David Nawrocki at Maseno, Kenya - Chapter 3

Chapter 3   Health Care in Kenya and the Role of Maseno Mission Hospital   Optimal health care is provided to those who can pay for it in Kenya .  If a resident cannot pay for their healthcare, then they will not typically receive it.  If a patient requires surgery or care for a catastrophic illness, they may be sent to a government hospital in Kisumu or Nairobi where they are asked if they can pay for the care they require.  If they cannot pay for the care, then they are held captive in the hospital until they can pay.  Healthcare can be withheld until a form of payment is provided.  If payment is not found by the family, the patient may become terminally ill while waiting for their necessary care in the hospital, or they may be eventually sent home with their family with their terminal illness.  Kenyans in the lower socio economic level of society (50%+) do not seek the care they need in many cases due to the cost.  Kenyans in Maseno and surrounding Luanda come to the Maseno Mission Hospital because they know they will be cared for here.  Patients receive nominal bills.  They are lucky to pay 25-30 percent of their bills in many cases.  Some of the patients leave before it is medically advisable in order to honor the portion of the medical bill they can pay.  Many are without food and without means to buy seeds, supplies and fertilizer for their crops.  Many cannot afford the cost of the medicine they need.  One gentleman left the hospital prematurely this afternoon because he was the sole caregiver for six children and stated that there would be no one to feed the children and care for them at home if he did not leave.  He was still recovering from his anesthesia. Despite the challenges of financially supporting the Maseno Mission Hospital , anyone who walks through the gates to the Maseno Mission Hospital compound is treated and care is given despite the realities of the healthcare system in western Kenya .  Maseno Mission hospital mission is a respite for the poor, the needy, and the sick that walk for miles in hope that someone will care for them or their children.  I have seen children brought to the hospital semi-conscious in the arms of their parents and go home a few days later with food and the appropriate health care.   Maseno Mission Hospital   Maseno Mission Hospital began as a small Anglican mission in 1906 under a fig tree.  The Luhya word for fig tree is "omasena" which was westernized by the early missionaries to Maseno.  Over time with the help of the Anglican Church, buildings for the clinic, outpatient department, wards, mortuary, operating theatre and x-ray department became established.  Maseno hospital mission grew from the 1930's to the 1990's with the help of Swedish Rotary.  Their support ended in 1999.  In 2001 Nan and Gerry Hardison arrived from San Diego under the auspices of the Episcopal Church of USA Volunteers for Mission for Services in the Anglican Church of Kenya to continue the work here.   Dr. Nan Hardison was professor of business administration at Pt. Loma University in San Diego , CA .  Dr. Gerry Hardison was a physician at the Veteran's Hospital in San Diego and a Professor of Medicine at the University of San Diego , CA. prior to retirement.  Nan and Gerry Hardison traveled to Nairobi , Kenya after retirement where Nan Hardison became vice chancellor of academic affairs at Africa Nazarene University while Gerry Hardison practiced and taught medicine at the University of Nairobi and Kenyatta National Hospital .  They were both asked by the Bishop Simon Oketch of the Diocese of Maseno North in the Anglican Church of Kenya to provide the necessary leadership at the St. Philips Theological Academy and the Maseno Mission Hospital , where they now reside.   The Basics of Life   Sunshine and moonlight dictate the cycles of life in Maseno.  We get up with the morning sun and retire with the setting sun and the rise of the moon.  The sky is flawlessly clear here at night at the equator.  The streams of clouds against the dimly lit blue evening sky gives reverence to another day's work and the many lives we have been touched by.  People here in Maseno rise early to gather their firewood, begin their daily chores by collecting and carrying water for their morning bath and meal preparation.  Washing clothes by hand is also done early in the morning to optimize the use of the community clotheslines and morning/noon day sun before the afternoon rains come.   I was washing my clothes this morning in a bucket on the grass behind our cottage.  As I was scrubbing my clothes in the water, I saw two little feet in front of me.  I glanced up.  It was one of neighborhood children. "Habari"  I said.  Good morning he said in English.  He asked, "Why are you washing your clothes with your hands?"  I told him that I needed clean clothes so I had to wash them before the week started.  He then looked at me and said,"Do you wash your clothes with your hands in America ?"  I replied, "No, we use machines to wash our clothes in America ".  He said, "oh, ok, kwaheri, kuonan."   We have been without electrical power for three days.  We rely on the sunlight and candles for our existence inside the cottage we live in when we are not in the clinic or at the hospital.  Showers in the morning are cold water with the use of a small bucket to pour water ceremoniously over one's head.  The water comes once again from what has been collected from the roof from the previous night's storm and the local water department (when it is working) so your mind is always thinking conservation.  Our housekeeper Emma boiled some water for us this morning so it temporarily muffled the shrieks and yells of the three of us pouring the cold water over our heads as we prepared for the start of another day.  Cold is relative here in Kenya .  If the temperature drops below sixty degrees Fahrenheit, people put on heavy winter jackets, ski caps if they have them and gloves.   Another Day   Each day begins with Helen (4th year medical student, University of California , San Diego ), Dan (2nd year physician resident, University of Tennessee ) and me having our communal breakfast at 6:30 am .  We walk down to the hospital at 7:15 am to see the patients in the hospital wards before we attend the 8:00 spiritual devotional church service which is in the open air chapel connected to the HIV/AIDS hospital clinic. We say good morning "habari za asubuhi" to the school children walking with us.  They respond in kind as they leave the hospital compound for school "kwaheri ya kuonana" until we meet again.  