Day 8: Goodbye for now!

Jambo!

Our last morning at Lewa has arrived and we will be departing for Nairobi just after lunch.  Hard to believe that our time here has come to an end.  It’s been a fantastic trip once again, with the team making great strides on our Chronic Disease and Vision programs.  The clinic staff seemed to be very receptive to all of the Continuing Medical Education sessions, asking many questions and absorbing as much knowledge from our doctors and nurses as possible in the short time we had with them.  

We also made progress in solidifying our relationship with Lewa.  We think it will be a fruitful partnership for many years to come for both of us.  Our hope is to develop a template that we can take to clinics throughout the NRT, the consortium of about 30 conservancies in Kenya.  Saving human lives and animal lives.  It’s a good fit!

And of course, the best part of this trip for me is being part of a collective of people who come together to do something good simply because it’s the right thing to do.  All of the doctors and nurses who support Naweza do so on a strictly volunteer basis.  And although we feel privileged to stay in nice accommodation at Lewa, the days are long and hard.  The doctors see complicated cases that many times they’ve learned about in medical school but have actually never witnessed in their practices.   These are often illnesses and diseases that really only occur in rural, low-income settings.  We try to provide some information prior to the trip, but nothing really prepares you for what you’re going to see. The access to testing is limited, so experience and intuition are many times all you have to go on.

Protocols, such as the one we use for our Chronic Disease screening program, help in these resource-limited locations.  They use very simple criteria and are a good tool when out in the field going door to door doing active case detection.  And it is simple enough that we can task-shift this job to a Community Health Worker, reaching more people for a fraction of the price.

So this is it.  I’ve just spent the last 9 days with some of my favourite people in the world.  Smart, funny, selfless, easy-going and with a sense of adventure.  A special welcome to Dr. Tanya who did an amazing job teaching and training the local clinicians, always with a lovely energy and smile.  Although she didn’t speak Swahili, she had an incredible way of connecting with them and the patients. And to Kristen, our nurse; when she was not assisting the doctors, being a model for abdominal exam teaching sessions (thank you!), or giving presentations, she was our official bug killer.  She might be the bravest Naweza family member ever!

Our next trip is planned for January 7 to 17th.  We will continue with our work on the EMR, hopefully launching it in January.  Danet, our IT person, worked on it with Dr. Michael and Jen throughout the week and has made good progress, but there is still more to do and we want to get it right before presenting it to the clinic.

So until then, thank you for reading.  And don’t forget to keep up with us on Instagram (@medcannaweza) and Facebook.  We’ll continue to update throughout the year on our progress and share our many photos we’ve all taken, capturing the many moments together as we help this special community.

With best wishes,

Stacy ☺

“Practicing medicine abroad is more similar than different”: Guest Blog by Dr. Tanya Stone

On this trip to Kenya, many of the patients came in with complaints mirroring the sorts of things I see at my clinic in Toronto. Together with the local clinicians, we saw one case in particular that really highlighted some of the differences, and more surprisingly a few similarities that I wasn’t anticipating.

Dr. Tanya presenting during our Continuing Medical Education (CME) sessions

This patient was a soft spoken young woman who had come to the clinic to get an opinion about her fertility. She had been trying to conceive for almost a decade with no success. She had seen a doctor in another city who had ordered some testing, but in the end recommended IVF. She came hoping for another answer. IVF, though available in parts of Kenya, is prohibitively expensive. The cost is approximately 300,000 Kenyan shillings, which is the equivalent to about $3,000 USD. To put that into perspective, the gross national income per capita in Kenya is $1,380 USD per year.

As with any other patient, we began from first medical principles and collected a thorough history. We went through an extensive list of questions about her general and gynecologic/reproductive health. She was healthy otherwise and complained of no symptoms.

We also reviewed the results she had brought with her. She had done bloodwork which showed that some important hormones were functioning properly, which was reassuring. Her husband had done a semen analysis which was also normal. She also had several ultrasounds over a five year period, showing some signs of inflammation.

