Kenya

Project Goal:

Enable the District Hospital to fulfill its role of providing back-up referral health care for the Turkana region.

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

Photo: Picture of a nurse using the new pulse oximeter and glucometer on a patient

Summary of RMF/MMI-sponsored activities carried out during the reporting period under each project objective:

Infrastructure:

Having successfully repaired and renovated most of the infrastructure in the previous quarter at the pediatric ward, RMF did the final repairs in the Fourth Quarter. The drainage system at the pediatric ward was blocked and the sewer had burst before RMF began work. It had been a major factor for transmission of diseases to patients admitted with severe acute malnutrition that had to stay in the ward for an average of 10-14 days for treatment. RMF took the initiative and repaired the burst sewer completely and constructed a new washing area bay for the ward. Now the guardians of the patients have a common area where they can wash their clothes, and this also lessens the amount of stagnant water around the facilities that brought mosquitoes and malaria.  RMF also purchased new dustbins for the ward as the ones previously used were old, broken and did not have lids to cover them. In addition, the old and rusty sinks at the nurses’ station were replaced this quarter with new steel sinks, ensuring that the cleanliness of the walls matches that of the sinks. All these improvements have made for a much cleaner environment at the wards.

Equipment:

RMF also purchased more equipment for the hospital this quarter: equipment such as bed blocks, ward bed clipboards, oxygen flow meters, bed cradles and drip stands. Each bed now has a patient file to keep track of the diagnosis being given to the patient, hence ensuring a smooth follow up with the doctor while doing the ward rounds. E.g., previously, patients admitted with fractures didn’t have the option to recover in the wards due to the unavailability of bed blocks and bed cradles to assist in their recovery process.

Medical supplies:

A full supply of drugs and non-pharmaceuticals was purchased during the 4^th quarter. Emergency drugs that are never supplied by KEMSA such as Augmentin, IV Venofar and Dextran (for anemic patients), Zinacef injections, Artenam injections, Ampiclox, Centrizine, Ibuflam, Ascoril, Pethidine, Ranferol-12, Fluconazole amongst others were procured during this quarter, ensuring that the pediatric ward doesn’t run out of emergency medical supplies.

RMF also purchased more non-pharmaceuticals such as Branulars, gauze rolls, strapping supply during the quarter.

Regularity in medical supplies is a novelty for the hospital as the ‘normal’ state of affairs before RMF/MMI’s general budget support was a paltry stock of essential and emergency medicines and pharmaceuticals.  One of the reasons for the steep increase in patient load may be that the patients no longer must purchase their own drugs for treatment.

Laboratory Reagents:

We also bought a full supply of lab reagents this quarter. The hospital can now do almost all of the laboratory tests needed, and some that had never been done before due to lack of reagents.  RMF/MMI provided reagents such as ASOT, Hepatitis B & C, grouping sera, full haemogram as illustrated in Appendix A, which had never been supplied or purchased at the hospital before.  Reagents such as Field stain powders, Grouping sera, VRDL Test kits, Xylene, Sensitivity disks, Brucella arbutus, Hepatitis B & C strips, formaldehyde were also procured. The supply of reagents went a long way to show RMF/MMI’s commitment to supporting the Hospital. 

Rehabilitation/Sensory Stimulation Centre

After the successful renovation of the pediatric ward by RMF/MMI, the environment is much more conducive for the hospital to create a rehabilitation and sensory stimulation center with an occupational therapist.  The patients using the rehabilitation and stimulation centre most frequently include: patients with cerebral palsy, Down syndrome, microcephaly, hydrocephalus, delayed developmental milestones/regressed developmental milestones, infantile hemiparesis, epilepsy and mental retardation.

The rehabilitation and sensory centre offers:

• Strengthening exercises to precede delayed developmental milestones training sessions
• Exercises to increase the range of motion of joints
• Manipulative exercises before applying plaster.

Modes of exercise include:

• Passive exercises for those who can’t follow instructions/are unable to exercise
• Active exercises for those who can follow instructions
• Delayed developmental milestone training
• Sensory integration and sensory stimulation through play activity.

The above are to help the patients attain developmental milestones, overcome their deficits, disability and/or to be able to cope with the challenges posed by their disability.

