was able to practice on the auto refractor and trial lens kit as well as receive lots of education on eye health.  They were also able to distribute prescription glasses that Naweza sponsored for 12 people.

It is especially meaningful when the children receive the glasses, giving them a better chance at doing well in school.  We’ve seen too many examples where the kids perform poorly in the classroom not because they are not capable students but because they simply can’t see the chalkboard.  This will hopefully improve their confidence and make a lasting impact on their future.  

 Dr. Sidiqa with a young patient.

Dr. Sidiqa with a young patient.

Dr. James’ last patient was a 42 year old man who presented with his left eye swollen shut and dramatic weight loss.  He was found lying down on the side of the street and two “Good Samaritans” picked him up and brought him in as they knew that “mzungu” (white people) doctors were at the clinic and perhaps they could help him.  After examination by Dr. James and Dr. Michael it was concluded that he likely had complications from HIV.  He would require further testing to confirm the diagnosis. A very sad case to end on, and unfortunately it is not uncommon to see cases this severe.

Tomorrow will be a day of outreach at a village not too far from the clinic. Ezekiel has organized for extra staff to come in so that his main staff are all able to go to the outreach to continue their training and education. However, the main emphasis is not on training; the purpose of the outreach is to see as many patients as possible, build trust in the community and to stay in touch with their most prevalent health issues.

The weather report is calling for rain, which always adds a layer of challenge. But we just take it as it comes here. All I can assure you is that it will be an adventure.

That’s all for now.  Thanks for reading!

Stacy

Day 2: Providing care and education through Community Health Workers

Jambo!

Dr. Michael, Jen and I had a fantastic day at Fluorspar.  We were really encouraged by the energy and enthusiasm of the staff and the Community Health Workers.  Considering our need for an early departure, we were worried our schedule was too ambitious.  An early start was necessary to keep us on track.

 An adorable little girl who came to the clinic with her mother.

An adorable little girl who came to the clinic with her mother.

We began with rounds and seeing some of the patients who are part of the Complex Case Care (CCC) program. If you read my blog from this past July, you may remember a young pregnant woman who presented with chronic asthma.  I had asked about her yesterday and the staff had told me that she was doing well and was due to deliver in a few weeks.  Well, in fact, she happened to deliver early this morning!  Imagine the timing.  It was the perfect opportunity for Dr. Michael to conduct a neonatal examination on the baby, which was a great teaching case for the staff.   I’m happy to report that baby and mama are doing very well!

 Dr. Michael demonstrating a neonatal examination on the newborn baby of the asthmatic mother.

Dr. Michael demonstrating a neonatal examination on the newborn baby of the asthmatic mother.

A bit of a success story involves a young man who is part of our CCC program.  He is a 26 year old with poorly managed type I diabetes, resulting in a myriad of complications including weight loss (he’s now 90 pounds and 5’9”) and numbness and tingling in his feet. Today, he came in with ulcers on his face - another complication of his diabetes.  The issue is that he has not been taking his much needed insulin because he doesn’t feel comfortable injecting himself.  We have Julius, the clinic manager, express to him the importance of being on insulin and that his issues are only going to get worse.  We can treat the ulcers with antibiotics today, but the chance of their recurrence is high. We also introduced him to one of our Community Health Workers, Alfred, who lives close to him. After talking to Julius and Alfred, the patient agreed to start taking insulin! We explained to Alfred that he needs to do weekly visits to see the patient and continue to counsel him on the importance of the insulin.   We will continue to follow him bi-weekly through our CCC program.  We are cautiously optimistic that he will finally begin his treatment and be vigilant in its practice and hopefully show considerable improvement by getting his diabetes under control.

 Dr. Michael introducing Alfred, our Community Health Worker, to a 26-year-old diabetic patient who will begin insulin treatment. Alfred will be visiting him on a weekly basis for support and to ensure adherence to the treatment strategy.

Dr. Michael introducing Alfred, our Community Health Worker, to a 26-year-old diabetic patient who will begin insulin treatment. Alfred will be visiting him on a weekly basis for support and to ensure adherence to the treatment strategy.

