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.

Photo: Parents and children at the newly renovated pediatric ward

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

Infrastructure:

During the Second Quarter, in regards to infrastructure, RMF concentrated mainly on repairs to the female ward. A new pit latrine and bathroom were constructed for the female ward to curb and reduce the drainage blockages that the hospital had been experiencing. In the previous quarter, RMF repaired and unblocked the main drainage of the whole hospital, and to ensure that the sewer remained unblocked a separate bathroom and toilet needed to be constructed for the female ward. One of the main reasons why the drainage system was blocked was as a result of patients throwing cotton wool and cloth into the flush toilets mainly in the female ward, which attributed to the blockage of the drainage manholes of the main sewer causing blockage.

Photo: Newly renovated latrine

In order to ensure that the drainage stays unblocked, RMF constructed the new pit latrine and bathroom with its own separate sewer and does not share the main hospital drainage/sewer system.

Photos: Female ward beds before (left) and after (right)

The female ward beds and bedside drawers were also repaired and repainted to give them a fresh new look. The female ward wall was painted, all the old wooden doors at the female ward were removed and new wooden doors installed. A new nurses table, chair and patient bench were also supplied to the female ward in the 2^nd quarter.

Disinfectant solutions:

Liquid antiseptic, detergent, bleach, antiseptic soap and liquid soap were purchased to ensure that the pit latrines constructed are kept clean and to curb infection to patients.

Photo: Medicine and supplies

Results and/or accomplishments achieved during this reporting period:

• During the Second Quarter, the hospital received new equipment from RMF/MMI: 2 pediatric monitors, 1 photo box, 1 incubator and 1 respirator.  Since the hospital started operations it has never owned a respirator or a photo box and this is a first in the entire Turkana region. The hospital staff in the various departments was elated and thanked RMF/MMI for their effort in promoting quality healthcare at the District Hospital.  

Photos: Nurses attend to patients

• There has been a significant reduction in sewer blockages at the hospital after RMF constructed a pit latrine and shower for the female ward patients. Misuse of the existing toilets at the female ward contributed to 65% of sewer being blocked due to disposing of cotton wool and cloth. With the pit latrine now, this issue has been reduced tremendously.
• The existing incubators at the newborn unit at the District Hospital were faulty and had broken down. With the new incubator donated to the maternity wing, the newborns now fully benefit from this new equipment.

Photo: New Incubator

• The nurses and various departmental staff have also benefitted by acquiring extra knowledge after being trained locally on the use of the new equipment. This has also added to careful and correct usage of the equipment, controlling misuse and breakdowns.
• With the upgrades to the inpatient unit that began with the pediatric ward, and now the male and female wards, there is a notable increase in patients seeking medical care at the District Hospital.

Photo: Spanish anesthetist orientating the theatre staff on how to use a respirator and monitor

• Now that the hospital has a respirator, patients who are admitted, and need to be ventilated and require oxygen can be assisted onsite unlike before when these patients had to be transferred to the hospital in Eldoret.

Number served/number of direct project beneficiaries: 

A total of 15,736 Outpatients and 781 In-Patients were treated during the Second Quarter.

Success story(s) highlighting project impact: 

• The hospital is recording a high number of inpatients and outpatients as a result of the upgrades already performed.
• The nurses continue to benefit from the added knowledge they acquired when the donated equipment was brought to the hospital.  Some who had never seen a respirator and photo box before were excited to learn how to use this equipment properly.
• There is a big reduction in sewer blockages at the hospital as a result of the pit latrine and shower constructed in the female ward.

Photo: Patient in newly renovated ward

• With the existence of the right emergency drugs at the pediatric ward, we are able to treat more severe cases.
• Terry Lokwatbor, a 5 year old male patient from Nawaitorong, came to the hospital with convulsions, fever and a 3 day cough. The diagnosis was meningitis and malaria and he had arrived at the hospital in a semi-comatose state. Upon admission his temperature was 38.3 degrees Celsius (100.9F), Bs for mps was +, and a full haemogram and esr were taken showing Leukocytosis.   Patient was put on an IV of Expen, Gentamycin, Quinine, oral multivitamin and Valium Parectum. Patient was also placed on daily nasogastric tube feeding and 2 hour turning. The expen and Gentamycin were discontinued after the patient was showing improvement by the 3^rd day and the child was started on Ceftriaxone 500mg OD.  The patient fully conscious by the end of the 3^rd day, but had coarse creps on auscultation. The child was lethargic and suffered appetite loss and was changed to Zinacef 375mg and continued with multi vitamins and daily ambulation for two more days. Patient was discharged in very good condition on the 5^th day, with an ongoing course of multivitamins. 
• The constant supply of Zinacef by RMF/MMI for the pediatric ward has been a huge benefit to the children admitted at the District Hospital. Any patient administered on this antibiotic has always recuperated fast.  It has to be noted also that the same drug (Zinacef) is not supplied by KEMSA since it’s a very expensive antibiotic (currently retails at 1,400 Shillings).
• Esinyen Lorogoi, a 2 year old boy, was admitted on the 12^th of March with a diagnosis of 25% of his body burned, caused by hot water. Normally, patients with burns above 20% of the body are managed at a level 5 hospital.

Photo: Burn vicitm carefully monitored

• Through the support of RMF/MMI we were able to manage the patient at the Lodwar District Hospital, and saved the family the burden and limited the cost to the family as the nearest referral hospital is 350kms away. The patient was managed on Floxapen 250mg for 2 weeks, Ranferon syrup 5mls for 2weeks, Clavulin syrup 5mls for 1 week. For the eight weeks that the patient was in the ward, the dressing material used included crept bandages and gauze; all required supplies are usually supplied by RMF. The management was done very successfully and the patient was discharged without complications on the 21^st of May.