Final Week

September 18th, 2010 by INMED
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Did someone say September 18th?! Somehow the time has flown here in Kijabe and I will be departing Nairobi tomorrow night! I have almost been in Kenya for five weeks, which somehow blows my mind. The weeks have run or maybe sprinted would be a more adequate description. Yesterday I finished my last workday at the hospital and so I now just have the weekend to pack up, say goodbye, and revel in my final experiences of Kenya (chapati included).


This past week was a little different than the rest. I was still working with the AIDS Relief group, but a short term mission team from Ohio was in for the week, working closely with AIDS Relief, so they thought it would be great if I joined in. Part of the Ohio team put on a “pastors seminar” for the first part of the week. I joined in on some of this as it wasn’t based much in public health, but it served as a great networking opportunity, not to mention, support and encouragement for pastors around the area. These pastors are connected with the AIDS Relief Program as many host the support groups for our HIV clients in their churchs. So, community networking was key here.


Several of the days I was able to go out with the other half of the Ohio team to do home visits to HIV clients in the program. It was a good marriage of cultures as we went along with the Kenyan community nurses and community health facilitators who have ongoing relationships with the clients and the American team who was experiencing much of the poverty and desperate situations of Kenya for the first time. Also, it was a good marriage of care as the Kenyan workers conducted their normal follow-up visits that included assessing the client’s phyisical and psychosocial complaints and monitoring medication adherence, whereas the American team was ready to listen to and pray for needs and provide food and clothing, thus addressing spiritual and basic physical needs. For me, it hit the heartbreaking string a little more powerfully as we went to a new area (for me) where the poverty was obviously more ramant. The city, Maaimahiu, is located down the hill from Kijabe, right at the base of the Rift Valley. It was hot, dry, dusty…whereas the hills several thousand feet above them are green, fertile and thus able to generate income. Most of the clients we visited there were single women with several children and new babies. There is not much there to generate income, but it is located on the main highway that leads toward Uganda, and so many find money as sex workers. Not surprisingly many have found HIV as well.


Yesterday we went to do some visits in the IDP (internally displaced people) camps down in the valley – something I have been wanting to do since I arrived! Most of these people are Kikuyu who came from the Western province as a result of the post election violence in 2007. The first camp we stopped at was quite impressive and seemed to be doing well. One hundred forty five families and 876 individuals, all living in well-constructed mud houses with tin roofs and gardens growing everywhere, despite the dry land surrounding them. They still have great needs, but their resilience was astounding to me. The next camp over did not appear so settled as most families were still living in tarp tents supplied by UNHCR. Again, struggling to survive, but each person was so welcoming and joyful to see visitors. The community health worker who is in charge of these populations was more than impressive. A Kenyan, she loves to visit these people, is an advocate for their health, and is even working closely with families who have had their human rights violated and is connecting them with lawyers in Nairobi.


And so, have had a little bit of a laid back week, but I count the home visits and the ability to see the reality of life and the needs in these areas as a privilege. Not to mention, what may have been the highlight of my week: working in the hospital kitchen on Wednesday, something I have wanted to do since week one. There is something about defying expectations and working with people who others think are near the bottom of the food chain. Plus, my curiosity about food is just undeniable. Most of the day I traveled out to the wards to serve meals to the patients, which was just entertaining to many as they saw the “mzungu” in the kitchen apron. The kitchen staff adopted me as their own in that short time and somehow I am readily responding to my new African name. I was answering to “Wambui” the whole day (as one of the drivers for AIDS Relief had given me a Kikuyu name previously). At least if all else fails, at least I’ve provided some entertainment…

AIDS Relief

September 12th, 2010 by INMED
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This past week I have settled into a more constant work of working directly in the AIDS Relief Program here at Kijabe, apart from Monday when I went along with JB, one of the community health nursing instructors, to Nairobi (we were dropping 22 nursing students to live and work at the biggest government run mental hospital). It’s been good to have some consistency where everyday I come across the same concepts which helps to solidify it all in my brain. So Tuesday I “put in my time at the office” as I worked in the Data department all day. This is where much of the patient information is put into a computer database and patient progress is tracked. Also, this is where they glean statistics about the program and how it is functioning. It sounds awesome, but I spent the day putting in what seemed like a million CD4 counts! However, the statistics are quite impressive. As of August, there were around 4800 patients enrolled in the program, which is spread out in between the hospital and four “satellite” clinics. Approximately 66 % female, 34 % male, 15 % not yet on anti-retrovirals, and 1-3 % mortality. That in itself is quite impressive.


