Update! September 2004

Dear Friends of Kijabe:

It has been an exciting and hectic time since I last wrote to you. I have been sitting on some important news now for several months, and I feel I can finally share it.

First, an update on our activities:

(1) Free voluntary counseling and testing services (VCT) have been available since June. We are grateful to those whose generosity helped us to re-model the necessary room, train our staff, and hire a full-time counselor. We are also indebted to the American Centers for Disease Control (CDC) for assistance with the training costs.

VCT services are meant to help individuals obtain confidential testing. For those who are HIV-negative, an emphasis is placed on changing sexual behavior. For those who are HIV-positive, early referral to the clinic will hopefully prevent the all-too-common situation of patients presenting very late in the course of their disease.

Almost 100 individuals per month are seeking testing at Kijabe. The positive rate is astonishingly high, approaching 25%. We hope and pray this figure will come down over time.

(2) Our new HIV/AIDS community nurse and educator is a very dynamic individual named Beatrice Kiama. Beatrice is an outstanding teacher with extensive knowledge of the areas surrounding the hospital. She has spoken to 5000 people in the region about HIV prevention, and almost 100 community health workers have been trained. She openly discusses those cultural practices which facilitate the spread of HIV. We know from experience in Uganda that such an approach, with an emphasis on abstinence, can result in behavior change. In that country, Kenya’s neighbor, research conducted by a Harvard anthropologist showed that nine out of every ten Ugandans who heard this message changed his or her sexual behavior. This change in turn has led to a significant reduction in HIV prevalence rates in a country which was once on the leading edge of the epidemic in Africa.

(3) Care of those already infected continues to absorb the bulk of our efforts. Currently, 135 individuals receive antiretroviral therapy in Kijabe’s clinic. We provide treatment of opportunistic infections (those which attack HIV patients) to hundreds more.

And now for the exciting news I have been wanting to share.

Recently, a consortium of Christian groups received an award from the President’s Plan for Emergency AIDS Relief in Africa (PEPFAR). This grant aims to provide life-prolonging care through Protestant and Catholic hospitals and clinics. Kijabe will receive assistance in the first year of the program, and our effort under this grant has just begun.

Like all such grants, the focus is narrowly defined: provision of antiretroviral therapy (ART). Fortunately, resources are available for expanded laboratory monitoring as well as for nursing staff to follow patients in their homes. The emphasis will be on providing “durable community ART’; in other words, an intervention that will allow effective therapy and the avoidance of drug resistance for years to come. We are partnering with community groups to identify and refer individuals before they end up terribly ill on hospital wards. In the first three weeks of the project, over 40 patients have received a home visit from Kijabe staff.

The grant is intended for patients immediately around Kijabe Hospital. Most of those already in our clinic will not be eligible. We hope to continue providing care to all of our current patients, many of whom will continue to depend upon the HIV Patient Fund.

We are excited about this recent development, although the increased patient load will place a serious strain on our already busy clinic. We are grateful to all of you for it is your assistance that helped place us in a position to receive this grant. The donors were impressed with our existing program and infrastructure.

Future directions include:

(1) Continued quality provision of antiretroviral therapy for those both within and without the project area. Patients receiving free drugs from the project still must pay clinic and other costs (the US government is particular about what it will and will not pay for), and many patients survive as subsistence farmers without any cash income. We are also afraid that the project may not provide enough drugs for children; our early community efforts have identified a disproportionate number of infected orphans. We would like to provide care for all of these children.

(2) Expanded support of HIV patients by helping to cover hospitalization costs. We already do this for many HIV-infected children. HIV-infected adults often have costly hospital bills which they cannot clear. The grant does not pay for hospital costs.

(3) Hiring of additional staff to assist with HIV-related activities.

(4) Nutrition assistance (using fortified flour) for those hungry in the region. Poor Kenyans tend to rely on unfortified flour because it is the only staple they can afford.

Ultimately, we will need to consider remodeling or even constructing new clinic space to handle the ever increasing flow of patients.

With your help, we have now entered our fourth year of providing antiretroviral therapy at Kijabe Hospital. Our HIV activities, which have included prevention of mother-to-child transmission programs, palliative care and antiretroviral therapy, now also consist of an active community component and VCT.

We hope to continue expanding both the number of patients treated and the variety of services offered at Kijabe Hospital.

One such person who has received antiretroviral therapy at Kijabe for three years is James, a 14 year-old orphan living in a children’s home close to the hospital. I have written of James before, to tell of his miraculous recovery from tuberculosis and rampant chicken pox infection. Today, although he has struggled with pneumonia, James is healthy and does well in school. Unfortunately, neither myself nor any of the Kijabe staff could bring ourselves to tell James just exactly what is wrong with him. That was left to a young missionary named Zane who has befriended James over several years and has helped with the costs of his care. Here is Zane’s account, which is worth quoting at length:

Sitting next to him sharing a cup of chai along with Jeremiah, we sat alone...the three of us after saying a prayer that God would be present, that He would sit with us. As we sat there asking questions it became clear that this orphaned child had no idea what disease his body carried, no idea why he takes nine pills a day, no idea why he visits the hospital twice a month for check ups and blood tests, no idea why three years ago he laid on a hospital bed sitting at death’s door, no idea why as a young child he watched his mother suffer from a similar illness only hers ended with an excruciatingly painful death.

Jeremiah and I sat for about an hour fumbling over questions looking into each other's eyes for some answer, for some way to get through this. How do you tell an orphaned child with absolutely no support system that he has HIV, that his body carries a disease that will eventually, inevitably take his life?

