Kenya

Project Goal:

The Ochieng’ Memorial Lwala Community Hospital is a community-based project that is managed and supported in partnership with the Lwala Community Alliance, a U.S. based humanitarian organization. The mission of the clinic is to meet the holistic health needs of all members of the Lwala Community, including its poorest. Whenever possible it addresses health problems at their roots through community health interventions. It aims to provide excellent community-based health care, not to become a tertiary care facility. The health center is part of a larger effort to achieve holistic health and development in Lwala, including educational and economic development.

Project Objectives during this reporting period:

1. Actively engage the community through preventative health education and education programs to regain patient numbers at the health center
• Hold monthly Hygiene and Sanitation trainings
• Hold monthly Umama Salama courses
• Host Children’s Club every month
• Institute new Girls School Uniform Program

2. Continue Capacity Expansion
• Complete new maternity and clinical care building
• Procure furnishings and equipment for new building
• Obtain grid access to electricity
• Obtain title deed for land
• Increase clean water access at the clinic

3. Improve operating systems for better accountability
• Adhere to accounting protocol established in 2010

4. Ensure quality of clinical care services
• Provide appropriate staff training in MCH and HIV

Summary of RMF/WCF-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans):

• Paid salary and other employment costs for Clinical Officer John Badia
• Paid for maternal and child health costs including:
o Salary and other employment costs for maternity nurse Rose Adhiambo Gayo
o Safe Motherhood (Umama Salama) Community Education Program
o 53% of medicine costs
• Paid for ambulance repairs and maintenance
• Paid for fuel for ambulance to provide emergency transportation
• Paid for obstetric emergency referrals

Results and/or accomplishments achieved during this reporting period:
The first quarter of 2011 was the most productive programmatic period in Lwala over the last 3 years.

Preventative Health and Education Outreach
• Maternity Dedication held March 21 with approx 250 community members. Attended by Provincial Medical Director, District Medical Officer, area Minister of Parliament. The ceremony was used to invite mothers to access the facility for delivery. Delivery numbers have increased threefold in April and May.
• Hygiene and Sanitation trainings have been held each month, with very good attendance and follow up.
• 3 day Umama Salama courses for life saving skills for mothers during labor have been going on every month with good attendance
• New program formulated to work with Umama Salama members to mobilize women to come to birth at the hospital. LCA splits fee for delivery with Umama members who refer women.
• In March, Umama Salama assisted going house to house to visit with the clinical staff members and doing HIV counseling and testing in the homes.
• Children’s Club conducted every month with more than 50 children in attendance each session
• In January, Girls School Uniform Program supplied 400 uniforms and 400 sets of menstrual pads to incentivize primary school completion to girls in class 6-8. All products were locally manufactured, employing 22 people.
• Preparations underway to pilot Tuko Pamoja, adolescent reproductive health, HIV and life skills curriculum, at Kameji Secondary School starting in June 2011

Capacity Expansion
• By March 31, the new maternity and private consultation wing was complete and awaiting MoH inspection
• New build expands Lwala Community Health Center to be Lwala Community Hospital with 10 inpatient beds.
• In January, new water access was created at the facility through drilling a bore hole. Next step needed to attach submersible pump and large water storage to the borehole.
• In February, the LCA gained electricity grid access for the first time in the village’s history.
• In March, the LCA gained the title deed for the land where the health center sits after 5 years process.

Systems Improvements
• New protocol for Kenya financials established and adhered to since 2010
• Almost all program staff signed new contracts during February and March
Quality of Care
• FACES technical team carried out a quality control assessment of HIV program.
• Continuing Medical Education provided by Dr. Jeff Andrews (OB/GYN), and 3 visiting clinicians
• Clinical team developed a checklist for the emergency box/tray
• Conditions that have led to low immunization coverage are being addressed with the Rongo DPHN (district public health nurse)
• New patient record booklet has been largely successful.

Number served/number of direct project beneficiaries (for example, average number treated per day or per month and if possible, per health condition).

Family Planning Clinic
Month Number of Women Initiating a Family Planning Method
January 14
February 31
March 29
Total 74
Average per month 25

HIV/AIDS
Number of patients reporting for HIV appointments
Month Total
January 282
February 263
March 368
Total 913
Average per month 304

Antenatal Clinic
Month Number of Women reporting for the 1st ANC visit
January 36
February 32
March 19
Total 87
Average per month 29

Deliveries
Month Number of deliveries
January 8
February 5
March 11
Total 24

Notable project challenges and obstacles:
As shown above, the first quarter of 2011 was the most productive programmatic quarter of the last 3 years in Lwala. The facility tripled in size, electricity and water were acquired, and patient numbers were up. The challenge has been to maintain funding to support the programmatic success. The revenue of the organization as a whole during the first quarter of 2011 showed a 29% drop from the same quarter in 2010 and a 50% drop from the same quarter in 2009. The Lwala Community Alliance is now more dependent upon Real Medicine Foundation, World Children's Fund and others for long term commitments to maintain the high level programs that are currently being offered.

If applicable, plans for next reporting period:
• Transfer of clinical care to new building
• Staffing and equipping new building
• Installation of hygiene/sanitation and water infrastructure at four pilot schools
• More Umama Salama workshops and Children’s Clubs will be held
• Continued health outreach at schools
• Recruit 2 new nurses for MCH and community health outreach
• Acquire more curricula, staff, and supplies for mobile health unit

Success story(s) highlighting project impact

1. Dedication of New Maternity Wing

On Monday, March 21, the new maternal health and clinical care building was publicly dedicated. Over 300 people were in attendance for this special event, including founders Milton and Fred Ochieng’, Executive Director James Nardella, the Provincial Medical Director, district medical and education officers, and other dignitaries. The new building triples the size of the hospital facility in Lwala and makes room for some inpatient care. The clinical care side of the building contains a triage area, 4 private consultation rooms, a procedures room, a small ward, and a health education room. The maternity has space for labor, deliver, and recovery. Two dozen local laborers worked 6 days a week to complete construction from July 2010 through March 2011. The expansion will enable staff to improve the quality of services and care that our patients receive. Following inspections by the Ministry of Health, the building opened for service during April.

Milton and Fred speaking at the dedication ceremony for the new maternity wing 

Patient Story: Leah
Leah has been a long-time beneficiary of Lwala Community Alliance in many regards. As an HIV-positive woman who is also suffering from TB, she regularly participates in the HIV support programs, receives her ARVs from the hospital, and is treated for opportunistic infections that result from her condition. Not one to hide in the corner because of her status, Leah has been outspoken in the community about living with HIV including encouraging people to be tested to learn their status and advocating good hygiene practices for people living with HIV as a WASH Trainer-of-Trainers (TOT). Through the WASH training, Leah became instrumental in starting up a group that is currently making liquid soap and disinfectant at the hospital for sale to villagers, schools, and other facilities.

Photo above: Leah at the clinic

 This project has been both a source of income for group members like Leah and has improved the availability of high quality, low-cost soap to improve sanitation and hygiene practices in the community. Leah recently fell ill with pneumonia as a result of her compromised immunity due to HIV and TB, and as she is a widow with three children in school, she could not afford care for her illness. Clinical officer John Badia felt that her condition was serious enough to warrant referral to Tabaka Mission Hospital and observation there for multiple days. Through income generated by the soap making group, LCA was able to cover the cost of her medical expenses and ensure that Leah had a full and speedy recovery.