Nyumbani means Home

After leaving Kisii, Noela and I had a week in Nairobi to wrap up our project and do final presentations at the University of Nairobi and the Kenya Medical Research Institute (KEMRI). And during that week, Noela and I also had the chance to visit Nyumbani, a home for children with HIV/AIDS who have been orphaned or abandoned.

The home was founded in 1992 by a physician who was also a Jesuit priest and today its executive director is a friend of Noela's so we were lucky enough to get a tour. I wasn't really sure what to expect when we arrived. HIV is one of those global health issues that has so much publicity and funding swirling around it that in theory there should be plenty of resources to treat and care for these vulnerable children. But I had just come from Kisii, where there were several women and children with HIV who were not getting medical care due to financial and social barriers.

Thankfully, that was not the case at Nyumbani. We were greeted by a sea of smiling faces, both from the children and the staff who take care of them. The children's home tries to create a domestic feeling by having individual houses, each with its own "den mother" who lives with and cares for up to 14 children, varying in age from infants to pre-teens. The older kids (teenagers) have boarding school style dorms where they live so they can have some more independence.

We also got to tour the amazingly state-of-the-art infectious disease laboratory that Nyumbani runs on its complex. They do all the medical care and testing for the children on-site. And their lab is so good that even large hospitals like Kenyatta National Hospital send HIV-related testing to them. It was a really impressive example of what is possible when adequate resource are put to good use.

Here are a few pictures of me & Noela with the kids. They are absolutely ADORABLE!

They were also strangely fascinated with my hair:

For more information about Nyumbani and how you can help, check out http://www.nyumbani.org/

~Ammu

Kitale & Kakamega

It seems as though no friendship in Kenya gets an official stamp of approval until you have visited your friend's home. Not just their house, but their real home, where their family lives. So it was almost a given that I would go and visit Jackie's home in Kitale and Noela's home in Kakamega while I was in Kisii.

Kitale is a small town northwest of Kisii near Mount Elgon, an extinct volcano on the border with Uganda. Jackie's grew up on her family's farm in a village near Kitale and her parents still live there. She and her husband have a farm of their own in a village called Kiminini just outside Kitale. This was our destination when Noela and I set out early one Saturday morning.

We started out from Kisii at 8am and went to the matatu station. Matatus, as I mentioned earlier, are 14 seat minivans that criss-cross the Kenyan roadways and are the most common form of transportation available. They're cheap and efficient but they have a lot of quirks. First off, there is no set schedule and they won't leave the station until they're full. There's heavy competition between matatu companies to fill their vans and they're not afraid to play dirty. This includes grabbing passengers' luggage and holding it hostage and hiring fake passengers to sit in their matatus to trick people into thinking that the van is almost full and ready to leave.

After some minor shenanigans, our matatu finally set off for Kisumu at around 8:45am. It was a really bumpy ride because most of the matatu drivers get paid for speed rather than how well they treat the vehicles. In Kisumu we switched to a bus which took us through Kakamega and up to Kitale. The bus ride was full of entertainment, like a woman who carried on chickens wearing plastic bags for diapers and a guy selling herbal medicines whose sales pitch claimed that his cream would cure "asthma, arthritis, bone cancer, baldness" and about 20 other ailments!

The bus trip was pretty grueling and we arrived in Kitale 6 hours later, grungy and exhausted. But Jackie was waiting for us at the station, and welcomed us into her lovely home with hot tea and snacks. We spent the weekend stuffing ourselves with food from her farm, especially maize and mango smoothies. We also visited her family's other farms and went to Kitale to visit the museum. Here are a few pictures from our trip...

This is Noela, Jackie, Jackie's husband Patrick, and Patrick's brother David at their farm:

This is me & Noela with Patrick:

This is a hilarious sign at the Kitale museum next to their snake exhibit:

These are some adorable kids at the church in Kiminini who wanted me to take their picture:

The following weekend, Noela and I ventured out again - this time to Kakamega to visit Noela's family. Kakamega is about halfway between Kisii and Kitale, and you might remember it from my earlier post about the Kakamega Rainforest. Noela's mom and most of her seven (that's right 7!) siblings live there.

We hung out with Noela's nephews and watched the Smurf movie, which they were crazy about although they kept calling the smurfs "smoothies". =) And stuffing ourselves with lots of tea and delicious food was happily a recurring theme.

Here I am with Noela and her family:

This is the stream where they collect water for their house. It's about a half a mile away.

