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 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.
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.
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…