A FINAL NOTE

We saw only a small section of Kenya in the two months we were there, but we did gain some appreciation of the country as a whole and of the problems and the potential shared by the Kenyan people. Drought in parts of the country, poverty, tribal hostilities, and a lack of educational and health opportunities make progress difficult for a country, even with the best of governments.  Yet, Kenya has a distance to go to rid its government of corrupt officials and to establish a democracy responsible to and trusted by its people.  Kenyans put great hope in their new constitution, which was approved last year. The document sets up a balanced government structure that will guarantee accountability and human rights. Parliament has made gains by establishing the Supreme Court, but has been very slow in implementing other parts of the new constitution. Kenyans also look to the 2012 elections with both hope and fear –fear that the ethnic rioting and violence following the 2007 disputed elections will re-occur. (Over 275 people were killed and 300,000 were driven from their homes.) The people hope that the 2012 national elections will be honest, orderly, and peaceful. We share that hope. 

We also share a love and appreciation of the Kenyan people we met and worked with. Memories of the smiles, the curious children, the exuberant worship services, the struggles of the poorest workers, the humor of the market ladies, and the beautiful singing are all memories we’ll treasure.  We’ll also remember the lush, gorgeous scenery, the mild climate, and the marvelous animals we saw at the three game parks we visited.  We  have enjoyed sharing those memories and experiences with you.

Maua Methodist Hospital’s problems are related to its precarious financial situation.  The money to maintain and operate the hospital runs short when patients have neither the  government insurance nor the money to pay for their medical services.  The fiscal crisis also leads to staff shortages and antiquated equipment.  The hospital struggles along however, and continues to provide the only hospital services in the area.  We were inspired by the sense of mission the hospital workers have and by their ability to provide services at the hospital itself and also to the outreach programs throughout the larger community. An opportunity to expand medical services at Maua lies in the scheduled opening of a medical school at Kenya Methodist University in Meru, a city 50 km. from Maua.  If the medical school develops as envisioned, students could do their clinical rotations at Maua Methodist Hospital.  For that to happen however, more clinical faculty would need to be recruited.

Leadership at Maua hospital has changed and continues to change.   As the full-time missionaries from the U.S. and from the U.K. retire, their positions will be filled by Kenyans.  Already Kenyans hold a majority of leadership positions.  Could the British Methodists who founded the hospital in 1928 have visualized a hospital for Kenyans run by Kenyans?  We hope so.  One negative possibility of this change in leadership is diminished financial support from the U.S. and the U.K.  Without American or British missionaries traveling through the country and interpreting the ministry at Maua, contributors might fail to understand the importance of Maua Methodist Hospital. The United Methodist Church in the U.S. makes it easy to donate to the hospital and its various programs through Advance Specials.  A donor can simply write a check, put the Advance Special # on the memo line and send it to their local Methodist Church.  None of the money for Advance Specials goes for administrative costs; all of it goes to the designated cause.  Advance specials for Maua Methodist Hospital include:

Advance # 09613A  Maua Hospital Service Fund – pays the medical bills of orphans, abandoned children and other poor children and patients.  Without this fund the hospital would be unable to continue serving the needy.  At least 30% of patients cannot afford to pay their medical bills as they are children and families of subsistence farmers.

Advance # 09610A  Operation Outreach, Maua, Kenya – provides mobile health care, takes essential preventive and curative health care services to areas where such services are not available and the population is too poor to seek services from other sources.  Services include preventive measures and treatment for AIDS, malaria, cancer, and diabetes as well as family planning and health education.

Advance # 982023  Giving Hope (ZOE Ministries)  - a comprehensive program for child-led families, Giving Hope offers resources and training to nurture and empower AIDS orphans to live healthy, productive lives in their own community, and to become self-sufficient. 