Though there are many causes of this, my immediate thought went to an infection, as this is a common reason for scarring which leads to infertility. When we probed further into these possibilities, she explained that she had previously been treated for some type of pelvic infection, but was unsure of the details. 

After completing the history, we then proceeded to do an exam. She did have some findings that would be clinically consistent with possible scarring and possible infection. Unfortunately, due to our remote location, lab testing and imaging is extremely limited. After completing the exam, we returned to the clinic room to chat further.

We had a long discussion with the patient. With the resources available, we really had very limited options. We were able to offer basic counselling, education and a management plan going forward. We reviewed the basic recommendations for any patient trying to conceive, such as the importance of folic acid and timing for trials of conception. We talked about treating her and her husband for a possible infection to halt any potential future scarring. The hard truth was, the scarring that was already present was likely not easily reversible. We also suggested she revisit a fertility specialist to discuss IVF and other options that might be available including monitoring or surgery for the scarring. She was on board for all of the above and would follow up as needed.

This patient encounter highlighted a number of things for me. The first is the universality of many conditions, like infertility, even in the developing world. I was initially surprised by the fertility concern; It hadn’t occurred to me that I would be consulted on fertility issues while in Kenya.

Fertility concerns cross borders and oceans and cultures. This patient was just like any other patient I have ever seen for this issue, just halfway around the world. In a country where families are typically large, her fertility issues were all the more devastating.

The second is the shift in the manner in which we approached the case. In Toronto, I would have ordered some additional tests and imaging, and put in a referral for fertility. At Lewa (and likely in other primary care centres in Kenya), there is very limited testing available. I was forced to use a more pragmatic approach, using what I had at my disposal – the history, physical and the most likely diagnosis. I also focused predominantly on the practical things – folic acid, timing of trying, and treating empirically for possible untreated infection, with the possibility of more expensive referrals or other testing if needed.

The final thing of note was the importance of a therapeutic relationship with the patient. I could tell that it was not easy for her to open up about this very personal concern with me, a complete stranger from another continent who spoke a different language and was from a seemingly different world. After this very difficult encounter, we were chatting about her life, work and hobbies. She told me that she enjoyed listening to music and dancing. “So do I,” I replied. She looked up and made eye contact, smiling, I think in surprise. I do believe she did find some therapeutic benefit with coming to see us about her concern. Compassion and a listening ear are at times, all I have to offer. It doesn’t feel enough, but in some cases, it has to be.

Dr. Tanya Stone is a family medicine physician who joined us for her first Naweza trip in July 2018. She works in the Medcan Year Round Care clinic and also has a bustling private practice.

Day 7: Connecting with the Community on Outreach

Jambo!

Today was outreach day and we were really anxious to get there.  But first I headed to the Lewa offices with Dr. Michael and Jen to finalize the Memorandum of Understanding between Lewa and Naweza.  Good news! After a bit of discussion, we agreed on the terms of our relationship.

We headed to Ngare Ndare, about a 45 minute drive from the clinic.  We arrived to a rather quiet clinic.  We were a bit worried that word didn’t get out to the community that we would be here.  But we were told that sadly there was a burial happening today and that many of the villagers were attending it.  The expectation was that there would be a large influx of people later in the day.  But there were still about 50 people already there and so we were able to get started after a brief introduction of our team to the community.

Dr. Michael providing counselling on the proper use of an inhaler

Dr. Michael saw a young patient, aged 9 months, who presented with a fever, cough, diarrhea and after a clinical examination had tachypnea or abnormally rapid breathing.  We ruled out malaria with a point of care diagnostic test.  The tachypnea was determined by counting the baby’s breaths for 1 minute.  For a baby his age, if the number of breaths is 50 and above then the baby has confirmed tachypnea.  This baby had 60 breaths.  Given all of his symptoms, it is determined that he likely has pneumonia and is treated with the appropriate antibiotic. 

