Afya (Health)

CHWs enjoying the outreach
Child with severe malnutrition that presented to the outreach

On Saturday Sept 24th, we held one of the bimonthly outreach clinics in Mekilingi, which is about an hour drive from Kisesini. As Vincent and I loaded up the supplies for the outreach (vaccines, syringes, depoprover injections,condoms, unimix, plumpinut, and oral rehydration suspension), he recieved two phone calls for ill patients. ‘What would we do without the ambulance?’ said Vincent,’it is a good thing that global health partnership does.’ The clinic is closed Saturdays, so we would need to take the patients to the closest health facility in Kitangi. As we loaded outreach supplies, we grabbed an IV kit and antibiotics and headed on our way. The first woman was 20minutes from Kisesini and she had been recently diagnosed with high blood pressure. We got her comfortable in the car and tore off down the dirt road to the second house. This old woman had been having diarrhea and vomiting for 3days and was dehydrated, but still able to walk to the car. As she climbed in, she laid her head on my shoulder for stability. We made it to Kitangi and helped the patients to the dispensary, which is open on the weekends.
We then continued to Mekilingi for the outreach. When we arrived, there were only about 10 mothers and babies, but by the end of the day we had weighed, measured and vaccinated about 40children and provided family planning to the women interested. We used both the WHO criteria to determine a child’s need for plumpinut or unimixm, along with the Moac, which is based on arm circumference. We found 4children who needed to be placed on unimix (moderately malnurished) and 1 needing plumpinut (severely malnurished). We also found some ‘strong’ (the term we use is plumpy) babies, too. Unfortunately, one child came in who was about a year in age, weighing 4.4kg. This child was less than -3 Zscore for the WHO criteria and was literally skin and bones (severe, acute malnutrition that is known as marismus). The mother repored that the baby refused breastmilk. The infant forumla over here is difficult to get (only in bigger cities, which are expensive to get transportation to) and it is VERY expensive (one can that lasts a week is 1,000Kenyashilling-about $10…which is more than most of these mothers would see in a week). It was a heart-breaking situation. So, we had the mother wait until we finished up at the outreach and she followed us in the ambulance to drop supplies off in Kisesini. Vincent then took her to Machakos to the hospital…he waited with her for 3hrs until she was seen and admitted. Vincent is an amazingly dedicated worker. Saturdays are usually his days off and it turned into a long one. He did everything without complaint.

Back in Kisesini!

CHW Mutinda with mother and baby, Damaris
Mutinda and ndulo (the driver) on our walk to the newborn visit

Wa Mukata! Good morning!

I have now been in Kisesini one week and have been able to participate in a newborn visit and help Nicholas, the Kisesini clinic nurse, with other Global Health Partnership tasks. On Wednesday, I went to Syokisinga, which is about a 45minute motorcycle ride, to meet Mutinda, a Community HEalth Worker (CHW). We met in the town of Itithini and began our walk down towards the Athi River. We were going on the final (day 7) visit of the baby girl Damaris. After introductions, Mutinda set to work counting the number of breaths per minute and determined that he did not hear any grunting or see any nasal flaring. He then took the baby’s temperature and looked at her umbilical cord to look for signs of infection. After confirming that no ‘danger signs’ were present, Mutinda began educating the mother. He told her that she should exclusively breastfeed until the baby is 6months and that she needed to take DAmaris to clinic as soon as possible for immunizations. This is part of the newborn visitation project set up by GHP where many CHWs have been taught to monitor newborns for danger signs, including fever, infected umbilical cord, or trouble breathing. The CHWs visit each newborn on day 1, day 3 and day 7 of life.
Currently the CHWs are interviewing all households in 5 different Sublocations so that an accurate under 5 mortality rate can be obtained. We will be collecting data for that project once the CHW are done at the end of September.

In clinic, it has been an exciting week! We had one delivery on Thursday at 8:00pm and the woman had to stay a bit longer than anticipated because she had a bit of heavy bleeding following the delivery, but Vincent (the other clinic nurse) took very good care of her. That same night, we had a small girl come in with a compound fracture of her femur. She was in a lot of pain, but Vincent started and IV and gave her some pain medications while stabilizing the leg for transport….this is where the ambulance comes in very handy- the little girl did not have a pulse in the side of the leg that was broken, so she was taken immediately to the Kituii hospital. We also have a man with a growth that is needing biopsy, but the next available spot for biopsy is in February 2012….Nicholas is currently loking for other options for the man. We will see what next week brings….