Kamba Basket Co-op shows wares

Sunday 31 July . Finally  a rest day. I (Rifka) tried to sleep in but the sunrise was too beautiful and the rooster was crowing . David made coffee and  lots of fried potatoes for breakfast. We also had scrambled eggs, chapatis and fresh papaya.

Yesterday, David experimented making a solar oven of a cardboard box and aluminum foil.  We painted a pot black and sealed it in a plastic bag.  Temps can reach 200F. We cooked a little bit of chard in about 2 hours (see www.solarcookers.org)
Justine (our lab tech who lives here with her two children) made 2 cakes today. One she cooked on her charcoal burner, the other we tried to bake in the solar oven.Unfortunately we waited till the afternoon and the sun went away so the solar oven didn’t work. The first cake came out great, just a little bit of burned crust on the top.
The village basket weavers came and showed us how to make baskets. It is a many step process, but we tried to roll the sisal (a little like maguey or century plant) fibers into string and then weave them together. It is amazing to watch how fast they can do it.
   Rifka brought little bottles of  nail polish that she gave to the ladies in the basket coop. It was a big hit and they all put  the nail polish on right away. You’ve got to see the pictures of David painting Chairlady Mbette’s fingernails!
   The basket co-op displayed of over 100 baskets for sale and it was very hard to choose, because there were so many colors and different styles. I did my best to support the economy.  The basket co-op has existed for years and currently has more than 600 members.  Baskets are priced by size a medium-sized one costs around $10 and takes 2-4 wks to make.  Tomorrow, the co-op will sell 300 baskets to a crafts wholesaler in Machakos.

Circumcision clinic for pre-adolescent boys

Saturday was very different than expected. I (Rifka) thought I would have a rest day but instead I was asked to accompany the nurses to help do male circumcisions (female circumcisions –FGMs– are not done here).  In old times, boys between the ages of 6 and 10 were circumcised in August as part of a ceremony that involved slaughtering a bull. Now people aren’t wealthy enough to do the full ceremony, but continue the circumcisions.

Wilfred, the nurse who was my translator 2 years ago showed up. He is now working up near the Ethiopian border where he said the biggest problem is malnutrition. He is on vacation for the next month but came back to this region to do circumcisions on young boys on his own time. The three male nurses gathered all the equipment from the clinic and we drove about 45 minutes to small village called Mekelingi. They set up in a small building with 2 tiny rooms. They set up their equipment which had been all sterilized on a clean cloth on the floor. Two circumcisions were done at the same time. Rifka helped with the anesthetics and handing instruments to the nurses.

The first boy was brought in and he lay down on the table with his lower legs off the end. His penis and surrounding groin area were cleaned with alcohol and betadine and then a local anesthesia was given. I’ll spare you the rest of the details, but it was done quickly and cleanly. Most boys cried but a few didn’t. During the procedure there usually wasn’t too much pain. Four of us from Kisesini  helped by trying to talk with the boys and sometimes held them if they were very scared. By the end of the procedure they had calmed down and were able to get up off the table without problem. They were dressed in a sheet, wrapped around them like a toga and tied at the neck.

It took about 3 hours to do 11 procedures, but we had to stop in the middle and resterilize the instruments. They were cooked over a small propane stove in the pressure cooker.

Visit the poor, learn about water, clinical impressions

Fri July 29. Evening time. We are mostly outside. One of the MPH students is playing air hockey on an ipad with 2 of our interpreters. They are delightful young men about 25 years old and will help us with anything.

Profiles of the Poorest

Today David and I walked about 4 miles around to 2 different very poor households. One woman was widowed and is trying to raise her 3 children by herself. Her home is about 8 x 8 feet. She cooks outside over wood. She has 3 chickens but no garden. Then we went to another home with an old grandma, who is 77. She barely gets around with a stick because she has such bad arthritis. They need everything, food, bedding, clothes and school fees for the kids. I came back covered in red dirtI came back covered in red dirt.

We  went to the river where people get water. They dig a hole in the dry sand at a bend in the  the riverbed. If they dig deep enough (sometimes 10′ down), water seeps into the bottom of the hole. People patiently scoop water off the bottom of the hole, filling a bucket, pouring each small bucket into larger ones tied to a donkey. The donkey can carry four 20 liter cans and he may have to walk several miles to get the water home.