Wednesday through Friday I worked in various clinics, traveling out to satellite clinics two of the days and stayed home at Kijabe clinic on Friday. My role has been helping with the triage, which is basically checking patients in, filling in paperwork, and taking vitals. I can’t do much else since I am still dealing with a language barrier. Most people speak a few words of English, but it’s not enough for me to think I could provide good healthcare. I wish I spoke Kikuyu or Swahili to help out a bit more and connect with the patients better, but it also puts me in a good place for observation. It’s been a good week to just solidify the process and flow of these clinics for me. The staff is all so gracious to let me join in.


One thing I noticed at the clinic in Githunguri is how many mothers with babies or young children there were at the clinic. The program has created a sub-program to address this: PMTCT (preventing mother to child transmission). Each pregnant woman who is HIV positive meets with a “mentor mother” to explain what she can do to decrease the chances that her baby will convert to positive as well. This involves a disciplined medication regime, keeping follow up and pharmacy appointments, placing the baby on anti-retrovirals, and most of the time in this area, exclusive breastfeeding until 6 months of age. They told me that if the mother follows this there is only a 10% chance the baby will be HIV positive.


Saturday was a bonus work day, yay… Ha! Just kidding. No, really, I had a great experience going to “kids club” at Thigio Clinic. This is the support group for HIV positive kids and their guardians which happens every month or two. The kids get together for the majority of the day to listen to or perform teachings, songs, poems, then go outside to play games and then share a meal together. There were about 20 five to twelve year olds and maybe a dozen teenagers. They were quite enjoying themselves and we joined in on the fun. This is what I call community based health care.


As for me I’m still enjoying lots of chai breaks and having my fair share of chapatis, which somehow grow on you to point that you crave them. It’s getting warmer here (apparently summer is coming) and it has not rained on my clean clothes on the line for a good week now. Last weekend I went on a real live safari and saw a lion consuming a zebra (that may be the highlight of my year, sorry to say). Also the other day I woke up to something on my face, slapped at it, and promptly fell back asleep. I woke up to find a very squashed spider on my pillow. Just a little reminder that yes, I’m still in Africa.

Out To The Rural Areas!

September 3rd, 2010 by INMED
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Community health, chai, ugali, butchery, ride-along, potholes, mud, fog, “wimwega!”. Just a glimpse into my Kenyan experience this week. Somehow this week is already over and I’m not too sure how that happened. I’ve had a bit more of a consistence as I was with the “Newborn Community Health Project” most of the week. A brilliant project that started two years ago in hopes to decrease unnecessary death and problems in the newborns in the rural areas around Kijabe. Just listen to this mission statement: “With God’s help to reduce neonatal mortality and morbidity through dissemination of knowledge and other health care intervention in the community around Kijabe hospital by promoting healthy pregnancy, safe delivery, and immediate care of the newborn.” Bam! The most brilliant part about this project is that it uses resources the communities already have and seeks to give them the power they need to take their health into their own hands aka. education. Health education is the key and it is aimed at pregnant and new mothers in order that they have a greater chance of healthy pregnancies and healthy babies.


So out to the rural areas we went! And I thought Kijabe was cold. Just about a half hour up the road, in the Mukeo area, we went, networking with the “Community Health Facilitators” (women in the community that lead and facilitate groups of women and who also serve as a contact point for the community nurses of Kijabe whom I was with) and doing home visits. One day the fog was so thick and the air so crisp, I’m pretty sure it could have snowed. Ok, ok, maybe not, but somehow the air is just cold at 2500 meters above sea level no matter how close you are to the equator.