Results and/or accomplishments achieved during this reporting period:

• For the first time in many years, the Lodwar District Hospital pediatric ward has registered the highest number of admissions and the lowest number of mortalities in the year when compared to the last two years, giving the child ‘a gift of life’ as demonstrated with the table in Appendix B.  Rate dropped from 7.6% in 2010 to 1.7% in 2011.
• A remarkable decrease in the number of mortalities in the year 2011 (55 patients died) as compared to 127 in 2010 and 139 in 2009.
• After the repairs of the blocked drainage and burst sewer, the number of diarrheal diseases after admission has dropped from 13 patients to 0.
• With the construction of the washing bay at the pediatric ward, patients are now able to clean their items in a common area hence preventing stagnant water around the pediatric ward that used to bring mosquitoes with the malaria parasite.
• The new dustbins with covered lids at the wards guarantee continued cleanliness and good health standards.
• After the equipment training that took place in the previous quarter, nurses are now able to effectively and efficiently use most if not all of the new equipment, e.g. the pulse oximetre and glucometre, something which they were not able to use before the training. The pulse oximetre was lying in storage unused (except by the Clinical Officer) for months – following the training, all the nurses take it out on a regular basis and it is a popularly used piece of equipment.
• Observations of a reduction in the breakdown of equipment after the health workers/staff were trained on correct equipment use and servicing.
• After RMF/MMI established the playground and renovated the pediatric ward, the hospital saw the need to set up the rehabilitation and sensory stimulation centre for children with special needs. The renovations made it conducive for this centre to be created at the pediatric ward.
• Regular availability of pharmaceuticals and non-pharmaceuticals, both at the pediatric ward and the Hospital as a whole. RMF/MMI has bridged the gap that existed since they started off in March to Date.
• More laboratory tests are being done as a result of availability of reagents which was supplied by RMF. Some of the most common routine tests done include: Hemoglobin estimation to rule out anemia in children, pregnant mothers and surgical cases, blood slide (BS) for malaria to rule out malaria and TB infections, urinalysis to rule out urinary tract infections, urine chemistry to monitor glucose and protein levels in pregnant mothers, VDRL to rule out syphilis in pregnant mothers and sexually transmitted infection management, widal titration and cultures to rule out salmonella infections, brucellosis to rule out brucella species infection, Rapid diagnostic testing leish strips to rule out leishmania species infections and blood grouping as part of antenatal profiles, blood grouping and cross match testing. See graph in Appendix A
• Availability of effective drugs to manage patients with severe infections that cannot be managed by first line treatment.
• Life supporting equipment is now available for severely sick children, e.g. oxygen concentrator and nebulizer.

Number served/number of direct project beneficiaries:

835 patients were treated during the Fourth Quarter:

• Malaria – 429
• Pneumonia – 107
• Anemia – 59
• Gastroenteritis – 53
• Severe Acute Malnutrition – 48
• Scorpion stings – 30
• Typhoid Fever – 23
• Fractures – 20
• Pediatric TB – 16
• Snake bites – 12
• Meningitis – 10
• Burns – 7
• Spider bites – 7
• Septicemia – 6
• Gunshots – 3
• Kala-azar (Leishmaniasis) – 3
• Neonatal sepsis – 2

Success stories highlighting project impact:

Nopet Lomarito, a 7 year old boy, was brought into the hospital as a referral, very sick and in a coma. The diagnosis was that he was suffering from cerebral malaria and meningitis.  He was immediately treated with intravenous quinine sulphate and ceftriaxone for 5 days but did not show any improvement. His condition worsened and he developed severe difficulty in breathing and was running a fever. The treatment was then changed to Zinacef 750mg (purchased by RMF/MMI) for 5 days. The patient condition then improved drastically. This is a patient we could have lost were it not for the availability of Zinacef, a drug which is not available through the normal medical supplies at the hospital, and the relatives of the patient would not afford.

Peter Lomurukai the Medical Laboratory Technologist in charge at LDH while receiving the reagents from RMF said:

“I am delighted to receive the laboratory reagents from RMF. We were not able to do most of the specialized tests such as rheumatoid factor (RH) for rheumatic infections, antistreptolysin O titre (for bacterial infections), hepatitis B & C antigens (for ruling out hepatitis infection), general bacteriological cultures and typing sera amongst others. You have really helped us very much. Thank you for the support and may God bless you abundantly.”