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