Our two months in Kenya seemed to just fly by.  They were filled with exotic adventures, some hard work, and so many fulfilling experiences.  Coming back home to what should be familiar surroundings, instead gave us some sense of unreality.  In part this feeling was brought on by our extreme fatigue.  Our flight from London was delayed by an emergency landing in Montreal, then a weather delayed leg from Dallas to Salt Lake.  In all it took 48 hours to get home.  Another part of our readjustment was getting re-used to the relative complexity of our US life style, with its distractions and consumerism.  We often lack focus on what is truly of value in our lives, and on the critical needs of the majority of people in developing countries. 

We again want to thank all of the people in our community and in our local church.   You supported us so well during our mission, by your financial help, but even more by your prayers and well wishes.   The medicines, medical supplies and small equipment that we brought were invaluable for our work at the hospital.  We were also able to give some of the medicines to a dispensary in a poor nearby region that had just about run out of drugs, and had no hope of getting any in the near future.  The Resusci-Baby manikins were excellent teaching tools, and will continue to be useful there for years to come.  The Neopuff resuscitator was well accepted and will be used for those babies that need help breathing.  A bone marrow needle helped save a child’s life.  The list could go on and on.  Thanks again for your prayers and your financial support.  You all helped to make our Mission to Maua one of the most deeply satisfying and fulfilling experiences of our lives

In many ways the most rewarding parts of our experience at Maua Hospital revolved around the people we met and the relationships we developed during our stay.  We want to share with you some images of these people.  Each has a story to tell.  We also want to share photos of some of the non-humans we encountered in some of the last wild places on earth.

Grace and Peace

Roger and Donna

Maua, the town and the hospital:

St. Joseph's Methodist Church, next to the Hospital

Administration building and Outpatient Department. This is the first building you come to on the hospital grounds:

Adam Baraka (aka "Lazerus" to Roger) and his mother the day he was discharged. He was 4 pounds at discharge. But look at his mother's smile! By the way, Baraka means "blessing." And he was.

Roger treating a patient at the rural dispensary.

Dr. Lumerai, pediatric intern with one of the premature babies at the hospital. A very capable intern! The incubator is antiquated and in need of replacement.

This was a very cheerful security guard at the hospital gate that we encountered most every day on our way to the hospital. She monitored people going in and out of the gate.

Some of the People:

One of the older men in the general community.

One of several older women we saw carrying a large bundle of firewood.

Isabella with her baby, Baraka, who shares a birthday with Roger. So we had a party and this is some of the birthday cake. He obviously liked it! Isabella was a housekeeper for us. She was a great fount of knowledge about her country and community. 

Some of the children on the playground at the Maua school. Their demeanor is quite different in the classroom, but here they are just normal fun-loving kids. Notice the Muslim students, who are Somalis who live in town.

This is the mother of Mary Mbai, who was at the church at Baroga, where we took a supply of drugs for their dispensary. Mary worked with roger at the Rwanda refugee camp many years ago. Mary and her husband currently live in Scotland. Her mother remains in Baroga, Kenya.

The animals:

Who is watching whom here?

My role at Maua Hospital

Roger: MY ROLE AT MAUA HOSPITAL

So far Donna has done most of the writing for the blog, but I wanted a chance to include my personal perspective on our work here at Maua hospital.  Before we came, I spent a great deal of time trying to figure out how I could best contribute to the program here.  I have spent most of my practice and teaching career focusing on areas of pediatrics that had little to do with this acute care tropical setting.  Then a preliminary report came out from the World Health Organization and the UN concerning maternal and child mortality in developing countries.  The report showed that over the past 7 years the death rate in mothers and in children age 1 to 5 had been cut in half, but the death rate in newborns and small infants had remained the same.  This finding has stimulated a worldwide effort focused on the newborn.  


