Day 2 began with Dr. James giving a talk about chronic disease, including the World Health Organization’s guidelines for assessing risk for prevention of cardiac disease.
We also had an opportunity to meet our new community health worker Emily who will help assess the risk of members of her own community. She’ll be using her cell phone to input 5 pieces of data on each person, including blood pressure, gender, whether they smoke, drink and/or a diabetic.
She inputs the data in her phone and then transmits the data to a computer residing at our other sister clinic Fluorspar. An SMS message is sent back to her indicating a risk score for cardiac disease. The score is either a green (no need for treatment) or yellow, orange or red indicating the person must go to the clinic to begin treatment. We’ve been using the community health worker program successfully at Fluorspar and are really excited for the potential at Lewa. Emily will be joining us tomorrow as well at our outreach working alongside Dr. James in order to begin the screening program.
Next, Dr. Michael had a talk on respiratory infectious disease for babies mostly focused on pneumonia and cough/cold. The clinic was quite engaged with lots of questions. One of the main goals was to provide training on when a patient requires antibiotics. Most of the time when an infant comes to the clinic with a respiratory issue, the infection is viral and not bacterial and therefore doesn’t require antibiotics. The tendency in the developing world is to overprescribe antibiotics and this unfortunately promotes antibiotic resistance -- a problem being dealt with worldwide, even in Canada and the U.S. However in low-income and low-resource countries like Kenya it is exacerbated by the fact the mothers or patients walk so far to come to the clinic and don’t want to go home empty handed. We discussed strategies on how to minimize overprescribing including following proper protocols when diagnosing in order to determine if the infection is bacterial or viral, as well as providing education to the patient on why they are not receiving antibiotics and guidelines on when it is recommended to come back to the clinic for another examination.
Dr. Sidiqa began training with Ezekiel on eye health and vision screening. The skills she’ll be teaching will enable him to better diagnose eye infections, conduct vision screening and operate the auto-refractor and trial lense kit in order to determine the prescription for glasses as well as readers. The ultimate goal is for him to begin a weekly vision clinic at Lewa whereby he’ll see patients from the community who require care. We’ve also identified a local supplier who will provide the glasses at affordable rates for the local residents. Naweza will also support the program by supplying readers throughout the year and glasses for programs we run while here.
We went back to our lodge for lunch and picked up the last member of our team, Dr. Sue (our OB/Gyn) who had just arrived at Lewa airstrip an hour before. We enjoyed a beautiful lunch in a stunning setting. And even had a special visit by a friendly tortoise.
Despite being completely jet lagged (such a trooper as she showed no signs of it!) she was the first on after lunch for a didactic session on Pelvic Inflammatory Disease (PID). The staff had several questions as they treat women for this sort of issue frequently.
The main discussion was about trying to determine whether the symptoms presented are PID or another condition. In the absence of diagnostic tools such as an ultrasound the ability to make a diagnosis are limited. This of course is always the problem here as the resources are in short supply. It is a difficult situation. The goal is to give them protocols and training so that when these patients present themselves they can make educated guesses and treat or triage accordingly.
Dr. Michael then did a talk on HIV. In fact he did it alongside John, the clinic’s expert on HIV. They were a perfect duo as Dr. Michael knows all of the prinicples of HIV and John knows the Kenyan guidelines on treatment.
One of the cases that came up by Lydia, a nurse at the clinic, regarded a member of the Maasai tribe who is HIV positive and refuses to go on meds due to the social stigma associated with HIV within the Maasai culture. Apparently, whatever happens within the community is public knowledge and if she goes on meds, word will get out that she’s being treated for HIV. She would rather succumb to HIV than have the community find out that she has the disease. The worst and most devastating part is that she is pregnant and actually has an excellent chance of delivering an HIV-free baby if she receives treatment. In fact, she has already had one baby who has died because she refused treatment. The progression of the disease is much quicker with babies, with mortality occurring often within the first year. It is truly heart breaking. But I think is an example of how HIV is not just a medical problem but social one as well.
The rest of the day was spent seeing HIV patients, chronic disease patients, and preparing for our outreach tomorrow. We have quite a bit planned for the outreach including, vision screening at a school, cervical cancer screening, chronic disease, pediatrics and nutrition.
Alex, our dietician will also have an opportunity to speak with children at the school about nutrition as well as a nearby market to assess what foods are available here so that she can make relevant recommendations to them with regard to the nutrition program.
So to finish this busy day off, I go home and use the washroom in my bedroom only to find a little “friend” waiting for me. A cute little black snake!
You truly never know what you’ll get here. Fortunately the staff at the lodge managed to get him to go back down the tiny hole he came from and plugged it with some toilet paper!
Let’s just say I’ve had more restful sleeps at Lewa Lodge! But I will say, no matter what you might have been afraid of during the night, the beautiful mornings always more than make up for it. It’s a special place with very special people. We are most happy to be here and are looking forward to our outreach tomorrow when we can visit more with the broader Lewa community.
That’s it for now. Will report back tomorrow with lots of photos from the outreach and stories from the day!
Thanks for reading!!