Lessons learned during a week in the Chemolingot Sub County Hospital

After my first week here at the Termes Center in Chemolingot, a small town in the Tiaty sub-county of Kenya, I feel as I have already learned so much. I have spent the week becoming familiar with the clinicians and staff that work to keep the Chemolingot Hospital- the largest functioning hospital of its size in Tiaty- operational. This facility serves one of the most diverse patient population in Kenya, and services an area the size of Rhode Island. The clincians provide a variety of services, including maternity and antenatal care, emergency care, routine labwork, and serve as the primary referral location for Visceral Leishmaniasis, an infectious disease endemic to the region. Through my interactions with the clinicans, I has learned about the many challenges that face the local community. In this region, many of the people are Pokot, a sub-group of the Kalenijin tribe. The area around Chemolingot is quite arid, and many of the people rely on livestock herding to survive, as the climate facilitates poor crops yields. As a result, food insecurity is a serious ongoing issue for many villages, especially those located in remote areas within the mountains, where isolation and transportation difficulties lead to difficulty accessing the key  components of a diverse diet. I had the opportunity to join the Kenyan Red Cross, along with the ACCIH field manager Mwatela Kitondo on an nutritional outreach to an isolated village called Donge. I learned that in the week prior to the outreach, news of its occurrence is spread throughout the surrounding communities. Oftentimes a community health volunteer finds an area where many community members will be found, such a water point to spread the message. The community members encountered at this location then spread the message back to their neighbors and friends back home. I learned that oftentimes, villages are located far from designated roads to reduce the risk of raids from bandits and/or police, which was especially an issue in the past. Although they have developed this mechanism for survival, it makes getting news of ongoing programming a bit more difficult. Despite this barrier, a large group of families from Donge and other villages attended the outreach. 

As the outreach began, the Red Cross provided the community with an “education session”. In this session, a variety of community health topics were discussed. This specific session centered around the varied aspects of hygiene. Community members were encouraged to practice safe water and food practices. There is a communal pit toilet in the village, however, the volunteer emphasized the importance of avoiding using the bathroom near drinking water, and to ensure any waste was buried if not using the pit toilet. Additionally, the importance of boiling drinking water, and cooking in a clean environment was also emphasized, especially in the context of avoiding water and foodborne illnesses. 

July and August are notorious for having high incidences of malaria infections. The rainy season provides the still water needed for mosquitos to breed, so the Community health volunteer also discussed malaria prevention techniques, such as the use of a mosquito net, and importance of clearing the bushes and brush around sleeping quarters.

Finally, the volunteer informed the community about nutrition and the nutrition supplementation program the outreach centered around. As mentioned before, in these remote areas, food insecurity and acute malnutrition remain serious challenges. 

After the education session, the outreach session begins. The Red Cross, with the support of UNICEF, the Kenyan Ministry of Health, and USAID runs a nutritional supplementation program for children under the age of 5 and pregnant/lactating mothers. Community members are screened for acute malnutrition through the calculation of a height-for-weight Z-score, and Mean Upper Arm Circumference (MUAC) test. A Z-score of -1 qualifies as mild malnutrition, -2 as moderate, and -3 as severe. Based upon the patient’s degree of malnutrition they receive sachets of peanut meal supplement or porridge. This supplementation is enough to last the enrolled patient 2 weeks, until the occurrence of the next outreach. Enrolled patients receive check-ins every two weeks until they are no longer considered to have acute malnutrition, at which point they are discharged from the program. This supplementation program serves as a lifeline for many Pokot families struggling with food insecurity and ensures the young children have the resources necessary to grow and develop, and that pregnant and lactating mothers can support the increased demands on their bodies.

In addition the nutrition supplementation program, there is also a robust vaccination initiative. I had the opportunity to observe as clinicians administered life-saving vaccinations to young children and babies in these remote villages, who otherwise might not receive adequate vaccination. I witnessed the administration of Polio, Rotavirus, and TB vaccines. Polio and Rotavirus are both oral vaccinations (which I learned to administer myself!), while BCG (for TB) is administered intramuscularly.

When speaking with the clinicians, I learned that not only is food insecurity a chronic issues in these areas, poverty is also quite prevalent. The primary care patients receive at these outreaches are vital touchpoints, as otherwise a patient may struggle to pay for transportation to the nearest health facility. The often hours-long journey across rocky dirt roads and flooded paths can cost around 1500 KSH each way, a price too high for many families to afford.

Despite the amazing experience this outreach was, I was disappointed to learn that its continuation is in jeopardy. The nutritional supplementation program, supported by USAID is at risk due to cuts to US global outreach and humanitarian efforts. Many of the clinicians emphasized that without the funding and support, many children, not only in Donge and Kenya, but around the world will suffer. 

I hope to continue to make direct impacts on the community level, by attending subsequent outreaches. I have prepared some of my own programing about Visceral Leishmaniasis and anemia to deliver at subsequent outreaches to help decrease disease burden. Once I return to Northeastern in Boston, I also hope to advocate for the continuation of USAID, especially after witnessing its direct impact.

I still have 3 weeks remaining in my research engagement and cannot wait for the many more insights I will have into the landscape of public health and clinical services in Chemolingot and wider Kenya.