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.

Mission to Maua-Giving Hope

I was happy for the chance to go with the director of Giving Hope to some more distant communities where the orphaned families live.  This time he wanted to show me some situations where the Giving Hope leaders work with others in their working group.  A working group consists of twenty families (representing about 80 people) and serves as both an extended family and a support group.  Family leaders elect their officers and choose their adult mentor, then meet on a regular basis to share ideas, problems, and be there for each other. The officers of working groups are also occasionally brought together for full day meetings at Maua Hospital to learn more about leadership, life skills, and opportunities for their communities

Working group leaders also get together periodically to help one family in their group.  The morning we were there, group leaders were in the field helping to weed the small farm used by one of the families. The working group also gets together whenever a new Giving Hope house is dedicated for one family in their group. We were able to visit a new working group that had come together just the week before.  They had already elected their leaders and, with the social worker’s guidance, were planning a project for their group.

We went to one area where there is rivalry, even hostility, between villages on each side of the river.  Giving Hope has paired mentors and families from both sides of the river into a working group, with the expectation that, by working together, the orphan families will encourage and model cooperation rather than the current rivalry.

We also had a chance to touch base with some of the recent graduates of the program.  They are doing well.  The seamstress has a small store where she also sells beans and other produce.  The girl working in her small farm plot will soon start a job as a teaching assistant, and the hairdresser had customers waiting for her services.  None of them will make a lot of money, but just a little income plus the subsistence farming will be enough for their families to survive and to be self sufficient.

I believe that Giving Hope is taking the right approach for these young heads-of-household by establishing a goal for their lives and giving them needed resources of food, housing, and start-up funds for their business or vocation.  Giving Hope is giving them the encouragement of professional social workers and mentors in their communities, and the support of other orphaned families in similar situations.  These orphaned children can then be healed emotionally and grow spiritually. With this comprehensive help, Giving Hope is empowering these families so that they will become self-sufficient within three years.  Once a family no longer needs their help, Giving Hope is then able to help other orphaned families. There are 42,000 orphans just in the Maua area alone.

Similar Giving Hope programs exist in other African countries.  For more information, contact their parent organization at www.zoeministry.org.