It's been eleven months since last I arrived at the Level III regional hospital here in Keumubu Kenya. It's always wonderful to see friends again, and meet new faces. In this place, in particular, where the needs are so great, my presence and presents brought many smiles. For the wards I brought eight basic stethoscopes, and a nicer one for the head doctor. The Matron, in charge of maternity, received seven handmade caps to give to the babies she delivers (Thank you Jan Bold). I photographed one placed on the scalp of a baby delivered shortly after my arrival. For the pharmacist I brought a bottle of acetaminophen (Tylenol), a drug not available here. I brought two blood pressure machines; the staff delighted in testing out the digital one. Also I gave an electronic thermometer.
They took me on a tour of the hospital changes. Primarily they've two projects, an x-ray room and refurbishing the surgical theatre. On my last visit they had no x-ray capability, so anyone with lung problems with concern for TB or pneumonia or cancer, or those with possible broken bones, had to be sent to the level V hospital in Kisii if an x-ray was needed. Now they finally have a machine (not sure who donated it, or even if it works), and they're currently constructing a building around the machine to house it. They decided to build at the entrance to the parking lot hallway, which will give good access, but blocked off the ambulance that parks in that hallway. When I pointed this out, that now the ambulance would be a permanent fixture in the hallway they said not to worry, it didn't run anyway. The surgical theatre was getting a makeover with fresh paint. The hospital administrator and all the other officials posed in the one room empty surgical suite for me to take photos (I'll send photos when I have better email access, or failing this, when I return to USA). They are very hopeful of having a surgeon someday soon, whatever that means.
As you know, my main goal on this trip is the water project. The hospital has no water, relying on carrying buckets into the hospital for the occasional use (such as cooking for the inpatients and laundry) from collected rainwater. The hospital was built with plumbing, but no source of water. So the project now has several aspects. First off is refurbishing the thousand liter holding tank. It's a giant cistern which initially had all the rain water that ran off the roofs into the gutters into the tanks. However, since they had no way to get the water out of the cistern, they rerouted the gutters to large water collecting tanks on the surface, which is where they currently get what little they have. Since the tank has never been used it will need to be refurbished, cleaned, the cracks cemented, etc. The next step is to reroute the gutters into the cistern, a minor issue. Third is to build the pump/motor/plumbing system to bring the water from the cistern to the existing plumbing structure. Fourth will be to route electricity to the pump/motor. This is not a minor problem, since electricity is variable and sometimes must run off an inadequate generator. Fifth is to refurbish the plumbing in the hospital as needed. Sixth is to supply a purifier in the system so the water can be consumed (it is useable for washing hands and laundry without one). Step seven is to fix the gutter system, which is old and leaks badly. Eighth will be to dig a well for when the rain isn't sufficient. I have $3000 in donations to work with initially, and am willing to put a couple of thousand of my own money into the system. This morning I met with the water engineer, a capable man who teaches engineering at the university. We went over the needs and he will develop an itemized budget to present to me tomorrow. So next blog should report how many of these steps we can afford.
I was supposed to have a purifier sent from USA. I had a contract and paid $2600 for the machine from Aqua Sun, with the understanding that it would be delivered to UPS at the Nairobi airport by the 26th July. When I went to that office, they searched but could find no record of it having been shipped. That evening I called the Aqua Sun office and found out it had never been shipped, that they had been out of stock of the UV lights, but were ready to ship it now. I told them to cancel, I couldn't arrange for the transfer to Kesumu if I wasn't there and this seemed too unreliable. So, the water engineer here will have to search for a local purifier, which probably is what I should have done in the first place.
Laundry is currently done by hand. They have a small washing machine in the laundry room, but it is broken. They bring rain water into a big tub and hand wash the sheets and hang them on the outside lines to dry.
I went on rounds at the hospital this morning. Only three children in the pediatric ward today, all with malaria. The youngest, about 18 months, presented yesterday with fever, vomiting, bronchospasm, and convulsions. She's much improved after 24 hours of IV Quinine therapy. In the woman's ward I examined a case of submandibular abscess requiring emergency drainage, a couple of cases typhoid fever, and a woman with vaginal bleeding whose uterus was tender and enlarged to 10 week size. In the men's ward there was a fellow recovering from malaria, another man dying of metastatic esophageal cancer, and a fellow who had been under treatment for 2 weeks, had been discharged the day before, but couldn't afford to pay his hospital bill so was kept prisoner in the ward until he could come up with the money (at a rate of $1.75 US a day). I asked the head doctor how long they would keep him if he never came up with the money and she said most patients wandered off after a couple of weeks. Another man was admitted with stomach pains the day before. I questioned him and examined him and determined he had a classic case of PUD, peptic ulcer disease. He mostly had pain after he ate, and his tenderness was well localized to the pit of his stomach area. I suggested they treat him with Pepcid, and stop the Rocephin and Flagyl they'd been using. They agreed to stop the Rocephin, and to add the Pepcid, but would continue the antibiotic Flagyl, which they consider appropriate treatment for ulcers. This is probably based on prior misdiagnosis in the past, so ... it's a practice that will continue.
This weekend Angela and I plan to head for Lake Nakuru, the national park famous for being home of 10,000 flamingos. This is the height of tourist season, it turns out, so there are no accommodations. Fortunately, Angela has friends (and cousins) everywhere and promises we'll find a place.
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