Lodwar Clinic, Turkana, Kenya Date: Fourth quarter, 2014 Prepared by: Derrick Lowoto I. Demographic Information 1. City & Province: Lodwar, Turkana, Kenya 2. Organization: Real Medicine Foundation Kenya (www.realmedicinefoundation.org) Medical Mission International (www.mminternational.org.uk) Share International Inc. (www.shareint.net) 3. Project Title: Healthcare Programs Turkana Drought Region, Northern Kenya 4. Reporting Period: Fourth quarter, 2014. 5. Project Location (region & city/town/village): Lodwar Town, Turkana, Kenya. 6. Target Population: 1. Nabuin Village 3,100 2. Chokchok Village 3,561 3. Nadapal Village 2,723 4. Nayanae Village 1,060 5. Elelea Village 2,830 6. Kaitese Village 3,491 7. Nayuu Village - 2,654 8. Nakabaran Village 2,926 9. Kanamkemer Village 6,120 10. Nawoitorong Village 6,450 11. Lodwar Town - 48,316 12. Lomopus Village 3,780 13. Nakoriongora 3,670 14. Kangikukus 3,820 15. Napetet 5,410 16. Nakwamekwi 6,210 17. Kerio Region 24,500 (includes: Lokori, Kalokol, Lokichar, Katilu, Kerio, Kalokutanyang, Kimabur, Lochwaa, Nakepokan, Nakoret, Kaikir, Kapua, Lolupe, Lokichogio, Lomuriae, Lorengelup) Target Population = 106,121 approximately II. Project Information 7. Project Goal: To improve the delivery of primary Health Care Services within the Turkana Drought Region in Northern Kenya, its capital Lodwar and the people living in the remote villages of Turkana, Kenya. 8. Project Objectives: Provide Medicines and Medical supplies to meet the needs of the targeted population Increase Mobile/Outreach Clinics in the remote villages Provide Medical Services at the Health Facility in Lodwar Town: Supporting the physical/medical needs of the targeted population Home visitations Referrals of patients needing advanced care to secondary and tertiary care hospitals, and HIV and TB government clinics 1
Teaching about and providing nutritious food Provide nutrition to babies and young children 9. Summary of RMF/MMI-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans): - During the fourth quarter, 2,992 patients were treated in the medical outreach clinics and 2,206 patients in the Lodwar Clinic. - A total of 31 outreach clinics were conducted in the rural villages in the fourth quarter. - 13 home visits were made in the rural villages and within and around Lodwar Town to patients not able to come to the Lodwar Clinic. - We made 14 referrals mostly collecting patients who were very sick from rural villages and transporting to our clinic in Lodwar and Lodwar hospital. - Continued public health education done at the beginning of every clinic session. - Purchased medicines. -The program met the cost of medical fees for some patients whom we referred for treatment to other secondary and tertiary health facilities. - The staff maintained the medicine inventory. - Mobile clinic vehicle serviced 10. Results and/or accomplishments achieved during this reporting period: - This quarter, we treated a total of 5,198 patients both in the Lodwar Clinic and villages. - During this quarter, 1,882 laboratory tests were conducted with 1218 tests showing positive results. Many patients tested had malaria. - The program conducted 31 outreach clinics in the rural villages where health facilities are far from reach. - We made 13 home visits mostly in villages on the outskirts of Lodwar Town. - We provided transportation for 14 referrals mostly from rural villages to health facilities in Lodwar. - Public health teaching was done at the beginning of every clinic day for the patients who arrive early and individual teaching on specific cases in the course of treatment. - Purchased medicines from pharmaceutical company in Nairobi, Kenya. - The program paid salaries for the staff. - Mobile clinic vehicle was serviced. 