Dr. Tanya saw a patient who presented with a rash all over his body which he’s had for the last 3 months.  He also complained of joint pain and weight loss.  He tells us he has been tested for HIV 1 month ago and it came back negative.  We’ve asked him to be retested and as well have asked that he be tested for TB and syphilis.  It is difficult to determine the diagnosis without these tests, but we stress the importance of follow-up as it is fairly certain that something serious is going on.  And although we are leaving, we will follow-up with the clinic once they have the results back and see if we can be of any further help if all of those tests come back negative.

Some of Dr. Sidiqa's younger patients for vision screening.

Dr. Sidiqa saw many patients for vision screening.  One in particular was a 36 year old man who had a visual acuity of 20/125 and 20/160  or about a -4 with astigmatism.    He said he could get by during the day but the night time was difficult.  The night time issue was due to the astigmatism.  What’s incredible is how he was able to get by during the day!  Here is an example of what his eyesight would be:

We’ve told him to come to the clinic for a proper evaluation using the auto refractor in order to determine his exact prescription.  Naweza will sponsor all of the glasses that will be given to the patients that came to have their visual acuity tested during the outreach.

One of Dr. Sidiqa’s patients complained of sensitivity to the light and difficulty seeing.  The visual acuity test determined his eyesight was fine.  She asked him if he had had anything to drink today.  He said no.  It was 2pm in the afternoon and he still had not had a drink of water.  This community does have access to water and so she educates him on the importance of drinking 8 glasses a day.  His condition is likely due to lack of hydration.  In fact, the majority of her cases involve dry and irritated eyes caused by dehydration, dust and smoke.  She educates these patients on the importance of drinking water, washing their eyes and cooking outside to avoid the smoke caused by cooking inside the house.

Emily (our CHW) was at the Outreach doing screening for chronic disease.  She identified a man who had a blood pressure of 195/95.  This puts him at a level orange for risk of chronic disease which means he as a 20 to 30% chance of having a cardiac event in the next 10 years.  He will be placed in our Chronic Disease program, which puts the total number of higher risk (orange or red) patients who are part of our program at 29.  These patients will be continuously monitored throughout the year and all of their drugs will be paid for by Naweza.  We’ve estimated the cost of medication for each patient at $30 USD per patient per year.

Another lady came in and she had sugars of 15.1, blurry vision, headache, frequency of urination and loss of weight.  Technically we would like to have her re-tested to confirm her diagnosis of diabetes.  But given her symptoms and the fact that she lives very far away from the clinic we begin to treat her immediately.  We don’t want to risk her not getting on a treatment plan.  She’s given a month supply of medicine and then must come into the clinic for a refill.  At that time, she will have her blood sugar taken again and they will begin to monitor her.  

Another patient arrived complaining of a cough and night sweats.  She had said that she had gone to the hospital 2 times and they gave her medication to treat the cough.  She had felt better while on the medicine, but once she was off the medicine, the symptoms returned.  Dr. Tanya was highly suspicious of TB and ordered a test to be done.  We asked the local clinicians why the hospitals she went to didn’t do a TB test and they told us that these specific hospitals actually don’t have labs.  Without labs they can’t do a TB test to confirm the diagnosis.  So, they basically just give her antibiotics and hope she gets better.  Fortunately, Lewa Clinic does have a lab and can do the TB test.  She will need to come to the clinic as soon as possible so that she can begin treatment if in fact the diagnosis is confirmed.

One of our cute (and shy) visitors at the Outreach

Our drive back is a 40 minute drive in an open jeep in the dark on very poor roads.  Benjamin our driver is a pro and navigates the terrain (not to mention the frequent zebra crossings) with ease.  We arrive safely home to Ngiri House for a cup of tea before dinner and share the many stories of the day as we sit by the fire that the staff prepares for us each night. We all agree that the time has flown too quickly.  

So tomorrow we leave for Nairobi and then all go our separate ways.  Already we all look forward to our next visit when we can continue our work with our Lewa family and hopefully help the people, if just a little bit, in this special part of the world.

Thanks for reading…

Stacy ☺

Day 6: Communication is Key

Jambo!

We’ve got another full day at the clinic planned with Continuing Medical Education in the morning and patients in the afternoon. We’ve reserved today for following up with patients who are currently in the Chronic Disease Program.

