Kenya Medical Outreach InitiativeKenya Mission Trip – January 12-22, 2012.
A full reporting from Mission Leader, Dr. Donovan Christie
Travel from Atlanta to Kenya. The Atlanta POHF mission team boarded our Delta Airlines flight at 5:00 p.m. and traveled to Amsterdam, Netherlands, an 8 hour non-stop flight. We had a 2 hour layover in Amsterdam, connected with our two other team members who flew from New York (Lorna Simmonds, Picture of Health Board member and her husband Howard, who were the organizers of this trip). Our team of 7 boarded a KLM airlines flight and flew non-stop to Nairobi, Kenya.
Several of our workout partners at Fitness Pro, Atlanta, were born in Kenya. Thanks to one of these contacts we were able to clear customs quickly. Fred, our driver for the rented bus, was waiting for us outside. Geoffrey, the owner of the bus company, accompanied Fred. The transition from the airport to our guesthouse was one of the smoothest ever experienced my 12 overseas medical relief mission trips.
On our way from the airport we stopped at a Gas Station and bought lunch (grilled chicken and potatoes). We arrived at the Homecare retreat center around 11:00 p.m. the following day, January 13th.
The original plan was to visit three centers: Homecare Spiritual Fellowship Inc., Kiberia; Pastor Gati’s Church, a center sponsored by Homecare Inc. in the Soweto village of Kiberia; and the Nyakahuho dispensary clinic in Mukurweini district. At the request of the Assistant to the Member of Parliament we were asked to visit a fourth clinic, Muthuthini dispensary. In total we were able to give medical care to almost 700 patients.
Day 1 – Homecare Spiritual Fellowship Inc., Kiberia
Lorna and husband Howard were stationed in Kenya for 2 years while working as diplomats for the US Embassy. During their stay, they met Reverend Dr. Judy Mbugua the founder of Homecare Spiritual Fellowship Inc. Homecare is an organization dedicated to helping women and children many of whom live in the Kibera slums. Dr. Mbugua initially started a prayer group in her home with women who were HIV positive and who engaged in prostitution to raise money to feed their children. Because of this great need the group expanded rapidly to 500 women. Eventually she was able to raise money to purchase a building, only minutes from the Kibera slums. Click here for video interview with Dr. Mbugugua.
Kiberia is one of the world’s largest slums, where one million people live in an area approximately one square mile. The area is typical of areas that have poor sanitation and massive overcrowding. Dr. Mbugua through Homecare Inc. has been reaching out to the children of Kibera on Saturday mornings, providing them with meals. On any given Saturday, Homecare Inc. will feed and educate close to 500 children. We planned on setting up the clinic on the Homecare retreat compound and expected to see between 150 and 250 children over the next day and half.
The Homecare retreat provided some pretty good accommodations. There was running hot and cold water, toilets and full size beds with clean linen. The staff prepared us a delicious breakfast of eggs, toast, chicken sausage with juice and coffee. So far we were not missing the comforts of home! We got to the retreat center after a 30 minute bus ride and had plenty of support from the staff at Homecare Inc. They made badges with their names on it with their specific duties such as triage, waiting area, registration, and discharge area. They quickly got us set up to do our duty in the center’s main area. We created a space for 3 providers, two treatment nurses, 2 pharmacy technicians and 2 discharge volunteers.
Jackie and I along with a local Physician Assistant, John Mwita examined the patients and then James Hill and Sonia provided the injections, wound care and testing. We performed testing for HIV and Malaria through rapid colorimetric analysis, utilizing whole blood obtained from the patient through finger stick. Alenka Hadziomerovic performed the triage function obtaining vital signs and Julissa Ashao operated the pharmacy. We had volunteers performing the registration functions and distributing toothbrushes, vitamins, protein bars and dried cereals upon exit. Howard and Lorna ministered to and prayed over the children while anointing them with oil.
The first day at Homecare was a bit of a surprise, only because of the number of patients that were seen– 70. The families were told to bring their sick children to the free clinic. The staff at Homecare believed this was the reason they had a lower than expected patient turnout. Many people come to the free clinics to get medications for a later time. Many complaints are distant in their presentation. The day went great without any significant drama. The children were well behaved and humble. The people we treated were really grateful for the services provided. We saw many cases of respiratory, skin and gastrointestinal infections. The next day we planned on going into the city of Kibera to set up clinic at Pastor Gati’s church.