Next, we met with the three Community Health Workers in order to present them with a comprehensive chronic disease binder that was developed by Vanessa. The contents of the binder have been inspired by the feedback and requests of the health workers. We want them to have the tools to educate the community on diabetes, hypertension and other non-communicable diseases and answer any questions the community may have. The Community Health Workers are typically not health professionals, but they are highly respected members of the community who are able to counsel people and refer them, if necessary, to the clinic.

 Jen meeting with the Community Health Workers. She is introducing the chronic disease binder, which is a tool kit enabling them to be better equipped to answer questions and educate people when they screen for chronic disease.

Jen meeting with the Community Health Workers. She is introducing the chronic disease binder, which is a tool kit enabling them to be better equipped to answer questions and educate people when they screen for chronic disease.

We asked the Community Health Workers to share their experiences when out in the field.  Overall, it is mostly very positive.  However one of their biggest issues is that our screening only includes people over 40 years old, so when they encounter someone under 40, many of those people are upset that they aren’t being tested.  The health workers advise them that the test sets the minimum age at 40 because the World Health Organization guidelines only outline the risks for clients over 40.  Despite the explanation, the people are still upset as they feel left out.  They want to know what the community member is going to do for them.  The fast and easy fix is for the health worker to take the blood pressure regardless of age and simply not enter into the system.  But it speaks to the importance of making sure the entire community feels included and taken care of.  As we build onto the chronic disease program we will take this into consideration, keeping in mind the interests of the entire community and not just one segment. But for now it is important to remain focused on our main initiative of identifying those at risk of chronic disease.

After our discussion with the Community Health Workers, it was time to return to the main house, have lunch and head for the airstrip. We arrived at the airstrip with a huge crowd surrounding our plane that quickly scattered when we approached.  It is an all too typical scene at the airstrip: the Kenyans gathering to wave hello and goodbye to the visitors.  So indicative of the warm and lovely spirit that exists here.

 The Kenyans seeing us off at the plane.

The Kenyans seeing us off at the plane.

Next stop was Lewa Downs where we were reunited with the other half of the team.  We landed in the middle of safari land - a surreal scene that is impossibly beautiful.

 The scene stepping off of the plan at Lewa Downs.

The scene stepping off of the plan at Lewa Downs.

Tomorrow will be a full day at Lewa which will include didactic training in the morning and seeing patients in the afternoon.  We will meet with our community health worker, Emily and further discuss the chronic disease kit which Vanessa presented to her today.  We’ll also have a chance to see some of the Complex Case Care patients to see how they’ve progressed.

That’s all for now.  Thanks for reading!

Stacy

Day 1: Getting off to a great start despite getting stuck in the mud!

Jambo!!

We have arrived back in Kenya ready for another adventure and productive 10 days with our sister clinics here as well as a new addition, a clinic in southwestern Uganda close to the Congo border. It will be interesting to say the least!

The team on this trip is comprised of:

Dr. James Aw – Medical Director of Medcan, general practitioner and one of the Founding Fathers of Naweza

Dr. Michael Hawkes – pediatrician, subtropical medicine and global infectious disease specialist and a Founding Father of Naweza

Dr. Sidiqa Rajani – optometrist and founder of the Naweza Vision Clinic

Jennifer Mannik – Senior Operations Associate at Medcan, Medical Protocol and Program Development

Vanessa Churchill – Nurse at Medcan, head of the bi-weekly call between Toronto and Kenya, manager of the Community Health Worker Program

Dr. Rajiv Singal – Medcan Director of Urology who will join us in Uganda

Given our desire to visit all three clinics (set in two different countries!) we will need to cut short the duration in each and divide and conquer.

After a fantastic day and a half at the Serena Hotel in Nairobi where the team had a chance to discuss the week ahead, half of the team headed to Fluorspar Mines and the other half to Lewa Downs Conservancy.  

 A food kiosk outside the Serena Hotel.

A food kiosk outside the Serena Hotel.

