Kenya

Making sure Lodwar Hospital works

September 3, 2013

Mwanaidi Makokha

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.

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

Medical Equipment:

During the Second Quarter, the maternity ward, male ward, and the physiotherapy department all benefitted from the purchase of emergency medical equipment. RMF’s aim this quarter was to ensure that each ward is fully equipped with its own emergency medical equipment to avoid the sharing of such equipment among the various wards and departments, ensuring patients are attended to without delay. RMF purchased a nebulizer and oxygen concentrator for the male ward, a nebulizer, infant weighing scale, oxygen concentrator and a suction machine for the maternity ward, and an infrared massager for the physiotherapy department. The purchase of this equipment has gone a long way in ensuring the three wards are able to function efficiently and independently.

Upon receiving the equipment at the male ward, the nurse in charge, James Mwangi, said:

“We appreciate RMF/MMI for the assistance and support they have provided in our department; starting with ward repairs and now the purchase of emergency medical equipment. The working environment has improved tremendously, especially now with the equipment. Patients are now being attended to immediately especially with emergency cases. This has never been experienced since I started working at the District Hospital 8 years ago. We are much more motivated now. We appreciate you. We are proud to partner with RMF and are happy to see all these positive changes in a very short period of time.”

Medical Supplies:

RMF purchased emergency supplies for the pediatric and maternity wards and medicines and medical supplies that are usually not supplied by KEMSA. Drugs such as Dexamethasol, Quinine oral drops and a Ventolin respirator, amongst others, were supplied for the pediatric ward. Quinine drops went a long way to help the pediatric patients during the malaria outbreak that occurred.

The maternity ward also received supplies purchased by RMF/MMI including neonatal Ampiclox, IV Gentamycin, Rocephin, Panadol suppositories and Dextran. Before we started supporting supply, patients had to buy these drugs since they had not been available at the hospital, nor supplied by KEMSA. Frequently, patients have died and parents lost their newborns due to lack of these drugs and the parents/guardians’ inability to purchase due to the high poverty rates of the population.

Non-Pharmaceutical supplies:

The pediatric ward and maternity ward once again benefitted from non pharmaceutical supplies in the quarter. Strapping adhesive, branulars, clean gloves, gauze rolls and crept bandages were purchased in the quarter by RMF. There had been a shortage of clean gloves and other non pharmaceuticals supplies at the hospital for the last 6 months. Availability of these supplies has now enabled the nurses in the wards to perform their duties better and the patients to be attended to faster.

Other supplies:

In a bid to ensure that the wards remain clean and germ free, RMF purchased cleaning and disinfecting materials for the wards; liquid soap, mops, buckets, dustbins and brushes were purchased.

Results and/or accomplishments achieved during this reporting period:

All wards continue to benefit from free quality medical services including supplies and treatment at the Lodwar District Hospital.
As a result of the above, LDH pediatric ward continues to record low mortality rates and high number of patients seeking medical services. (5,835 up from 3,662 pediatric outpatients in Q1)
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.
The male ward benefitted with the acquisition of its own new oxygen concentrator. Initially, the only working oxygen concentrator that was shared by all the wards at the hospital was the one that was purchased by RMF 2 years ago. The oxygen concentrator has enabled the staff at the male ward to attend to the patients with difficulty in breathing without delay.
The male ward also benefitted by RMF acquiring a nebulizer. This has ensured that patients with respiratory problems, especially asthmatic patients, are assisted without delays.
Staff at the male and maternity ward, specifically the nurses, continue to have high morale due to the availability of medical equipment at the ward. It had been very frustrating for them to share one oxygen concentrator and nebulizer for the 3 main wards.
The maternity ward benefitted in the second quarter by receiving a comprehensive supply of medical supplies. The supply has gone a long way in reducing the mortality of newborns in the ward.
The maternity ward also benefitted from the purchase of a nebulizer, oxygen concentrator and weighing scale by RMF for the ward.
The wards continue to remain neat and hygenic due to the availability of cleaning materials supplied by RMF for the hospital.

Number served/number of direct project beneficiaries:

A total of 21,236 Outpatients. (5,835 Pediatric outpatients); 868 In-Patients; and 253 Occupational Therapy Patients were treated at LDH in Q2 2013.

Dorcas Akunoit

Dorcas and her mother upon admittance

Dorcas Akunoit, a 1-year-old girl, was admitted to the pediatric ward with complaints of coughing, vomiting and high fever. After having been seen by the doctor, she was diagnosed with Severe Anemia and Respiratory Tract Infection (RTI).

