I wake up every morning to the sounds of waves and cows. I am the medical director at the Matoso Clinic in southwest Kenya. The clinic is one of several branches of the American organization Lalmba, which specializes in health and orphan care in East Africa.This is one of the poorest areas in the world, one where millions of people have no access to clean water, basic latrines, adequate food, or basic medical care. Thousands of small children die of severe malnutrition and pneumonia, and 1 of every 10 women dies in childbirth. Lalmba operates medical clinics in Kenya and Ethiopia that provide over 100,000 life-saving medical services a year.
8:30 AM
I start the day by going into the clinic to check on a patient in the emergency department (ED)—a concrete room with a few cots. The patient was brought in early this morning after being bitten by a black mamba snake. This happens about once a month, so we always have antivenom on hand. The nurse on call administered the antivenom, and the patient appears to be doing very well. It looks as though he won't need to take the hourlong ride to the hospital in one of our four-wheel-drive Land Cruiser ambulances. I then go to the laboratory to remind the staff that their quarterly report is due to me by the end of the day. The report details the number of malaria, typhoid, schistosomiasis, and HIV tests we have completed this past quarter. In 2010, more than 11,000 cases of malaria, 218 cases of typhoid, 342 cases of schistosomiasis, and 376 new cases of HIV were diagnosed. Finally, I go to the Patient Services Center (HIV/TB clinic) to talk to one of our counselors about a lecture I will be giving for some volunteers next week.
9:00 AM
We begin loading up one of the Land Cruiser ambulances with chairs, jugs of water, and other supplies for our community mobile clinic. Twice a week, our outreach team travels to surrounding communities within 10 miles of our clinic or dispensary to provide health education, examinations, and vaccinations in areas that have high vaccine dropout rates. Most of these places are more than 2.5 miles from the nearest clinic or health facility. When people have to walk this distance carrying a child on their back, it makes for a long journey. We have seven sites in our area that we visit once a month, and today we are starting a new mobile site in the village of Rapogi.
10:00 AM
On the way to Rapogi, we stop by our organization's remote dispensary, which is 2 miles from the Tanzanian border. This five-room concrete facility is maintained by one nurse and four other staff members. I try to spend one day a week here, helping to see patients and leading the outpatient malnutrition program. Even without electricity and running water, the facility provides care for about 35 patients a day and has a fairly well-stocked pharmacy and a refrigerator that runs on propane to store vaccines. We greet the staff and collect the vaccines, medications, and record books we will need for the day. Our Kenyan nurse-in-charge gives me a brief update on an 11-month-old child in our malnutrition program who is HIV-positive and has been declining rapidly. The nurse says that the mother has finally agreed to start the child on antiretroviral drugs and has promised to keep an appointment we set up for her next week.
10:30 AM
A Kenyan medical assistant and I are dropped off at a nearby school while the rest of the group continues on to begin setting up for examinations at Rapogi. Twice a year, our mobile team visits local schools to distribute deworming medication. Today is our first visit for deworming
at the Rapogi school. The children line up to receive their dose of mebendazole and to stare at the strange white lady handing out the tasteless white pills. Deworming helps greatly to reduce diarrheal
diseases in the children here and is required by the government. It allows the students to attend school continuously without getting sick and ensures that they have every opportunity to be healthy enough to focus on their studies.
12:30 PM
Clinic hours begin inside the rickety church building, which is nothing more than a concrete shack with a tin roof and a dirt floor—a very typical mobile accommodation. Around the main room are several tables: one for registration, one for the pharmacy, one for examinations, and one in the corner with a tarp draped in front of it for prenatal examinations. Volunteers from the community conduct the registration and weigh the children, using a produce scale hung with rope from the rafters. Our staff members continue with well-child and prenatal examinations, vaccine administration, and the dispensing of deworming drugs and vitamins to both the children and the mothers. Today, I am helping by doing the well-child examinations. Many of the children have rarely, if ever, had a physical examination. Most of them appear to be fairly healthy, but many have minor skin infections or anemia. This is a semiarid region, so food and water for cleaning are scarce this time of year. A few children come through with significant splenomegaly, which I explain to the parents is probably due to either malaria or sickle cell disease (both of which are very common in the area). I strongly encourage them to bring the children to our clinic for a blood smear. We try to explain to the parents that the test is very important, but often we will see the same children a month later and they will not have gone.