The topics for the CME include:

• Dr. Michael: Brucellosis
• Dr. Tanya: Dyspepsia, GERD and Peptic Ulcers
• Dr. Tanya: Tips for Physical Examination

Dr. Michael’s talk involved Brucellosis, an infectious disease caused by a type of bacteria called Brucella which can spread from animals to humans.  There are several different strains of Brucella bacteria, but the main ones found in Lewa’s herding community are the ones found in cattle, goats and sheep.  People contract the bacteria by eating or drinking unpasteurized dairy products by animals infected with the Brucella bacteria. In terms of symptoms, fever by itself is a big telltale sign.  Once other conditions like malaria are ruled out, a test can be done which will confirm the diagnosis.

We’ve determined that the clinic has been treating the patients with the correct medication but for a shorter duration than is recommended.  It is a difficult condition to cure and recurrence is common.  Therefore following the longer treatment schedule is really important.  In fact, 20% to 30% involve the bones and joints, often resulting in back pain.  This is called osteoarticular disease and is treated with the same medication but with a longer treatment plan.

Later in the morning, Dr. Tanya provided a clinical training session on how to conduct a proper abdominal examination.  Our nurse Kristen bravely volunteered to be the “patient” so that Dr. Tanya could demonstrate the techniques and the clinic staff could practice.  It was a fun and easy atmosphere with lots of laughing, which I think resulted in a very safe environment for learning.  The staff asked lots of questions and demonstrated their knowledge giving Dr. Tanya an opportunity to offer tips and guidance.  She would pose questions like, “If you want to examine the spleen, where would you press?  How would you go about it?” or “How do you test for an enlarged liver?”  It proved so useful that we decided to try to fit in a session on cardiovascular clinical assessment before we leave.

After lunch we headed back to the clinic to see our chronic disease patients.  Dr. Tanya’s first patient is a gentleman who has had a stroke.  Before the actual stroke, he went in to the hospital after falling when he got up in the middle of the night to use the washroom.  He arrived at the hospital presenting with stroke-like symptoms.  But the hospital sent him home after observing him for several hours and the initial symptoms disappeared.  Dr. Tanya said to the staff that this was unfortunate as this scenario suggests that what the man had experienced was a “mini stroke” or transient ischemic attack (TIA) and that it should have been a big sign to the hospital that he was at very high risk of having a stroke.  And sadly, the next day, he had a stroke and is dealing with some paralysis on his right side.  The paralysis will likely not improve, but he’s able to walk very slowly with a cane.  

This case was an excellent opportunity for Dr. Tanya to ask lots of questions of the nurses with regard to his current treatment plan.  They identified that his blood pressure was still too high and that they should adjust the dosage to bring it within the protocol limits. We then discover it is not easy to determine what medications the patient is taking.  The medication that is listed in his file seems to be inconsistent with what the man (and his wife) thinks he takes.   We’ve advised him to bring in all of his medication next time so that they can confirm that he is taking the right drugs and the correct dose.  Unfortunately, inconsistencies in the information you receive from patients is very common and can be a challenge when trying to care for them.  Our doctors remind me this is true everywhere in the world and is not just the case here in Kenya.  Poor record keeping can also layer on another obstacle to ensuring this patient is prescribed the correct medication.  The EMR that we’re building will help with this immensely.  Each patient will have an electronic file which we can use to manage the patient in terms of their prescriptions, dosages, reminders for follow-up visits, etc.

Dr. Michael and Jen had a meeting with Phoebe to review the Chronic Disease Program, including the list of eligible patients as well as the drugs that we will cover.  Some of our challenges have been ensuring only those patients screened by Emily (our CHW) will be included in the program and that only the chronic disease drugs that we approve will be covered by Naweza.  It is simply growing pains and we’re hoping through clear guidelines and lots of communication any potential issues will be mitigated.

