The construction of the maternity center for the Kisesini Community Health Project is now underway! This is a dream, many years in the making, come true.
Many women in Africa die in childbirth, and many of their newborn infants die during or soon after birth from lack of professional health care. The community that is served by the Kisesini project in Kenya has been seeking that professional care, with an increasing number of women arriving at the clinic to deliver their babies. Until now, they have been delivering in an exam room, and immediately walk back home with their newborn infant, sometimes walking for many hours. With the generous support of GHP donors, the construction has begun of a building next to the Kisesini clinic that will serve as a maternity center. The women and their newborns will soon have a safer and healthy environment for childbirth and newborn care.
To date this project has been done ahead of schedule and under budget, thanks to the expert supervision of our nursing staff at the Kisesini Community Health Project.
Next we need some beds, linens, equipment and supplies to make this a top notch Kenyan Maternity Center. Please consider a contribution to this worthy project.
An infection recognized early can save a newborn’s life
After a long walk to the home of a mother and her newborn infant, Salinas promptly began her assessment of the infant. Salinas is a volunteer community health worker (CHW) who has more than two years of experience with newborn home visits, having participated in the first training program that was implemented by Global Health Partnerships. The infant that she is visiting today in a village of Makusya sublocation was born three days ago without complications or problems. When Salinas checked on the baby the first day after birth, all was going well and there were no signs of illness or problems. On today’s visit Salinas starts by greeting the mother, asking if breast feeding is going well and if the mother has any concerns or has noticed any problems. She notes that the baby seems alert and active, has no skin pustules or boils, and her temperature is normal. But when Salinas counts the breathing rate, she finds a rapid rate of more than 60 breaths per minute. Recognizing this danger sign of serious illness, she calls her supervisor Nicholas Mutuku, who quickly arranges for the mom and baby to be transported to the Kisesini clinic. Nicholas confirms the diagnosis of pneumonia, promptly starts antibiotic therapy, and arranges hospitalization of the infant. A few days later the young infant has recovered and is back at home with her mother.
In Kenya 40% of childhood deaths occur during the neonatal period (the first month of life), and three- fourths of those neonatal deaths happen in the first seven days. Young infants can become very ill and succumb to their illness quickly. The key to reducing the death rate is early recognition and prompt treatment. Over the past three months Salinas and the other 19 CHWs visited a total 198 infants during their first week of life. The visits were conducted on days one, three, and seven of that first week, as recommended by UNICEF. There were no deaths. In the absence of the newborn home visitation program, 4 or 5 of those 198 young infants would likely have died, based on the national neonatal mortality rate in Kenya. The dedicated CHWs of the Kisesini Community Health Project have accomplished this successful effort because of your donations to this GlobalGiving project. If adequate funding can be found, GHP is planning an expansion of the project so that a larger number of newborn infants can be included.
Some of the best Community Health Workers (CHWs) in the world work with the Kisesini Clinic. These trained lay people do critical work that saves lives, beginning with the first day of life. Up to now they have received a per diem of $2.50 for a day’s work. This is not enough to keep their bicycles in repair to enable them to travel to the remote locations they visit. There has been significant inflation in Kenya in the last decade. The GHP board has agreed to raise the per diem of the CHWs to $3.50. Thank you for your life-saving work.
July 9 2013
Today we visited sand dams to learn how they work and the progress in building them. There are several sand dam projects in Kyua Sublocation, the same area as the Kisesini Clinic. Earlier this year, GHP provided funds to Chief Peter Kavulo to repair and improve the dirt roads to Kisesini Dispensary. The Chief met us in Kisesini. As we drove toward Kyua Market, he pointed out work that the County had done on the road. There was a heavy rain in March that washed out parts of the road into Kisesini. They shored up the edges of the road with bags filled with gravel and dug trenches to let the water drain away from the road. The main road into the clinic is now much easier to drive but longer-about 12K from the tarmac road.
We drove a short distance outside of Kyua (pronounced chew-ah the nearest town) and followed a road until we reached a dry stream bed.We stopped and walked a quarter of a mile until we saw what seemed a mirage. There was pond surrouned by banana trees and along the shore tomatos and maize. The water impounded by the sand dam supports drinking, animal and crop use. Four villages collaborated in building a series of dams that catch stream water when it rains. Several dams about a kilometer apart gradually fill up with water and sand. Excess water flows over the dam and is caught by the next dam. Even though a dam is filled with sand, the sand holds water that in theorys can be collected by digging down until water is reached.
The dams are built of concrete and anchored into bedrock. Each takes 300-600 sacks of concrete and a lot of labor. The project is supported by Utooni Development, a community based organization based in Makuini District south of Kisesini. The villages and members provide labor in return for eventual access to the water. Late in the afternoon, we visited a series of dams close to Kisesini. We followed the stream and saw 5 of 6 dams built since 2009. The dams were filled with sand, but none of them had water and there was little evidence of water being harvested from the sand that had filled the dams. This led us to question the concept. Does this mean that the water from the last rain has already been used or is the water too deep to reach? If the water is in the sand, it isn’t very accesible for irrigation. GHP will continue investigate this approach to providing water in this arid region. At this point we are still uncertain whether sand dams will scontribute to our strategies for improving the health of the communities by addressing nutrition and agriculture.
