It is said that time stands still once one sets foot in Africa and true to the fable several days have passed yet it feels as though our troupe has lived and worked in Kenya for many months and not only a few days. Local people often view us with a sense of bemusement whence greeted with the customary ‘Sasa?’, … ‘haberi-arco?’, but once the initial novelty of meeting a westerner passes, people are extremely welcoming – especially the children. One suspects that people are particularly grateful to be afforded healthcare which might otherwise prove unaffordable.
We have visited two clinics: an outpatient facility and a hospital. The outpatient clinic at Olturoto was founded and built by a community health nurse, Maria, who arrived in Kenya over 30 years ago but somehow neglected to close shop and return home to her native Italy. She proudly skites to being a ‘volunteer’. Her credo is affordable healthcare – including the provision of medication and aliquots of practical public health information – for people in need, funded entirely by gratuities and modest patient fees. A range of blood and urine screening tests are offered and the clinic is staffed by two Clinical Officers and several support staff. Patient presentations vary but circle around a common theme: infectious disease. I worked in the dispensary whereupon I unlearnt everything I took for granted at University: complex labelling is faux pas: simple instructions using diagrams increases compliance. I wish I had a month and not a week in the dispensary. In a few short days we created a template for computerised inventory management and discussed treatments for H.Pylori. From time to time, a patient in need of urgent medical care will present and Maria will bundle them into her car (read: the patient most likely walked to the clinic, in pain or at imminent risk of medical misadventure) along with their family, drive them to hospital, oversee their care, then return them home or to the clinic. Why do we accord professional sportspersons the title of ‘legend’? I submit: Maria deserves it more than a bloke who can kick a rugby ball really far.
Typhoid fever, brucellosis, malaria and intestinal parasites still reign supreme and when pressed as to whether she champions the cause of preventive medicine, a twinkle in the eye and a wry smile confer a dose of European defiance in the face of a problem which is bigger than ought to be addressed by a few people alone.
Arrow Web is a hospital in Kayole which is similarly staffed by Clinical Officers, a laboratory, dispensary, and several support staff. They too charge modest fees and rely on external funding to maintain solvency. The main difference between the Urafiki Clinic at Olturoto and Arrow Web is the provision of inpatient and maternity facilities. Many children are born at Arrow Web hospital. On first inspection its location is distressing (in the midst of a rubbish ridden shanty town) but aside from the limited facilities, the flickering fluorescent light and rising damp, one might be forgiven for believing that one is standing in a private hospital such is the resolve of the dedicated staff who might elect to work anywhere but Kayole but choose to stay.
Several Clinical Officers are employed at each clinic. Clinical Officers complete a three year Diploma in practical clinical skills and have prescribing rights, but do not possess the requisite education commensurate with those of a medical practitioner. Nonetheless they are comfortable and competent in dealing with a selection of diseases and patient presentations. The naysayers might crow in horror that non-medicos are treating patients but who are we to cast dispersions on a system which seems to be working lest patients are left with no medical care because they simply cannot afford it.
In meandered a young boy who looked up at me sheepishly. I thought my eyes were kindly enough. No matter. His mother spoke Kiswahili and motioned to his leg. On examination was a ruptured mucopurulent boil. Only one? Actually no. There were several. No. Six – probably more – on the arms and legs. Using an interpreter, I explained how to clean and dress each wound with CLEAN WATER and authorised appropriate antibiotics with the Clinical Officer.
Nearly every child I examined had the telltale pale conjunctiva of anaemia. Whether it was the primary presentation arising from malnutrition or secondary to some infectious complaint, I eagerly ‘prescribed’ iron and multivitamin supplements and explained the importance of eating fresh meat and vegetables (cooked and washed correctly, respectively) in a vain attempt to make things good. I am blessed with a cheeky wit which I hope patients warm too; so when I said to each parent ‘promise me you’ll try?’, I was rewarded with a smile. I will be a good doctor. One day.
At the end of the day it may be argued that questionable public health initiatives, poor education, a paucity of instruction in basic hygiene; and food preparation practices steeped in tradition conspire to feed a cache of diseases which should be scarce in presentation.
Particularly erudite medical students eat up PPH lectures with a spoon. The rest of us use the aforesaid spoon to pluck out our eyes once the first slide bearing the words ‘prevalence’ or ‘public health’ appears. Heavy with irony, the moment we hit dusty earth and visited a bathroom at Nairobi airport, I knew that Karma was to taunt me: Must Pay More Attention in PPH Lectures and CD. In Australia, we take it for granted that ‘most’ people use bathrooms appropriately, do not litter, refrain from using public waterways as a latrine, wash their hands, and try to eat reasonably. However, in our own small way, I trust that the inaugural Kickstart Kids Global Health Excursion candidates each helped a handful of children who might otherwise have slipped though the cracks.
