Tumaini Status

08/25/06

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We will be in Kenya for 10 weeks departing from Seattle on June 7th, 2006. 

My goal is to post the status of our work on the project at the end of each week:

August 18, 2006         

    After a week in Mombasa enjoying the wildlife and beaches of coastal Kenya, we are back in Nairobi for one week of final preparations. It is a little nerve-racking to think that after all the intense personal attention we have given the project, soon we have to step away all at once, fingers crossed, and see what happens. Luckily, I feel the support on the ground is solid and our staff is ready to stand on their own. As time consuming and occasionally tedious as it could get, being thorough with details such as patient education or designing endless forms really helped set the stage for a smooth execution later on. We have to do our best to make sure everything is documented properly and that each person involved is clear on their role and where to go to get help if needed. Our staff point-person on the ground is one of the Clinical Officers at Hope. His job will be mainly to keep track of patients as they make their way through the screening process. There are several systems that we have put in place to record who gets what and who needs what along the way. And to do so within the current structure of the clinic is very important so that integration of the project is as smooth as possible. I think it is amazing how little waves we have felt so far (knock on wood!).

  There was the small issue of space in the clinic: we sort of usurped the nurse’s station for the hospital’s private rooms for the clinical activities of the project from 3-5pm daily. We had the blessing of the hospital director but had to put up with the nurses coming in and out to get supplies. He was very kind and understanding of our needs and said, “I think we Egyptians are even more conservative than Americans so I understand your concern for patient privacy. However, the nurses need that room to care for their patients so we cannot keep them out.”  The discussion led us to the conclusion that we should try to move back into the Hope clinic facility and take over one of the nursing rooms there. Not a perfect solution seeing as how the clinic is practically busting at the seams – there are already several tents in the clinic garden to serve as offices for the counselors – but since we are already taking a nurse, we might as well take a nursing room as well. To do this kind of work we must be willing to work to a consensus among differing perspectives, navigate through existing structures (both physical and sociological) and improvise given limited resources. And in the end, the most important consideration is always whether or not we are still offering a valuable service to the patient.


August 2, 2006

  I am happy to report that the program has officially started and we have already screened several women. We are slowly integrating the nurses into the role as primary screeners and though it will take a little time for them to feel comfortable with the procedure and with handling the flow of patients, we feel very confident that they will manage in time. More importantly, though, they feel confident that they will be able to manage.
  Another concern is that the nurses, as well as the doctors who will be referring the patients, will have enough knowledge to be able to adequately inform and educate the patients. There is a shocking lack of information concerning cervical cancer and Pap smears here so I feel this is a great opportunity for us to spread the word and disseminate good information. Plus, if we provide good care to the patients at Hope, they will be more likely to speak favorably about cervical cancer screening to their family and friends who may, in turn, feel like getting screened. So, at the training, on July 15th, we tried to stress the importance of informing the patients to the extent that there is even a consent paragraph on the initial visit form for the patient to sign, showing their approval of the procedure and that they have been adequately educated about it. Of course, you can’t expect everything to be totally clear in an afternoon training session but I think we made some real progress and at least we know that everyone is on the same page as far as our reasons for starting this project in the first place (in fact, we have been asked by many staff members whether they or their friends can come in for screenings!).
   Now that we have started enrolling patients, we are seeing the types of questions patients have and how the doctors are handling these questions. All the little details of the project come into focus and it has been like submerging our inner-tube to discover where the leaks are. It is a great way to test our problem solving and also shows us that for the most part, a strong foundation for the project has been set. So we busy ourselves with designing, redesigning and printing forms, buying office supplies, rounding up stock for the exam room (and then making signs so the equipment doesn’t wander off), etc. Then in the afternoon, we see patients, all the while smoothing out rough spots. But really, the learning and teaching that occurs - sometimes overtly and sometimes secretly - is the most rewarding part of the process and will be the most lasting, both for us and the staff here.
 

July 14, 2006

Hey guys very busy but here is what's up:  The weather has definitely turned and it is chilly most days. I brought a fleece lined jacket thinking I wouldn’t need it much, but these days I wear it everyday. In fact this morning I was even able to see my breath on my walk to the clinic. This week is also significant in that it is our 5th week here in Kenya, half way through. It is pretty incredible but understandable how fast time has passed seeing as how busy I have been. But I think the work is really paying off and this week will mark the official introduction to the clinic of our program, CCSP. It is great to see the project in the final stages of preparation. On Friday we have a presentation to the entire staff, outlining the generalities of the program and describing how it is important in this setting. Then on Saturday, we will have a training for the doctors (who will be referring patients for screening) and the nurses (who will be doing the actual procedures). So this week we are busy making training manuals and presentations and finalizing and printing out forms to practice with. The paperwork associated with a program like this is formidable, especially when we have put such an emphasis on tracking patients so we make sure that these women are getting the care they need.
Getting a program of this size going requires quite a bit of logistics, especially since we are working with two different hospitals and four different nationalities. For the most part, though, I think everyone is committed to the patients and to having a successful program.