Dr. Sidiqa visited the Naweza-sponsored optometrist who comes to the clinic once a month to provide training to Lydia, conduct vision tests and write prescriptions if necessary.  On our last trip, we planned for Lydia to do vision screening at a school of 500 students.  Any of the students who failed the test would be directed to the clinic to be followed up with the optometrist.  He would examine the student and write a prescription for glasses.  Naweza would pay for these glasses.  However, we noticed that there weren’t any prescriptions written and we were wondering why.  He indicated that the problem was that transportation to the clinic was too difficult for the children, so the kids weren’t able to have their follow-up assessment.  We didn’t realize this would be an issue when planning this pilot project.  Now the plan is to have Naweza pay for transportation and hopefully the children will soon have their glasses!

Our sponsored optometrist's clinic

The optometrist also indicated that other people who come in for the monthly vision clinics don’t want to pay for the glasses and so he hasn’t been writing any prescriptions.  However, through working with suppliers, Naweza has obtained a much lower price ($10-16 per pair versus $50 per pair).  We thought our optometrist was aware of this discounted price, and it’s not actually clear where the breakdown in communication occurred, but it’s a reminder to us the importance of constant communication and touching base just to see how the project is coming along.  The plan now will be to revisit these patients and offer them the better price and hopefully provide them with their glasses.

Tomorrow will be our outreach day.  We’ll be heading to Ngare Ndare, the same location as the last time we were here.  It will be great to see the community again and hopefully provide some help to them.  It will be our chance to connect with hundreds of patients and create goodwill with the people.  It is truly one of our favourite days, despite the chaos that inevitably ensues!  But I’m sure with Rosaline there, all will be just fine!

Until tomorrow, lala salama!

Stacy ☺

Day 4: Using Algorithms to Simplify Care

Jambo!

Ready for another great day at Lewa.  We started with our circuit training session outside overlooking the savannah of Northern Kenya.  It’s a healthy beginning to our morning and in keeping with our message of prevention of Chronic Disease.  

After our breakfast we take our short ride to the clinic breathing in the fresh air and smells of nature.  We arrive to the big smile of Rosaline (of course) as well as patients who are already waiting at the clinic for the afternoon clinic hours with the Naweza doctors.

But before we see the patients, we have a full morning of presentations by our doctors as well as Benard, the lead on our Kenyan research studies.

The topics included were:

• Benard – Findings from the CVD Program
• Kristen – Type 1 Diabetes
• Dr. Tanya – Diabetes and Hypertension Review + Post CVD Event Care

Benard gave an excellent summary of our CVD program study so far. The study will provide proof-of-concept that a community health worker, equipped with a novel “mHealth” technology on her cell phone, can screen for hypertension and diabetes in the community setting. Non-communicable diseases are increasing in importance globally, and these “silent killers” contribute to cardiovascular disease (heart attack and stroke) which are now overtaking infectious diseases as the leading causes of death. Our study is an innovative strategy for active case-finding in a rural setting, in order to identify patients in need of lifestyle and pharmacologic interventions to reduce the risk of cardiovascular disease. By subjecting our program to the scrutiny of a scientific study, we are applying a high level of rigour to our clinical activities, and we will be able to report our findings to the scientific community for potential scalability.

Dr. Tanya’s discussion was quite interactive, with several questions and references to cases that the nurses encounter at the clinic.  They also had the opportunity to get up in front of their own peers and work through different scenarios of potential CVD patients.  They needed to determine, based on certain data, which risk categories to put those patients into.  Depending on the category, the patient will have a different treatment strategy.  It was a good exercise not only to give the nurses a chance to demonstrate to their co-workers their own knowledge, but also was a stepping off point for a robust discussion on the nuances of cardiovascular disease cases and how you might navigate a particularly tricky scenario.

We were told that there has recently been a big increase in cases of malaria.  Usually in a month’s time the clinic will see about 10 cases, but last month alone brought in 44 cases.  This is mainly caused by the above average rainfall that the area has received.  Good news for the animals and vegetation, but it doesn’t come without a cost.  The stagnant water attracts the mosquitos and is where they like to breed.  Fortunately the clinic has access to point of care diagnostics and can quickly determine if a patient presenting with a fever and other flu like symptoms has malaria, and if positive, commence immediate treatment with anti-malaria meds.

