Chronic Disease

Day 3: Cervical Cancer Screenings, Cryo Procedures, Chronic Disease Assessments, Vision Care, Nutrition and more...

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. 

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. 

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. 

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. 

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. 

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. 

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. 

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. 

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. 

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 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 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. 

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

Day 2: Another great day with the Lewa Team

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. 

Dr. James giving a talk on chronic disease, which included a review of the World Health Organization's guidelines. 

Dr. James giving a talk on chronic disease, which included a review of the World Health Organization's guidelines. 

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.

Emily, the community health worker, practising taking blood pressure on Dr. James Aw. 

Emily, the community health worker, practising taking blood pressure on Dr. James Aw. 

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.

Geoffrey, one of Lewa's nurses asking Dr. Michael a question. 

Geoffrey, one of Lewa's nurses asking Dr. Michael a question. 

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.

The view from our lodge. 

The view from our lodge. 

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.

A friendly tortoise joined us for lunch.

A friendly tortoise joined us for lunch.

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. 

Dr. Sue leading a talk on Pelvic Inflammatory Disease, one of the topics requested by the Lewa staff. 

Dr. Sue leading a talk on Pelvic Inflammatory Disease, one of the topics requested by the Lewa staff. 

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. Sue answering a question from Faith, who will be Dr. Sue's partner over the next few days during the cervical cancer screenings. 

Dr. Sue answering a question from Faith, who will be Dr. Sue's partner over the next few days during the cervical cancer screenings. 

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. 

Dr. Michael and John conducting a talk on HIV together. 

Dr. Michael and John conducting a talk on HIV together. 

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.

A friendly snake keeping warm in my bathroo.

A friendly snake keeping warm in my bathroo.

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! 

The Lewa Lodge staff pushing the snake back down the hole it came from. 

The Lewa Lodge staff pushing the snake back down the hole it came from. 

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!!

- Stacy