July 7, 2006

  Sorry for the delay in updates; all I have been doing lately is running around and working. We have several projects going on (and several more in the works) but one big one that has taken up the bulk of our time (including nights and weekends!). One of my smaller projects has been perfecting the brochures that are used in the clinic to counsel patients including a Kiswahili translation of a training manual for the clinic counselors (they spend 4 sessions with the patients in the early stages of their treatment).
Also, I have been working on a treatment protocol for managing patients with extensive Kaposi’s sarcoma (a common cancer of AIDS patients that presents quite differently in Africa than it does in the States), which is challenging working within the confines of drug availability (and affordability) in this setting. However, the big project has been the project that most of our (and your) hard earned Tumaini money is being directed toward, the Cervical Cancer Screening Program (CCSP). We have been doing research and interviews and marketing of this project to all concerned to try to plan and implement a project that will really add to the value of HIV care at the Hope Clinic. As it stands, women in Kenya rarely get screened for cervical cancer even though it is the biggest cancer killer of women (maybe the biggest cancer killer overall). And immune-compromised women may be at higher risk for invasive cancer than other women. We are really excited about the progress we have made and have passed most of the barriers that were in our way. Frankly, it has been an unbelievably smooth operation compared to my previous experiences working in developing countries. I think we have had great support and a bit of project money in pocket never hurts for getting things moving!
 

June 23, 2006

   This is the end of my second week in Kenya. We have been very busy getting used to the place and trying to keep up with all the work!  Most of our time is spent at Coptic Hospital where the Hope Clinic is located. The Coptic hospitals are run by Egyptians who basically are volunteers and are involved in various areas of the hospital. There are more Kenyans than Egyptians but most of the administration is Egyptian. At the Hope center (where the HIV work is done), it is mostly Kenyan with a couple Egyptians (and a couple Americans!). It is much more organized than I had expected. There are doctors, nurses, pharmacists, counselors, social workers, receptionists, and volunteers. It is a great operation. They have a strict protocol that they work from and each patient must follow all the steps including multiple counseling sessions on various issues, from adherence to nutrition, before they can start on HIV medications. It is an effective set-up and it ensures that the patients are well aware of their conditions and what it will take to keep them healthy in the future.

 

June 11, 2006

Hello everyone. this is my first message from Kenya. We had a good flight and were able to take the opportunity of a half-day layover in London to stretch our legs in town and see some of the sights. Robyn has lots of experience in London so we were able to find a nice walk and get back to the airport in time for a latte and our next leg of the journey. Touching down in Kenya, I felt excited to be back in Africa and interested to see how this country would compare to the others I had lived in. We got through the airport with little incident (I'm happy to say they didn't lose my bag like the first time I flew through Nairobi) and we were able to easily meet the drivers from the hospital, Peter and Cornelius. Our first real interactions with Kenyans was very successful and it seems as if east African hospitality extends all the way up. The guys were very happy to learn that I spoke Kiswahili and joked that they would find me a Kenyan wife so I could really be Kenyan! We picked up a SIM card for the phone and came back to our new apartment. It is a spacious place on the 4th floor of a building that is about 15 minutes walk from the clinic. We have two bedrooms, 1 1/2 bath, a kitchen and a dining room. We settled our things, took a nap and then set out on the town to find some supplies and to get a lay of the land. So far, Kenya is very similar to Tanzania. People speak Kiswahili on the street (though more people can speak English), they dress very similarly (at least to people in Dar es Salaam), and they seem to be engaged in the same sorts of activities. There are more cars here and though people commute in these mini-buses ('dala-dala' in Tanzania, 'matatu' here), there are many more in Dar. As for the weather, it has been nice with temperatures between 60 or 70 and overcast. I can see how it can get cool though and we'll see how things progress through the summer. We spoke with Dr. Michael Chung and he offered to take us shopping so we may do that this weekend and then he is going to pick us up to go to the clinic on Monday. I am excited to see what all is going on there!

 

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This site was last updated 08/25/06