Day 2 – Pastor Gati’s church, a center sponsored by Homecare Inc. Soweto Village, Kiberia
We rose to a great breakfast of pancakes, sausage, eggs and cereal. I was not hungry so I had a bowl of granola and raisin cereal topped with organic milk. We picked up Peris, Dr. Judy’s executive assistant and Lucy, a volunteer worker and headed out to Soweto village in Kibera Township. The devastation was evident as soon as we reached Kibera. The shacks were made of zinc metal and mud reaching only about 6 feet off the ground. Most of them housed many people and were stacked side by side. They were built on a hill so one could stand at the bottom of the hill and see a cascade of them extending up the hill and creating a checkered pattern. The fronts of the shacks on the main road were small businesses ranging from electronic shops, to hair salons. Many of them sold food goods and coal for cooking. There were ditches in front of them that carried water and garbage waste. The area had a strong odor with a pungent smell and at times foul smelling. There were piles of garbage alongside the road that several people were rummaging through.
We arrived with the two men appointed to us by the Chief for protection, to a downhill road path. The bus could not go any further so we carried the 9 bins with medical supplies about an eighth of a mile down the hill to the church. The church was approximately 15 X 25 feet and was made from wood and zinc shingles. There was one entrance door and a side door about 15 feet from the entrance. There were two windows with handmade wooden shutters and no glass. We created a makeshift clinic using the church cloth-covered benches, several desks and long wooden benches. We spread a piece of large plastic to divide the waiting area from the treatment areas. We set up a registration, triage, and pharmacy and gift area and within an hour we were ready to see patients.
We started to see patients at a little before 10am and we worked until 1:30pm. In 3 and ½ hours we were able to treat 120 patients. We had several positive tests for Malaria and treated many skin wounds caused by the patient scratching, insect bites and abrasions. Many of the children were barefooted and wore tattered clothes. They were well behaved and respectful. Some of the pre-teen and teenagers spoke English as a second language but many only spoke the local language of Swahili. The volunteers from Homecare worked side by side next to Jackie and me as translators. We treated many cases of worm infestation, bronchitis, pharyngitis and skin diseases. The landlord did show up for our free services and we provided for him as well, including vitamins, cereals and worm medicines for his family. We hoped that our good intentions would soften his heart to one day offer the clinic space for free to other missionaries in the future.
The staff worked hard and in unison. By the grace of God, we were able to see 120 patients in that short period of time, and no one was angry about not being seen when we decided to shut down the clinic. We then had to carry the bins back up the hill to the bus. On our way up the hill we recognized many of the patients we serviced. They waved and smiled at our team with a sense of appreciation for what we had done for them. Maia Christie, my 13-year old daughter, had a great day as she helped in registration, and was surrounded by many of the children. She made many friends in the slums. She ran with them for a quick soccer game. I realized just how easy it is for young people to make friends and not to focus on their circumstances. When the bus was packed they blew kisses at her and she knew then that she had made an impact on their lives.
We drove back in absolute excitement proud of what we had accomplished by the grace of God in such a short time in the slums of Kibera. Alenka, our surgical technician exclaimed in excitement “I worked hard but this is truly amazing how they responded to us”. She was saddened by the conditions of the people, but happy that she was able to help. We went back to the guest house, ate lunch and loaded up for our 4 hour ride to Mukurwei-ni district. There we will work with an established dispensary clinic without sufficient man power to meet the healthcare demands of the area.
The clinic is usually staffed by a Nurse, one medical assistant and one nurse assistant. They normally provide services to 10 to 30 patients per day for a low cost. Medications also have to be purchased after the consultations. Many people cannot afford this reduced fee even though the fee is the cost of a hot dog and soda in the United States.
We arrived at the Legacy Homes guest house at 9pm. We were pleased with the rooms as they had hot water and firm beds. The guest house is owned by a husband and wife team and they were very accommodating. We had a dinner meal prepared by the chef John consisting of beef stew, stew chicken, chapatti bread, fresh cabbage salad, green bean, carrots, brown rice, and fruit. Thus far this trip we have been very pleased with the accommodations. Were it not for our day trips to the remote areas we could have been in a bed and breakfast in the US, minus the insects and bird noises.