The land is very dry and dusty. There are aloe plants and other cactus. The plant that makes the fiber the women weave into baskets looks like the century plants we have in Albuquerque. Mango trees are the only lush tree in sight. They are beautiful bright green and tall.

Today’s Clinical Impressions

I (Rifka) worked in the clinic in the afternoon. I did get to see a few very healthy babies. It was great to reassure the moms that they were doing a good job and just had to keep breastfeeding their babies. One of the moms had started supplementing her 4 month old with goat’s milk and the baby had a little diarrhea. I explained how important it was not to give anything but breast milk for 6 months. Later, I saw a 32 year old man who had lost a lot of weight and had a large growth in his upper abdomen. We are taking him to the nearby town of Machakos for more testing.

Every day I have a better sense of what are common complaints, what tests and and what medications I can prescribe, but everyday there is something very difficult and challenging that I have not seen before, or I feel I can not do much  help.

Cloudy days mean little power

It is peaceful here and when the sun is out we can see rolling hills for miles. It has been very cloudy and it is interfering with our ability to communicate because we can’t charge the solar batteries enough to keep our computers running and our internet connections are so slow.

Mother of Seven, has home, little else

Mwalimu is forty-one years old.  She  has seven children under the age of ten. They live in Kwa Kisai village about 45 minutes by foot from Kisesini Clinic.

There’s no father in the picture.  Her grandmother lives a little way up the road.  Last year when Mwalimu’s  house, made of sticks and mud burned to the ground (see photo 1), donations from GHP helped build her a new house—this time made of cement, even with a floor–and now, they still have next to  nothing.  They have no mattress, sleeping pad or even platform–they all  sleep on a pile of rags (seen in the photo drying in the sun). The rest of their belongings fit in a couple of burlap bags stacked in the corner of the house.  The oldest child attends school, two twins nurse, a boy gazes  blankly of into space.  They say he is unable to learn, so can’t go to school.(see photo 2).
As I tried to interview them, I looked at this family, their eyes seemed dull, lifeless.  I thought, there is nothing I can say or do to connect with these people. I had a package of sesame  and peanut planks in my bag.  Giving each of them a piece of candy, there was no surprise, or even reaction.  I gave a piece to the older child and she handed it to the younger, Mwalimu, chewed a piece of peace of peanut candy, spit it out and fed it to one of the babies pulling on her breasts.
There was no food in the house and the children had not eaten all day.  I gave them 250 shillings, about $3, to buy food.  Their is not prospect of getting more money or food unless a neighbor or the GHP clinic gives them something.
Mwalimu has a plot a land near the now-dry-river, and has begun clearing a plot for a garden near the house.  A drought  plagues all of east Africa.  Even if the spring rains come, they will have no money for seeds.
You can can help this family eat, make a kitchen garden, and get help for a possibly retarded child.  Only $30 per month, three dollars per day can give life to eight people.  Unlike other charities, every dollar you give will go to this family.

Baraza, a community meeting

Baraza, a community meeting

When the community comes together to make a decision or plan in Kenya, it is called a Baraza.  In preparation for a new project that will provide grants to community groups to improve agriculture, chickens, or goat stock, the Chief called on the elders of villages to participate in such a meeting.  In addition to 150 representatives of villages, the Agriculture ministry extension officers for agriculture and livestock, a representatives from GHP, AMREF, communities in Kibwezi, community health workers, and interpreters came together in ___village.
While everyone awaited the arrival of the chief, a group of women presented several tribal dances, the first for thanksgiving, others asking for help with draught and support for getting seeds.
The Chief–actually an appointed representative of the government to the people, not a tribal elder, opened the proceedings describing the intention to introduce a new project in collaboration with GHP.  Then each of the representatives, mentioned above made presentations, providing information and guidance about the proposed project.
David and Stephanie presented some of the recommendatoins from the meetings held with the communities in Kibwezi. Dr Tomedi summarized the work that GHP has done over the past 5 years.  Our work has changed from establishing and running the clinic to addressing nutrition, and economic and community development.
At the end of the baraza, community members chatted with the chief, the Amref representative,  The CHWs from the area presented proposals for projects.   Plans were made to create an oversight committee to manage the grant projects and review proposals.  Global Health Partnerships has proposed to fund six projects spread across the Syokisinga sublocations.   Initially, GHP has grants that will fund about  US$20,000 or 2 million Kenya Shillings divided among up to six sites.