11. Impact this project has on the community (who is benefiting and how) Having adequate medical personnel and medicine stores has enabled us to treat more patients and combat a wider range of diseases on a regular basis, especially in the remote villages of Turkana. Our target population of this project is at 106,121 and rising. The villages we serve do not have access to other regular medical care. We are able to provide predictable clinic coverage monthly as well as follow up if patients can travel to the Lodwar Clinic. The nomadic nature of the Turkana tribe causes the population of these villages to migrate about every 4 months and to be a new group of villagers about every 4 months; therefore we are providing service to more than the estimated population of persons living in each village at one time. The improved quality and regularity of medication purchase from MEDS in Nairobi through RMF/MMI funding has allowed the clinics to be conducted and improved the quality of the service. Previous to RMF/MMI involvement, medication was scarce and depended on availability of specific donations each month. The clinic staff serves all villagers who come for treatment, but we see an especially high number of children and pregnant women. Prior to the funding provided through RMF/MMI, there were an average of one to two mobile clinics per month, based on variable funding availability through private donors; now there is an average of 30 mobile clinics each month. Previously, there was often not enough medicine in stock to treat all patients; now the proper medication is always available. 12. Number served/number of direct project beneficiaries (for example, average number treated per day or month and if possible, per health condition). A total of 5,198 patients were treated during this quarter; 2,078 patients were male and 3,120 were female. We treated 7,284 cases during this quarter. See Appendix A 2
13. Number of indirect project beneficiaries (geographic coverage): Our services are available to all residents of central and western Turkana, approximately 900,000 persons. 14. If applicable, please list the medical services provided: - Outpatient diagnosis and treatment - Medication available with pharmacy counseling - Public health education with each clinic session - Minor surgery - Wound care - Referral to secondary and tertiary care centers for advanced care - Nutrition supplementation to the elderly, malnourished children and terminally ill during mobile outreach clinics and home visitations - Care of patients with advanced and/or special needs: arranging transport and accompaniment by staff if needed to referral centers for special consultations, procedures, etc. 15. Please list the five most common health problems observed within your region. - Malaria - Respiratory tract infections - Eye infections - Skin diseases - Gastroenteritis 16. Notable project challenges and obstacles: The present maternal and child health clinic does not have adequate space to cater to the population requiring its services. Two additional rooms in the clinic are required to build upon the small and congested building, which currently lacks a friendly environment for women presenting for prenatal care and for children visiting the clinic for immunizations. Maternal and child health services are currently not sufficient to provide for all the patients in rural villages needing these services, where, i.e. children are not immunized against childhood immunizable diseases. The major problem is a shortage of staff that can offer these services to mothers and children. Three additional staff members are required to run these programs to ensure adequate provision of maternal and child healthcare to the population we are serving. 17. If applicable, plans for next reporting: - Thirty six mobile clinics in the next quarter. - Make emergency trips to villages and offer transport to Lodwar Hospital if needed; especially for complicated deliveries and other medical conditions. - Twelve hospice services (home visits) in the next quarter. - Consider how to best meet the needs of the special cases, which require funds not in the budget. - Pay salaries for the staff. - Purchase medicine from pharmaceutical company in Nairobi, Kenya at least on monthly basis. - Continue supporting education for staff members, including additional training for the nurse in charge. - Continue looking for additional means of support as with the county government of Turkana supplying the program with medicines on quarterly basis through the ministry of health. 18. If applicable, summary of RMF/MMI-sponsored medical supply distribution and use: Please reference Appendix B 3