Day 3 – Nyakahuho dispensary clinic in Mukurwei-ni district
In the morning we got a late start because we had to meet with the Constituency Manager of the Nyakahuho area, the dispensary we planned on practicing for the next two days. From the guest house to the Constituency Manager Office was a one hour drive. We briefly talked with Mike, assistant to Member of Parliament Honorable Kabando-wa-Kabando, who then led the bus to the Nyakahuho clinic in Mukurwei-ni District. The ride was about 15 minutes in the rural terrain of rolling hills and farm land. The clinic building was small but efficient. There was a registration area, two small exam rooms and small lab. The rear of the building was under construction and we used the framed structure as the pharmacy. Julissa and Lorna and Howard set up the pharmacy. James and Sonia set up treatment room and lab testing. Alenka worked with two of the clinic staff in the triage area. Jackie and I set up our rooms and we were ready. Joseph a local clinical officer (the equivalent of our Physician Assistant) in the district was sent by the administrator to work with us. The Nurse in Charge, James Chiuri, worked in the pharmacy area charting the demographic information of patients that had been treated.
We started to see patients at 11:30 a.m. after all the setting up and travel distance. In the late morning session we treated primarily children. We took a break at 2:00 pm and had snacks and water. We had already seen 80 patients by 2:30 p.m. The children in this area were not used to missionary free clinics. They were not as communicative, were more reserved and apprehensive towards the staff. Some of them wore school uniforms which made me think that they missed school in order to come to the free clinic. The clinic had a sign on the door that advertised the arrival of the American missionaries and services we would provide. We treated much of the same things headache, abdominal pain, cough, joint pain and fever. The children had a lot more cavities in this area which I attributed to eating more sugar cane and candy.
The afternoon session was truly a geriatric clinic. Nearly 90 percent of patients had high blood pressure. Half of them were diagnosed today. They presented with headache, dizziness and fatigue but did not go to the doctor to find the cause. I attributed the high incidence of high blood pressure to stress in their lives cause by wars, political conflict, corruption in government and financial woes. We ran out of high blood pressure medicine so I asked James Chiuri to purchase more atenolol. I also brought additional antacids, gastritis medication and eye medicines. My eldest patient of the day was a 94 year old man who complained of urinary symptoms. I asked him for a few pearls on his longevity. He mentioned that he worked outside all his life, tending to the cows. He was a field hand, ate from the ground, got plenty of fresh air and drank plenty of tea. He seemed well preserved but weighed no more than 120lbs. The crowd at the door never died down until we announced the time we would be leaving. Many of them crowded the door, just waiting for a number to be seen.
We stopped seeing patients at about 5:00 p.m. and the total patients seen for the day was 170. We worked hard as a team and everyone was grateful and we felt rewarded.
Day 4 – Nyakahuho dispensary clinic in Mukurwei-ni district
We awoke early at 6:00 a.m. and ate an hearty breakfast made by the chef. We left the guest house at 7:30 a.m. and drove to the constituency house to pick up our translators. We arrived at the clinic at 8:50am. We promptly set up the pharmacy as we had left the medication bins locked up in a closed room of the clinic. Today was to be our fourth and last day of medical services but when Mike, asked us to visit another clinic the following day we were mystified but consented to a half a day. He told us that the Honorable Kabando-wa-Kabando, M.P. (the US version of a state Senator) was coming to pay us a visit to personally thank us for our services to the people of his constituency.
We started at a quick and efficient pace, seeing an average of 10 patients per hour (6 minutes per patient). The way we are able to do this is through a system where we have the information right in front of us from the members of the team. First the patient gets registered and the demographic information is obtained. Then the patient is called by the triage personnel and vital signs such as blood pressure and temperature is obtained. The chief complaint is also obtained and this is a big help when you are moving at a rapid pace. The information is placed on an index card and the patient carries the card from one station to the next. The patient is then brought into the consultation room. The provider will review the vitals sign, the chief complaints and then talk with the patient for a few minutes and provide a directed examination. The symptoms are very similar. A child with Malaria will present with fever, chills at night, bone and joint pain, abdominal pain and fatigue. The physical exam will usually show a fever with sclera citrus (yellow sclera), distended abdomen and enlarged liver. If you are still not convinced it is better to treat the child than not to treat the child. There is only one opportunity to get it right and errors or no treatment is not appropriate under these circumstances. Our approach is usually to treat, because a 3 day treatment for Malaria is usually 2 to 4 pills 3 times per day.
