Thursday, I had the privilege of tagging only with a peds team to Nyahururu - a town NE of Kijabe. I did not really know who would be going and in what mode of transportation, but I was not expecting to be the only non-Kenyan person....however, I was:).
I was picked up at 6am by a paid driver in his small personal car, Gilbert (social worker from Kijabe), and Jan (a Kenyan nurse on the peds ward). We then drove up the mountain above Kijabe and picked up Mary, another nurse from the peds ward. Thanks to my brothers, I am very used to the back middle seat with my knees pressed together:). I was told the drive would be about an hour and it really was almost 3....this is very Kenyan. Oh, I forgot to mention that I am always early here as well. Driving in Kenyan or riding is a car is pretty scary...there are no lanes really and they have these crazy road blocks with spikes and really high speed bumps without markings.
Once we arrived in Nyahururu, we ate breakfast at a cafe which is kindly paid for by the hospital fund. I had eggs, toast, and a bottled water for about a $1.25. The group spoke swahili the whole time unless the questions were directed towards me.
The clinic was held inside of a nice building run by a Catholic Ministry (if it were not for Christian organizations many of these services would never be offered!) which catered to street kids, substance abuse, HIV tx, and disabled individuals by providing housing and work opportunities. We were located in the "physical therapy gym" and laid out all of the patient paperwork and charts to start seeing patients. Many of the patients were there for a follow-up visit following spina bidida repair or shunt placement as these clinics are set up over a years time all over Kenya by Bethany Kids so families told have to travel the distance to Kijabe. However, there were new patients which was where it got interesting.
The two most interesting ones I saw were:
An emaciated 10 mo male was the first patient with his mom who was also malnourished. He was covered with tons of dirty blankets and when I uncovered to look at his back I saw a very large, unrepaired myelomeningocele that also had a fungal infection on the sac. Wow! - I have never seen this in a child this old as in the states it is repaired in utero now or shortly after birth. This patient had never had any real health care. When I did the exam, it was clear that the infant was flaccid from the waist down and had a neurogenic bladder. My goodness. The mom did not understand the condition and still had hope that her child would walk someday. Jan did a really good explaining this to her in Swahili. She told the mom that she needed to be honest with her so the mom could begin to adjust to the reality of the situation and get involved in a support group. There were definitely tears and this was a blunt conversation (so different from the way we often sugar coat things in the US and well as don't speak in absolutes in order to avoid lawsuits), but hopefully the mom can make the transition. Gilbert set her up with a transfer to Kijabe on Sunday so the child could have surgery next week.
- the sad thing about it is Jan said the dad might divorce the mom or may not even approve of her seeking medical care. There is so much stigma here with disabilities and many of these babies are abandoned. Many of the tribes believe this would be a curse and/or use some form of witch craft/alternative tx for the child, which may do more harm in the end.
The other shocking patient, was a 6 week old whose mom had noticed an increase in head size for about 3 weeks. She went to a local hospital where she was told to go to Kijabe but the family could not afford the transporation. The body of the child was teeny but when I measured the head it was 51cm! Average size for HC at 6weeks is about 35cm and my HC is 58cm as an adult (and I have a large head). This child was sick and needed to have a decrease in ICP! The nurses here are trained to perform a tap of the fontanel and it would have been extremely helpful. The child had been vomiting for a week and only able to eat about 4 times per day. The father did not approve of the mom being there so Gilbert told her to not go back home as he would not allow her to go to Kijabe. She also has six kids at home and is a farmer (many of the women are farmers -a very small operation). The Catholic organization was able to pay for the transportation and she went straight to the hospital.
I saw the infant on Friday in the OR holding area and he was waiting to have a shunt placed. However, this child will never be okay and it will likely not be good for the family.
We gave out lots of folic acid and I walked around in the waiting area giving all of the kids Vitamin A drops. It was incredible.
The hospital treated me to a late lunch which consisted of a whole fish with the head still on:) and chips (french fries) for about $2.75 which was the most expensive item on the menu.
I was unsure whether we would make it home as we had to push the car at one point and traffic was crazy! I got back at 7:20pm and said goodbye to my new Kenyan friends. It was so nice that they let me come along.....as they were probably thinking who is this young looking white girl from America when they first picked me up:).
I have a new passion in my nursing profession.....teaching moms about spina bifida in Africa and giving out folic acid. We have talked to many of the US docs here and it is interesting to see their opinions on funding that is given to Africa. Huge sums of money are given for HIV meds and they say this is good, but they would like to see more money go to prevention programs and to patients who they deem "have a chance of life and are not terminal." Hopefully, I can make this possible some day and really raise some funds to help prevent spina bifida.
Once I got home, Jas and I rushed over to Anne and Robert Mulwa's house for dinner - Anne is the pediatric tutor I have been working with and Robert is a nurse in the peds orthopedic department. The authentic African food was great (Anne knew I did not eat beef) and it was so fun to talk about life in Kenya from a young couples perspective. At the end, we decided that in the US or in Kenya, married couples have the same ups and downs. We hope that they will visit us in the US someday or we will see them when we return to Kijabe.
Friday is our last day in Kijabe and we will head to Nairobi for Jason to fly home:(. I don't think he is ready to go or to leave me! It has been an amazing trip and we have really grown together as a couple. Thank you for following our blog - I am hoping to post some more but I don't think there is wi-fi at the orphanage as there is not hot water.
Much love, Em
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If you new passion is Hydrocephalus and Spina Bifida then you want to check out CURE International (www.helpcurenow.org). CURE runs the only fully dedicated paediatric neurosurgical hospital in sub-Saharan Africa in Mbale Uganda and offers neuro services at is hospital in Zambia.
ReplyDeleteSB is one of the most common congenital birth defects, affecting 1 to 2 in every 1000 live births. Hydrocephalus is an enormous problem among infants in the developing world. Because of high birth rates, the lack of health care and tremendous poverty, the incidence of neonatal infection is higher in poor countries leading to higher rates of infantile Hydrocephalus. The traditional treatment for this condition, insertion of a ventriculo-peritoneal shunt, is poorly suited for children living in the developing world. Almost 50% of shunts fail within 3 years of placement requiring frequent replacement. Shunts are at high risk of infection and, again, this risk is even higher in poor countries; there is the likelihood of shunt failure at some point in the life of the child and shunt failure after closure of the anterior fontanel is an urgent and life-threatening situation. Shunts require frequent monitoring by a trained neurosurgeon and well trained neurosurgeons are not available in the emerging world. Cost, travel, lack of qualified care and limited understanding of disabilities in general among those living in the Global South have created the situation where the greatest need for a comprehensive response exists in countries whose capacity to respond is least.
An alternative procedure for the treatment of hydrocephalus is the endoscopic third-ventriculostomy (ETV). The ETV is less invasive than a shunt, is a one-time procedure, and is less costly. Dr. Benjamin Warf introduced the ETV to Uganda through his work at the CURE Children’s Hospital of Uganda (CCHU). Prior to this, ETV had rarely been performed in the developing world; to date, more ETV procedures have been done at CCHU than anywhere else in the world. CURE is leading the world in treatment, training and even prevention of hydrocephalus and SB