Friday, February 11, 2011

Pre-team thoughts

From Kathy, Jack and Ed about their adventures:
Kathy, Jack, Ed, and Ted (the pre-team) arrived Friday evening, January 31st, and spent Saturday with Anne Josiah and Bernard from Chalice. It was a great meeting. Kathy adds, ‘As always they provided insight, sensitivity to culture, and guided our way.’ Jack mentions that he couldn’t sleep Saturday night due to the time change and jet lag.
Sunday morning they went on safari and saw lions, cats, rhinos, antelope, Masai giraffe, regular giraffe, Masai zebra, regular zebras, and impalas. The two pessimists (I won’t name them) said they didn’t see cheetahs or leopards, but saw everything else. They remember with a note of sadness a large pile of ash that was made from illegal sales of ivory tusks and surrounds a memorial to discourage the practice. Sunday afternoon was quiet and they spent the afternoon shopping for shorts for Jack. (Note: Jack somehow arrived in Africa without shorts and Ted has suggested that they stop and buy him a pair of shorts every time they pass someone selling him). They went to a high end mall in Nairobi, quite different from the stores in Mikinduri.

Ted playing with Silvanos' children

Jack spent the evening with his friend while Ted played in the pool with Silvanos’ wife and children. Silvanos was the manager of MCOH in Mikinduri (locally called MHCDO), and was murdered in December 2005 in Nairobi. His family has remained a part of the MCOH family and when Ted mentioned playing in the pool at their visit last year, the children remembered and were quite overjoyed to go in a pool for their first time.

Now that the pre-team was more acclimated to the time change, they were ready to get to work.  Monday morning at 8am, Ed, Father Bernard, Antony, Bernard and Jack met with APDK. Kathy, Ted, and Anne met with the Lion’s Club. The meeting was with Eunice Wandei of APDK, coordinator of community based rehab programs. They reviewed requirements for establishing community based rehab programs and learned about the micro-financing programs for people with disabilities. They saw the outside of the factory that produces wheelchairs for only $200, tailored to the specific needs of the disabled, with larger wheels for the rough road, more like a mountain bike would have so it can be repaired easily in the villages. They also make crutches, braces, and prostheses.  In a different part of town, the meeting with the Lion’s club was with Dr Khan and Mr Datoo. Their mission statement is ‘we serve’. They were eager to partner and support and outreach for eyecare. It was a beautiful hospital and they balance the services well. People with money would pay for dialysis and eyework, which allow them to offer services to the poor for a minimal price. A second meeting was set up to discuss the possibility of the partnership. At 10am (yes all that was in only two hours!), they all promptly returned to the Methodist Inn to meet Zarah and Leah, consultants recommended by Amref Canada, who were hired by MCOH to do an environmental scan (more detailed than an assessment), as part of a feasibility assessment for community based health care. They presented a preliminary report with the promise to deliver a final comprehensive report mid-February. They spent so long in the meeting that the consultants nearly missed their plane!
Data measures they track for Community Based Health Care
Monday afternoon, they took off for Makindu, a town East of Nairobi, half way between Mombassa and Nairobi in a place called the ‘hunters lodge’. Makindu is a model Amref site for Community Based Health Care that they visited on Tuesday. They learned so much about Community Based Health Care and were able to visit two different sites that day. They met two CHEWs (Community Health Extension Workers) and were show the types of data collection and indicators that were used by the Dept of Health to monitor program effectiveness. The second site was a demonstration on using computers for data collection for Community Based Health Care. Community Health Workers (CHW) directly entered the information on their areas on health conditions to send to Amref that they’re responsible for monitoring. It gave them insight into the relationship between CHWs, CHEWs and Community Development Committee (the board). On the trip back to Nairobi, Jack purchased a GPS for better investigation of water locations…and went on a second shorts shopping trip.
On Wednesday, they had a more extended tour of the Lion’s clinic and were quite excited to start a partnership that the Lion’s would provide support at the vision clinic during the Mikinduri health clinics this year! The Lion’s club will do screening for diseases and eye conditions, i.e. cataracts. They can do very accurate vision testing. It provides an interesting opportunity to facilitate referral of patients to Nairobi and possibly more regular clinics if the need is present. Meanwhile, Jack and Fr Bernard went to the national statistics agency and got some great information about the Mikinduri area. They bought two publications on Population and Household Statistics by Administrative unit, the smallest unit in the country, which gave them a good baseline on the population that they’re serving. That book cost 4000 shillings ($50). They bought a second book called Socio-Economic Characteristics which was a bigger geographical unit and will be very representative. That book was also 4000 shillings. They were searching for topographical maps of the Mikinduri area. On Wednesday evening, they had the pleasure of meeting Bernard’s family: Emily and Joy.

Education before clinic began
The next week of their activities are in the previous blogs, so jump to Tuesday February 9th:  APDK from Embu and Meru had a clinic at the Mikinduri dispensary where MCOH clinics are held. We learned many things from them about how to run clinics.  They started with micro-education, and taught a large crowd preventative teaching: the importance of immunization and particularly how it relates to polio; they emphasized the importance of vitamins especially in pregnancy; they reviewed the importance of early recognition of club foot (with the consent of a four year old teetering by with club foot, the Occupational Therapist, Peter Kareoke, the Embu Regional Coordinator of APDK, demonstrated club foot, the importance of early diagnosis and treatment to prevent the need for later surgery or amputation); and the importance of health insurance and joining the national health Insurance Fund and national disability fund the Kenyan government has established. That also provided an opportunity to instruct the people to be screened in the manner the clinic was going to be conducted. They divided into three teams: Physical therapy (PT), occupational therapy (OT), and orthopedic technologists, with one person from Meru and one from Embu. Those from Embu were training the Meru staff on how to run a clinic so the Meru staff can come back on a monthly basis for screening and assessments.

Boy with Club Foot

They saw 176 patients. Approximately 40 custom made wheel chairs were ordered. They will be made at the facility previously toured and sent directly to Mikinduri. Crutches were measured and ordered. Orthoses, custom footwear, were measured and ordered. Patients were referred for follow-up for school assessments, and subsequent follow up with the OT and PT. The patients were amputees, one with a bilateral above knee amputee walking around with 5-year old limbs that were in great disrepair, but he was able to walk around with his crutches. It was inspiring. He was fitted for a new wheelchair. There were 18 year olds carried on their parents back, who have never had wheelchairs. There were people with spina bifida, cerebral palsy, leprosy, scoliosis, muscular dystrophy, downs syndrome, spinal chord injury, elephantiasis, development delay, autism, epilepsy, ADHD, and mental illnesses. There was a man who arrived carrying his wife on his back, and on her back was her 6 month old baby! She was paralyzed from the waist down and the baby was malnourished. The APDK team was very surprised at the frequency of malnutrition, leprosy, elephantiasis, and they commented on the relatively high frequency of upper extremity amputations due to trauma (from machetes).

The APDK team had previously indicated that they would consider monthly clinics in Mikinduri if there was need, and due to the overwhelming response, there will be clinics the second Friday of every month. This is a great success that will continue even after Kathy and Ed head back to Canada. The number of people who arrived for the clinic was overwhelming, due so much to the local Mikinduri community. They found out the clinic was going to occur in less than 5 days, and the community banded together, Antony, Fr B, Chief Alex, Cynthia, and the community did a great job passing on the word! A fine example of the effectiveness of community based health care.


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  2. Oh, It is so great to see Ron and Antionette having fun in the pool. Great picture, thanks!!