Mobile Clinic

Gatithi Medical Clinic

This week, both Christina and I were able to help out with the HIV mobile clinic. Basically it is like the Comprehensive Care Clinic that has been loaded into a land rover. On the day we helped out we stopped at Gatithi, a small town about 30 minutes outside of Tumutumu. There is a small clinic there that is still under construction. There we unpacked large boxes of medications, patient files, equipment, and other various paperwork. We even took our own table and chairs.

The idea of the mobile clinic is to create a satellite of the CCC that is more accessible to the patient population. Even though Tumutumu is only a 30 minute drive, many people do not have cars and do not have the money to pay for the matatu to the hospital. Without this service, many of the people would be non-compliant with their medication regiment, an act that would not only be dangerous for them, but also for the rest of the community.

The people walk from their homes to the clinic and line up hours before the team arrives. The patients check in with a nurse who weighs them, takes their vital signs, counts their pills, and provides teaching on their medications. Education is really stressed and patients are expected to know what medications they are taking and at what times. The nursing staff is fairly aggressive and will chastise those patients who fail the quiz.

From there, the patients see the doctor and describe any symptoms they might be having. Mostly the patients were complaint free, but occasionally we would treat a simple upper respiratory or skin infection. There were also a variety of muscle and joint complaints although no seriously ill patients. After seeing the physician, the patient goes to the mobile pharmacy and picks up their HIV medication and any other antibiotic or pain medication prescribed. This is where Christina worked and it kept her pretty busy. The pharmacist provides further counseling and education on their medications. Again, all the anti-retroviral medications, multivitamins, and antibiotics are free to the patients and provided by USAID.

The mobile clinic is a great addition to the CCC and an invaluable resource to the patients it serves. We saw about 50 patients, many of which were either pediatric or elderly and would not have the time or the energy to get their badly needed medication. It was also a great opportunity for Christina and me to see the patients out in the community and to see the patients in their home environment. The poverty was sobering. There were fewer nice suits and dresses, which you see a lot of at Tumutumu, and more tattered, second-hand clothing (one 45 year old gentleman had an "Ohio State Grandma" sweatshirt). It was a chance to reach out to the community at large and witness their daily struggle first hand.

Matthew and a Medical Officer evaluating a patient.

Patients waiting to be seen.

Patient signing a compliance contract stating that he understands the medications being prescribed and will take the medications.

Comprehensive Care Clinic

Today I had the opportunity to help out at the Comprehensive Care Clinic (CCC). This clinic serves individuals with HIV and Tuberculosis. Mainly, this is clinic provides free medications to those with HIV and TB and follows up on routine concerns such as CD4 counts and treatment failures. As part of the CCC, community workers even visit the homes of patients to ensure medication compliance. The workers often go on daily runs and has a fleet of bicycles, motorcycles, and a vans to accomplish this task. Fortunately most people are very reliable and appreciative of the care that they receive.

The clinic sees an average of about 50 people a day. Most of the visits are very short and consists of checking vitals, refilling medications, and occassionally checking CD4. However, a few patients do require additional testing to evaluate for pneumonia or other infections. These tests and their medications are all provided at no additional costs to the patient and is funded by USAID (United States Agency for  International Development).

Clinicians will take bicycles and motorbikes into the community to find non-compliant patients. 

It was a good chance to see many different members of the community. Even some of the Tumutumu hospital employees frequent this clinic. The patients were all very friendly and grateful to be seen. Often times working in the emergency department is a thankless job... it is nice to be able to provide care to patrons who truly appreciate it.  

The Pharmacy

One of the questions I was frequently met with as I prepared for this trip, and a question I liked to avoid, was, “So,  Matthew will be seeing patients in Kenya, and what are you going to do?”.  It distressed me a little.  I was assured that I was needed and that I would be put to work but my exact function was unclear.  I had this fear, with such a loosely defined role, that I would be only superficially needed, or that I would have time on my hands.  I've had jobs like that and nothing is worse than watching the clock, waiting for lunch or the end of the day.

This is why I have been so pleased with my position helping out at the pharmacy.  One major pharmacy serves both the out-patient needs and the wards.  The unit is always busy and I have always felt needed.  My first afternoon was spent learning the system and becoming familiar with the drugs – the commonly used trade names vs. the generic names.  All of which are a little different than what is used in the US.  My tasks range from restocking shelves to filling prescriptions. 

Most often I account for which medications and how many are distributed to which patients in the computer system.  The hospital uses a hybrid system of processing drug requests.  Most orders are handwritten and logged in the computer.  The pharmacy then reviews and verifies the orders and reconciles any discrepancies.  It is a somewhat tedious task that often reminds me of creating a plant schedule where size, number, common name and scientific names are specified, a common task during my time as a landscape architect.

I am most grateful for the people I work with in the pharmacy.  Everyone is unfailingly kind and patient.  They are always interested in teaching and never bothered by my endless questions.  Everyone who comes to the counter, patients and staff, is interested in the white girl, often greeting me with a smile and welcome.  It is truly a reflection of their culture that this has been such an easy transition.  After a few days here I have begun to feel comfortable (with my handmade cheatsheet of drugs), familiar enough with the rhythm of the day that I am able to anticipate the next task. 

The one regret is that I don't deal much with patients.  The mystery of this place is that three different languages are commonly spoken: Kikuyu (the tribal language wildly spoken in the central highlands), Swahili, and English.  And then there is another variation that is a hybrid of Swahili and English.  The pharmacist (there are 2 working in overlapping shifts) exclusively interact with the patients and staff in Kikuyu.  This leaves me in the dark.  They make jokes that I am not included in (maybe they are about me!).  But also, comments from staff and their exchange with physicians and nurses are always beyond my comprehension.  

An unexpected benefit of this position is that finally Matthew and I are working in the same world.  I know this sounds silly, but the endless talk about his work is now a little more of our common work.  Though much of it still is tedious and goes without comment from me it is nice that we are vested in the same interest of patient care and a well run hospital system.