The spiritual devotional church service always begins with hymns sung in Swahili, the lesson for the day, the Apostle's Creed and the day's New Testament lesson spoken in Swahili.  Sometimes the sermon is presented by one of the resident nursing students studying at the local nursing school.  Portions of the service are translated sometimes in English for the white "mzungu" (non-African) visitors.  The day's lesson is always related to the importance of the care we will all provide to the patients of Maseno Mission Hospital that day.  The resident minister always asks Helen, Dan or me as visiting health care providers to give the parting blessing of the day before we enter the patient wards for another day of patient care.   Making the Patient Rounds   We meet Dr. Gerry Hardison the medical director (also known by the staff as" The Professor") and begin rounding (visiting) the patients in the wards at 8:30 am.  The wards all have open windows (no screens or windows) and of course everyone including the patients sleeps under mosquito nets.  Patients are attended by nurses from the resident nursing school and clinical officers that provide clinical coverage seven days a week.  The out patient clinic opens at 9:00 am.  Patients begin to come in from the countryside.  Surgeries begin in the operating theater mid morning, and minor procedures (putting casts on broken bones, wound care) begins in the treatment room adjacent to the operating theater later in the morning.  Helen, Dan and I see patients in the medical wards at the beginning of the day and then we go to wherever we are needed.  I have spent most days so far in the out-patient area of the hospital running an Ear, Nose and Throat clinic, starting IV's, assisting with endoscopies, explaining to families the nature of their loved one's illnesses, working with my 4th year medical student and first year resident colleagues setting broken bones and applying casts, visiting with patients and family members in the evening when the family member will probably pass away during the night due to terminal illness.    We stop sometimes for lunch at 12:00 pm and then continue seeing patients into the early evening.  Our days end around 5:30 unless there is an emergency case that arrives through our gates.  Earlier this week we had a young man who was admitted to the hospital with pneumonia, tuberculosis, and seizures.  That same day, a young man who had been hit by a truck after drinking the local "chunga" came in with a skull fracture.  Sixty minutes after he was hospitalized he became paralyzed on the left side due to internal intracranial bleeding.    There are no MRI's, CAT (Computer Aided Tomography) Scan's for immediate clinical diagnosis or trauma centers to send people to here.  There is no Cardiopulmonary Resuscitation (CPR) administered because there are no ventilators to help people breath after CPR, nor are there any intensive care units.  There is no physical therapy, occupational therapy, speech pathology or long term care facilities in Maseno.  Families care for their loved ones both inside and outside the hospital.  There is an x-ray machine in the hospital with limited x-ray capability, and a laboratory.  Endoscopies are done by Dr Hardison (he is the only physician in western Kenya who does them) which is interspersed between the other patients throughout the day and on the weekends.  Medical care is given based on the time honored discipline of a good physical examination and the knowledge of tropical medicine, HIV/AIDS and internal medicine.  The rest is made up as you go.  Splints for IV's are made of cardboard found in boxes.  Some medicines such as amoxicillin and cephalosporins are readily available.  Antibiotics such as fluoroquinolones and clindamycin are not.  You treat your patients with the medications you have and hope for the best.    Maseno Mission Hospital came into existence in response to a need to provide healthcare for rural Kenyans in western Kenya who had no other alternative.  People of Maseno, Luanda and neighboring towns come to the Maseno Mission hospital to be seen by medical officers, physicians, visiting medical student and nurses and anyone else who is willing to take the time to travel to Maseno to provide free health care.  It is not uncommon to have patients tell us that their home is several kilometers away or a 3-4 hour walk one way.  The people of Kenya are warm, and gracious with smiles that beg introspection into what is really important in one's life.  Once the patients are seen, they are prescribed medicine or they may be admitted to the hospital ward if they are critically ill.  Many of the patients we see have tuberculosis, HIV/AIDS, and malaria.  Little children in most cases come to the clinic with malaria with other illnesses added on top of it.  Children are often seen with malnutrition because the parents cannot afford to feed their child or themselves.  Patients that come to the clinic will tell you their symptoms have been present approximately two weeks.  Their physical presentation often betrays their self report of a two week illness.  Malnutrition and disease processes that have lasted for several years are often the clinical presentation that we see.  Patients come to us in many cases in the last stage of their illness when it is too late to do anything.  Many remain alive for a few days in the hospital wards and then succumb to their illness.  Family members are usually present providing care for their loved ones throughout their hospital stay.    Death occurs every day at some level here in Maseno.  In my first week here I have seen the death of several patients and the emotions of the grief-stricken families as they attempt to cope with their loss.  This week we saw one family who lost two children in one week.  I am constantly reminded by my colleagues that death is part of the circle of life and that the circle of life is also seen in the beautiful faces of the children of Maseno.  The children here in Kenya are gorgeous, radiant, innocent, and filled with the spirit of life itself.  They remind us that life is very brief and should be enjoyed for every moment it offers.  Faith in God and the Lord Jesus Christ plays a pivotal role in the lives of so many of the people we care for here in Maseno as well as the staff.  Our daily morning spiritual devotional service reminds us that God is present in the lives of everyone who comes through the gates of Maseno Mission Hospital and that we should always be thankful for what we have.