Today was another full day. The community has heard that doctors from the West are in town and so the crowd has grown. The clinic was also full of patients we had referred from the outreach clinic the day before, including children to be seen by Dr. Sidiqa for vision examinations and chronic disease.
Dr. Sue began the didactic training with a talk on urinary tract infections. She spoke about the protocols for prevention, diagnosis and treatment that the staff can follow. She specifically spoke about the importance of treating pregnant women due to the fact they run the risk of pre-term labour if untreated. Also, a very common natural treatment for UTIs is cranberry juice but cranberry juice is not available here. There is no natural alternative available here, another reminder how this is a challenging setting where options easily accessed in the west are simply not options here.
Dr. Sue also informed the team that new findings recommend that the length of treatment on antibiotic is now 3 days instead of 7, which will help reduce unnecessary usage,expenditure on expensive antibiotics and the spread of antibiotic resistance.
We will provide written protocols for the team so that they can begin to utilize a systematic approach to diagnosis and treatment in order to improve outcomes.
Neo-Natal Resuscitation Education
Dr. Michael led a 2 hour course on neo-natal resuscitation called Helping Babies Breathe.
John, Faith, Joy and Lydia were present and taking lots of notes. Dr. Michael made the course quite interactive posing questions throughout the session. The staff was taking turns reading out loud and answering questions, as well as posing their own on past cases. He reviewed the supplies the clinic currently has including their oxygen unit. After evaluating the equipment it was discovered that the plug was missing, the mask was not inflated and it was too big for most babies.
One of the key messages of the Helping Babies Breathe program, is the “golden minute”, the window of opportunity to save lives at birth.
Dr. Michael stressed the importance of having the unit absolutely ready at all times because when there is an emergency and a baby is born “flat” the last thing you want to have happen is that your machine is not ready.
Children's Vision Care
Dr. Sidiqa worked with Geoffrey and Ezekiel on training of the auto refractor and trial lens kit.
Once they had a base level of knowledge she invited the school children she examined yesterday and had referred to the clinic for a full examination. Out of the 50 she examined yesterday and the 10 that were referred from that screening, 4 actually require glasses, which will be provided by Naweza.
It was a long day of training but she believes they will have enough skills to continue the eye clinic in order to bring consistent care to their community after we leave.
Dr. James saw patients during the morning alongside Duncan. Many of the patients are from the clinic yesterday who were referred to the clinic for the chronic disease program. One patient was a 42-year-old man who had suffered a stroke. He has semi-paralysis on his left side and used a cane to walk.
He is an example of why we want to implement the chronic disease program here at Lewa. His stroke was likely preventable.
If he had been screened for chronic disease he would have received a risk score of at least orange given that he has high blood pressure, and is a drinker and a smoker. He would have been put on medication and counseled on lifestyle and nutrition strategies. His outcome could have been different. The goal now is to prevent him from having another stroke or other cardiac event by putting him on medication.
He also provided training on doing a proper knee examination on an older woman who has severe knee pain with swelling. The diagnosis was to be put on anti-inflammatory for a week and then re-examine her. The additional learning was determining the right medication given that she has high blood pressure. The drug combinations can be dangerous and should be determined carefully.
Preventing Illness Through Nutrition
Alex had an opportunity to visit with around 100 of the Lewa Wildlife Conservancy's security personnel, which represents the largest portion of the Lewa staff. We’ve learned that they often suffer from illnesses as they work deep in the rural area and cook for themselves. The symptoms of these illnesses suggest nutritional deficiencies. We’ve been asked to assess their diet to determine what is missing and how they can fill in those gaps.
One solution suggested was to build gardens near their outposts enabling them to grow vegetables that are lacking in their diets. The security guards would maintain the gardens providing a sustainable approach to improving their diets and health.
Complex Case Care Program Review
Dr. Michael and Dr. James also had an opportunity to see patients that are part of the Naweza Complex Case Care program whereby every other Tuesday Naweza doctors in Canada use Skype to connect with the clinical officers in Kenya in order to discuss the difficult cases. The cases presented are ones that are complex in nature and on-going. The Canadian doctors are able to access their professional networks to get more specialized opinions. One of the cases involves a young girl with juvenile rheumatoid arthritis.
Naweza doctors have been following this case for a few months now. We are at a point where she has been diagnosed and stabilized and are now working with a physiotherapist who is recommending strategies for feeding and dressing herself. Her mother has told us that she gets very tired when she is writing at school. We will consult with specialists at home to give strategies on how she can function for effectively at school.
Minor Surgery, Major Relief
We ended the day with Dr. Sue removing a large splinter (a total understatement) from the side of a little boy’s face. Dr. Sue injected him with Novocain and proceeded to cut an incision to remove the particle. Apparently thorns and large splinters frequently get lodged in people’s skin and eyes. Children many times lose eyesight because an acacia thorn gets stuck in the eye. The acacia tree is common in this area and the thorn is what the elephants and giraffes eat.
Back at the Lodge: Snack Check, Check!
So back to the lodge we went. I decided to work on the blog in my room before dinner. Did the quick snake check in my bathroom and it was all clear. The toilet paper still stuck in the hole. Phew. So I relaxed and sat on my bed, sipped my tea and typed away. After about 30 minutes I just happened to look up only to find a small little black bat!
Once again the Kenyan staff came to the rescue and swatted it out of the room with a long stick. And I must say I felt a tiny bit better when they too screamed a little when the bat would swoop down in the room while they were trying to guide it out. However, ultimately they were far braver than I evidenced by hiding behind the door every time the bat flew across the room. The Kenyans are tough people who endure a life much harder than we can imagine in our world. This story paling in comparison to other issues that we’ve witnessed in our short time here.
Tomorrow is another outreach and we’ve been told it will be busier than the first. So a good night's sleep is in order and everyone retires early in anticipation of the large crowds. I myself have resorted to not only using my mosquito net which of course is mandatory but now tucking it under around my bed to minimize the chance of any other “friends” keeping me company while I sleep. Fingers crossed for a quiet night.
Until tomorrow…and thanks for reading!