Kenya

Project Goal:

Provide funding and support to the Lwala Community Hospital that serves the population of North Kamagambo in Migori County, Kenya. Poor physical infrastructure, including impassable roads during the rainy season, lack of electricity and lack of reliable drinking water, have helped to create a critical healthcare challenge. 

The health center was recently upgraded to a community hospital with RMF funding, and is part of a larger effort to achieve holistic health and development in Lwala, including educational and economic development.

Other programs include Emergency Ambulance Services and a Safe Motherhood (Umama Salama) Community Education Program. Based on the populations of school aged children and the number of families related to the 13 primary schools in the Lwala area, there are over 20,000 people who are able to access health care at the Lwala Community Hospital by foot or short motorcycle transport. 

Photo: Community members work in the garden

Project Objectives during this reporting period: 

1. Actively engage the community through preventative health education

• Hold monthly Water, Sanitation, and Hygiene (WASH) trainings
• Conduct consistent weekly outreach by clinic staff
• Host Children’s Club every month
• Complete stakeholder sessions at 4 additional primary schools to create participatory action plans for water and sanitation school programs in 2012
• Complete the making of over 500 school uniforms and sets of sanitary towels
• Begin trainings for girls mentoring program

2. Continue Capacity Expansion

• Continue staffing and equipping former clinic building to serve as administrative block
• Recruit and train an ultra-sound technician
• Recruit 2 new nurses for MCH and community health outreach
• Acquire more curricula, staff, and supplies for mobile health unit 

3. Improve operating systems for better accountability

• Adhere to accounting protocol established in August
• Continue process of bringing all Kenya accounting for 2011 into Quickbooks

4. Increase enrollment of patients in HIV Care

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

• Paid salary and other employment costs for Clinical Officer in Charge Fred Muraha
• Paid for maternal and child health costs including:
• Salary and other employment costs for maternity nurse Rose Adhiambo Gayo
• Safe Motherhood (Umama Salama) Community Education Program
• 58% 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:

Preventative Health and Education Outreach

• Umama Salama members are now working in rotations as accompaniment to maternal health clients.
• Children’s Club conducted every month with more than 50 children in attendance each session.
• Agricultural support project, in partnership with DIG (Development in Gardening) began in October 2011 with the creation of a small demonstration garden behind the original clinic building. The HIV Support Group and Umama Salama members are actively engaged in the project. The garden will support patient meals and food supplement for HIV infected persons. (Photos at end of report)
• World AIDS day marked at Ndege Oriedo with over 100 people attending and about 50 tested for HIV status.
• Education program is progressing to 4 Phase II schools for 2012. Stakeholder meetings have been conducted to gather input from students, teachers, parents and school management held at Phase II schools. Phase I results from first 4 schools were reported to interested stakeholders through two well attended community meetings. The Girls’ Education Program and water and sanitation infrastructure are on track to reach Phase II schools starting in January 2012.
• A WASH training was held for new participants in October and a refresher training was held in November. A December training was conducted for school children during their break. Home-based follow-ups were also conducted to track adherence.

Capacity Expansion/Infrastructure

• A nationwide posting in December for new mid-level managers in clinical care, public health, economic development, and education yielded hundreds of applications. Staff is currently screening applicants and selecting qualified candidates for an initial round of phone interviews.
• The money has been raised for a new ambulance and staff is working on its acquisition.
• Challenges with electricity persist due to sporadic issues on the line.

Systems Improvements

• New protocol for Kenya financials established and adhered to since August 2010
• LVDC (Lwala Village Development Committee) has reviewed and approved all budget and actuals before submission to the U.S.

Clinical Care

• Nearly 1,000 people are currently on HIV care or treatment. We continue to enroll more than 30 per month. With 16,500 people in North Kamagambo location and an MoH estimation of 24% HIV prevalence in the area, we potentially have at least 3,000 more to enroll.
• Continued to maintain the high number of women coming for ANC, delivery, and postnatal care.

Number of direct project beneficiaries:

A total of 1,412 patients were treated during the Fourth Quarter.

Success stories:

Community Empowerment through Improved Organic Farming

Photo: Demonstration garden on the hospital property

Through a partnership with Development in Gardening (DIG), a US-based NGO that works to improve nutrition and heath through sustainable agriculture, the Lwala Community Alliance has begun a program to bring improved farming knowledge and practice to the people of North Kamagambo.  This project includes the development of a vegetable garden to act as a demonstration plot for the community and to supply vegetables to the hospital and community.  DIG focuses on providing the types of vegetables needed for people living with HIV because the current treatments for the disease are most effective when taken with a highly nutritious diet.  This means in the inclusions of vegetables such as amaranthas, black nightshade, beet root and fruits like passion fruits that people in the area did not know could assist those living with HIV in their journey to remain healthy.  In addition, the garden has three areas for community groups to have hands on training in organic agriculture techniques that ensure that water sources, soils and produce stay free of chemicals and are often cheaper for farmers as they use locally available materials. The three groups currently training are the Umama Salama group which work as community health workers to encourage women to give birth at the hospital; the HIV support group; and a youth group made up of young men and women, many of whom do not have enough money to stay in school but can use the knowledge and skills gained through this program to earn their way back to school.  While some of the produce is consumed by the hospital patients and community members, much is sold for the sustainability of the project and income generation for the individual groups.  By ensuring that members are provided information on the nutritional value of different produce and how to prepare them in the most nutritious manner, we can be certain that community members are gaining skills that will help them to stay healthy, earn more money for their families, and protect the earth in order to provide long into the future.

Milestone: 1,000 people on HIV Care

Photo: Children playing a game at the monthly Children's Club

As of December 2011, the Lwala Community Alliance is now reaching 1,000 people with HIV care, with an average of approximately 30 additional patients enrolling each month. At the beginning of 2011, there were 670 enrolled in care. The tremendous growth in this area has been influenced in part by the opening of our new maternity and integrative HIV care wing in April. Through this increased capacity, the Lwala Community Hospital has been able to provide a higher quality of clinical care, increase support, and reduce the stigma to those infected with HIV. In addition, the HIV support groups and monthly Children’s Clubs (which serves children infected with or affected by HIV) has empowered community members to seek care and live more openly with their HIV status. With 16,500 people in North Kamagambo location and a Ministry of Health estimation of 24% HIV prevalence in the area, we potentially have at least 3,000 more patients to enroll. With the ongoing support from Real Medicine Foundation/World Children’s Fund, we are able to continue providing quality services to those living with HIV.

One of a Thousand: John Omollo (pseudonym)

Photo: C.O. Fred Murara examining John Omollo

On November 4, 2011, John Omollo, aged 54, came to the Lwala Community Hospital for care. He was seen by Clinical Officer Fred Morara and complained of pain in his chest. C.O. Morara examined Mr. Omollo, listened to his heart, and discovered a heart murmur and bulging veins, common secondary symptoms of HIV. Understanding the possible underlying conditions, C.O. Morara diplomatically encouraged Mr. Omollo to undergo a rapid test for HIV. Fifteen minutes later, Morara met privately with Omollo to discuss the results, which, as Morara suspected, were positive.

Upon receiving the diagnosis, Mr. Omollo asked several questions and was counseled to more fully understand HIV. After accepting his status, Omollo elected to be enrolled in care at the Lwala Community Hospital, where 1,000 other community members are now receiving care and treatment for HIV. During the conversation, Omollo stated that he believed his wife is still negative. He was counseled on the importance of condom use to prevent transmission and on testing so that all of his family members could know their statuses. Omollo's CD4 count was also taken at that November visit. The result was low enough to be enrolled in antiretroviral treatment, which he began in December 2011.