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: The new RMF/MMI donated surgical suction machine in use in the Lodwar Hosptial Surgical Theatre

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 sponsored activities carried out during the reporting period:

Medical Equipment:

For many years, the surgical theatre at the Lodwar District Hospital has been short of the most essential orthopedic surgical equipment and had to refer many patients to other, better equipped hospitals. RMF purchased a variety of equipment for the operating theatre during the First Quarter 2013 upon the direct request of the medical staff, consisting of: skeletal traction equipment, suction machines, skin grafting knives, K Nail sets, K wire sets, amputation set, hand drill, cerclage wire roll and other basic orthopedic equipment supplies. The new equipment has gone a long way in assisting the surgeon and anesthesiologist to perform surgeries at the theatre. 

The surgeon Dr. Ekitela had been requesting the hospital for most of this equipment for close to 5 years with no success. Dr. Ekitela was overjoyed and upon receiving the equipment said:

‘I thank Real Medicine Foundation for purchasing the equipment for the Hospital. For years I have not been able to perform some procedures due to lack of equipment at the theatre. Now with this supply, I will be able to perform procedures and attend to patients without further referral. I will take good care and use the equipment to my best ability and ensure that the Turkana people are served best. God bless RMF’.

Medical Supplies:

During the 1^st Quarter, RMF also purchased a comprehensive list of medical supplies for the Pediatric ward to ensure patients admitted to the ward continue to receive treatment at no cost. Purchases included:  IV medications such as Ceftriaxone, Phenobarbitone, Sodium bicarbonate, Hydrocortisone, Dexamethasone, Gentamycin; syrups such as Ranferon and Cyclopam; disinfectants like Spirit, Lysol and Cidex and many other medicines. The supplies will go a long way to ensure that patients continue to be treated using modern medicine best practices, and for free, since many cannot afford care at that level, thus allowing us to maintain low mortality numbers.

Results and/or accomplishments achieved during this reporting period:.

• Patients at the Pediatric ward continue to benefit with free medical supplies and treatment at the hospital and inpatient and outpatient visits remain high.
• Mortality numbers remain low and we have been able to maintain these low numbers due to continuous availability of medical supplies and medical equipment.
• LDH continues to record a high number of patients seeking medical services in all 3 wards.
• The inpatient unit at the District Hospital continues to record better working conditions for the staff that are much more motivated to work.
• The operating theatre at the Lodwar District Hospital benefitted from the purchase of a comprehensive selection of new equipment many of which had never been purchased by the hospital before, hence enabling the surgeon to perform his duties effectively and execute surgeries that he had never been able to do before for lack of the appropriate equipment.
• Orthopedic cases can now be addressed at the District level without any further referrals.
• Suction machines purchased for the operating theatre have enabled patients to be attended to without any further referral.
• RMF/MMI activities at the hospital were recognized and appreciated by the Provincial Ministry of Health team that visited Lodwar District Hospital for the yearly assessment in March 2013.

Number served/number of direct project beneficiaries:

A total of17,898 Outpatients. (3,662 Pediatric outpatients); 1,496 In-Patients; and 176 Occupational Therapy Patients were treated at LDH in Q1 2013.

Success Story 1

NAME:Peter Erot

AGE: 12 years

WEIGHT: 28 kg

DIAGNOSIS:Malaria/Meningitis

Peter was found by a fellow student and teacher lying unconscious on the way to a village called Kalokol, 80km from Lodwar town and was brought directly to the hospital. On admission, Peter was in a semi-comatose state, no fever present with a temperature of 36.8C and a pulse of 78/min. He was admitted, diagnosed with Malaria/Meningitis and immediately started on medication/treatment.

TREATMENT & MEDICATION

Peter was put on Chloramphenicol 500mg QID

• Paracetamol tabs-500mg tid
• IV fluids, normal Saline alternating with 5% Dextrose
• Specific nursing care
• Vital signs –every 4 hours
• Nasal gastric tube feeding
• 2 hourly turning
• Care of personal hygiene

All the above medications are purchased and supplied by RMF/MMI. The following day Peter developed a fever of 39C and he was introduced to Ceftriaxone 500mg bd5/7, anti-malarial Quinine sulphate 560mg loading dose and 280mg maintenance dose 5/7. On day 3, Peter’s temperature settled to 37.2C; he regained consciousness but remained confused.  On the 6^th day his general condition had improved immensely, vital signs became normal and he regained full consciousness. The NG-tube was removed and he started feeding orally. He was reviewed by the doctor and was found to be stable and fit for discharge.

 The Managing Doctor:

“Peter was admitted with a severe medical condition. His drastic improvement was due to availability of appropriate drugs that were used to manage his illness. All of the drugs used to manage Peter were donated by Real Medicine Foundation. We appreciate your continuous support because most of the people we serve are economically disadvantaged. It is through RMF/MMI’s support that the Pediatric ward can manage to save lives.”

Success Story 2

Lokonomor Epus

Lokonomor Epus, a 9 year old boy from Kadese villlage in Turkana County, was admitted to Lodwar District Hospital after having been bitten by a snake. Epus is the third born in a family of six siblings, and does not attend school but helps with his father’s goat-herding.  Epus had been hunting for a squirrel that ran into a hole, which he dipped his hand into to chase, and in the process was bitten by a snake. On admission he was in pain and had massive swelling and blisters on the affected hand.

Epus upon admission

TREATMENT & MEDICATION

Epus was taken to the surgical theater for treatment based on: Anti-snake Venom, i/v Fortum 500mg for 5days, followed by Augmentin syrup 10mls bd 5/7, Flagyl 200mls for five days, and IV Dexamethasone 2mls QID for 5 days, all supplied and purchased by RMF for the Pediatric ward. Daily dressing of the wound and high protein diet were also included. He progressed well and was discharged after four weeks.

Epus on discharge, fully recovered.

SUCCESS STORY 3

Erukudi Ayapan

Erukudi  Ayapan, a 3 year old boy from Lokori in Turkana county and 70km from Lodwar town, and the sixth born child in a family of seven. His mother is a housewife and his father a herdsman. After taking a brief history of the family, it was found that both parents are both on Anti-TBS drugs. Erukudi was admitted to Lodwar District Hospital on 28/03/2013 with the following prevailing symptoms:

• He was severely underweight
• Diarrhea
• Vomiting
• Cough
• Lack of appetite

Erukudi  Ayapan

TREATMENT & MEDICATION

Ekurudi was given Vitamin A, IV ExPen, Gentamicin, Metronidazole, Multi-Vitamins, Zinc and Ranferon. B/S was performed, mps were +++.  He was put on i.v. Quinine and started on a loading dose of Quinine Sulphate. On the fifth day of treatment, he started taking Anti-TBS medication. Ekurudi’s condition has progressed well from the time of admission and he continues to improve under careful observation. His mother said that she had lost hope for her son and feared that he would die soon, but is now hopeful and very grateful that he has progressed so much thanks to the treatment received at the hospital. 

The old suction machine that was used at the operating theatre:

The two new suction machines purchased by RMF/MMI for the theatre:

A portion of the medical supplies for the Pediatric ward purchased by RMF in Q1 2013: