Kenya Heart and Sole

Our last and final clinic of the trip. We all looked forward to it with eager and excitement in our eyes. Eager because this was the first slum that most of us have ever encountered in our entire lives and excited because after this clinic, we would finally be able to catch up on our sleep. The day began early, clambering back onto the bus and heading over to the University of Nairobi campus to pick up our partners. Watching our partners get onto the bus was bittersweet for some of us because we knew that it would be our last time working together, but regardless our trip to Ongata Rongai was in high spirits.

Making our first turn into the slum, it was unmistakable as to where we were. People seemingly occupied every square inch of this area, whether they were selling vegetables, cooking food for others to buy, or tending to their houses. Goats, dogs, and chickens ran along side our bus on the dirt path that we drove on. Upon our arrival at the heart of the slum, the clinicians went to set up their exam rooms (where two clinicians shared one room), a medication table (intended to be our pharmacy) was placed right outside of the exam rooms, and a tent was erected for the undergrad nursing students to take a histories and triage.

The patients slowly trickled in. One of my most memorable cases was a 22 year old boy who came for high blood pressure. He told us that he initially became aware of this condition when he had to get surgery for his ankle, but the doctors believed that he was nervous about his procedure and overlooked his elevated blood pressure. During his follow up visit, his blood pressure was still elevated at which time he chose to come to our clinic and get a second opinion. The boy told us his story and the doctor completed an assessment. She gave him blood pressure medication and referred him to Kenyatta hospital where they could do more extensive blood work on him and make a definitive diagnosis for the cause of his hypertension. This boy was a student and it is so unfortunate that from lack of access and most likely a scarcity in money, this boy will be afflicted with hypertension for the rest of his life.

This boy was not the only sad case that we encountered in which we were limited in our means to help patients. A pregnant woman came to us with a sky high blood sugar. This woman had type 1 Diabetes Mellitus and was hoping to get free insulin, which we unfortunately did not have. Stories like this woman, made me think about complications that could arise during delivery and the impact that her elevated glucose has on the baby. While we encounter complications like this in the States, it is easier for U.S. doctors to manage because of advancements in technology yet in Kenya this can have devastating outcomes.

While these stories are simply two examples of the sad cases that we encountered, we, on the flip side, also had a positive impact on individuals and the community. We educated people about weight loss, we provided cardiac medication to people who would have otherwise been unable to obtain them, and we even caught new diagnoses that would have been overlooked.

Upon helping over 200 patients, it was time to pack our supplies and head back to the hotel. We left around 5pm that day. The drive back on the dirt path was not even comparable to when we initially arrived. Seemingly unfathomable, more people crowded the dirt paths hoping to get their last sale in for the day. We had to close all of the windows on the bus for security reasons which only caused the bus to be stifling. Only 5 minutes into our drive out of the slum, a truck blocked our way which caused us to simply wait (since the road would not accommodate more than one car at a time). After what seemed like an hour, we finally got onto the main road and were on our way “home”. We sadly said goodbye to our University of Nairobi partners and then made our way back to the Guest House (i.e., our hotel).

The day started early, many of us up around 5 am, so that we would have time to pick up the University of Nairobi nursing students before heading to the two separate clinics of the day in Kambui and Kigumo. Since Nairobi traffic is always unpredictable and usually horrendous, we made our best efforts to eat breakfast, grab our bags and be on the bus by 6 a.m. Since we were dividing into two clinic groups with the Kijabe students from last Saturday in one group and the Nairobi students in the other, when we arrived at the U. of Nairobi campus half the team introduced the other half to their partners before we quickly loaded back onto the bus and began reviewing the protocol so that when we arrived at clinic 5 in Kambui we would be ready to get started right away. We struggled to hear each other on the noisy bus, and had were packed close enough together that it was hard to have enough space to show and explain to our partners the various handouts and forms we would be using during the day. But our partners caught on quickly, or were quickly refreshed if returning from last year, and we were all ready and in good spirits when we arrived for what we knew was likely to be a busy day.

After the other half of the team drove off to Kigumo where they would meet up with the Kijabe students for clinic 4, we went inside the clinic building to determine a layout and get set up as quickly as possible, especially in the registration and anthropometrics areas. Off of a main hall the clinicians set up in three small rooms towards the far end, while the screening stations were set up in the first 3 or 4 and the registration station was just outside in an entrance foyer. Surface area was sparse in this clinic, so we did our best to find tables and desks to be used for screening and treatment. Some of us were able to dust off and use a narrow bench we found for both seating and table space, while others were able to find and share tables, and still others were set up in only chairs or ended up standing or rotating around while doing patient measurements. Ready or not, before long the patients started making it through registration and the anthropometric (body measurement) stations and coming to our somewhat organized screening stations.

We were fortunate to all start the day with two Nairobi nursing students to work with instead of just one, and worked on the go to both see patients and screen accurately while also trying to find the most efficient system with and extra pair of helping hands and additional interpretation ability. At some stations the groups of three were able to work fluidly to take detailed histories, ask questions about lifestyle and diet, and take the all important measurements of blood pressure and blood glucose. Others found working with pairs of students to one patient to be more efficient, which enabled a group of Nairobi nursing students to sit with patients just outside the screening rooms to interpret and take a lot of information for the forms before they reached our screening stations, saving the screeners a lot of time with each patient. Students from Nairobi and Peer Mentors were also able to rotate among the groups of waiting patients and take preliminary blood pressure and glucose measurements, and also cover screeners for much needed 10 minute tea breaks.

At my station I was partnered with David, a student who could speak Kikuyu, the most prevalent tribe and most common language amongst our patients. Since many of our partners from Nairobi spoke only Swahili, David spent a lot of time moving between stations to help interpret for patients that only understood Kikuyu. Whenever he had to move to another station, however, there was always another Nairobi student ready to sit down and help at my station. In the whole day there was just one instance where I was able to communicate with my patient on my own as they spoke great English, but it was nice even the once to be able to do all of the questioning and health teaching. At some point in the day many of us at the clinic were visited by a gregarious (and mischievous) toddler with an attraction to medical equipment. I was reminded quickly of the dangers of handing a two year old your watch to play with when you were going to need it in less than 5 minutes. But she was a welcome visitor at our screening station, and provided a lot of smiles as we got through the dragging middle of the day.

As the day progressed I know many of us were working with challenges such as short supply of certain supplies, close quarters and limited surfaces to work on, little time to sit, our partners being needed in more than one place, and so many patients to see before dark approached. But overall felt that the day went smoothly, I think we met those challenges and got through the day on a positive note. We were able to see around 130 patients at Kambui, and the clinicians were then able to quickly pack up and go to assist a few miles away at the Kigumo clinic. Considering we were not originally planning for two clinics in one day the team, clinicians and peer mentors especially, did a great job of making a well oiled machine out of what could have been a very difficult and hectic day. Having the group of students filling out the back-of-the-card questions with the patients and having some of the measurements done before screening and health teaching made a big difference in our end of the clinic.

Our success and hard work were rewarded with a generous and delicious lunch (with plenty of chapatti) from those in charge of the Kambui clinic, and those of us who were not asked to go and help at clinic 4 were able to spend quality time talking with the Nairobi students and sharing stories about the day. After a few hours the bus returned filled with the weary Kigumo team, and we loaded in the rest of the group and supplies for a long ride back to Nairobi, with the pleasant thoughts that our double clinic day was now successfully behind us, and that the next day we would be able to rest and recuperate at the guest house.

What an interesting day! We were very busy due to the fact we actually had TWO clinics scheduled. Originally, we did not plan on serving at two clinics. We first planned on having a clinic in Kigumo on Tuesday and another clinic in Kambui on Wednesday. Somehow there was a miscommunication and both clinics were advertised for Tuesday. These clinics are advertised far ahead of time and many people travel far distances to come be screened. By the time we were aware of the mistake it was too late to change the date. One clinic is tiring enough alone, so at the time two clinics seemed impossible. It was decided to split the Boston team in half, sending half our team to Kambui and half to Kigumo. Thankfully we had the support of our partner nursing students and staff from Kijabe and the University of Nairobi which made it easier on us. Nairobi students went with half our team to Kambui and Kijabe students went with our half to Kigumo. Our morning started off early, leaving the guest house around 6 am. We picked up the University of Nairobi students around 630 am and then made our drive to Kambui. Thankfully the clinics were located fairly close together so we were able to drop off those assigned to Kambui and then make our way to Kigumo. Once we arrived at the clinic we found a large group of people who were already waiting to be screened. It makes me wonder how far they have to travel or how early they had to leave their house to be at the clinic before us. The students from Kijabe met us at the clinic soon after we arrived. Together we gathered in front of the large crowd where we were introduced by the clinic staff. Although the staff were speaking in Kikuyu, it was to my understanding they described what we were there for, what we could offer and what the process entailed. After, the entire clinic was lead in a prayer which has been typical before we start most locations. Then we proceeded to set up our screening stations while our Kijabe partners delivered a health message to the crowd about cardiovascular and metabolic diseases like diabetes and hypertension. Half of our screening stations were located in the courtyard while the other stations were located in a clinic building. Thankfully my station was outside and I was able to enjoy the beautiful weather all day. We were able to treat many people for hypertension, diabetes and those suffering from chronic pain. At the end of the day I think we were successful in screening/treating as many as 150 people. Our clinic ended around 530 pm followed by a long bus ride back to the guest house in congested Nairobi traffic. Although it wasn’t ideal circumstances, I am happy to say we made the best out of it.

The four hour long drive to Kijabe was mostly filled with nap breaks and awed looks of the landscape that flew past the bus windows. We arrived around lunch time and were introduced to our Kijabe partners before taking a tour of the hospital. Being that this was our third hospital visit, it was interesting to note the differences between all the hospitals we had toured thus far. Following the tour, we headed down to take a peek at the Great Rift Valley.If you ever have a chance to travel to Kenya, you cannot miss the sight Great Rift Valley near Kijabe. Spectacular views of what seems to be infinite greens, beautifully landscaped farms, a mountainous skyline that extends of into the horizon- and the set of The Lion King. After the walk, dinner and medication packing awaited us back at the hotel, to finish off the night before clinic three.

Clinic three was located in Nyanduma, at a small dispensary on top of a mountain with an amazing view of farmland. To put it simply, it was a gorgeous and inspirational way to begin the day. At the time of our arrival, many patients were already waiting around outside of the dispensary. While we began to set up, the Kenyan students welcomed those waiting and delivered a health message surrounding cardivascular and metabolic diseases.Following the message, the first patients began to be registered and from there on out it was a steady flow of patients until near sunset. We saw pateints of both Kikuyu and Swahili-speaking descent. Luckily most of out Kijabe partners spoke both languages, so translations were not a problem. We saw over 250 patients of all ages suffering from a wide range of problems- from the expected diabetes and heart disease to cuts, bruises, burns and respiratory ailments.It is technically the winter season here (though no where near the blizzardy streets of New England we all know and love- sometimes), so we saw multiple patients with coughs and suffering from the common cold. Often our advice was the same as it would be back home- rest, lots of fluids and hot packs if able.

The director of the clinic had arranged a lunch for us with white tea at 11:00 and lunch around 2:00. It was a delicious combination of rice and lentils to fuel us to finish the afternoon strong. After finishing up for the day, we were all tired and after a quick photoshoot we started the long and very bumpy trek down the mountain. After saying goodbye to our Kijabe partners back at the hotel, the Boston team jumped back on the bus to continue our journey to our next stop, Nakuru. Here we were treated to a relaxing day filled with an array of animals as we drove through Lake Nakuru National Park for a day of safari. After an enjoyable brunch at the hotel in Nakuru, we loaded onto the bus for the trip back to the guest house in Nairobi to begin our second week here in Kenya and clinic number four. We look forward to the adventures that await us in week number two!

The good thing about the day before being so chaotic was that we learned our lesson. Today we put an early cap on the amount of patients we could see (250). This helped us all in terms of controlling the flow of patients throughout the day and budgeting our time more wisely. Another added benefit was that we had been at this exact location the year before, so the returning students from both schools knew exactly how to set it up to maximize flow.

Once everything was set up and almost ready to go, we went outside to be welcomed and listen to various community elders, leaders, clinic officials, and Tumutumu students to address the crowd. There were already about 50-100 people waiting for us to screen them. The Tumutumu students gave a health message to the crowd, explaining diabetes and hypertension. They also explained the informed consent process so that patients would be able to register more quickly once we got started.

Things got underway quickly once introductions were completed. After the day before, the team had a much better idea of what to expect, and all of the Kenyan/US pairs had worked out systems of their own that worked for them. We were all impressed with how well everyone collaborated and how smoothly everything flowed. This time, Darren and I were in the front with the screeners while Annya worked in the back with the clinicians and graduate students.

One hitch we ran into- no light bulbs! The screening room was already dark in the early morning and we were concerned we wouldn’t be able to work for long without some illumination. Fortunately, Jacob came to the rescue! He appeared out of nowhere once we had started screening, and stacking chairs on top of tables (hakuna matata), quickly installed light bulbs for us.

After a few hours, we began giving people breaks, which was something that was impossible to structure the day before. Another huge thank you to James and the Tumutumu peer mentors (especially Mary!) for making sure all of their students (especially the ones doing registration, anthropometrics, and back of the card) got breaks. James even stepped in and started screening patients!

I spoke with a woman I remembered seeing at the clinic last year, and was so happy to see that she had again braved the long line to come and see us! What a great feeling. She thanked us for what we were doing and was so grateful for the services we were able to provide her.

We ended up seeing all 250 people in a timely manner, and managed to finish up before dark! What a relief. The contrast between the day before impressed all of us. Mary arrived at the end, as we were finishing up the last 10-15 patients and handed out hot samosas to all the students, which were well appreciated.

Back at the guest house, we had dinner and hangout time with our Tumutumu partners. After dinner, they invited us to take a more informal tour of their hospital since we had not gotten to take a tour as we originally planned. Despite being tired, most of us went. We loaded up with our partners and drove the short distance to the hospital.

Here we split into smaller groups and our Tumutumu friends showed us the various wards, outpatient settings, student dorms, classrooms, and the hospital grounds. We saw an avocado tree and some were lucky enough to claim a couple avocados for themselves. Despite the long day, our gracious hosts were willing to answer our numerous questions. After the tour, we said goodbye to our partners and returned to the guest house.

We all turned in upon our return and gathered our things for the long journey to Kijabe the next morning.

What a day! We had gone to bed feeling we were well prepared and ready to go the following morning. Boy, were we in for a surprise! After gathering our Tumutumu partners we arrived at the site to discover over 100 people awaiting us!

We quickly separated, with the clinicians, graduate students, and our exercise physiologist, Heather, going into the back of the building to set up, while the undergraduate students and peer mentors began setting up registration, anthropometrics, and screening stations in the front of the building. We worked with local community members and clinic workers to rearrange furniture and set up the rooms in a way that was conducive to an easy flow of patients through each station.

Darren was working with the nurse practitioners and graduate students and helped to set up their “pharmacy” and patient rooms while Annya and I made sure every station had what they needed before we began. We handed out paperwork and patient educational materials, and did our best to answer last minute questions. Once the registration desk and anthropometric stations were ready, we opened the doors and let the first patients in.

The beginning is always quite slow as we’re waiting for the first ten patients to make it through registration and anthropometric measurements and get to the patiently-awaiting screeners. It then takes even longer for them to be screened and to assess whether or not they need to see the nurse practitioners, or if they need to be referred to the local health care facility. Despite the clinics being an effort to screen, diagnose, treat, and ultimately better understand cardiovascular and metabolic disease, people come in with a wide variety of other ailments in addition to wanting their blood sugar and blood pressure checked.

Chaos ensued, despite our best efforts at organization. The first clinic of the trip is always a bit hectic since all the new team members are still getting used to the protocol, and trying to figure out what works best for them and their partners. Add to that a line of over 400 patients waiting to be seen, and it’s easy to see how crazy/busy things became. We had to assign an extra 2 people to the anthropometrics station to help get people through the first part of the process more quickly. I realized that we were running out of all of our paperwork, including the card we were using to gather research data and record patient results, as well as our patient education materials. Jacob ran off to have more copies made.

In the meantime, we decided to set up an 11th screening station in an effort to help move things along more quickly. My partner, David, and I screened patients for over 3 hours while running around to check on everyone in between patients. Annya and I eventually switched, and she took over screening patients.

The lines backed up everywhere. People were crowding into the anthropometrics area, so it was difficult for our team to measure peoples’ waist circumference. We had to keep moving people back towards the door, but then they would eventually crowd back in and we’d have to do it all over again. The lines lengthened. Everywhere. Lines to be registered, lines to fill out the questionnaire, lines for anthropometrics, lines for screeners, lines for clinicians. Lines everywhere! We were rapidly running out of paperwork again, and had to resort to creative measures.

Eventually, we had to cut off the lines and prevent more people from entering. We shut down anthropometrics and were just checking people’s blood pressures and blood sugars, and sending those to the clinicians we knew we could help. Despite this “fast-tracking” we still didn’t finish until after dark. People were exhausted, hungry, and probably a little shell-shocked. The team helped clean up the room, return furniture, and pick up trash. We loaded up the practitioners and got on the bus.

We owe a HUGE thank you to the community members that sacrificed their time and energy to help us out. Joyce at the registration desk was SO helpful and so positive, I don’t think I saw her without a smile on her face once. And there was a former teacher from the primary school we visited the day before helping to usher patients through everything and helping manage the lines. Not to mention the faculty at Tumutumu (especially James and Vincent!) and their AMAZING students.

The guest house attendants were gracious enough to leave dinner waiting for us, and we devoured a cold meal. Our Tumutumu partners arrived and asked us to pack meds for the next clinic in the morning. None of us were very interested. We had originally planned to pack meds the next morning before the clinic since we were within walking distance and everyone was so exhausted already. However, they were quite persistent and got their way!

Despite it being around 11 pm, we busted out the medications and sorted, divided, and packaged them for the next morning. Those Tumutumu students surprised all of us with their tenacity and dedication.

Finally, very late at night, we made it to our rooms and to our beds, knowing we were going to do it all over again tomorrow. Very early tomorrow.