So, over the course of the week we did a lot of driving from one house to the next, sludging through the mud and potholes. We checked in with the community health facilitators and made home visits at their referral. We saw a few newborn babies who had previously been very sick at Kijabe, a few pregnant mothers who had pressing concerns. We even visited the home of a girl, maybe five years old, who had been raped and was now taking post exposure prophylaxis treatment for HIV. That one was a little sobering…


In between these visits we would pop into a community group, which may be based out of a church or just the village itself, and do a short presentation on a health topic. I even got the chance to teach on how to prevent and recognized infections, especially in the newborn. Hopefully some of it got across amidst the translation. Really it was a joint effort, me and Bertha, (one of the project workers) because I would say a few points in English, and she would translate it into Swahili, which ended up being her talking for about five minutes!! I think she did more teaching than I did!! At any rate, I’m assuming health information got across in one language or the other.


Ok, side note. Let me tell you about my cultural experience of the week. I somehow ended up at a funeral. Most of the time I have no idea where we are going or what we are doing partly due to the fact that the staff is speaking Kikuyu amongst each other and partly because I’m just new. So there we are, driving in a car and we drive into this yard that is packed with people. I’m talking about maybe 200 people. We drive smack into the middle and get out with everyone staring, all the while, the pastor is giving some sort of speech to all 200 sitting around the yard. And yes, I’m quite aware that I’m the only white face in the crowd and I have no idea who has just died!!! Somehow, all went well. The lady who had died was the mother of one of the Community Health Facilitators, so our team went to show support. We were escorted to the back to sit and we finished out the service there, listening to the pastor and singing some lively drummed songs.


Ok double side note, can I just take a time out to address food in Kenya? Maybe you could call it my food regimen because it seems like wherever I go the Kenyans just want to feed me! I know it’s polite to take what is offered because it’s more about the gathering together instead of the actual food. I think I’m averaging about three cups of chai per day and every time I go out with the car with at team we usually stop at a cafe, um I mean BUTCHERY to eat lunch. You enter in and the small room in front with glass windows is filled with animal carcasses hanging there. For example, Wednesday we were off with the newborn community health team by about 10, but halfway out they stopped and said, “we must take some tea now”. So in we go to drink some chai but I am also required to eat a “chapati”; basically a thick fried tortilla-like pancake. Then the next two house visits we did, they made us sit down and drink another cup of chai!!! Sometime later, someone gave us some roasted corn to munch on, then finally when the day was done we stopped at the butchery “to take lunch”. This meal was meat stew (I mean meat, fat, gristle, and bone stew), ugali (the starch staple of Kenya, boiled maize meal), and cabbage dripping in grease from the cow. I think they are living up to Mrs. Muchendu’s request to take good care of me here…

Out And About

August 28th, 2010 by INMED
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How can I describe this week? Observant. Eventful. Culturally enlightening. Swahili-filled… Flexibility is key as my plans seem to change from day to day or I get word from the principle of the nursing school (who is coordinating my experience and schedule here) that I am supposed to be at a certain place at a certain time to go along with these people. What exactly does that mean? I never know, but I do what I’m told and have ended up participating in a handful of very valuable experiences! Tuesday I was able to go out with one of the Community Health instructors and a driver where we picked up a car full of nursing students who are working and boarding in a town maybe 30 km up the road in Naivasha.


We then drove further northwest to a small down called Gilgil where the task of the day was to assess and do a “supervision visit” of a small dispensary. Mainly this means to determine if the clinic is functioning well and safely. It was good, for me, to see how this small dispensary works and what services they offer: immunizations, child welfare checks, antenatal clinic, family planning, HIV care, and basic outpatient consultations. It is largely funded by the government, hence the need for our visit. Bonus, on the way home, the instructor wanted to check out a facility to send nursing students to in the future: a mental health ward in a small hospital! I was shocked. Can you imagine, mental health care in this developing country?


Wednesday I was shocked again, as I did another ride-along with the “Palliative Care Team” from Kijabe Hospital. Yes, you heard me, there is also palliative care in this area of Kenya as well. This team is in the process of vamping up their program, so the first half of the day we went to different commercial businesses where the nurses gave them the opportunity to donate and support the community by investing in this palliative care program. The main goal of their care is to provide pain relief, symptom management, and increase the quality of life for those with terminal illnesses. About ninety percent of their patients are those with cancer, while the others have AIDS or various organ failures. In the afternoon, we ended up doing three home visits to check up on patients. All the conversation was conducted in Kikuyu, a local dialect, so I didn’t understand anything, but I’m realizing the opportunity to visit Kenyan homes was a privilege. Some had a one to two room house with dirt floors. One even welcomed us to sit in the living room while the chickens were moseying around there as well!!


