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.

Project Objectives:

• Rehabilitate the infrastructure at Lodwar District Hospital, beginning with the pediatric ward and proceeding to male and female wards.
• Rehabilitate equipment set at Lodwar District Hospital, beginning with the pediatric ward and proceeding to male and female wards, outpatient department, operating theatre and physiotherapy department.
• 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.
• Provide outreach campaigns.

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

Medical Equipment:

RMF has now fully equipped the pediatric, female and male wards at the Lodwar District Hospital with all the medical equipment needed by a doctor to fully attend to a patient in the case of an emergency. None of these wards need to share equipment moving forward and are all able to operate independently during an emergency. Finalizing the equipment purchases in Q3, we purchased the following:

Pediatric Ward: New bed sheets covering the previously only plastic covered mattresses, which were very uncomfortable for the patients in the high temperatures prevalent in Turkana.

Female Ward:Nebulizer, weighing scale, suction machine, wheel chairs and oxygen concentrator.

Male Ward: Weighing scale, suction machine, wheel chairs and stretchers.

Upon receiving the equipment at the female ward, there was much excitement and the matron in charge, Sister Anne Sifuna had this to say about the support from RMF/MMI:

“In the female ward, we have never owned an oxygen concentrator and suction machine specifically for us. We had been used to borrowing and sharing all of this equipment purchased for us by RMF and sometimes it was difficult to access the emergency equipment considering that most of the time they were in use. With that, it has been impossible for us to save as many lives as possible as we would wish. Now that we have all the needed emergency equipment, we are very excited and promise that we will make good use of the equipment and save more lives. We are happy with the support RMF has shown not only to this ward but to the entire hospital. It has been a magical transition since RMF begun its work here at the District Hospital. Thank you very much and we hope that you continue to support us, may you never lack”.

Medical Supplies:

As we have since taking on the support of Lodwar District Hospital, RMF ensured that the pediatric ward is always well stocked in terms of medicines and medical supplies. In addition to the comprehensive medical supplies procured in the previous quarter, we purchased emergency supplies for the pediatric and maternity wards and medicines and medical supplies that are usually not supplied by KEMSA. Since RMF/MMI began their partnership with the hospital, the pediatric ward has never run out of emergency drugs which are provided free of charge for the treatment of the patients. This has gone a long way to ensure that many lives are saved.

Non-Pharmaceutical supplies:

Lodwar District Hospital also benefitted in Q3 from the supply of non-pharmaceutical supplies. We procured methylated spirit, examination gloves and gauze rolls for the hospital. Such supplies are essential for the hospital in case of emergency situations such as traffic accidents.

Results and/or accomplishments achieved during this reporting period:

• RMF/MMI continues to purchase emergency drugs for the pediatric ward thereby ensuring that most if not all of the patients admitted are treated for free and discharged with minimum referrals.
• All wards continue to benefit from free quality medical services including supplies and treatment at the Lodwar District Hospital.
• The male ward continued to benefit by receiving additional basic emergency equipment ensuring that it is fully equipped and fit to attend to patients without delays. Equipment like weighing scale, stretchers and wheel chairs were also purchased.
• The female ward benefitted by obtaining a nebulizer, weighing scale, oxygen concentrator, suction machine, stretchers and wheel chairs in this quarter to be used specifically at the female ward.
• The staff at the female ward especially the nurses and doctors continue to have positive attitudes and high morale due to the availability of emergency equipment at the ward. It had been frustrating in the past to have to share the equipment at the hospital, especially in emergency situations when fast responses to and treatments of the patients were required.
• Lodwar District Hospital continues to register high patient numbers in the inpatient and outpatient departments.
• Mortality numbers continue to remain low and have been maintained that way due to continuous availability of medical supplies and medical equipment.
• Admitted patients at the pediatric ward can now enjoy the comfort of good sleep thanks to the supply of new bed sheets.
• With all the upgrades at the inpatient wards, the district hospital has managed to maintain a new, high level of cleanliness, promoting high hygienic standards.
• Turkana County was one out of the 22 counties that participated in the Polio vaccination campaign that took place in this quarter.  Turkana West, North, South, East, Central, Loima and Kakuma were the districts that took part in the campaign. In total, 140,575 children under 5 were immunized against polio during the campaign.

