Oct 25, 2017

Progress and even a Palliative Care Walk!

Start line
Start line

Jambo!

I just returned from my 7th trip to Kenya and the Palliative Care Team and their patients never cease to amaze me. The team’s dedication and generosity is inspiring, and the love and care expressed by patients and their family is remarkable.

Many in the US are challenged by the cost of medical care, but legally care must be provided for life threatening illnesses. That is not the case in Kenya and families frequently must decline important therapies based on financial considerations. While struggling to pay for medical care remains a significant issue, I am glad to report I have seen progress since my first visit in 2014. More families are enrolling in the government’s National Health Insurance Fund which provides coverage for hospitalizations, inpatient medications, and some laboratory and x-ray procedures. This has made care significantly easier, both logistically and financially. About one year ago, the government program began paying for chemotherapy. This has brought therapy to patients who previously had little, if any option, for cancer treatment. Coverage coincided with the opening of the Chandaria Cancer and Chronic Diseases Building which now has a large room for chemotherapy administration and oncology clinics. Palliative Care’s offices and clinic room are smack in the middle of this space and the team is very active in addressing symptoms in the large number of oncology patients.

Our fledgling research program is up and going. The team conducted a survey of patient starting chemotherapy and found a high incidence of pain and other symptoms. They are now addressing how to manage symptoms closer to disease presentation. Our clinical protocol seeking to evaluate telecommunication as a means of delivering home hospice is now open and accruing. Research efforts have also funded the addition of a wonderful clinical officer, Silvanus Kibiwot, who joined the team in August. He is a dedicated, talented clinician and a great addition to the team.

I got to participate in a march to raise awareness of Palliative Care and Hospice which took place one Saturday Morning in Eldoret. Dr. Millicent Korir and Silvanus participated and Dr. Korir got to say some remarks at the conclusion of the walk. A Salvation Army band from Eldoret made sure everyone in town knew a walk was going on. I got to march next to the tuba and can assure you the marchers were sending a loud message about the importance of Palliative Care! I’ve included a photo from the walk as it passed by the hospital.

Your support has helped our efforts in obtaining pilot grant support. Research can help us understand the most pressing issues and help us focus our efforts. We also use donated funds to assist families in need. We see families struggle to raise just a few dollars to arrange transport of a patient home or to an inpatient hospice. Outpatient drug costs are usually not covered, so ensuring patients have bandages, colostomy supplies, and the basic medications needed to control pain and nausea are how your support can assist our patients.

Finally, I am writing this report the day before the October 26th repeat presidential election. Everyone I met during my trip was anxious to move forward but quite apprehensive regarding the potential fallout. Please, keep the Palliative Care Team and the people of Kenya in your thoughts and prayers.  

As always, thanks for your support.

Ken                      

Tuba Solo
Tuba Solo
PC Walk
PC Walk
Oct 10, 2017

Under One Roof: HIV Care and Salsa Dancing

This weekend was truly magical . Key stakeholders (about 8 in total) from across North America and Kenya came together to discuss the infrastructure of care in the adolescent clinic: areas of strengths, areas of improvement, and short and long term goals. This meeting demonstrated deep rooted committment and momentum among those who advocate for our clinic. 

Here are a few of the issues we discussed:

Strengths:

  • Integrated into the hospital system with the majority of staff from the hospital 
  • Provides a model for outlying sites 
  • Draws both HIV negative and positive to clinic
  • Provides free reproductive health care
  • Committed staff
  • Engages youth beyond their medical illness- Yes, thats right: daily salsa dancing, bead works, and spoken word

Areas of Improvement:

  • People who are not known to be living with HIV are coming to the clinic, but not seeing the clinician. 
  • Working closer with schools which will help with ART adherence
  • Uptake of reproductive health care

To start to address the above, we plan to increase adolescent friendly educational and health related signage to attract the usage of our services to non HIV positive youth, start working on establishing connections with administrators in school, and ensure clinic staff are well versed in counseling  reproductive health issues. A training is in the works (which will be a refresher for some). 

The clinic is the love, sweat and tears of all of us. Those areas of improvement will come with perservence and passion (which we all have) to provide adolescents the best health possible. We have an amazing and powerful set of assets, which leds itself to sustainability, resilience, and delivering the best care to our teens for a long time to come. 

 

Best, 

Sep 26, 2017

Responding to Urgent Needs: Charles Oteino's Story

Charles Oteino (changed name) is a 19 year old who was referred to me by a social worker in Khunyangu, one of our busier clinics in Busia County. When I saw Charles at our Mosoriot clinic he was a frail skeleton, clearly near the end of his painful journey.

Charles was infected with HIV at birth and as is too often the case became an orphan when first his father died with the disease and then his mother. Charles was ultimately sent to live with an Aunt in Siaya. Unfortunately, the Aunt had no interest in Charles and simply wished he would go ahead and die. She would throw out his antiretroviral drugs and refuse to give him transport money to attend our clinic in Khunyangu. Even though he had reached high school, the Aunt refused to support his school fees as well.

Charles was determined to try to survive and began walking over three hours to keep his clinic appointments in Khunyangu and then walk back home. The social worker in Khunyangu realized that Charles would not survive much longer and sent him to our shelter in Mosoriot where I saw him the next day. All of our initial attention was focused on treating opportunistic infections, changing him to second line antiretroviral drugs and food, food, food. Before long a new Charles began to appear----a fine young late teenager needing love and some hope for a future. It was clear to all of us that Charles could not return to Siaya and any meaningful plan would demand a new beginning.

Thanks to the generosity of those who have donated to my humanitarian fund, Charles has a modest wardrobe a smart school uniform, all of the books/supplies he needs and tuition paid in a nearby boarding high school.

During school breaks Charles returns to the Mosoriot shelter as “home” and helps with the chickens and gardens that feed the guests in the shelter. Over the weekend, Sarah Ellen and I love having him over for a meal in town. His favorite has become the Chinese restaurant where he loves the food while struggling with chopsticks. 

Dr. Joe Mamlin shared this update with us at AMPATH, as an example of how your contributions are used. Asante Sana! 

 
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