By Keith Gregoire
It is amazing how quickly two weeks can fly by! After 16 hours in the air and a 5 hour layover coupled with a 7 hour time change, we have now returned home safely to Canada. One good night’s sleep later, I finally have some time to document about the amazing experience we just went through.
We arrived at MCF Ndalani on Monday, August 20 and were greeted by the children singing us welcome songs in English and Swahili. After such a long journey, we were overjoyed at such a magnificent welcome.
On the first Tuesday and Wednesday, we had an orientation to MCF operations at Ndalani and Yatta respectively. My family and I had last been to MCF in 2010 and so much has changed since. New buildings have sprouted up and new sustainability projects are being established including a poultry farm. The whole team was impressed with everything that MCF is doing despite the ongoing challenges in the African climate. I was personally amazed at the vision, faith & ingenuity of Dr Charles Mully. For instance, a few years ago there was a severe drought through their entire region that lasted for two years. The Thika river that supports them ran completely dry during that time. Not only did MCF managed to survive through it, but they used the opportunity afforded by the dry river to complete a bridge joining the property on the two sides of the river and to dredge sand from the empty river bed! As a result, they now have sand for their building operations for years to come.
We used the time after orientation on Tuesday and Wednesday to set up the clinic and prepare for work on Thursday. It was a good thing, too, because we were greeted Thursday morning by hundreds of patients! I think the total for the first day was well over 350. We started after breakfast and worked till 9 o’clock at night before we finished seeing everyone. Over the five days of clinic, we saw 1280 patients.
The clinic was set up with a waiting area to the side of the medical building, where patients were lined up and given a single numbered sheet of paper that indicated their place in line and functioned as their medical record. It included the demographics, vital signs, triage note, doctor’s notes and an area at the bottom for prescriptions. The patients were then funneled through triage, where 3-4 nurses obtained the initial health information and took the vital signs. Each nurse, each PCP and the pharmacist had their own translator. Most of the people did not speak English. Some didn’t even speak Swahili, but only their local, tribal language. Our translators were senior high school students from the MCF program. Most of them had some interest in the medical field and were doing this as a way to get some practical experience to see if medicine was for them. My translator was a young man who wants to be a nurse. He, like most of the translators, picked up on things very quickly. For instance, if a child had diarrhea, I always asked how frequent, how many days and if there was blood and/or mucus present. By the end of the five days of clinics, when I asked, “Does the child have diarrhea?”, there was often a one or two minute conversation that went on before my translator said, “She has had diarrhea four times a day for two days with mucus but no blood.” I am sure he will excel as a nurse.
After going through triage, the patient then went to see one of the four practitioners. We had access to several tests including a hemoglobin, urinalysis, malaria rapid test, stool for parasites and serologic testing for typhoid, brucellosis and H.pylori. The lab worked very efficiently and we always had the results back quickly.
We would then prescribe the appropriate medications and the patient would take their paper to pharmacy. In the pharmacy 2-3 nurses and my son-in-law, Connor, helped Balu as they gave out probably close to one thousand prescriptions per day. Each patient had individual counselling regarding the medications and were given them in brown envelopes labelled with their name and instructions for use in a way that could be understood even by those who could not read.
The team saw and treated a variety of diseases and conditions. There were all the usual issues – URIs, hypertension, diabetes, chronic headaches, arthritis/arthralgia. The difference is that here, even getting access to over the counter medications that we take for granted can be a challenge both economically and physically. In addition to these usual conditions, we saw conditions totally foreign to Canada. Parasites were rampant. I treated several children with Ascaris lumbricoides or Entamoeba histolytica infestations and in a few cases children who had both! Typhoid fever was not uncommon among the villagers. Thankfully, the children and staff at MCF have a water treatment plant so that is not an issue at MCF. Interestingly, there was no malaria this time. There was a great deal of problem with dry eyes. I think this is due to a combination of the dusty environment and the smoke from cooking stoves in the houses. Next time, we will have to bring enough artificial tears so that everyone can take home a bottle!
In addition to the four practitioners we brought from Canada, there were 2-3 African practitioners that worked alongside us, seeing patients and giving us some insight into the tropical diseases. One person in particular that was a joy to work with is a young man named Benedict who was a beneficiary of the MCF program. He has been on my heart for years. Our family met him when he was a young boy and he told us he was going to be a doctor. Now, years later, he has made that dream come true! He is working as a physician in Kenya and came to help us on two of the five days.
I am so grateful to each member of the team that we brought from Canada. They provided excellent care in a low service area despite cultural and language barriers, fighting off jet lag and living in barracks-type conditions. To say I am proud of them is a massive understatement. Every one of them is a hero in my eyes. And I am so grateful for the pharmacies, physician’s offices and the people at Health Partners International of Canada who all donated medications to assist with the project. Finally, we could not have done this without the generous financial donations that family, friends and colleagues gave to support us. Thank you all so much!