The many articles I read and the encouragement of a former partner Dr Lloyd Jensen, helped me to decide to concentrate on saving the newborn.  I went to workshops to update my very rusty skills, and planned presentations and workshops.  Most of the newborn deaths here in Kenya, and in all parts of the world, are due to 3 causes, birth asphyxia, infections, and prematurity.  Birth asphyxia means that before, during or after birth, the baby’s brain is deprived of oxygen, causing either death or severe brain damage in survivors.  I have concentrated on giving lectures and hands on workshops to medical staff, interns, nurses, and nursing students on helping babies breathe.  The teaching aids and medical supplies we brought have been a great help, as well as has the Neopuff, a special machine that is used in newborn resuscitation. I will be giving this machine to the hospital when I leave, so I hope I have taught them how to use it well. I have also worked in the pediatric ward and the nursery, attending rounds and doing one on one teaching.  


Maua has been one of the most rewarding experiences of my life, challenging and difficult at times, and one that I could not have done without the help of Donna, the prayers of all of you back home, and many times a fervent prayer for help and guidance.

Mission to Maua – Healthcare

Kenya’s healthcare system falls far short of the need.  Doctors are in short supply (only one per 10,000 Kenyans) and only 1,000 of them work in public hospitals.  Most Kenyans can’t afford private health care or the many hidden costs of public hospitals, so fewer than 40% visit a hospital when sick. The average life expectancy is 53 years.  The government is making efforts to offer greater accessibility to health care by building district hospitals and rural dispensaries, staffed by nurses or clinical officers. Yet, one third of clinical jobs are vacant and medicines are in short supply, if available at all.  The government health care system is plagued by “corruption, staff shortages and poor facilities” according to the Kenya Anti-Corruption Commission. 

The closest district hospital has no doctor on nights or week- ends; sometimes not at all.  They frequently run out of medicine and offer a poor option for health care for people in this area.  This leaves Maua Methodist Hospital to fill the gap, even though it severely strains the resources of Maua Hospital.   When the district hospital had no insulin for diabetic patients, they sent them to Maua, which in turn diminished Maua’s supply.  Two near-by highway accidents last week brought scores of victims to Maua Hospital because the closest hospital with a doctor on duty is an hour and a half drive away.  The district’s doctor doesn’t perform C-Sections, so patients needing that surgery come to Maua. 

Maua Methodist Hospital is struggling financially.  At the end of 2010, MMH had a deficit of almost  $100,000. The hospital depends on patient fees or patients’ government insurance for maintenance and operating costs.  Methodist Churches in the U.S., U.K., and Germany and other donors fund various projects both at the hospital complex and in the community outreach programs. Volunteers in Mission teams help spruce up the antiquated buildings.  The main problem is that in a time of 12% inflation, rising food prices, and drought, many patients are just unable to pay their fees.  The hospital has worked hard to reduce expenses and to ask for pre-payment or evidence of government health insurance before admission. (except, of course, in a life or death situation.)  Efforts are continuing to make the hospital’s financial outlook more stable.

The nursing shortage is another problem for Maua Methodist Hospital.  More than thirty nurses have resigned within the past year in order to work at government hospitals.  The appeal of easier work and shorter hours and giving them the option of opening up their own private clinic, for the same salary is too hard to resist for some.  Some clinical officers, trained at Maua Methodist Hospital, are also leaving to assume government posts. 

On the positive side, 2011 saw the beginning of a new medical internship program at MMH and the current four interns are well educated, hard working, and will make excellent physicians.  The Nursing School continues to produce eager, knowledgeable students.  Medical interns, clinical officer interns, pharmacy interns, and student nurses all complement the staff at Maua.

Maua Methodist Hospital has come a long way since 1928 and is working to modernize its facilities and services today.  MMH was in ministry offering health care then and it is in ministry offering health care now.  With God’s help, a lot of prayers, and a lot of support, Maua Hospital will continue its ministry well into the future.

Education in Kenya

The Community Health Dept is addressing the AIDS problem not only through treatment, but also through prevention.  A pilot education program is sending Jill, from Seattle,  and James, from Maua, both registered nurses, into area schools to present classes on reproductive health and prevention of HIV/AIDS.  I had the chance to accompany them into six different schools and to observe both the prevention classes and also the schools themselves. Even though we were there for these special presentations in the six secondary and primary schools we visited, I was able to observe some vast differences between Kenyan public schools and our schools in the US.