This is the beautiful countryside around their home:

After these wonderful weekend trips it was time to head back to Kisii and wrap up our project! More on that next time. Kwaherini,

Ammu

Moraa & Kwamboka's Exchange Transfusion

Sorry for the long delay in posting to the blog. We've gotten really busy with our research project in the past few weeks. So, now that you've gotten and introduction to Nairobi and Kisii, I thought it would be good to share a little bit about my experiences in the hospital here and about the project that Noela and I are working on...

On our first day at the KEMRI-UW office in Kisii, we were told that we needed to have Kisii names for when we went out into the local villages to meet with community health workers and traditional healers. Noela said that she had already been given a Kisii name by one of her friends from the area - "Kwamboka" - which means someone who has crossed over rough waters to arrive where they are today. But I was still name-less. Luckily, Peter, one of the office staff, came up with a name for me - "Moraa" - which means always happy & smiling.

Armed with our new names, we set out to see the hospital and brainstorm about our research project. We got a tour of the hospital wards and met some of the nursing staff. Kisii's hospital is a Level 5 facility, which means that it is supposed to be a referral hospital for the Kisii District and just one level below the national Level 6 referral hospitals - Kenyatta in Nairobi and Moi in Eldoret.

However, Kisii Level 5 has no pediatric ventilators or ventilators for newborns. It actually has no pediatric or neonatal ICU. There is only one certified pediatrician on staff, who is supposed to supervise the care of the entire pediatric ward and newborn unit. She works with several medical officers and clinical officers -- mid-level health care workers who have some general medical training but have not gone to medical school or completed a residency. These MOs & COs provide the majority of the care to the children who are admitted to Kisii Level 5, and actually to most patients admitted to government health facilities all over Kenya. There is a critical shortage of qualified medical providers in Kenya - both doctors and nurses.

On the day we arrived in Kisii, the pediatrician was away in Nairobi for a meeting. That meant that Noela and I were the most highly trained pediatricians at the hospital. The pediatrician had communicated with our mentor in Kisii - Jackie - that there was a newborn recently admitted who was very sick.

Baby E. was a 10 day old girl who had been born at home and whose mom had not gotten any prenatal care. Her mom brought her to the hospital because she had developed jaundice. Once she was admitted it was also clear that she had a serious infection (sepsis) and probably meningitis. But the jaundice was the most concerning issue because it was not responding to the phototherapy that been used for the past 3 days.

The next step to try to prevent the jaundice from leading to permanent brain damage was to do an exchange transfusion. For the non-medical folks that's a special type of blood transfusion where a baby's entire blood volume is removed and replaced with fresh donor blood. Replacing the baby's blood helps reduce the level of bilirubin, the chemical that causes brain damage in jaundice.

Obviously, it's not a procedure you do every day. It can be very dangerous and can even kill a baby. It has to be done under sterile conditions and you need to monitor the baby very closely and check lab tests frequently. I was pretty apprehensive about attempting to do this procedure because the newborn unit had no electronic monitors and I didn't think they could set up a truly sterile area for us to do the transfusion. The unit is chronically overcrowded and they usually have 2 or 3 babies in each crib, and up to 4 under each phototherapy light.

But it turned out I didn't have to worry because we didn't even get that far. First of all, the blood bank didn't have enough blood for the transfusion. And secondly, we were never even able to check the baby's bilirubin level to confirm if it was high enough to cause brain damage and thus worth the risk of doing the procedure. Why were we not able to do this basic lab test? Because the machine in the lab was broken and kept giving us the wrong results.

So in the end, we just continued to treat the baby with phototherapy and antibiotics. Her jaundice eventually improved, but over the next couple of weeks we watched her develop the signs of brain damage from her initial severe jaundice. She started to have episodes where she stopped breathing. And then one day, we came in morning and heard that she had passed away overnight. It was really heartbreaking to watch because it should have been prevented. If her mom had delivered at a hospital and gotten good prenatal care & health education, if she had brought the baby to a doctor just a couple of days sooner, if the hospital had a working laboratory and a functional blood bank, if the newborn unit had monitors and enough space and staff....if any of those things were true, Baby E. could have lived.

Baby E.'s story inspired us to focus on newborn babies for our research project. We decided to look at neonatal infections and how the outcomes differ between babies who are born at home and those who are born in a hospital. So far we have interviewed and surveyed health care workers, community health workers, traditional birth attendants, and mothers about their knowledge of neonatal infections and proper newborn care. We're also investigating the outcomes for newborns admitted to Kisii Level 5 with infections based on where the baby was delivered. Hopefully we'll end up with some useful results!

Ammu