This is Elizabeth Mutheu Mbunda and she is a now healthy and happy 5 and a half month old. She was born in July 2011 and was very premature. After she delivered the baby at home, she called Alice, her village CHW. Alice promptly called Nurse Nichlas Mutuku and Dr. Tomedi, who came to pick her up and take her to Machakos, the nearest Hospital with incubators. Elizabeth stayed in the hospital for 3 weeks before she was healthy enough to go home to Syokisinga. She has been very healthy ever since and has been attending the outreaches regularly. She has 4 brothers and 3 sisters who all help to take care of her at home.
After having busy monthly outreach on Saturday in Syokisinga, I was able to sit down with a mother and child who have been attending the outreaches regularly since the first one in July of 2009. The outreaches, which are sponsored by GHP, are conducted at very rural sites where hospital care is diificult to access. The outreaches provide malnutrition screening, immunizations for pregnant women and children under 5yrs, family planning, and prenatal labs/care. These are services the women may not have been albe to reach, as the nearest clinic is several hours walk. I was able to see, firsthand, how GHP has helped save lives. Naomi was identified at the very first outreach as being severely malnurished and was treated with proper food supplementation. Included is a photo of her today.
Naomi Kakethe was brought in by her mom to the outreach this past Saturday. She was found at the very first outreach with a Z score of -3SD, whish indicates severely malnurished. She was started on Plumpinut in July 2009 and moved to unimix before coming off at 3yrs old. She has been attending the outreaches regularly and has not needed food supplements ever since. She is now well over 3yrs old, born in May 2008, and doing very well. She is very social and loves to smile. She has 2 brothers and is the middle child. Her favorite food is ugali.
Greetings from Kisesini!
The last several weeks have been very busy! GHP has now started an agriculture project in Syokisinga. This project started recently with 4 agriculture groups and 3 poultry-raising groups out of Syokisinga. All the groups are composed of more than 30members each. The loans that have been provided to the groups will be used to start group shambas (farms) and poultry houses with the idea that the local market will be flooded with eggs, fresh produce and chicken meat. Along with this project, GHP is educating all pregnant women in Syokisinga about infant nutrition. Some of the key points include breastfeeding within 30minutes of giving birth, not introducing other foods/liquids until 6months, and introducing a variety of foods (eggs, oranges, soft kale, spinach, bananas, etc) after 6months. The women are very interested and always ask lots of questions. We are currently taking birth weights on the newborns in Syokisinga and will re-weigh them in 2 years to see if the education classes along with the increased availability of foods, through the agriculture porjects.
The group in the picture is the first poultry group that met 2 weeks ago in a village called Yiaani. Wambua, from the department of agriculture, conducted his first lesson with the group. He gave them instructions and a list of building supplies they would need to porperly build a chicken house. He explained the variations in chicken breeds and gave the pros and cons of the various breeds. The group will meet again in the coming weeks for more lessons.
I met with the Women’s Basket Group 2 weeks ago to give them money from the porfit they made from our most recent basket order, which usually comes to New Mexico twice per year. Dr. Rifka Stern is now in charge of the orders, so if you are interested in beautiful woven baskets please let her know! The women are now raising money to build their own storeroom in Kisesini to keep the baskets as they sell them. They are a very motivated and friendly group and have clear goals for the future.
The clinic has been very busy with the holiday season. Many people home from Nairobi and Mombasa coming to clinic for various illnesses. We have seen some Typhoid, Brucella and Giardia. The ambulance has gotten a lot of use this month, as we have had several transfers to Kituii hospital for a retained placenta, a man with vomiting and high blood pressure, and another very sick woman. The ambulance has also been used to go pick up women in labor so that they can deliver at the clinic. We had one this past WEdnesday. She delivered and ended up having postpartum hemmorhage. The bleeding was stopped,the woman was observed and told to return for close follow up. It is becoming more evident that this clinic could benifit from a maternity ward: these women come in painful labor and are told to walk around outside, as there is nowhere for them to lay during clinic hours (the labor room is also used for injections and wound cleaning). As for the women that come in at night and must stay for observation until morning, there are no beds for them to rest. The other benifits, from the standpoint of the provider, include access to oxygen, proper birthing bed, and medications they are not allowed to have as the clinic is now, according to government regulations.
The outreaches have been busy with dozens of children and mothers coming for malnutrition screening, family planning and childhood immunizations. We have now added prenatal care to the outreaches in Syokisinga, as many of those women do not get prenatal care otherwise. Justine Nafula, the lab technician, has started coming to the outreach to complete prentatl labs, such as urine analysis, syphillis testing, HIV testing and blood group. The CHWs that show up to help weigh and measure children are so valuable and help the outreaches run smoothly.
During the holiday season, GHP provided a Christmas dinner and clothes/blankets to 11 of the poorest families in this area. Nicholas brought the car loaded with a chicken for each family, flour, sugar, salt, rice, oil, tea, milk, and a few sweets. The families were invited/taken to the market to buy clothes for the children under 12yrs. The families that were not able to make it to the market were given a large, warm blanket. It was great to see all the families so happy and grateful! These families were able to have a Christmas meal thanks to GHP!
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.
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….
6 Aug 2011
The first stop at the Outreach Clinic in Syokisinga was child malnutrtion screening with Sai and Katie, CHW Mutinda and others. The children were weighed and measured to determine nutrition status.
The severity of malnutrition is based on the weight for height measurement . . Although the majority of children were considered malnourished, the number that met the criteria for supplements was small.