Fifty to sixty students fill a classroom in Kenya’s primary schools and students sit three to a desk. Students learn by rote (which I believe stifles creative thinking) and learn basic reading and writing skills. They will also learn English, which, when added to their mother tongue of Kemeru and Swahili will make them tri-lingual.  Students at both primary and secondary level are very quiet, well disciplined, and sit still, even in an auditorium, outdoors on the lawn, or in a regular classroom. The classrooms seem difficult to work in: blackboards are so old it is difficult to read the writing; there was no electric light in one dim room, and classroom supplies are scarce.

Schools in Kenya are not really free.  Primary students must pay $33.00 and secondary students at day schools, $44.00 - $55.00 per year.  Those students in secondary boarding schools pay $250.00. In addition, students must pay for their uniforms and some school supplies.  As a result, many children are not in school because their families cannot afford the fees.

Teachers require three years of higher education at a teachers college to be certified, but schools in hard-to-serve areas sometimes hire an uncertified teacher with only a high school diploma. A projected teacher shortage shows that 71,000 additional teachers will be needed by 2012.  Teachers earn $88.00 – $150.00 a month while an uncertified teacher might earn only $44.00 a month. The teachers union is working to increase pensions and “hardship” allowances for those teachers in hard-to-serve areas.

The literacy rate for Kenya is 70%, but in the Maua area it is only 35.9%. The government made an attempt in 2002 to offer primary education that was actually free, with no fees.  However they had to restore the fees within a year because the government just didn’t have the revenue to sustain free education.  The government still spends over half of its budget for public schools even though it doesn’t pay the full cost of education. 

 

A major scandal involving fraud and embezzlement of public school funding was recently reported.  A government investigation revealed that $42,000,000 of “free learning money” never reached the schools. Over 100 people, including top civil servants are involved.  As a result, the UK and other international donors have indicated they will withdraw their donations, then re-direct them through non-state channels. The Kenyan government vows to prosecute the offenders and recover the funding. 

Pediatrics at Maua Hospital

It is hard to adequately describe the pediatric ward here.  The closest picture I can come up with is that of a battle-field.  The immediate enemy is disease, but we’re also fighting malnutrition, fear, and lack of education, and always, always poverty.  We don’t have adequate weapons to win all of the battles, only the skirmishes.  There are 8 beds to a room. The place becomes even more crowded because the mothers or caretakers have to stay with the children at all times, feed them and give them their cares.  The ward is dilapidated, at times not too clean, and many things don’t work any more.  The nurses are critically short-handed, and the hospital is critically short on finances.  

Given all these constraints, what the hospital accomplishes here is nothing short of a miracle. The intern that I have been working with is exceptional.  He is bright, conscientious, and deals with mothers very well.  My hope is that he will decide to go into pediatrics.  Right now we have 20 acutely ill patients on the ward, including some patients that would tax the ability of a tertiary hospital to care for them.  There are 8 patients in the sick nursery, including 5 premature infants.  We have lost a couple of the preemies because we exceeded the capacity of the hospital staff to care for them.  At times I have felt that I was in over my head, both with the numbers of patients, their emergent needs, the unfamiliar diseases, the difficulties with language, (Most of the patients do not speak English) and huge cultural differences.  On the other hand I am having one of the best clinical experiences of my life.  

