Kenya

Project Background:

Lodwar District Hospital (DH) is the only functional government regional referral hospital for all of Turkana region, spanning a population of almost 1,000,000. This is where the vast majority of the Turkana and other populations of Northwestern Kenya as well as people from across the borders to Uganda and South Sudan seek help when they need more advanced care requiring medical equipment and specialized skills that cannot be provided at dispensaries, health centers, or private health clinics. Lodwar DH has been struggling for years with wards in need of major repair, and supplies and drugs that come in with great irregularity from the government health supplies department in Nairobi.

The situation had become so dire that patients were often requested to purchase disposables and medicines themselves in Lodwar town because the hospital could not provide them. Dr. Fuchs realized back in 2009 that referral care could only be improved for the Turkana people if the hospital would receive additional support to supplement supplies, upgrade the infrastructure and equipment, and conduct on-the-job training for the healthcare and biotechnical staff.

Project Objectives:

• Rehabilitate the infrastructure at Lodwar District Hospital, beginning with the pediatric ward.
• Rehabilitate equipment set at Lodwar District Hospital, beginning with the pediatric ward.
• Provide regularity to supplies of basic medical devices, disposables, and pharmaceuticals, complementing the items from Kenya Medical Supplies (KEMSA).
• Provide equipment maintenance and spare parts management.
• Organize on-site clinical training, beginning with general equipment use and care, and pediatric emergency care.

Results and/or accomplishments achieved during this reporting period:

• Continued increase in the number of patients seeking care at the Lodwar District Hospital not only in the Pediatric ward, but also in the Male and Female wards.
• Pediatric ward at LDH still recorded a reduction in the mortality rate despite the increase in number of admissions as a result of essential drugs at the Pediatric ward and other supplies to the whole hospital.
• As a result of the improved infrastructure and availability of essential drugs and equipment supported by RMF/MMI, LDH has been approved by the Nursing Council of Kenya as a “Training Institution” and a future internship centre for clinical and medical officers.
• Staff is motivated to work and provide higher quality care by the clean environment and the infrastructure repairs at both the Male and Female wards with support from RMF/MMI.
• Anemic patients are now manageable due to the availability of drugs such as IV Venofar and Dextran purchased by RMF/MMI in the first quarter.
• The equipment at the District Hospital and especially the Male and Female wards are now secure as the doors are now lockable.
• Improved sanitation of the Male and Female wards after the drainage and lavatory repairs.
• With the new lighting system the wards are looking bright as never before, and it is now possible for nurses to conduct procedures at night.
• During the Annual staff party for Lodwar District Hospital that was held in February 2012, RMF/MMI was recognized as the best partner/NGO (from a total of 7 partners that work together with the hospital) for the year 2011 for the good work and great partnership last year.

Photos: Before (left) and after (repairs)

Number served/number of direct project beneficiaries:

2,808 patients were direct beneficiaries in Q1, January – March 2012 with various health issues.

Success story(s) highlighting project impact: 

• RMF with support from MMI was recognized by the Hospital as the best partner in the year 2011 for the achievements and developments they have brought about at the hospital – the needs-oriented approach is still being applauded by the Medical Superintendent and other partners are asked/ requested to take the same approach.
• LDH has been approved by the Nursing Council of Kenya as a training institution and a future internship centre for clinical and medical officers. This wouldn’t have been possible without the infrastructure repairs and availability of medical supplies that RMF has been providing constantly since February 2011.
• Napetit Lomarito, a 7-year old boy, and a referral from Kerio Division, 55Kms from the District Hospital was admitted to the hospital on Jan 11^th, 2012, and discharged on Feb 14^th, 2012.  He was diagnosed on admission with severe anemia, and a blood test showed an Hb of 3.7 g/dl, malaria parasite ++.  General condition upon admission was in a comatose state and a temperature of 40 degrees centigrade. Treatment consisted of: managed fixed NG tube, blood for grouping and cross matching taken, and transfused 2 units of whole blood, a Quinine sulphate loading dose of 600mg in 5% dextrose and maintenance doses of 300mg in 5% dextrose 3 times a day for 5 days. He was also put on Ceftriaxone 500mg twice a day for 14 days and Ranferon syrup 10ml twice a day, and Paracetamol 500mg oral 3 times a day. The patient remained in the comatose state for the 2 weeks of this treatment. The treatment was then changed to Zinacef 500mg IV 2 times a day for 1 week and continued with oral Quinine. The patient soon regained consciousness but was too weak to walk and could not communicate orally. An occupational therapist became involved and the patient was able to walk again and regained his speech. The patient was discharged after one month in a stable general condition. We regard this as one of our best success stories of the quarter because the patient, having been put on Zinacef, responded well. The parents would not have been able to afford such a drug (KSH 1,200) due to their high level of poverty. The drug (Zinacef) was one of the drugs that was procured by RMF/MMI during the quarter and had never before been supplied to the hospital by KEMSA.
• Amanikor Echam, a 5-year old girl, was admitted to the hospital on Feb 19^th, 2012 and discharged on March 4^th, 2012. The patient was a referral from Kakuma, 200km from LDH. She presented with convulsions, fever and had no history of trauma. She then became restless, developed bizarre behaviors before going into a semi-comatose state. Diagnosis ruled out epilepsy and meningitis. Investigation done with blood test for Hb showed that it was 3.2g/dl. She tested positive for malaria. Other investigations were conducted: full haemogram and ESR, abdominal ultrasound, HIV tests. A blood transfusion of 450 mls of whole blood was performed, and a dose of Diazepam 7.5mg started. Additional treatment consisted of: Phenobarbital IV 60 mg twice a day, Quinine 40 mg IV in 5% dextrose, a loading dose of 450 mg of Quinine in 5% dextrose, maintenance doses of 225mg of Quinine in 5% dextrose for 3 days and a Paracetamol tablet 400mg three times a day, Ranferon syrup 750ml twice a day for 14 days, IV fluids of 5% dextrose alternating with normal saline, and an NG tube was fixed for feeding. After 5 days, the blood tests were repeated and the patient showed negative for malaria parasites but she was still in a semi-comatose state. She was then put on Ceftriaxone 500mg b/d for 3 days. On the 10^th day, the patient regained full consciousness and continued treatment until the 14^th day, and was finally discharged in a stable general condition. This patient was very sick looking and presenting with multiple diagnoses upon arrival at the hospital. The anemia and malaria were easily managed but she also had a systemic infection which was addressed by Ceftriaxone and Ranferon which were supplied with the support of RMF/MMI.