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.
Friday Aug 5 2011.
Rifka Stern, MD
Today started out slow but got busier and more complicated. I saw some very interesting cases.
Aug 3 2011. Late in the day we were called to the clinic to see a severely malnourished child who was 10 months old but weighed only 10 lbs, about half of normal according to WHO standard growth curves.
The mother, Patricia, 35, had stopped producing milk when little Katwili was only one month old. She substituted goat milk and a little porridge. She has not thrived. Patricia has 7 other children aged 3 to 15 years old. Her husband hauls water and sell it at the market. No one else in the family can work, and with the drought the garden produced nothing last year.
No Supplemental Food
The have a few chickens, but no other animals. Today, the baby had a cough, Patricia took her to the Katangi Health Center, but seeing the malnourished state of the baby and because they had no PlumpiNut for supplemental feeding, they sent her to our clinic–several hours on a motorcycle taxi away.
On investigation, we learned that there are six other children and a husband in the family. Mbitha was a twin and her brother died last month after a brief illness.
Your support can help
Would you like to help this family? Global Health Partnerships is establishing a fund to be administered by the head nurse to help the most vulnerable families. Consider setting up monthly credit card donation of $50, $1.60 per day, for Patricia and her family. Every cent will help this family and we’ll send you occasional updates and photos.
Sunday 31 July . Finally a rest day. I (Rifka) tried to sleep in but the sunrise was too beautiful and the rooster was crowing . David made coffee and lots of fried potatoes for breakfast. We also had scrambled eggs, chapatis and fresh papaya.
Saturday was very different than expected. I (Rifka) thought I would have a rest day but instead I was asked to accompany the nurses to help do male circumcisions (female circumcisions –FGMs– are not done here). In old times, boys between the ages of 6 and 10 were circumcised in August as part of a ceremony that involved slaughtering a bull. Now people aren’t wealthy enough to do the full ceremony, but continue the circumcisions.
Wilfred, the nurse who was my translator 2 years ago showed up. He is now working up near the Ethiopian border where he said the biggest problem is malnutrition. He is on vacation for the next month but came back to this region to do circumcisions on young boys on his own time. The three male nurses gathered all the equipment from the clinic and we drove about 45 minutes to small village called Mekelingi. They set up in a small building with 2 tiny rooms. They set up their equipment which had been all sterilized on a clean cloth on the floor. Two circumcisions were done at the same time. Rifka helped with the anesthetics and handing instruments to the nurses.
The first boy was brought in and he lay down on the table with his lower legs off the end. His penis and surrounding groin area were cleaned with alcohol and betadine and then a local anesthesia was given. I’ll spare you the rest of the details, but it was done quickly and cleanly. Most boys cried but a few didn’t. During the procedure there usually wasn’t too much pain. Four of us from Kisesini helped by trying to talk with the boys and sometimes held them if they were very scared. By the end of the procedure they had calmed down and were able to get up off the table without problem. They were dressed in a sheet, wrapped around them like a toga and tied at the neck.
It took about 3 hours to do 11 procedures, but we had to stop in the middle and resterilize the instruments. They were cooked over a small propane stove in the pressure cooker.