Update! March 2005
Dear Friends of Kijabe:
Over the last two months I have several times attempted to provide an update on our progress, but the situation continued to change so rapidly I decided to delay.
Now, finally, we have a moment to share…
(1) Since its inception in August 2004, the Kijabe Hospital component of the President’s Emergency Plan for AIDS Relief (PEPFAR) has grown exponentially. We are working closely with our oversight agencies, Catholic Relief Services and Catholic Medical Mission Board, to provide quality care to as many patients as possible. At Kijabe Hospital, this effort is known as AIDS Relief.
As of this writing, 675 patients are receiving care through Kijabe’s HIV clinic. Of these, 73 are children less than 14 years of age and over 60% are women. Two hundred and ninety are on antiretroviral therapy (ART). The rest are being treated for opportunistic infections or are being prepared to begin ART.
We stress patient education and home visits prior to and after starting ART. Our nurses and adherence officers, alongside 375 trained community health workers, provide home-based care and alert the clinic staff to any problems. We are fortunate to have such hard-working professional Kijabe staff overseeing this effort, but they are stretched thin trying to attend to so many patients over such a wide rural area.
This past week we visited a remote region about 45 minutes’ drive from Kijabe. We visited patients and confirmed they were using their drugs appropriately. Attached is a picture of Elizabeth with two of our community workers, our driver Hiram and nurse Stephen. Elizabeth is pregnant and taking drugs both for her own health and to prevent mother-to-child transmission of the virus.
On another home visit we saw Susan (see attached), who has been on ART for a year and half. She has regained her health and works in her shamba (small farm) to feed her family. Jane (see attached), who has also been on drugs for a year and a half and now has a high CD4 count, is shown with her baby. The child, born at 27 weeks, stayed for two months in Kijabe Hospital and is now HIV-negative. The Kijabe Medical Patient Poor Fund paid for part of the hospitalization.
Unfortunately, not all cases have yet turned out so well. In Alice’s home, we found a thin woman under treatment for TB trying to care for five children, including two of her sister’s. One of these, a nine year-old HIV-positive boy, was developing Kwashiorkor malnutrition from lack of protein. Hunger is a distressingly common problem. While visiting a 21 year-old woman also under treatment for TB, we asked if she was using the fortified flour given to her in the clinic. She replied that she had prepared a little that morning, but that there were too many people in the home, and she was too hungry to share.
In terminal cases, we provide home-based palliative care: pain management, wound and skin care, counseling, prayer, and unconditional love and support.
(2) In conjunction with the ART program, voluntary counseling and testing (VCT) services have grown. We now have five trained counselors, allowing us to conduct mobile VCT. In January, over 250 clients received free testing and accurate information about HIV. Because the positive rate is high (between 25 and 30%), many of these are referred for care to the ART clinic at Kijabe.
(3) To meet this growing demand we must continue to train and mentor qualified and committed Kenyans. Our team now consists of two dozen people and we hope to expand in the near future to meet the needs both in the clinic and in the community. We worry that the project will not provide all the necessary staff for such a large number of patients. Currently, in addition to myself, there are four clinicians, seven nurses, six adherence officers, and other assorted personnel in the lab, pharmacy, medical records, VCT, and accounting sections of the hospital.
Training volunteer community health workers has also been a priority. We have conducted one-week sessions for 375 people living in surrounding areas. Of these, 175 have been pastors, many of whom are now fully engaged in helping their parishioners and other community members. They refer positive members of their congregation and try to reduce stigma in their communities.
We have also conducted barazas (community meetings) and have visited schools stressing prevention, abstinence, and compassionate care for the infected. Over 10,000 people in surrounding communities have received accurate information about HIV from a Kijabe Hospital staff member.
(4) We are happy to report that in the first six months of the program not one Kenyan shilling has been denied as a valid expense by the donor. In fact, we have been informally told that Kijabe’s financial reporting is the best not only in Kenya but of all the Catholic Relief Services sites in 10 different countries. We also hired an external auditor and its report confirms this good news.
(5) Both the Medical Patient Poor Fund and the HIV Patient Fund continue to help patients with hospital and other bills (for example, antenatal and maternity care or surgery) not covered by the US government (PEPFAR) grant. Thanks to the efforts of our Dr. Ivy Mwangi, women are aggressively screened for cervical cancer; with some financial assistance, one such patient was recently able to undergo a needed hysterectomy. We find these funds invaluable to provide holistic care to the patient. It does not make much sense to provide an HIV-positive pregnant woman with antiretroviral drugs yet deny a safe birth in the hospital because of poverty.
(6) In the past, the Kijabe HIV Patient Fund has focused on the acquisition and provision of antiretroviral drugs on behalf of the poor. To an extent, this is still the case. Certain necessary ARV drugs are not provided by the US government (PEPFAR) and we must continue to buy them privately. And still other drugs—for pneumonia and many other conditions—must be purchased with this account because the grant is not able to meet the needs of such a large number of complicated patients.
Any cursory comparison of the pressing needs and resources available—even including the Catholic Relief Services program—shows a great discrepancy. For an expanded catchment area including over 60,000 HIV-positive patients, we still only have five clinicians and the personnel mentioned above. We hope to expand staff beyond the grant’s allowance. Not only must we hire these personnel, we also need to train them appropriately. In addition to clinic and hospital costs, we have an urgent need to create space to deal with such a crush of patients and to house our growing staff. We are seeking to partner with individuals and community groups to provide clinical services closer to patients’ homes, a logistical challenge that can only be met by having more competent personnel. And patients are requesting more of the fortified flour to supplement their low-protein diets.
We are grateful for the generosity of so many of you as we struggle to meet these new needs and challenges. Two and half years ago there was an HIV clinic with 32 patients and one provider, myself. We had no community effort aimed at education or follow-up. Today, in terms of both patients and staff, these numbers have increased over 20-fold. We have an active community care program to complement outstanding clinical services in the hospital.
All of this makes a tremendous difference in the lives of patients, as some of the above stories attest. A recent study found that, in the West, ART adds 15 years of life for an HIV-positive person. (Compare this figure to 20 months of life for coronary artery bypass surgery for a heart disease patient.) We believe this number can be even higher in Africa, utilizing community-based models of care. The key is developing sustainable on-the-ground structures for delivering this care which can then be matched with people of generosity and good-will.
We are eternally grateful for the generosity and support shown by all of you to these people--forgotten for so long--whom you have never even met. Assuredly, this is love.
Grace and Peace,
Jon