Dr. Michael, Jen and myself headed to Fluorspar on our 50 minute charter flight down into the Kerio Valley. We were told that the airstrip on which we were landing was potentially too muddy for landing, but they were “hopeful all would be ok." So we boarded with a bit of trepidation and we bumped along to Fluorspar in the hot humid air. I’m happy to say we landed with no issue however as the plane made its turn the front wheel became stuck in the mud. Luckily there was the usual welcoming crowd of neighbours, school kids and thankfully this time, about 20 young men who are part of the National Youth Service. Their school just happens to be next to the airstrip and for fun they will come to watch the planes land and take-off. They were kind enough to help the pilot and co-pilot push the airplane out of the mud (apparently the plane is “really light”) while we watched from our vehicle. After the plane was freed from the mud, the pilot repaid the good samaritans by allowing them to climb onto the plane to take each other’s photos, resulting in lots of smiles and laughs.

 The NYS students helping push the plane out of the mud.

The NYS students helping push the plane out of the mud.

After lunch we met with a member of Fluorspar’s management team to discuss the future at the mine. As you may remember, Fluorspar was forced to close the mine just before our last trip in July due to a new entrant in the market who is able to produce a high quality fluorspar at competitive prices. This has been devastating to the community as Fluorspar Mines is basically the sole employer in the valley. Without it, the people literally have minimal to no employment options. Most have refused to move and are remaining in their homes praying that the competitive climate will improve and the mine will reopen. Given the cyclical nature of the mining industry, the people are optimistic that things will pick up and the mine will resume operations.  The question is: when. The clinic’s operations are funded by the mine and with its closure the future of the clinic is uncertain. For now the mine has decided to keep the clinic open and it seems business as usual, albeit a bit slower.

We then headed to the clinic and met with Julius, the clinic manager, and Noah, one of the clinical officers. We discussed the morale of the clinic staff and community. He said that despite the obvious stress that everyone is under, people are doing okay. They are a tough and resilient community and they very much appreciate the generous spirit of the owner of Fluorspar Mines who has agreed to fund the clinic and the school for the time being.

 Jen and Dr. Michael auditing the Chronic Disease data and ensuring the patients who have been identified as at risk are being followed up properly.

Jen and Dr. Michael auditing the Chronic Disease data and ensuring the patients who have been identified as at risk are being followed up properly.

 Reviewing the Chronic Disease data on the computer provided by Naweza. The Community Health Workers have screened over 3,000 people over the age of 40 to identify those at risk of a cardiovascular event in the next 10 years,

Reviewing the Chronic Disease data on the computer provided by Naweza. The Community Health Workers have screened over 3,000 people over the age of 40 to identify those at risk of a cardiovascular event in the next 10 years,

We were happy to find that the Chronic Disease Program which we have begun here at the mine is doing very well.  The three Community Health Workers we’ve hired have screened over 3,000 people over the age of 40 for cardiovascular disease (CVD) risk utilizing an SMS technology which measures 5 data points of each patient. 

We are proud to say that Naweza is the first to utilize this WHO CVD risk protocol in a novel mHealth tool, which empowers community health workers to screen for chronic disease in their communities. 

 Apparently a rooster decided to "write" an email by pecking on this keyboard and in doing so damaged the keys. The computer was provided by Naweza to help manage the Chronic Disease program.

Apparently a rooster decided to "write" an email by pecking on this keyboard and in doing so damaged the keys. The computer was provided by Naweza to help manage the Chronic Disease program.

Our next step, which we are currently in the process of developing, is to build an EMR (Electronic Medical Record).  This EMR will enable the clinicans to follow-up with the patients ensuring that they are adhering to their treatment strategies, thus resulting in better health outcomes.

Tomorrow our plan is to:

·        do rounds in the morning

·        provide didactic training on diabetes and COPD (Chronic Obstructive Pulmonary Disease)

·        train the Community Health Workerson HIV and hear their thoughts on how they think the program is doing

·        see the patients who are part of the Complex Care Case program

We will then leave on an afternoon charter flight to Lewa Downs Conservancy where we will meet up with the other half of our team. We look forward to an update from them on how their first day went with the Lewa team.

That’s all for now. Thanks for reading!

Stacy