Seeing an average of 10 patients an hour is a compulsory action. You want to treat as many of people as possible because many of them must walk miles to get free care. We saw over 230 patients on day 4 to bring up our total to about 600 in 4 days.
Hon. Kabando wa Kabando was very graceful in his compliments to our staff. He also invited us to dinner the following evening. I interviewed him on video and that is available for viewing on the POHF website www.pohfoundation.org. We packed up the medicines and brought them to the next clinic and then went back to the guest house tired but with a feeling of great accomplishment.
Day 5 – Muthuthini dispensary
We awoke early and bid our farewell to Winnie and Akmed from Legacy homes. We thanked Chef John for his wonderful meal preparation and presentations and headed out to the Muthuthini dispensary. We again made a stop at the constituency office to pick up our translators. Mike told us he would meet us at the Muthuthini clinic to make final arrangements for our afternoon at the National Park. When we arrived at the dispensary, many people were standing outside the door and on the grounds waiting to register for the free care.
To our surprise we met 4 other clinical officers who were dispatched to the clinic on our behalf. We arranged with the nurse in charge to use the balance of our medication in return for us to use any items of theirs that we needed to treat the patients. She reluctantly agreed and we proceeded to see approximately 150 patients from 9:30am to 1:30pm.
Mike who travels back and forth to Nairobi every week decided to ride back with us on the bus. He knew a shorter path to Nairobi which directed us through a long dirt road. We got back to the main road and Fred our driver took us to the bank to exchange dollars for shillings. We headed out on the main road and stopped at a gas station to use the rest rooms. While there, a soldier with a rifle approached the bus and started to yell at Lorna claiming she took a photograph of him. He held the rifle behind him. She stated that she did not take a photograph of him but he was adamant. His superior officer came outside from the newly constructed gas station and spoke with Fred. I am not sure what they talked about but we noted that another soldier was on a cell phone during the conversation. We pulled out of the gas station and headed to the main road. Approximately 10 minutes down the road was a road block. Now, normally the police officers would allow private excursion vehicles free passage, knowing that they had tourists, missionaries or governmental visitors occupying the vehicles. This had been the case with every single road block we came across throughout our journeys. This time was different. The police officer spoke with Jeff and they exchanged words. He then came around and sat in the passenger seat of the bus next to James. He instructed Fred to drive the vehicle to the police station in the nearby town of Thika.
We were appalled. The officers at the road block reported that we were speeding and that we had to go to the police station to go before the commandant. They had clocked the bus going 90 kilometer per hour vs. 80 kilometers per hour (approximately 6 miles over the limit). According to our driver, the bus is programmed not to exceed 80 kilometers per hour. Fred adamantly insisted that he was not speeding. The police officers were officious in their approach and despite our efforts they proceeded to confiscate the bus. We communicated with our contact for the secret police; Mr. Kabando, Member of Parliament; and the US embassy and they were not able to reverse the decision. The US embassy called the commandant office and they concluded that the bus needed to stay in Thika so that the governor, the device used to prevent speeding, could be checked by a technician.
Geoffrey arranged for small van to pick us up from Thika. We were detained for 4 hours and lost the balance of the evening. We got back to Nairobi at approximately 10:00 p.m. frustrated and exhausted. Carol and Teresia had prepared dinner for us at Homecare retreat. We ate and retired for the evening.
Reflecting on the day I realized that the devil tried to steal our joy by creating this unfortunate incident with the police. But our enthusiasm to help the people of Kenya is not deterred. In the 4 and ½ day of medical clinic we treated a total number of 670 patients and truly had an impact on their lives. We left the remaining medications with the Muthuthini and Nyakahuho dispensaries with the direction to not charge the patients for anything that we had left.
The night before our departure a close friend of Lorna and Howard Simmonds’s restaurant owner Salomie, threw us a dinner party at her restaurant. She invited about 20 people, including business owners, pharmacists and US diplomats. They gave Howard the floor and then he invited me to speak about our experience. I introduced the team and discussed our Kenyan adventure. We had a wonderful evening with grilled meats, salads and desserts. They thanked us for the Picture of Health Foundation mission and vowed to help us during our next trip to Kenya.
The following morning we got up at 4:00 a.m. and got ready to leave the country. We arrived at the Airport at 6:00am for an 8:00am departure. The plane ride was filled with moments of reflection on the wonderful journey we had just experienced. The entire team reflected on the richness of the experience.
That is what it is all about, the joy of helping others.