The challenges are stimulating, the teaching is going well, and I have learned to repeat the Serenity Prayer often. “ Lord, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” 

Mission to Maua - FGM

Female Genital Mutilation, or female circumcision, is illegal according to Kenya’s constitution, but still widely practiced, especially in rural areas with strong tribal traditions.  FGM covers a wide range of procedures, from a small symbolic cut to removal of the clitoris and external genitalia.  Strong social pressures in the village lead girls, particularly girls not in school, to continue this rite of passage.  Side effects of FGM can be chronic infections, severe bleeding, infertility, life long pain during sex, and spread of HIV.  Over 90% of female patients at Maua Methodist Hospital have been circumcised.
The World Health Organization and the UN Human Rights Convention condemn Female Genital Mutilation, but the effort to stamp out FGM is sometimes perceived as part of a Western conspiracy to undermine African cultural identity.  Fortunately, Kenyan women’s groups and churches are offering an “alternative rite of passage” for girls who might
otherwise undergo female circumcision. 
 
The Women’s Organization at the local Methodist Church in Maua  is one of many church groups that have sponsored “alternative rites of passage” for girls in the area. The program is preceded by a meeting with mothers and grandmothers to help them understand and win their support of an alternative rite.  The adolescent girls participating then attend a two week program that will offer them an alternative way, without surgery,  to signal their passage into womanhood.  In 2008, ninety six girls participated; in 2010, one hundred forty girls did so.  The girls pay 100Ksh (about $1.20) each to show their interest and commitment before attending the program during their school vacation in December.  In alternate years, the participants meet for an evaluation and to help facilitate the next year’s program.  The goal of the Women’s Organization is to take the alternative rite of passage into the villages where Female Genital Mutilation is most entrenched.

Mission to Maua # 12 - Prime Minister, Volunteers in Mission

(Blogmasters note: the hard drive on my computer self-destructed recently, so I have been forced to use an older computer with older browsers, which are not entirely compatible with the newer blog formatting. Hopefully when my repaired computer arrives, pictures will be placed where I want them in future blogs. My apologies.)

Volunteers in Mission –Last week’s team from the Houston, TX area left Saturday morning and another team from Texas arrived that night.  While here, some of the twelve members worked on plastering apartments on the hospital grounds, others went to offices and on field trips learning about the hospital’s community health programs.  The remainder worked on the AIDS Orphans house.  Several in the group had been here before and it was interesting hearing their perceptions on how things had changed at Maua Methodist Hospital.  The climax of the week was the dedication service for the AIDS orphan house.  The receiving family, their working group, the evangelist (who led the worship litany and prayer), the director of Community Health, staff of Giving Hope, all the people associated with the VIM program, and of course, the members of the VIM team were all present for the dedication.  Kathie Mann, leader of the VIM team, had the privilege of presenting the keys to the family who will now live in their new home.  

This week the cycle will be repeated with new VIM team members, also from Texas. I enjoy getting acquainted with people in this new group, but look forward to welcoming the next team from the Oregon/Idaho Conference.  They will be bringing more of the medical supplies ordered by Roger before we left.

Prime Minister, Raila Odinga, came to Maua on Saturday.  We didn’t go to the stadium to hear him because no one knew what time he’d appear.  We weren’t the only ones who didn’t go.  Seven of the nine area MPs (members of parliament) also shunned the meeting because they feared their appearance would negatively impact their chances for re-election next year. Mix political party disputes with tribal disputes and you have a political situation that is beyond my understanding.

News of Odinga’s appearance was eclipsed by news of the death of Fazul Mohammed.  Fazul was the mastermind of the US Embassy bombing in Nairobi that killed 218 Kenyans and 12 Americans in 1998.  Somali government officers killed Fazul at a checkpoint in Mogadishu.  Victims’ families and survivors of the embassy bombing here are understandably pleased that Fazul is dead, but some say they would only be able to celebrate if the American government honored its pledge to compensate victims of the 1998 attack.

Your tax dollars at work!  Last week a stack of 50 or so boxes sat in front of the Administration Building, waiting to be taken to the proper place in the building.  Written on the boxes was “Kenya Ministry of Health/USAID”, and also “from the American People”.  I don’t know what was in the boxes but was pleased that USAID (US Agency for International Development) was partnering with the Kenyan government to help a private hospital like Maua Methodist.