Kenya: Lwala Healthcare Project
Lwala Community Hospital Report, Q3 2014
December 21, 2014
Katherine Falk and Liz Chamberlain
Summary of Activities
Summary of Activities
• Funded maternal and child health costs including
• Funded ambulance repairs and maintenance
• Funded fuel for ambulance to provide emergency transportation
• Funded obstetric emergency referrals
• Funded miscellaneous additional needs
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Improved patient care and clinical operations
Quality Improvement Plan Implemented
A quality improvement plan was put in place under the supervision of the Head Clinician that includes improving the quality of care and staff communication, decreasing patient wait time, establishing a clear fee and billing structure, and restructuring meeting times to early in the morning before patients arrive.
Improved access and facility infrastructure
Hospital Expansion Re-design
The hospital expansion was redesigned to include ward space as an addition to the current building rather than a separate building in order to reduce cost and minimize future ongoing expenditures.
Recruitment Efforts Prove Effective
Q3 saw an increased effort on the girls mentoring program, including recruitment of almost 50 out of school mentees.
Income Generating Activities
New Products for U.S. Market
The New Visions Sewing Cooperative produced a variety of new products including aprons, Christmas ornaments, and bags for the U.S. market.
Increase impact of health outreach programs
26 outreaches were carried out in the community, serving over 1,500 community members.
Lwala is a village of approximately 1,500 people near Lake Victoria in western Kenya. Within an hour’s walk, approximately 3,000 additional people live in nearby villages accessible by dirt roads. Poor physical infrastructure, including impassable roads during the rainy season, lack of electricity and lack of reliable drinking water, have helped to create a critical healthcare challenge in Lwala. The mission of the Lwala Community Hospital is to meet the holistic health needs of all members of the Lwala community.
- Improve patient care and clinical operations
- Improve access and facility infrastructure
- Expand and improve quality of education programs
- Professionalize the organization through better policies and practices
- Properly procure and account for physical, financial, and human resources
- Increase impact of health outreach programs
- Build capacity of community members in income generating activities
- Improve programs through better communication and monitoring and evaluation
The Lwala Community Hospital provided an average of 2,333 monthly patient visits in Q3, down from an average 2,709 in Q2. A new government hospital opened in the catchment area which likely accounts for the lower patient numbers. An average of 42 babies were born each month at the health facility, a slight decrease from an average of 46/month in Q2.
Successes in the prevention of mother-to-child transmission (PMTCT) of HIV
Pregnant mothers with HIV are an important subset of people to track and care for. In LCA’s former system of tracking HIV clients, mothers were included in the general population of clients who were traced when they defaulted on their treatment. However, due to the importance of PMTCT and being aware of the status of the mother and the baby, the clinical staff at Lwala Community Hospital devised a book to specifically track these women and their babies throughout their pregnancy and for two years after birth. Additionally, a woman from the community was hired as a “mentor mother” to maintain the tracking log, follow the women from pregnancy to birth, and enter the infants in a new log for tracking them up until 18 months. The new system allows for ease of documenting the women’s progress as patients and for improved quality of care. HIV+ mothers now have shorter wait times for clinical visits and a dedicated location in the hospital to go for care.
Furthermore, defaulting mothers are now more easily identified, quickly traced by the dedicated staff person, and systematically treated. Finally, the new tracking system allows staff to easily monitor the infants’ care and testing for HIV. After the new process improvement, all babies enrolled in the program during the quarter tested negatively for HIV.
Carroline Ongoma is a married mother with six children. She started working as a Community Health Worker with the Lwala Community Alliance in January 2013. In this role, she is assigned to an area with 80 households. When she initially started her community health work, only 26 households in her precinct had latrines. At that time, she started teaching her community members on the importance of having latrines, clotheslines, utensils racks, and rubbish pits as well as other effective hygiene practices.
Because she wanted to be a role model who practices what she preaches, she made sure that she constructed a latrine, a rubbish pit, a clothesline and a hand washing station at her home that were working at all times. The community was impressed with her efforts, which simply motivated her further to create a healthy and hygienic community.
The Community Health Extension Worker (CHEW or the government employee who oversees a number of CHWs) for Carroline’s village visited the community and noted that many households still had no latrines. She explained to Carroline and the community that they would not be able to send a team to the annual WASH Sports Tournament if more households in the community did not construct latrines. Even with this potential penalty looming, some of the community members were unwilling to change. Carroline took the initiative to continue visiting these households, talking to them about the benefits of employing proper sanitation and hygiene practices. She also involved the local administration and community leaders during her household follow-ups in order to meet the targets that the CHEW had set.
The village was triggered for Community Led Total Sanitation (CLTS) when there were only five households left without improved facilities. Carroline worked tirelessly to encourage these remaining households to complete their requirements after the CLTS follow-up. It took three weeks to finalize the latrine construction and have the requirements in place.
As a result of these efforts, Kojwang Border Village was ultimately declared open-defecation free (ODF) by the Kenya Ministry of Health, making it the first village to be declared ODF in North Kamagambo. Because of her determination and follow-through, Carroline has been recognized as the best community health worker of the year for 2014.
Stesline Achieng’ is a 14-year-old student in class 7 at Andingo Primary School. She is a member of the Andingo Health Club, where students learn about issues of diseases, hygiene, and sexual and reproductive health and receive training on how to plant, grow and sell vegetables. Stesline explained, “This is the first time I have learned about how diseases are contracted. I know that washing my hands and staying clean can prevent cholera and typhoid. I also now know that girls can get HIV, STIs, and even become pregnant at a young age if they are not knowledgeable. All of these things might cause you to drop out of school.”
Stesline was one of the recipients of a pad kit this past July. She is incredibly happy to have received the pad kit. Before being given the pads, Stesline was using pieces of old clothes during menstruation and appreciates the fact that these pads are reusable. Stesline stated, “Before, I was not coming to school during my period, but now I am. Nowadays, I can improve my marks because I don’t miss lessons.” Stesline has done remarkably well in school this year, and she is ranked second out of 40 students in her class. She dreams of attending Limuru Girls School, a highly-ranked national school in Kenya, and someday becoming a lawyer. When asked about life as a young woman in the community, Stesline explained, “I am very proud of being a girl here because we receive pads, uniforms, education and mentorship that help us to be happy and successful.”
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