Kenya: Lwala Healthcare Project
Non-pneumatic Anti-shock Garment (NASG) Saves Lives: Q4 2018
February 18, 2019
Summary of Activities
Lwala Community Alliance (LCA) is a community-led, nonprofit health and development innovator working in Migori County in rural western Kenya. Through Lwala Community Hospital, the organization provides approximately 50,000 patient visits each year. The mission of the organization is to build the capacity of rural communities, including their neediest residents, to advance their own comprehensive well-being. The hospital is part of a larger effort to achieve holistic development in Lwala and the surrounding community, including educational and economic development.
The primary beneficiaries of RMF-supported Lwala Community Alliance are children, women, HIV-infected persons, and the elderly. Prior to the establishment of Lwala Community Hospital, there was no immediate access to primary health care or HIV/AIDS testing and care in the area. For this reason, Lwala’s health intervention has focused on primary care for children, access to medicines (particularly vaccines and antimalarials), HIV testing and care, public health outreach, and safe maternity.
During this quarter, RMF funded maternal and child health costs including:
- Personnel costs for nurse Caren Siele and clinical officer Wycliffe Omwanda
- 58% of medicine costs
Sustained Reduction of Morbidity and Mortality
- We saw 101,613 total patient visits across all seven facilities that we supported during the year 2018.
- In November, we graduated our cohort of 63 HIV-exposed infants from the elimination of mother-to-child transmission (eMTCT) program. Of the 64 children that were enrolled into this cohort in May 2017, only one child has tested positive.
- Through our community-led reproductive health model, we have drastically increased contraceptive uptake. In 2018 we provided 14,833 couple years of protection (CYP), a measure that weighs the value of a contraceptive method by the number of years it provides protection from pregnancy.
- This year, we scaled up the non-pneumatic anti-shock garment (NASG) to treat obstetric hemorrhage, a leading cause of maternal death.
Public Health Program
Improved Health-Seeking Behavior
- 10,179 children under five regularly received care from our cadre of 204 Community Health Workers across our innovation hub (North Kamagambo) and expansion site (East Kamagambo)—a 60.1% increase from our 2017 enrollment rates.
- We continue to provide education to community members on the consequences of poor sanitation and the benefits of latrine construction through an intensive community-led total sanitation (CLTS) initiative. This year, 12 villages in our catchment area were certified Open Defecation Free by a third-party verification firm contracted by the Ministry of Health.
- Lwala has continued to exceed its target of fully immunizing 90% of children under five. *We achieved an immunization rate of 97* for 2018, which is significantly higher than the county rate of 57 (DHIS 2014).
Improved Outcomes for School-Aged Children
- We hold three Better Breaks sessions every year to give kids a fun, safe, and educational activity to enjoy during school vacations. In our 2018 Better Breaks sessions, we administered 96 pregnancy tests, provided 528 pieces of contraception, and tested 691 children for HIV. We survey the attendees of our Better Breaks sessions on topics such as contraception access, gender-based violence, and perceptions of safety in the community.
- For the 2018 school year, we provided 706 girls with school uniforms and 1,120 girls with sanitary pad kits. We also provided mentorship to 385 girls in school and 117 girls who have dropped out of school.
Economic Development Program
- In order to provide financial access to even the most impoverished community members, Lwala partners with the organization Village Enterprise. Village Enterprise provides training and microgrants to community members so that they can start their own small businesses.
- In Village Enterprise’s 2018 fiscal year, our enrollees increased average household savings by 91% to $43.12 USD, and average household consumption increased from $273 to $352. Both of these measures are standard indicators in measuring economic wellbeing and reflect how our innovative partnership with Village Enterprise is improving the livelihood of our community members.
Monitoring and Evaluation
Understanding Health Impacts
- In September, Lwala published a peer-reviewed article with Vanderbilt University in PLOS ONE (the Public Library of Science journal) on our achievements in under-5 mortality in Rongo-Sub County. This cross-sectional survey found a significant decrease in under-five mortality following the establishment of Lwala Community Alliance.
- We are in the midst of conducting a robust evaluation of our program expansion. In December, we trained 21 enumerators for our latest surveying effort, who will collect baseline information in two locations that will be included in our catchment area during our expansion. For the first time, we are engaging a control site in a neighboring sub-county, Uriri, to better understand the impact Lwala has had in our catchment areas.
Administration and Management
Sharing Progress and Innovation
- Lwala Executive Director Ash Rogers was published twice, once as a co-author of the Community Health Worker Assessment and Improvement Matrix (CHW AIM)—a toolkit for improving CHW programs—and once on One.org to showcase our efforts to end maternal mortality and share her personal experience of obstetric hemorrhage.
- Lwala Sexual and Reproductive Health Coordinator Elisha Opiyo traveled to Kigali to present our innovations in adolescent and youth reproductive health at the 2018 International Family Planning Conference.
- Lwala Co-Founder Fred Ochieng was featured on the Future of Healthcare podcast to share the story of how Lwala Community Alliance was born to bring hope from tragedy when his parents died of AIDS.
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
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Patients Served This Quarter
Lwala Community Hospital
- Outpatient Visits due to Illness: 4,054
- Wellcare Visits for Children Under 5: 2,861
- Family Planning Clinic: 668
- Inpatient Ward: 181
- Antenatal Clinic: 807
- Deliveries and Postnatal Care: 298
- HIV/AIDS appointments: 2,671
NASG Saves Her Life
On July 3, 2018, Mary Ochieng, a 17-year-old young woman, arrived at Lwala Community Hospital. She had come from a village called Gem, which is 40 minutes away by motorbike. Mary was semi-conscious and complaining of abdominal pain.
Mary was immediately put on IV fluids and assessed by a clinician. During the assessment, Mary became unconscious. The tests revealed that she was pregnant, and the clinicians determined that Mary was suffering from internal bleeding due to an ectopic pregnancy. Ectopic pregnancies are the most common cause of death for women in their first trimester. Often, women experience a rupture in the fallopian tube, which leads to internal bleeding and can cause hypovolemic shock and, ultimately, death. Patients in middle- and lower-income countries are 10 times more likely to die from their ectopic pregnancies than patients in wealthy nations.
The clinicians applied the non-pneumatic anti-shock garment (NASG), a tool that RMF-supported Lwala Community Alliance has introduced to facilities throughout Migori County, and Mary regained consciousness five minutes later. She was then referred to Homa Bay County Hospital for surgery.
A patient can remain in the NASG for up to 72 hours because it conserves blood flow to the vital organs. This addresses a major cause of death in cases of obstetric hemorrhage: delays in care while waiting to be seen by a clinician or during transport to a higher-level facility. The NASG can reduce almost all obstetric bleeding while redirecting the remaining blood from the lower extremities to the vital organs, which keeps the patient stable and reverses shock.
Mary was accompanied by one of Lwala’s clinical officers, Tom, on the ambulance to Homa Bay County Hospital for further treatment. Tom instructed the operating team to perform Mary’s surgery without removing the NASG. Homa Bay County Hospital was able to successfully perform the surgery to remove the damaged fallopian tube while Mary remained stable in the garment.
Mary recovered at Homa Bay County Hospital, and the NASG was eventually removed. She has been able to make a full recovery and was discharged and sent home on July 6, 2018. As a clinical officer, Tom is grateful for the value the NASG has brought to his community. He can recall many instances before the introduction of the NASG in which patients died while being transported to receive advanced care. During the time it takes to initiate the referral process, find a facility with blood, and transport the patient, the NASG keeps the patient alive. To date, Lwala has trained over 166 healthcare providers from 17 clinics on the NASG as a lifesaving intervention.