First day in Kenyan Clinic: wide variety of cases

Rifka’s note.   7/24/11

I worked in the clinic all day. It was slow getting started because the nurse-practitioner was late getting here. At first there were very few people in the queue. but as the day went on it always seemed like there were more people waiting. A few of the older people just came in for a blood pressure check. Many children with cough and runny nose. A young woman with high fever, bloody urine and back pain. I was worried that she had a kidney infection. There was a 3 month old baby with high fever up to 101 and very fast respirations, about 80 a minute. She felt so hot when I first touched her but she was bundled in 2 blankets and 3 sets of clothes. After taking off some of the clothes and blankets she looked better. She was able to nurse and I did not here any bad lungs sounds but I still felt that she had pneumonia. Another women has a deep cut on her leg about 4 inches long. It was stitched up last week and she came in for a wound check. I could see the whole lower leg was swollen. It was very infected and I  had to open up the stitches and irrigate the wound. We gave her antibiotics and pain medication. Everyone has very dry skin here. It is very dusty and dry. It took pictures of some of the people but then the day seems to blur and I can barely remember who was who. We had lunch around 1:30 and I rested until 2:15.  We were able to finish because another tranlator came and I was able to see patients on my own.  Stephen,the nurse practitioner, does things differently than I do in some cases. We tested a few people for malaria but all were negative.
After work I went shopping with Sai, Katheryn and Sydney. We found candy for the children and I bought a huge avocado for 20 cents. I also found the seamstress and want to get an African outfit made. She had great fabric. I bought 4 baskets from Mary, who is cooking for us.
Now to bed. It is 9 pm and everyone goes to bed early because it is dark outside.
Good night.

Information and solar power for Kisesini Clinic

We’re travelling with lots of stuff–may be only 20 lbs of clothes each, but we have a complete 15 watt solar electric system, and a 5 watt one.  Baby blankets, bulb syringes, medical equipment, calcium, school and office supplies, two gps, one computer, 40 lbs of paper household records. lots of rechargeable batteries.  I’m preoccupied with power issues. Most of the work we plan to do requires a computer and computers require electricity.  The last time I was here I begged space at the Catholic Mission in Katangi and spent a day working in  something like a monk’s cell with one table and one chair and a power outlet.  This time, if the sun shines, that won’t happen.

One of my goals for this trip is to lay the groundwork for a community health information system that will integrate the household survey we’ve done each year, trying to identify where the children under 5 are,  with a means for tracking households involved in our various projects, and clinical information: patient registration, reason for visit, labs, and medications.
Almost anything we do at the clinic will require additional power.  There is a solar panel and battery that is just enough to run the vaccine refrigerator, microscope, and some lighting.  MPH student Kathryn Chinn  has been working on ideas for the hardware for this system:  a wireless router and a computer that can serve as a server.  The software is a more difficult question.  It would be nice to have it all intergrated, but that will require custom programming.  We’re looking at open source electronic health record  called  GNU Health and DHIS,  District Health Information System.  There is also software designed specifically for mortality and nutrition surveys.  The Gates Fdn has funded research on rural health information system needs in Africa.
The US is well along converting from paper to electronic health records;  when we opened  the Kisesini clinic in 2007, patients brought their records in little note books that they carry with them.  At each visit, the go different places, the doctor writes a note and even a prescription in their book.  They can take this to the pharmacy in town.  We initiated a card system for tracking problems and patient register  (in a big book).  The lack of continuity in tracking health problems and treatment in the developig world is certainly a disparity that results in poorer health outcomes.
I hope to explore with the clinic staff, nurses and lab tech, what they preceive  to be the greatest needs and their capacity to maintain and operate a computerized system. I want to explore satellite based internet access.  I hope to find out where the Kenyan Minisitry of health is on information systems in small clinics, whether they have plans and models.