Lodwar Clinic, Turkana, Kenya Date: April 30, 2015 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: January 1 March 31, 2015 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 first quarter 2015, 2,253 patients were treated in the medical outreach clinics and 2,214 patients in the Lodwar Clinic. - A total of 32 outreach clinics were conducted in the rural villages in the first quarter. - 10 home visits (hospice 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 11 referrals mostly collecting patients who were very sick from rural villages and transporting them to our clinic in Lodwar and Lodwar District 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. - The mobile clinic vehicle was serviced. 10. Results and/or accomplishments achieved during this reporting period: - This quarter, we treated a total of 4,467 patients both in the Lodwar Clinic and villages. - During this quarter, 1,882 laboratory tests were conducted with 1,218 tests showing positive results. Many patients tested positive for malaria. - The program conducted 32 outreach clinics in the rural villages where health facilities are far from reach. - We made 10 home visits mostly in villages on the outskirts of Lodwar Town. - We provided transportation for 11 referrals mostly from rural villages to health facilities in Lodwar. - 567 children and expectant mothers were immunized where 230 were male children, 250 were female children and 87 were expectant mothers. - 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. - The mobile clinic vehicle serviced. - We started building a new room for maternal-child health services and medication storage. 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 monthly clinic coverage 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 a new group of villagers arrives 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 4,467 patients were treated during this quarter; 1,860 patients were male and 2,607 were female. We 2
treated 5,439 cases during this quarter. See 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 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-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 relieve the congestion in the current small building, which currently lacks a friendly environment for women presenting for prenatal care and for children visiting the clinic for immunizations. Maternal-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 would be 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: - 36 mobile clinics in the next quarter. - Make emergency trips to villages and offer transport to Lodwar District Hospital if needed; especially for complicated obstetrics deliveries and other medical conditions. - 12 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 like the County Government of Turkana supplying the program with medicines on a 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. Success story(s) highlighting project impact. By Derrick Lowoto 1. During the last four years, Lodwar Clinic has been having space problems following the increasing activities taking place in the current building. Due to this, the program has been working on plans on how to raise funds that will help to ease this problem of space. This February the program received a consignment of medicines from the county government of Turkana through the Ministry of Health that provided enough medicine for February and March. This enabled the program to channel money from RMF/MMI usually required for purchasing medicines and add it to the money that has been raised locally for the same purpose. For now one room is under way to serve as maternal child health clinic as well as a store for medicines. We are hoping to add another room as funds become available. Many thanks for RMF/MMI s support! Construction of one additional room at Lodwar Clinic Front part of the room constructed at Lodwar Clinic. 2. The month of January began with drought and famine. Water was hard to come by, and Turkana people who are nomadic had to travel long distances in search of water for their households and domestic animals. Following this, 4
there was a rise in diarrheal diseases experienced in many rural villages, so the health program mobilized enough medicines to treat these conditions. Moreover, the program increased networking in villages that are hard to reach within the catchment area to report cases of diarrhea once they are noticed. We hoped to arrive as soon as possible to treat patients with diarrhea early in the course, especially vulnerable children and babies. Moreover, people received public health education in relation to clinical diagnosis and management of diarrhea in the event it occurs in the absence of health workers. Besides that, we had to stock enough medicines and schedule enough time for the regular medical outreaches in the villages. This made a big impact for the patients suffering from diarrheal diseases. In the course of the month the cases we encountered were managed right there in the field at the village level. Water also was delivered regularly by the SI water truck to the villages. But this water was not enough considering the many villages we have in the rural areas. So, people again had to walk long distances to get water for their domestic use and animals. Patient with diarrhea seen by health worker before medication provision Mobile Clinic in a rural village 5
Immunizations in a rural village during medical outreach Pharmacy in Nariamao Village during medical outreach 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. E-mailed separately from accountant. 6
APPENDIX A Total patients treated 4,467 Total cases seen 5,439 a) Morbidity by Disease Type Disease type Male Female Total Respiratory tract infections 646 821 1467 Malaria 682 911 1593 Skin diseases 121 125 246 Ear infections 67 85 152 Sexually transmitted diseases 9 12 21 Brucellosis 23 34 57 Allergy 11 25 36 Accidents 10 16 26 Eye diseases 108 138 246 Gastritis 20 42 62 Typhoid 48 82 130 Candidiasis 19 26 45 Peptic ulcer disease 3 6 9 Gastroenteritis 158 217 375 Worms infestation 19 29 48 Anemia 30 49 79 Myalgia 83 157 240 Malnutrition 121 165 286 Gynecology/Obstetrics 0 68 68 Arthritis 33 21 54 Dysentery 5 8 13 Epilepsy 2 2 4 Urinary tract infections 48 78 126 Dental 9 15 24 Insect bites 7 6 13 Burns 5 3 8 Assaults 2 1 3 Cardiovascular 1 1 2 Constipation 1 1 2 Septicemia 2 1 3 Stephen Johnson Syndrome 0 1 1 TOTAL 2293 3146 5439 b) Morbidity by Village Village Male Female Total Nawoitorong 536 588 1124 Kanamkemer 445 442 887 Kaikir 33 52 85 Lomopus 122 208 330 Nayuu 37 57 94 Nabuin 76 179 255 Kakwanyang 5 3 8 Nakoriongora 89 173 262 Lodos 38 86 127 Chokchok 57 114 171 Kalokutanyang 40 72 112 Elelea 7 10 17 Nakwamekwi 19 25 44 7
Sopel 2 3 5 Nakudet 84 146 230 Kerio 10 11 21 Lokichar 5 6 11 Nadapal 1 1 2 Nayanae 3 2 5 Monti 6 5 11 Nakabaran 60 129 189 Napetet 16 21 37 Nariamao 91 155 246 Kimabur 2 3 5 Lodwar Town Center 18 19 37 Kangikukus 58 97 155 TOTAL 1860 2607 4467 c) Morbidity by Age Age Male Female Total 0-5 671 630 1301 6-15 333 444 777 16-24 289 494 783 25-49 411 831 1242 50 + 156 208 364 TOTAL 1860 2607 4467 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 8
e) Immunizations MALE FEMALE TOTAL Measles 24 26 50 BCG 34 39 73 Polio 64 67 131 Pneumonia vaccine 54 59 113 Pentavalent/HI Type B 54 59 113 Tetanus for pregnant mothers - 87 87 TOTAL 230 337 567 9