Lodwar Clinic, Turkana, Kenya Date: April 30 th, 2014 Prepared by: Derrick Lowoto and Jonathan White 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: January 1 st March 31 st, 2014 5. Project Location (region & city/town/village): Lodwar Town, Turkana, Kenya. 6. Target Population: 1. Nabuin Village 2,950 2. Chokchok Village 3,200 3. Nadapal Village 2,500 4. Nayanae Village 950 5. Elelea Village 2,300 6. Kaitese Village 3,200 7. Nayuu Village 2,300 8. Monti Village 2,600 9. Nakabaran Village 2,700 10. Kanamkemer Village 5,400 11. Nawoitorong Village 5,700 12. Lomopus Village 3,500 13. Nakoriongora 3,400 14. Kangikukus 3,600 15. Napetet 5,200 16. Nakwamekwi 5,800 17. Kerio Region 24,500 (includes: Lokori, Kalokol, Lokichar, Katilu, Kerio, Kalokutanyang, Kimabur, Lochwaa, Nakepokan, Nakoret, Kaikir, Kapua, Lolupe, Lokichogio, Lomuriae, Lorengelup) Total Target Population = 79,800 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 Teaching about and providing nutritious food 1
9. Summary of RMF/MMI-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans): - During Q1 2014, 2,406 patients were treated in the medical outreach clinics and 1,167 patients at the Lodwar Clinic. - A total of 30 medical outreach clinics were conducted in the rural villages during the first quarter. - Twelve home visits were made in the rural villages and within and around Lodwar Town to patients not able to come to the Lodwar Clinic. - 14 referrals were made, mostly collecting patients from rural villages and transporting in the clinic vehicle to our clinic in Lodwar and other secondary and tertiary health facilities in the country. - During this first quarter, we purchased medicines and supplies twice from a major pharmaceutical company in Nairobi, Kenya. - Staff salaries were paid for the whole quarter and staff was very appreciative of the 10% raise made available through RMF. - Continued maintenance performed on the mobile clinic vehicle. - We covered the costs of medical fees for some of the patients who needed advanced treatment and whom we referred for treatment to other secondary and tertiary health facilities. 10. Results and/or accomplishments achieved during this reporting period: - In the first quarter, we treated a total of 3,573 patients both at the Lodwar Clinic and through outreach mobile clinics in rural villages. - We also conducted 30 medical outreach clinics in rural villages where health services are difficult to access and health facilities are far from reach. - 12 home visits were performed, mostly in villages around Lodwar Town. - During this quarter we made 14 patient referrals, mostly from rural villages to health facilities in Lodwar Town and other secondary and tertiary health facilities in the country. - Public health education was conducted at the beginning of every clinic day for patients who arrive early and individual teaching was provided on specific cases in the course of treatment. - We purchased medicines twice in this quarter from a major pharmaceutical company in Nairobi, Kenya. - The clinic vehicle was maintained. This quarter we did one major checkup and several mechanical repairs. - During Q1 2014, 1,139 laboratory tests were carried out and 699 tests showed positive results for various communicable and non-communicable diseases. A majority of patients was diagnosed with malaria. - Salaries were paid for the staff who also received a 10% raise. 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 continues to be at 79,800, 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 3,573 patients were treated; 1,371 patients were male and 2,202 were female. We treated 4,673 cases during this quarter. 2
Please also refer to Appendix A. 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 surgeries - 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 company 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 and gastrointestinal infections 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: Continue providing medical outpatient services at Lodwar Clinic from Monday to Friday and mobile clinics in the rural villages from Wednesday to Friday three mobile clinics per week since our focus is on providing care in the rural villages where other health care services are not accessible. Conduct emergency trips to villages and offer transport to Lodwar District Hospital, if needed, especially for complicated deliveries and medical conditions needing advanced care. 15 home visits to be conducted in Q2 2014. Continued consideration into how best to meet the needs of special cases, which currently require additional funds that are not allocated in the available budget. Continued maintenance of the mobile clinic vehicle. Pay salaries for the clinic staff. Consider how to fund the building of a maternal-child health clinic building to accommodate vaccinations and prenatal care. 18. If applicable, summary of RMF/MMI-sponsored medical supply distribution and use: Please reference Appendix B 3
19. Success Stories: By Derrick Lowoto 1. The New Year has begun with a difficult time for the rural folks here. Life is hard due to the ongoing drought and famine for the last six months because of no rainfall. People and animals are both facing challenging circumstances. People are migrating from one place to another in search of water and pasture. Some family members are left alone in their usual dwelling place while others have to travel far in search of pastureland for the goats. The areas to which they are traveling are not safe for the elderly and for children because of hostile tribes near the Kenyan-Ugandan border. Due to this hostility from other tribes, children, mothers and the elderly are left behind until rainy season when other members, mostly the men and boys caring for the livestock, join them again. They are left alone to face various challenges ranging from illnesses to starvation