History

Dorcas is the last born in a family of seven siblings .Her mother is a business woman and her father a casual worker. She had never been admitted in a hospital nor had any blood transfusion.

Management

On her admission she was given:

– Ranferon syrup 5mls bd

– Panadol syrup 5mls tds

– M/vitamin 5mls tds

– I.V Ceftriaxone 250mg x 5

– Oscoft syrup 5mls tds x 5/7

– Flagyl 5mls Tds x 5/7

– ZnSO4 20mg od x 10/7

Her condition progressed well after being managed with the above drugs as they were readily available. After a week and a half stay at the ward, Dorcas was stable and later discharged. Drugs administered on Dorcas like Ranferon syrup, Panadol syrup and iv Ceftriaxone are usually purchased by RMF and provided at the pediatric ward for free since KEMSA does not supply these items. Availability of such drugs has enabled Dorcas’ and many other patients’ lives, admitted at the pediatric ward, to be saved. The nurse in charge on the day Dorcas was being discharged said:

“Thanks to our immediate drug donors (RMF) for having saved lives of the young ones by providing these drugs for free to the patients. These drugs aren’t easily accessible and affordable to everyone.”

Dorcas Akunoit and her mother on the day of discharge

Losekon Lobei

Losekon Lobei upon admittance

Losekon Lobei was an admission from the Outpatient Department at Lodwar District Hospital with the following symptoms:

Diarrhea
Vomiting
Excretion of blood stained stool
Sunken eyes
Loss of skin turgor
Severely wasted/malnourished
Pus discharge from both ears.

History

Losekon is a boy from Karukoi village in Kerio division. He is 2y ears old and the third born in the family of three children. He was brought up by his father as the mother died after being shot at when Losekon was only 4 months old. The father is a herdsman.

Management

The following drugs were administered to Losekon:

Vit A200,000 at a start
Folic acid 5g od
Multivitamin syrup 5mls tds
Metronidazole syrup 5mls tds
Oscoft syrup 5mls
Ceftriaxone iv 250mg tds x 7/7
Panadol syrup 5ml t/d x5/7
Zinc pellet tabs 20mg od x 1/5
Enrolled in nutritional programme
Zinacef iv 60mg tds x 5/7
Cefixime replaced Ciprofloxacine following an adverse reaction.

Losekon’s condition progressed well. After 4 weeks of inpatient care, including enrollment in our nutrition program, Losekon was stable and looked much healthier.

On the day Losekon was being discharged, his father said:

“I am so grateful to the hospital and the donors that are providing these drugs for free to our children. I am a herdsman, with no income; I would never be able to afford to purchase these drugs for my son. Thank you for treating and healing my son.”

Losekon Loibei on day of discharge

Lokoolil

Lokoolil upon admittance, in a semi-comatose state

Lokoolil, a 5-year-old boy, was admitted to Lodwar District Hospital’s pediatric ward as a referral from the Naposmoru Health Center, approximately 250kms from Lodwar Town. Weight 15.9kg.

Diagnosis

Severe Malaria and Meningitis

History

Lokoolil’s family has no history of chronic illness. Lokoolil is the 3^rd born in a family of 4 siblings. His father died. His mother is the sole bread winner, but does not currently have a job.

Investigation

Blood slide for Malaria +

Full haemogram

WBC 9.5%

HB 9.5/dcl

Management

Quinine sulphate iv, intravenous loading dose 300mg in 300mls of 5% Dextrose
After 8hours 150mg in 150mls of 5% Dextrose 8hourly x 3 doses
Oral Quinine 150mg 8hrs in every tds x 10days
Ceftriaxone750mlg twice a day x 10days
Gentamycin 60mlg o/d for 1 week
Ranferon syrup 10mls orally tds for 14days
IV Fluids ½ strength darrows 150mls in 24hours
Paracetamol orally 500mlg tds x 5 days

The patient was admitted as a referral from Naposmoru with complaints of fever, vomiting, difficulty in breathing and coughing that had started four days before admission. He was admitted at Naposmoru Health Center in a very poor general condition, very dehydrated, but stable. His general condition worsened shortly after being admitted and he went into a semi-comatose state at the health center. On admission to Lodwar District Hospital, investigations were done and treatment was administered as above. After rehydration and treatment, the patient improved and his condition stabilized. Lokoolil was later discharged healthy to the great relief of his mother.

Lokoolil and his mother on the day of discharge

The three patients above admitted at Lodwar District Hospital’s pediatric ward would not have recovered if it were not for the support from RMF/MMI with free emergency medical supplies and treatment.