Month: February 2018

This week I ventured outside of Mutomo to participate in two hospital sponsored outreaches.  Non-communicable diseases are becoming more prevalent so the hospital has increased its efforts around screening programs.  This week we focused on hypertension.  Kasaala is 45 minutes from Mutomo on an unpaved road. As we passed a few other small towns en route, we noticed a young woman carrying an infant on her back.  She stuck out her arm and we slowed down, the driver recognized her as one of the health center patients. She was on her way to her child’s appointment.  After she joined us, I realized that what would take us 20-25 minutes to travel by car, would have taken her hours of walking along the dirt road in the blazing heat.

When we arrived, the patients were waiting with their Health Passports, which contain records of their previous blood pressure readings and current medication.  We evaluated each person and made changes to their regimens as needed.  At the end of the queue, the clinician phoned each person who had not yet arrived. Some were on their way, including two ladies, a mother and daughter, who said they would be unable to make it but still hoped to be seen.  After a quick lunch of chapatti and cabbage, I declined the matumbo (tripe) soup, we headed back along the bumpy road toward home only to be flagged down a few kilometers into the trip.  Our two ladies had made their way to the road to have their appointment.  Robert checked their blood pressure and we dispensed their prescriptions.  A quick stop for us, but possibly a life-changing event for the two of them.

The next day we made our way to Mathima.  Only 30 minutes away, Mathima is even smaller than Kasaala.  That day we saw patients with hypertension, and some for HIV follow-up.  The hospital requested that I give a short health talk about the dangers of undiagnosed high blood pressure, the importance of routine screening and the need for appropriate treatment.  Stephen translated my words into Swahili (of course) and our efforts seemed well received.  The two patients that stood out to me that morning were a young woman of 22 and her absolutely beautiful 4 month old daughter; both newly diagnosed with HIV.  Rates of HIV can be up to 1 out of 10 people in this part of the country, underscoring that we still must be vigilant in our fight against communicable diseases as well.

As we concluded our afternoon, we had one patient who had not arrived for his appointment.  Instead, his family appeared on his behalf and asked if we would consider making a house call.  The older gentleman was too frail to make the journey into town. On the way, we stopped for lunch. This time green grams (a type of lentil), chapatti and cabbage were served to us at the best restaurant in town.  We then traveled to the outskirts of Mathima accompanied by the social worker, David, who routinely visits patients in their homes.  We spent some time reviewing medication, and the importance of compliance, with the patient and his family.

I appreciated learning more about delivery of care at the health center level as well remembering that some need a little extra time and assistance to make their way.

Growing up, the front room of my house was called the flower room.  It was always filled with a variety of plants that my parents tended to like members of the family.  They both have the proverbial green thumb.  My dad still has a fig tree that my mom bought him after he had his tonsils removed in 1978.  For whatever reason, they did not pass the green thumb gene on to me.  A plant left in my care often does not make it through the season.  Those who try to encourage me have recommended that I try to grow a succulent or a cactus.  They don’t need much maintenance they say, you can’t kill them… Well the sentiment is correct at least, cacti survive in desert terrains with minimal water and often-scorching temperatures.

• When visiting some of the more remote areas of Kitui county, in the weeks before rainy season, the cacti struck me.  Along the side of the road, they had drooped limp, clearly a consequence of the lack of water in the region.  The people of the area depend on rainfall that accumulates over several months to provide drinking, washing, and bathing water for the rest of the year.  Groundwater does exist but is rare and difficult to access. Additionally, the salt content makes it unsuitable to drink and it’s very harsh on bodies and clothes.

Some of the women in this area rise before daybreak to retrieve water from public pumps located in town or watering holes that have been dug where rivers used to be.  Some carry as much as they can handle on their person, others use carts and/or donkeys to transport larger amounts. The journey can be up to 5 kilometers, which on foot can take up to 3 hours. This time does not include waiting for possibly 2 more hours in the queue once they arrive.  These are women in the prime of their lives and are as well the prime economic movers of the Kitui economy. Calculating the hours lost in the community in order to access water, 1 decade, 10 years, of potentially productive hours are lost every year (i.e. 14,421 households*6hrs per day to fetch water= 86,526 hours).  Even more disheartening, is the fact that this water that the community really struggles to get, is often contaminated and not safe, predisposing the entire household to diarrhea and water related diseases.

One of the CHildren And Mothers PartnershipS (CHAMPS) initiatives of CMMB Kenya is to ease this burden in Kitui South.  The WASH (water, sanitation, and hygiene) component, led by David Magina, aims to improve access to safe water for approximately 14,421 households in the Athi and Kanziko wards of the county, which have a projected population of 69,411 people. According to their quarterly report, “this project will enable the beneficiaries to meet immediate short-term needs for clean water, and provide support for activities related to WASH that will lead to long-term behavioral and structural changes.”

The other day, I complained, pouted even, when our water tank ran out.  Which means instead of being able to shower, wash my hands or wash the dishes under running water, I had to go outside to fill a bucket and then scoop the water out to perform those basic tasks.  Moments later, I felt horrible.  How could I complain about walking outside my back door to get water when there are those who regularly walk miles to and from their homes carrying water on their backs?

The rainy season revived the drooping cacti, filled the catchment tanks and provided irrigation for planting a few crops. However, if you came to visit me today in Mutomo, I still could not offer you a cup of drinking water from the tap.  As a MPH student, one of our professors asked us to do one thing for the environment during the course of her class. Taking up the charge, I undertook efforts to conserve water, including shortening my showers, making sure I turned off the water while I brushed my teeth and I chose to stop buying plastic water bottles to decrease my carbon footprint. I find myself recommitting to these action steps now. At home, I haven’t  always seen how those things make a difference.  But here, I notice everyday.