Thursday and Friday was spent with the AIDS Relief team, which I will biasly say has been my favorite time spent here yet. The program is amazing. Well thought out and functional within their community. They not only have an outpatient clinic at Kijabe Hospital but are actively going into more rural areas to provide clinic services to the people there. They are strict, don’t get me wrong. Patients have to show adherence to the medicine regime to be entered in the program, which they have to keep up and are also required to disclose their positive status to at least one person in their family or community (which has proven to increase adherence). Despite the toughness, there seems to be much support – each person is required to attend a support group in their community. Here is where the clinic leaders disseminate health education and where the patients get support from others going through the same things as they are.


Friday: Happy New Constitution Day for Kenya. The day has turned into an unofficial national holiday. Lots of excited Kenyans here today!

Welcome to Kijabe

August 20th, 2010 by INMED
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Welcome to Kijabe, Kenya. Land of the feeling of never being warm but never so cold, the land of tea breaks, and the land of probably the most beautiful people on earth. I arrived here two days ago and am already feeling quite spoiled. My own room, already made bed, hot water, refrigerator, electricity, and the chance to walk right up the street where there is an abundance of fresh fruits and veggies. All a little different than my previous home in rural Haiti. I’m still trying to grasp if this is the real Kenya or if Kijabe has been built up so that it is somewhat privileged, but, oh so taken care of. I had a little wake up call to the fact that I was really in Africa as we were driving up to Kijabe from Nairobi. It took me by surprise: the Rift Valley just popped into view. It was beyond vast. Something that makes you feel quite small and that’s when I realized I am probably the farthest I have ever been from home.


So! It is quite the set up here. The hospital is big and offers a wide variety of services. I’m just pretty amazed so far. I know I’ve only been here two days and my assessment skills are probably tainted by awe and wonder right now, but everything seems well set-up and well-functioning and a substantial asset to the community. Pediatric orthopedic surgeries, C-sections, palliative care, and lab, radiology, ultrasound, and x-ray all under one roof, just to mention a few! And from what I hear, they have a pretty incredible AIDS relief program. One that has somehow succeeded in bridging the gap between health policies and the actual people in the community. This is something I’ve got to see and I’m hoping I will have a chance to follow along in the weeks to come.


So far I am working with the School of Nursing that is running here (oh yeah, did I mention they also are training their own healthcare workers in a seemingly vigorous program?). I was introduced to the Maternal Child Health clinic today that is basically being half-run by the nursing students (I was impressed). This is one aspect of public health at it’s best: pre-natal care, including blood work and HIV testing, health education, child growth monitoring and an abundance of immunizations. It was a happening place and made me pretty happy. It’s well; it’s functioning…but I’m beginning to think there is a secret for their success: a lot of support, leadership, and direction from the government’s public health system, which is the Ministry of Health for Kenya. I’m not sure how it would function, if at all, without that piece of it.


Needless to say, I am pretty impressed at what is going on here, even though my time has been short so far. Hopefully I can be a sponge. And hopefully I can get out to the rural areas to see if people are able to access the wealth of services that are available here. That I believe, is the biggest challenge to overcome, to say the least.

Departing For Kenya

August 11th, 2010 by INMED
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I will be leaving for Kenya in five days!  This seems a little unreal.  Don’t worry, will try to keep the freak-out packing phase to a minimum this go around.  I’m excited for this new adventure to begin and am definitely have no clue what the other end will hold.  No doubt it will be eye-opening, worthwhile, educational, and just a meaningful experience in this little life of mine.  Hopefully you all can share in my journey and experiences as I journey to Kijabe Hospital in Kenya, where I will be trying to learn as much as I can about international public health.  Hope you all enjoy the ride as much as I do!

My First INMED Blog Post

August 10th, 2010 by INMED
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hansen-rynaHello! My name is Ryna Hansen. I am a registered nurse and I’m starting my INMED service-learning experience at Kijabe Hospital in Kenya, beginning in August 2011.