Kenya June/July Update #1

 I am back in the Kisumu area with 4 young adults (ages 17 - 22).  We have been on the ground now for a week.  It has been very good to have some time to adjust and to get settled-in before we begin the real work ahead in Miwani and Yala/Siaya areas.  I flew to Amsterdam 2 days before the rest of the team to give my aging body a chance to adjust to the 10 hour difference between Seattle and Kenya; met with the team at Schiphol airport in AMS before we then flew together to Nairobi.

Our first week has been focused on friendships and re-establishing Kenyan contacts.  I have been in conversation with Dr. Jackton Omoto as often as the internet connection will allow, in regards to the surveys we will undertake in Miwani and Yala.  While our team in the US had established a short form, Dr. Omoto it seems has bigger plans!  The form our team had created focused on BMI (weight, height, age), visual acuity, blood pressure, mosquito net use, dental condition, water and sanitation.  Dr. Omoto's 7 page form incorporates those parameters, but also looks at income, housing conditions (floor, walls, roof), hand washing, family planning, preferred contraception, immunizations received, dish rack use, appliances owned and a few other things.  I must admit, at first I was very skeptical we would be able to obtain this information, yet Dr. Omoto hopes we can be well received by having several Kenyans on our survey team - with more Kenyans than Mzungus (perhaps 2 Kenyans for each American).

Again would say, I don't feel I have any right to ask a Kenyan living in a rural area about how much they earn every month, or other personal questions (such as family planning) - BUT, perhaps with other Kenyans present that may occur.  Also I am reminded, the purpose of our smaller team is to prepare the way for the larger Bainbridge team coming after us - and to trial the survey to see how it actually works.  So in the spirit of adventure and for the sake of learning even more about Kenyans in Miwani and Yala, our team will gear up for the task!  If it does not go over so well in the two areas we are going to survey, then we will look at altering the methods and length of the survey.  Dr. Omoto feels we should due able to get all the questions answered within 30 minutes of time per hut, or housing unit.  The goal is to understand health conditions as well as their living environment/socio-economic status.

Beyond the survey discussions, I am working on my lectures for the medical school in Siaya.  The schedule is a more manageable 2 days of presentations.  I will incorporate a few Problem Based Learning cases from my teaching at the University of Washington school of medicine that will tie in with the topics covered.  Lecture topics will be Motorcycle Accidents in Kenya: statistics and trends; Lower Extremity Trauma, Head Injuries/Trauma (both topics as they relate to motorcycle trauma), Diabetic Emergencies, Chest Pain, and my personal story as it relates to lessons I have learned from being a patient, and how care providers can connect more closely with their patients to meet both their medical needs and their emotional needs.  I am hopeful the Problem Based Learning cases will impart some practical knowledge, and teach a method of thought to craft a differential diagnosis list, a problem list and the manner of thought needed to either rule-in or rule-out a potential diagnosis.  I look forward to seeing how Kenyan medical students work in a small group setting where they come up with learning objectives, and report back to each other the following day on those potential diagnoses.

I will do my best to keep this site updated.  Our internet coverage has been very sketchy, with frequent outages, and literally a small zone (like a 10 foot square area of coverage) of reception.  Once evening hits, the mosquitos become rather active, and since my reception is outside - I am a ripe target!  Possibly a fried electrical part will be replaced this coming week.....

Back to Kenya! June - July 2012

Yes, the title is correct!  In less than 2 weeks I am headed back to the Kisumu area for more medical work.  This trip will be for a bit more than 4 weeks in length, returning home in time for our 30th wedding anniversary!  I will be leading a team of 4 college aged adults from Bainbridge Island, who will help me along the way.

I will be involved in several medical adventures this time; whereas the first trip involved more observation and understanding of the Kenyan care delivery system, this trip will include many more hands-on endeavors from teaching at a medical school near the Siaya District Hospital for nearly a week, to studying the health of two separate populations.  One of these near Siaya, the other close to the Nehemiah International property/farm east of Kisumu.

Dr. Jackton Omoto, chief of staff at Siaya District Hospital, has asked me to speak to medical students and medical officers on various topics of Emergency Medicine.  We are still working through those details, as he initially hoped I would be able to provide 6 hours of lecture per day for 5 consecutive days!  I simply do not have the time to prepare that much material.  Instead I have suggested I would be able to teach over 2-3 days; including several problem based learning cases (an interactive teaching method I have learned as a volunteer at the University of Washington school of medicine the past 6 years).  Additionally I would like to spend a day or two observing emergency care delivery in the Siaya hospital to see if any improvements may be realized - looking at everything from supplies, response to crises, available medications and testing capabilities.

While in that area, Dr. Omoto has asked that our team survey the health of children and adults.  I have been purchasing equipment to perform a basic health assessment on people for this trip.  This will include BMI (body mass index - which gives a very good sense of nutritional status from age 2 to adult via measuring weight/height/age), hypertension screening in all over age 20, visual acuity, and dental hygiene - looking for obvious cavities.  For villages we hope to obtain population, births and deaths in the past 12 months, mosquito net use, sanitation (garbage and human waste) and water sources.

This will also be undertaken in an area around Nehemiah in an effort to begin to understand the health needs of the community and how we can begin to meet them.  More details below.....

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