Number served/number of direct project beneficiaries:

A total of 22,555 Outpatients. (5,372 Pediatric outpatients); 1,434 In-Patients; and 383 Occupational Therapy Patients were treated at LDH in Q3 2013.

Sharleen Nation

Sharleen Nation, a 1½ year old girl, was admitted to the Pediatric Ward through the Outpatient Department on August 1st, 2013 with severe wasting, diarrhea, mouth sores and difficulty breathing. She had been treated before with no improvement, this was her second visit to the hospital.

History

Sharleen is the third born in a family with three children. Both parents are HIV+; there has been no history of tuberculosis or chronic illness in the family.

This was her second admission complaining of the same conditions.

Her mother had delivered Sharleen at home with no complications, and she got all the immunizations as per schedule. The parents were tested for HIV and turned out positive. Sharleen is HIV+ as well.

Investigations

Blood slide (for malaria parasites) negative

Malnutrition (SAM  – MUAC  9cm)

Diagnosis

Pneumonia  with severe acute malnutrition in HIV+ child

Treatment

Amoxil 5ml tds x 5/7

Paracetamol 5ml tds x 5/7

M/Vit 5ml tds x 5/7

Oral Resoma

Gentamycin 50mg ODX5/7

Management of Malnutrition

Therapeutic milks F-75 for 3 days; F-100 for 5 days

On discharge, Sharleen was given RUTF (Ready to Use Therapeutic Food)

Charlene’s condition progressed well and she was discharged in good condition after a 3-week stay at the Pediatric Ward.

Gloria Akatorot

Gloria Akatorot was admitted in July with complaints of diarrhea, vomiting, coughing and fever for a period of 2 days. She was brought to the hospital as an outpatient and given medication without improvement.  

History

This was Gloria’s third admission as an inpatient presenting with the same complaints.

Gloria’s mother attended antenatal clinics at the Lodwar Clinic. She was immunized with Tetanus, Toxoid vaccine, HIV test was performed. Gloria was delivered at Lodwar District Hospital without complications. She has received childhood immunizations as per schedule and she has attained developmental milestones relatively well.

Gloria is the third born in a family with three children who are all alive and well. Gloria’s father is a Mason, her mother has a small scale business of selling vegetables. There is no history of tuberculosis contact, and no known major medical conditions nor allergies in the family.

Investigations

1. HIV test –

2. Full hemogram –hemoglobin level 7g/dl

3. Blood slides

4. Chest x-ray suggestive of Tuberculosis

5. Nutrition assessment MUAC 11.5

Diagnosis

Tuberculosis with severe malnutrition

Treatment

Penicillin 250,000IU 4x/day

Gentamycin 20mg 3x/day

Zinc Sulphate 10mg 2x/day for 2 weeks

Multivitamin syrup 5mg 2x/day for 2 weeks

Resomal (oral rehydration fluids) freely

Therapeutic milk: F-75 ( for 2 days), F-100 (for 7 days). RUTF on discharge.

Gloria did not respond to the above treatment until she was started on combined Anti TB treatment for 2 months:

-Isoniazid

-Rifampicin

-Pyrazinamide

-Ethambutol

-Then Isoniazid and Ethambutol for four months.

After discharge, Gloria is now followed up on in the Lodwar District Hospital outpatient therapeutic program .Her mother was so happy with the progress of her child because of the treatment she received. She said the recurrent illness of her baby had interfered with her business and has eroded the little income for the family. She is grateful for the support and thanked RMF for the support they offer at the Pediatric Ward.