Day 3 began with a full schedule of reaching out to communities with our partners. Sit down, because this is going to be a long entry!
On our way to the outreach in Ntumburi. That's Mount Kenya in the background.
We started the day in Ntumburi, a village about 30 minutes from Lewa Clinic. When we arrived, people were already lined up. And patients continued to arrive as the day progressed. Final patient tally: 104.
Arriving at Ntumburi. Patients wait in line. They arrived early before the clinic even opened.
On today's agenda:
Cervical Cancer Screening and Cryotherapy Procedure
Dr. Sue worked with Faith and Cecilia, another nurse from a government clinic, who assisted in the cervical cancer screenings.
Cervical cancer is a major concern in the developing world and with the vaccine being exorbitantly expensive ($300/patient), we have decided to incorporate training on the next best thing, screening.
Dr. Seth Berkley, CEO of GAVI, the vaccine alliance, says, “Of the 275,000 women who die of cervical cancer annually, 85% live in the world’s poorest countries. Cervical cancer is one of the leading cancer killers of women in the developing world.”
We’ve been told that a woman who is diagnosed with a small lesion and is told to go to the county hospital to receive treatment simply won’t go. Therefore it’s essential that if we find a minor lesion we must treat it if possible during the same visit. Otherwise the woman runs the risk of having the minor lesion progress into cervical cancer.
Dr. Sue and Cecilia, the government nurse, standing next to the cryotherapy unit, which is used to remove minor lesions on the cervix.
A cryotherapy unit is used to treat minor abnormalities. We bought one for the clinic prior to our trip but unfortunately it was back ordered and didn’t arrive in time. Luckily we’ve been able to use a second unit from the county hospital for usage during our trip. A clinical officer from the county hospital has also joined us and is able to receive further training on proper screening from Dr. Sue. It will hopefully prove to be a good partnership going forward.
Supplies for the cervical cancer screening including homemade cotton swabs and household vinegar.
At this particular outreach we did 21 screenings and discovered one abnormality. Dr. Sue and her Kenyan team were able to successfully remove the lesion with the cryo unit. This literally could save this woman’s life by having early detection with immediate treatment.
General Medicine and Chronic Disease
Dr. James worked with Geoffrey at the general medicine/chronic disease station. The conditions that were presented included potential kidney stones, metabolic syndrome (pre-diabetes) and diabetes. One of our observations is that as we are beginning to screen for chronic disease, the drug formulary (an official list giving details of medicines that may be prescribed) will need to change accordingly. Many times we found that the drugs that were brought from the Lewa pharmacy were inadequate for treating chronic disease illnesses. Our recommendations will include a model formulary and proper stock levels to ensure drugs are available at the time of need.
Dr. James and Geoffrey seeing a patient at the outreach clinic.
Emily, our new community health worker was here collecting data on chronic disease patients. Using her smartphone, she was able to digitally collect data on 70 patients.
Community Health Worker Emily records the blood pressure of a patient at the outreach clinic.
The high-risk patients (see photo below) were instructed to go see Dr. James and Geoffrey, who will begin a treatment plan that will be a combination of nutritional and lifestyle counseling and medication depending on their individual score. This was an excellent start to the program. Emily has kindly agreed to join us again on Wednesday when we open our second outreach clinic.
An alarming blood pressure taken at the outreach clinic. A normal score is around 120 over 80. This patient had no idea and felt relatively fine. The issue with chronic disease is that it is asymptomatic - so people don't know they are at risk of stroke, diabetes or other cardiac event. Through the screening program, this patient will receive treatment before such an outcome occurs. Preventive health at its best.
Peadiatrics
Dr. Michael worked with Lydia in the pediatrics area. A few cases involved children complaining of red/itchy eyes.
A little boy whose eyes are suffering from the smoke effects of having an open wood fire used for cooking in the house.
The likely cause after taking a history of the patients was that the red eyes are due to smoke in the house as it is quite common in this region to use an open wood fire when cooking. Many times the only exit for the smoke is the window that the fire is positioned next to resulting in eye irritations in the family.
Dr. Michael seeing patients at the outreach clinic.
The only treatment is education on proper ventilation. Unfortunately easier said than done when trying to change behaviour that is so embedded in the culture as well as limited resources.
Vision and Nutrition
While some of the Medcan Naweza crew were seeing patients at Ntumburi, Dr. Sidiqa and Alex were at a school to conduct vision screenings, teach health literacy sessions and perform nutritional assessments.
Dr. Sidiqa and Ezekiel worked until dark to examine patients. Rather difficult to do vision screening when only using a flashlight, but it would be worse to turn them away after waiting hours (all day for some) to be seen by the doctor.
Dr. Sidiqa had the opportunity to work with Ezekiel to continue training on general eye health explaining the difference between various eye infections. As well, she trained him to use eye charts so that they are able to determine if the child needs to come to the clinic for a full examination. Today the team screened 50 children. Ten kids likely require glasses. They’ll come to the clinic tomorrow to be examined using the auto-refractor and trial lens kit to determine their prescriptions for eyeglasses of which Naweza will provide.
Dr. Sidiqa also educated the children on proper hydration and its importance for healthy eyes, especially in this very dusty environment. She gave them water bottles and had each of them write their name on the bottle. She instructed that each must refill the bottle at the school tap at least once during the day to ensure proper hydration.
Alex providing dietary advice to a patient. This consult was virtually done in the dark with the only light provided was from my camera flash.
Alex had the opportunity to meet with the children and hear what they eat in typical day. The school actually had its own garden! The kids all have a role in maintaining the garden, which supplies the lunches for both the children and teachers. For lunch at the school that day was maize and beans with no greens. In comparison, interestingly, the teachers' bowls all contained greens.
She also had a chance to visit a market and see first hand what the Kenyans are buying and the cost of the food.
A sweet moment when this little boy, who had befriended Alex, jumped in the jeep with us when we were leaving. His mom eventually got him out of the jeep with the help of a lollipop we gave him.
Tomorrow will be another day of capacity building and training at the clinic. We’ll also have a chance to see patients who are more complex in nature. These patients are the ones we review on our bi-weekly call with the clinic when we are in Toronto, so the doctors are most eager to see them face to face.
That’s it for now! Thanks for reading. Be sure to check us out on Instagram and Facebook for more photos from the day.
- Stacy