20. Successful story(s) highlighting project impact. By Derrick Lowoto Vaccination against childhood diseases is a vital activity during our medical outreaches. Many of the diseases that occur in Turkanaland are preventable, and it has been the effort of every stakeholder engaging in medical care to make sure that children within the program catchment are immunized in order to save their lives. There are reports now of cases of measles and polio in Turkanaland. Our program has increased efforts to make sure children within our catchment have immunization against various childhood diseases. We also target expectant mothers for tetanus vaccine. This November we have been engaging in educating rural villages on the importance of bringing children for immunization. We also emphasize diseases that occur due to lack of immunization. The message was received positively and elders in various villages were given the task of making sure mothers bring their children for immunization during medical outreach days. An expectant mother receiving individualized health education on importance of immunization. Baby immunized during medical outreach. During our medical outreach in Nabuin Village, we managed to save the life of an old man who had a severe diarrheal disease. Mr. Joshua Maraka, aged 78, developed diarrhea a day prior to our clinic day in the village. On our arrival to the village, we found him waiting at the usual venue of the clinic. Immediately on our arrival we started him on the necessary treatment and by the end of outreach session, he was in a fair state. We gave him more medicine, promising to visit him the following day. We asked his relatives to call if his situation worsens again. The following day, we called his relatives to see how he was doing, and they said the patient was doing very well and he had even started talking and eating. 4
Mr. Joshua Maraka with severe diarrhea. III. Financial Information 21. Detailed summary of expenditures within each budget category as presented in your funded proposal (file attachment is fine). Please note any changes from plans. Please see Appendix to be emailed separately from accountant. APPENDIX A Total patients treated 5,198 Total cases seen 7,284 a)morbidity by disease type Disease type Male Female Total Respiratory tract infection 915 1221 2136 Malaria 1019 1257 2276 Skin 107 162 269 Urinary tract infections 113 163 276 Myalgia 112 184 296 Allergy 25 36 61 Gastroenteritis 211 263 474 Accidents 9 12 21 Gastritis 21 43 64 Epilepsy 3 4 7 Typhoid 39 34 73 Gynecology and obstetrics 0 51 51 Sexually transmitted diseases 18 20 38 Candidiasis 17 32 49 Peptic ulcer disease 15 19 34 Ear 83 127 210 Eye 160 194 354 Dysentery 7 9 16 Arthritis 45 53 98 Worms infestation 21 29 50 Anemia 33 50 83 Malnutrition 114 157 271 5
Brucellosis 32 45 77 TOTAL 3119 4165 7284 b) Morbidity by village Village Male Female Total Nawoitorong 583 643 1226 Kanamkemer 509 563 1072 Lodwar town center 22 24 46 Nayuu 72 127 199 Nakabaran 40 67 107 Nakwamekwi 30 23 53 Elelea 19 16 35 Kakuma 1 0 1 Nabuin 81 185 266 Lokichar 7 10 17 Kangikukus 64 135 199 Lodos 78 152 230 Nakoriongora 114 203 317 Lomopus 69 162 231 Kalokutanyang 82 168 250 Kaikir 54 130 184 Nakudet 70 177 247 Chokchok 61 146 207 Nadapal 3 1 4 Monti 7 8 15 Napetet 17 16 33 Sopel 3 3 6 Nayada 1 0 1 Nayanae 4 6 10 Locheremoit 1 3 4 Kimabur 1 3 4 Kerio 26 20 46 Nariamao 59 129 188 TOTAL 2,078 3,120 5,198 6
c) Morbidity by age Age Male Female Total 0-5 694 704 1398 6-15 343 561 904 16-24 356 636 992 25-49 517 949 1466 50 + 168 270 438 TOTAL 2,078 3120 5198 d) Laboratory report. Category No. of tests done No. of positive tests done Male Female Male Female Malaria -blood smear 588 616 419 457 Typhoid- widal test 65 75 36 36 Brucellosis-brucella 74 64 29 25 Urine- urinalysis 34 47 17 33 Pregnancy- urine - 61-50 Syphilis-blood for VDRL 6 6 1 3 Stool-for Amoebiasis 15 18 7 11 Gonorrhea 3 5 2 3 Blood for HIV 41 49 5 7 Hemoglobin level 31 58 11 38 Blood grouping 11 15 10 18 TOTAL 868 1014 537 681 e) Immunization VACCINE MALE FEMALE TOTAL Measles 22 25 47 BCG 33 38 71 Polio 63 67 130 Pneumonia vaccine 54 59 113 Pentavalent/hi type B 54 59 113 Tetanus for pregnant mothers - 87 87 7
TOTAL 226 335 561 8