due to lack of food. Water is a scarce commodity in these times of drought. Mothers and children walk long distances in the hot, dry weather to get water. Malnutrition is increasing due to the scarcity food. Thankfully, UNICEF is providing supplementary food which it makes available to other health organizations for distribution. We are able to distribute these supplements to the most malnourished during our clinics in the rural villages. During the month of January, we concentrated our activities in the villages that are farthest away in our assigned area of responsibility. During this round, we focused on public health teachings on the management of malnutrition both at present and in future. For example, villages along the Turkwel River received teaching on how to start vegetable gardens along the river. The people living here were eager to start some vegetable gardens but lacked money for seeds and tools for cultivating the land. Access to vegetables is very important in order to reduce the cases of night blindness due to vitamin deficiencies experienced during this time. Unfortunately, with the drought and increased presence of malnutrition, cases of it are increasing. Supplementary food was distributed during outreach clinics as well as in our Lodwar Clinic, which also helped. Patients in Nabuin Village are given milk during a medical outreach clinic 4
A mother receives a tetanus vaccine during a prenatal clinic Patients are given public health education on how to use medications 5
A patient is being examined during a medical outreach clinic 2. In the month of February, our medical team reached a village called Nariamao about 48 miles northeast of Lodwar Town. The village consists of pastoralist communities whose livelihood focuses on the raising of domestic animals. This village is in an isolated area far from essential services such as health care facilities, schools, shopping centers, roads and clean water. The pastor who has planted a church in the village is the one who reported the needs of the village to us for help. Our mobile clinic entered the village upon the invitation of the pastor of this church who asked for medical help in the village. When our team went there for the outreach clinic, the need of this village was obvious. The sick had nowhere to go to seek medical services. The nearest facility is 18 miles away. Our arrival for a medical outreach in the village was received as a blessing from God. The whole village came to witness the medical clinic going on, since they have never seen one before. Even patients from nearby villages came for treatment. That day, it was difficult for the team to control and triage. It took the team nine hours to treat the sick. At some point some medicines were used up, and we had to proceed treating what we could with the available medicines. The elderly, the mothers and the pastor expressed a lot of joy for the medical clinic. They were frank to say that that was their first medical clinic ever in the village and they were thankful for our services. They made a request to be considered for a monthly medical clinic. We promised them a medical clinic every month including immunization and nutrition services. 6
Patients from Nariamao Village waiting to be seen during the first ever medical clinic in their village Pharmacy technician takes time to explain the use of medicines. Especially when a mother comes with two or more children for treatment, he explains in thorough detail when and how to take the medicines. In this village almost everyone is illiterate and so there is much need for public health education on good medicine use. 7
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, Mr. Peter Musee. Appendix A Total patients treated - 3,573 Total cases seen 4,673 Morbidity by Disease Type Disease Male Female Total Malaria 423 597 1,020 Respiratory tract infections 542 775 1,317 Gastritis 18 25 43 Eye diseases 95 135 230 Myalgia 52 67 119 Urinary tract infections 38 45 83 Gastroenteritis 93 133 226 Ear infections/ diseases 51 76 127 Skin diseases 128 135 263 Sexually transmitted infections 10 15 25 Accidents 7 7 14 Gynecology and Obstetrics 0 44 44 Bites 4 5 9 Dysentery 4 8 12 Typhoid fever 39 56 95 Burns 3 6 9 Candidiasis 10 21 31 Malnutrition 323 407 730 Brucellosis 21 32 53 Peptic ulcer disease 8 13 21 Arthritis 35 56 91 Dental diseases 14 24 38 Worm infestations 22 27 49 Anemia 7 12 19 Assault 1 1 2 Epilepsy 0 1 1 Pelvic inflammatory disease 0 2 2 TOTAL 1,948 2,725 4,673 Morbidity by Village Village Male Female Total Nawoitorong 262 267 529 Kanamkemer 189 256 445 Nakoriongora 113 166 279 Chokchok 90 98 188 Nakudet 59 126 185 Nakabaran 48 124 172 Lodos 102 148 250 Kangikukus 57 168 225 8
Kapua 5 4 9 Kerio 17 24 41 Nayuu 54 113 167 Lomopus 75 161 236 Lodwar Town Center 18 18 36 Kaitese 3 1 4 Naporoto 1 2 3 Lochwaa 3 4 7 Lokichar 5 7 12 Kimabur 1 1 2 Nakwamekwi 17 26 43 Kaikir 78 114 192 Nariamao 56 124 180 Sopel 2 1 3 Kalokutanyang 33 79 112 Monti 5 7 12 Nabuin 42 98 140 Nayanae 19 46 65 Kakuma 1 2 3 Lorugum 1 1 2 Napetet 4 6 10 Elelea 3 3 6 Lorengelup 1 2 3 Nadapal 2 1 3 Kangalita 1 1 2 Locheremoit 1 2 3 Kalokol 2 1 3 Napeikar 1 0 1 TOTAL 1,371 2,202 3,573 Morbidity by Age Age Male Female Total 0-5 519 538 1,057 6-15 229 320 549 16-24 239 374 613 25-49 258 803 1,061 50 + 126 167 293 TOTAL 1,371 2,202 3,573 Laboratory Report No. of Tests done No. of positive tests Category M F M F Malaria-blood smear 323 396 251 307 Typhoid-Widal test 49 57 24 33 Brucellosis-brucella test 41 58 20 25 Urine-urinalysis 26 46 11 25 Pregnancy-urine test - 34-19 Syphilis-blood for VDRL 7 5 1 1 Amebiasis-stool test 15 9 4 5 HIV-blood test 28 32 3 4 Gonorrhea 6 7 4 2 TOTAL 495 644 318 421 9
Immunization Report Vaccine Male Female total Poliomyelitis 36 42 78 Hemophilia Type B 36 41 77 Measles 48 20 28 Tetanus 15 49 64 Pneumococcus 36 42 78 TOTAL 171 194 325 10