Arrival in Kenya!

3/19/12

Posted by Lisa Ryujin, MD (a fourth year Ob/Gyn resident from Kaiser Permanente Oakland serving  a global health elective in Kenya with The Tiba Foundation/The Matibabu Foundation).

It was so great to be welcomed back to Matibabu and Ukwala with such affection and joy. It was beautiful to see all the friends that I have been staying in contact with through facebook and email, and to see how wonderful things have been progressing. The new hospital is built! The Nzoia clinic has been developed from the 1 room clinic that I saw 2 years ago to a bustling HIV counseling center and treatment center! I even was able to participate in some educational support groups for HIV + mothers.

I was lucky enough to go into the Northern Ukwala community with one of the most incredible community health workers. He told me his story as we were walking, door to door, to find his patients. He was a accountant in Nairobi and fell ill, when he went to the hospital, he was told he was HIV+ and given drugs. He said that he knew he was O+ and that he wondered why he was being given drugs, but took them. Later, he had to go back because he had TB, during this hospitalization, he was counseled thoroughly that HIV was the cause of AIDs, which he had heard of. He began to understand that he was infected, and after his treatment, came home to Ukwala to sort things out. During this visit, he found that there were local government programs that would provide his medications for free and so he was going to be treated here at home. During this time, he returned to the community, and began to recognize the signs and symptoms of HIV, and began to encourage them to get tested and to know their status, and thus, the community health workers were born. He continues now, 22 years later, going door to door and helping patients to access health care.

The first patient home that he took us to, we had to arrive by motorbike along windy and unmarked dirt roads. It reminded me of working on the reservation, only a local could find their way to these houses. We were greeted by many people, sitting along the side of the house, in the front of the house, all appearing as if they were waiting…for us? For an educational session? He walked in, although he too seemed puzzled. As we made our way inside, shaking hands and exchanging greeting along the way, we found that the man we had come to visit had passed away last night, and that these friendly faces, all waiting, were in fact mourning. It was incredibly sobering, and as we tried to express our condolences, I could see that he was affected. What if he had come last night instead of today, could anything have been done? These questions, you have to ask yourself as a health care worker, and just as you saw the sorrow on his face, he pushed it aside and proceeded to lead us to the next house, the next patient that needed to be checked on, and the next family that needed help. He called the clinic to let them know that this patient had passed away, and also told the family that after his work was done, he would return. I knew he would.

We did this for the entire day, we visited sick patients, occasionally finding that we could help, sometimes able to offer suggestions, many times asking them to go to clinic and get further treatment. His dedication and persistence was admirable, and this is what truly transforms health care. I think that the community health workers are the secret weapon to combat disease in these rural communities, but how many men and women do you meet with this sort of dedication?

Although we were meant to come to Kenya to operate at the Siaya district hospital, the nurses have been striking and we have found ourselves in this strange limbo. But I couldn’t have imagined a better use of our time, last week we taught the nurses to enhance their ultrasound skills, identifying multiple gestations, abnormal placentation and malposition. We assisted in deliveries, talked through difficult gyn cases with the clinical officers, and now we are able to go to offer a door to door service that gives us an idea of what patients go through to even make it to the doors of the clinic.

We are suppose to move to Siaya at the end of the week to start operating on the patients that we screened last week, but I am also happy staying here, seeing how it all fits together, how the team effort produces better patient care, and just being a part of it. All I can say, is that this month hass only just begun, but that I feel grateful to be working alongside with such wonderful and dedicated clinicians. It gives me hope for the future of medicine, here and at home.