After a quick lunch, the team headed back to the clinic to see patients.  Dr. Michael worked alongside one of the nurses providing training on the IMCI (Integrated Management of Childhood Illness) algorithm.  This is an algorithm that can assist on when to give and withhold antibiotics.  A child came in presenting with cough and cold symptoms and they were able to use the tool to determine that the patient did not in fact need antibiotics.  Antibiotic stewardship, as well as managing the limited resources available to the clinic, are the ultimate goals.  The nurses are too often inclined to give antibiotics to the patients when in fact it is unnecessary.  This is mainly due to their uncertainty in the diagnosis and fear that they may get it wrong.  The IMCI tool will hopefully give them confidence that they are in fact making the right decision and providing good care for their community.

One case in particular involved 2 young HIV+ boys.  Unfortunately the boys had begun late on the antiretroviral agents (ARTs) and as well were not fully compliant on the drugs.  By not taking the ARTs on a regular basis, their immune systems were compromised, resulting in warts developing on their face.  Dr. Michael reinforced the importance of staying on the drugs in order to halt the progression of the warts and/or any other potential conditions caused by a depressed immune system.

Dr. Tanya worked with the nurse, Hagai.  They saw several interesting patients including one woman who complained of knee pain when she squatted.  Dr. Tanya thought it sounded like a condition called patella-femoral which normally would require a knee brace to help keep the knee cap in line.  The interesting thing was the woman designed her own make-shift brace with a piece of gauze which she claimed made the pain subside, a design which Dr. Tanya thought actually resembled the brace you would normally get in Canada.  The fact that she was able to intuitively put this together is sort of incredible if you think about it.  But these are the kind of survival strategies that the community must employ in order to manage their health.  Despite having access to the clinic, the woman’s ability to afford such a brace is limited.  And the clinic’s access to such a brace is unlikely.  So Tanya advised her to continue to wear the “brace” and teaches her how to do exercises that will help strengthen the area.  

That’s it for now.  Looking forward to another day of training and seeing patients tomorrow!

Thanks for reading!

Stacy ☺

Day 3: Tea and Training

Jambo!

Our first full day at Lewa is finally here and we are really excited to get started.  We begin with a hearty Kenyan breakfast of sausage, bacon, eggs, crepes, toast, roasted tomatoes, fruit and cereal.  And lots of tea!

We headed to the clinic with Benjamin our main driver for the week.  Our commute in is always incredible.  The air, the animals, the sounds, the people walking along the roads….it all creates an atmosphere of reflection and gratitude for this opportunity to be here and to help this beautiful community.

We arrive to Rosaline, a complete force of nature.  One of those people you hear before you see.  Her energy could quite literally power a small city.  I first met her some years ago now when she was cleaning floors at the clinic.  Our autorefractor we brought with us to donate to Lewa had blown a fuse and we needed desperately to replace the fuse.  She was the first to step in and offer to drive the 40 minutes into town to buy a new one.  She quite honestly saved the day and I will never forget her big smile when she returned and proudly handed me the bag holding the new fuse.  Since then I’ve seen her do any number of things at the clinic, including cleaning floors, carrying supplies, driving into town to run clinic errands, crowd control at outreaches…. anything that someone needs, she’s there for you.  But what I most know her for is her enormous smile and incomparable, unconfined energy and excitement when we arrive at the clinic.  When we arrived, she was hugging all of us, including the new team members, making us feel so welcome.  She is truly special and we are so happy to see her.  Later that day it is Rosaline who will prepare tea for everyone and pass it around personally to each person, tray with cups and sugar in one hand and a steaming thermos of milky tea in the other.  Once again, spreading her magic and making everything just a little bit better.

The morning is spent conducting Continuing Medical Education to the staff by the doctors.  Most of the presentations are by request of the staff based on medical topics they would like to learn more about. Today’s talks include:

• Dr. Michael – Integrated Management of Childhood Illness
• Dr. Sidiqa – Trachoma (eye disease)
• Dr. Tanya – Sexually Transmitted Infection Prevention and Treatment

The doctors take more of an interactive approach to training.  Combining case studies from Canada and Kenya, and questions from the clinicians have provided the best learning experience in the past. We want the staff to be an active part of the talk so that we understand the real-life situations that they encounter and the challenges that they are up against. 

One of the best moments was when Dr. Sidiqa asked Lydia to get up in front of everyone and show how she performs a vision screening test on a patient.  On the last trip Dr. Sidiqa provided Lydia with a “Vision Screening Kit” which includes:

• A vision chart (PEEK app on Lydia’s phone)
• Measuring tape to measure the distance from the chart to the patient
• A mat for the patient to stand on at 3m 
• A bright torch and some batteries
• An Ophthalmic Emergency manual
• Naweza Stickers “I had my eyes screened today”
• Logbook and stationary 

A typical Vision Screening uses two mobile apps.

1. Using a smartphone-based vision check app called PEEK, Lydia shows the patient a visual acuity chart (the letter “E”) on her phone at 3m away. The patient is asked to point with their finger the direction of the letter “E” that they can see. Lydia then swipes her screen in the same direction as the patient. The E keeps getting smaller and smaller until the patient is no longer able to tell its direction. The app gives Lydia the final visual acuity of the patient which she then records on the second mobile app on her phone.  
2. Utilizing her phone once more, data such as patient’s name, age, school/area they’re from and the visual acuities are recorded on an online database called KoboCollect. Lydia analyzes the patient’s visual acuities from the PEEK app and records the results as “pass” or “fail”.  Any patient that does not pass the vision screening is then referred on to our local optometrist visiting Lewa once a month.

Lydia loves being able to use her mobile phone to do the vision screening as well being able to record the results online! This also allows Dr. Sidiqa to be able to remotely follow the process of the screening and review the data.

After returning to Ngiri House for a delicious lunch, Dr. Michael, Jen and I visited John Kinoti at Lewa’s offices to discuss the future of our relationship with Lewa.   For the last 6 years we’ve been coming to Lewa and working with the clinic, providing education and training to the staff.  All of the programs that we’ve done have been based on mutual trust by both parties.  And it has worked very well so far.  But we both feel it’s time to formalize the relationship as we’ve reached a point of bigger potential.  Our goal is to make Lewa a “Centre of Excellence for Chronic Disease Prevention and Treatment.”  Our framework includes:

• A Community Health Worker (CHW) screening communities using SMS technology
• EMR system managing treatment and compliance of Chronic Disease patients
• Training and education of the clinic staff
• Data collection to conduct research studies to ensure program effectiveness

With early detection and proper treatment management, we believe that health outcomes will improve for the Lewa community.  

While we met with John, Dr. Tanya, Dr. Sidiqa and Kristen went to the clinic and saw patients.  They worked alongside the nurses and provided real time training.  The process they follow is:

• Lewa nurse obtains a history of the patient and communicates it to the Naweza doctor
• Lewa nurse performs a clinical examination with the Naweza doctor providing guidance
• Naweza doctor asks the Lewa nurse for their opinion on the diagnosis
• Naweza doctor and Lewa nurse discuss, providing an opportunity for the doctor to train and educate

It’s important that the Lewa nurse still “owns” the patient and that the Naweza doctor is simply there to provide guidance.  We are only here twice a year and if our doctor makes all decisions with regard to the patient, we will have not prepared the Lewa clinicians as well as we could have. The goal is that when we leave, the nurses are able to provide a higher level of care to their community.  We also want to build confidence in the community by showing that we believe in their nurses to take care of them and provide quality healthcare.  And as I’ve mentioned in past blogs, the Lewa Clinic has access to a doctor once or twice a month.  But the clinic cares for  many patients a week who sometimes suffer from complex conditions that would be handled by a doctor if they were in Canada.  But in this resource-limited setting, the nurses are expected to step in as the “doctor.” A very big expectation and a lot of pressure for the staff!  So we try to give them training, education and technological tools to help them manage these complex cases and hopefully improve the level of care provided to their community.

That’s all for now.   Thanks for reading!

Stacy ☺

Day 1 & 2: Excited to be back in Kenya!

Jambo!

The Naweza team is back in Kenya and excited to continue our work with our Lewa family.  We’ve planned a robust program that will include:

• EMR (Electronic Medical Record) continued development with potential soft launch
• Training of a new CHW (Community Health Worker)
• Continuing education on chronic disease as well as other medical issues the clinic has requested
• Review and evaluate the data collected by Emily, our chronic disease CHW
• Provide education around proper nutrition for chronic disease patients
• Review vision program – specifically the school program we began in January
• Provide training and education on  STIs (Sexually Transmitted Infections)

Our Canadian team includes:

• Dr. Michael Hawkes – Global infectious disease expert and peadiatrician
• Dr. Tanya Stone – Family physician
• Dr. Sidiqa Rajani – Optometrist
• Kristen Gregson – Nurse
• Jennifer Mannik – Executive Director of Naweza

We also have Danet Opot and Benard Ochieng joining us. Danet is a Kenyan programmer who built our SMS tool and is working on our EMR. Benard is a researcher from the Kenya Medical Research Institute who is the principal investigator for our chronic disease research program.

We arrived in Nairobi on Wednesday and spent the next day at the hotel, acclimatizing and working together.  It was such a good opportunity to get caught up, discuss the week ahead, work on presentations and share our experiences with our new team members, Dr. Tanya and Kristen.  

It also happened to be the night of the semi-final World Cup match with England vs Croatia.  The hotel bar had 5 different TVs positioned around the room.  It was a fantastic night with the local Kenyans cheering on the teams and enjoying the easy atmosphere.

Watching the World Cup in the hotel bar

We arrived in Lewa on Thursday and were greeted by our two drivers, Benjamin and Jacob, who took the team to Ngiri House, our home for the next week.  Rose, Ngiri House’s manager, and her team met us upon arrival and showed us to our rooms.  We then enjoyed a lovely lunch of salads, boiled potatoes and sweet corn fritters.

After lunch we met with Phoebe, the Clinic’s manager, in order to review our itinerary for the week.  Lewa has just completed their annual Marathon which attracted 1,400 runners from around the world.  It’s one of Lewa’s main sources of funding and is undoubtedly their busiest time of year.   And although they’re all a bit tired after the intense lead up and ultimate day of the marathon, Phoebe assures me that the team is eager and happy to see us and are looking forward to a productive week.  

The good news is that she’s identified a potential new CHW who we’re hoping to train to run the school vision screening.  This will ease the workload of Lydia, the clinician who we’ve trained to do the vision program at Lewa. The idea is that the CHW will conduct vision screening at the schools and refer those children who failed the vision test to the clinic for a more in-depth evaluation by either Lydia or an optometrist that Naweza sponsors. The optometrist would come to the clinic on a monthly basis to provide on-going training with Lydia as well as see patients and write prescriptions for glasses.

We ended the day with a two-hour game drive that afforded us the opportunity to see many white rhinos, buffalo, antelope, monkeys and the most amazing herd of elephants that were literally 10 feet away from us.  They were so close we could count the eyelashes.  Absolutely spectacular.  

I always like to begin with a game drive to remind us of the reason we are partnering with Lewa.  Lewa, a wildlife conservancy in Isiolo county (45 mins plane ride northeast of Nairobi) has four clinics providing healthcare to its community in an effort to win their support in the fight against poachers.  Their hope is if they provide services such as education and healthcare, the people will be less likely to give information to the poachers, thus protecting these beautiful animals.

Our first full day at Lewa begins early tomorrow and will include presentations by Dr. Tanya, Dr. Michael and Dr. Sidiqa.  The afternoon will be used to see patients and provide real-time clinical training to the nurses and clinical officers.

That’s it for now.  Until tomorrow, thanks for reading!

Stacy ☺