It didn't matter, he needed to know. I had spoken with his doctor, the nurses, his dorm mother, the director of the orphanage. None of them knew how to tell him. No one knew what to say. The sad thing was at that moment neither did I. Who am I to tell him? I don't live with him. I'm not a family member. I'm not the director of the orphanage. I'm not his doctor. Then I realized what made it my place to tell him were not my qualifications or the time that I spend with him. What made it my place was that he loves me and I love him. That God had brought our paths together and at this particular moment in his life he needed someone. Someone to love him enough to be honest.

Turning to James I began to tell him how much I love him and I asked him if he knew how special he is to me and to every person who enters his life. I talked to him about his heart and how when God created him He put something special inside his heart. Jeremiah then asked him if he knew how much God loves him. Growing increasingly aware of the weight in the air James responded with a muffled "yes."

I then asked him if he knew what HIV stood for and if he knew what it does. I then proceeded to inform him about the disease and that it causes a person’s immune system to become weak, so weak that it becomes difficult to fight off any illness. I told him that that was why his mom died. At that moment his head dropped. Placing my hand on his leg I proceeded to tell him that just like many things that we receive from our parents he has received HIV from his mother.

His body collapsed as he broke into tears. As he began to cry I kept talking. I told him it was nothing he did. I told him that it wasn't his fault and that he is going to be okay. I reassured him the best I could by telling him Jeremiah and I are here for him. I told him I loved him, Jeremiah loves him, and that we will never stop loving him. I told him that he is going to live a full life and that he will continue receiving the medical care he needs to keep healthy.

We sat there, Jeremiah and I, alone with a fourteen year old orphan crying...crying in absolute fear that his life is no more. Crying with no one to hold him, no mother, no father, no one. The tears would not end. It took everything I had not to cry. I couldn't even look at Jeremiah because I knew if I did the tears would flow. So we sat and we sat with only prayer to comfort us in the stillness. I asked James to talk to us but he couldn't. He could barely catch his breath between the pain of his tears.

About thirty minutes passed and he finally calmed down enough to where he could look at us. I asked him what he was thinking and immediately his head sunk back down with tears. I then realized there was nothing we could do except be with him. So there we sat, losing track of time, only aware of how hopeless our situation was and how real the pain.

So that was exactly what the three of us did...we shared the pain.

It is hard to imagine repeating this story 100,000 times in Kenya, for there are 100,000 infected children, and a million orphans in this country. I have seen James since this episode took place, and he is the very definition of courage.

Some readers may remember the family (whose picture I shared) described in my last update. I am happy to report that my namesake, Fielder Esiokoon Ekai, is HIV-negative. The fact that he is alive and HIV-negative is due to the antiretroviral therapy provided to his mother Alice by the Kijabe HIV Patient Fund. Unfortunately, because of the family’s financial situation, the child became very malnourished and developed tuberculosis. With food assistance and drugs, he has improved and we expect a full recovery.

This past week I accompanied two of our nurses on home visits. Some patients have started drugs under the project, and for the first few weeks they are visited frequently to detect side-effects and other problems. One patient walks two hours—one way—to the hospital. Her house commands a stunning view of the Great Rift Valley. I asked her, through our nurse, if she knows that she lives in a beautiful place. The nurse translated her Kikuyu response: “She has not been knowing that. She says it is remote.” What for me is a pleasure, this wonder of creation, is for her a hardship.

It was heartbreaking to visit homes and see whole families—parents and children--ostracized by their relatives. Still, many communities are mobilizing to help affected individuals and families. We have tapped into existing community structures and home-based care groups to identify and assist those in need. We hope that this approach will allow communities to take an active role in improving the health of their members.

The Kijabe Medical Patient Poor Fund

We continue to assist impoverished patients, with and without HIV, to obtain the medical care they need and to clear their hospital bills. The sad fact is that the hospital is owed 205,000 US dollars by patients, most of whom will never be able to pay. A few examples:

(1) Grace is a 50 year-old woman who arrived at the hospital in shock due to heart failure. I took one look at her heart with the ultrasound machine and told the intern that maybe we should just make the patient comfortable. But we decided to giver her a chance in the intensive care unit using intravenous medicine to improve the pumping action of her heart. Am I glad we did that! She improved dramatically and was able to leave the hospital, albeit after we helped clear her fairly large bill. (The family was able to pay a small amount.) Two months later Grace is doing quite well, without any fluid build-up in her body.

(2) Elizabeth is a 30 year-old pregnant woman with HIV and pulmonary tuberculosis. She improved in the hospital but had literally no money to pay for her care.

(3) Gloria is a 45 year-old HIV-positive widow who had been doing very well on antiretroviral therapy, with help from the Kijabe HIV Patient Fund. Then one day she experienced sharp pain in her pelvis. At the hospital she underwent emergency surgery and was found to have a twisted ovary, which was removed. After the surgery she developed a pneumonia but again recovered. Her family paid a small part of the bill, and we paid the rest. Today, she continues to be well while taking her HIV drugs. I recently visited her home, and she will be able to participate in the new project.

(4) Peter is a 13 year-old boy who presented to the hospital with juvenile diabetes, a devastating diagnosis in Africa because of the expense of insulin. A long hospitalization was covered by the Medical Patient Poor Fund.

(5) Some readers may remember Teresiah, a 24 year-old HIV-negative woman with severe tuberculosis. I included her x-ray with my last update. Teresiah almost died, but with prompt attention at Kijabe and the high flow of oxygen we are able to give, she pulled through. Her care was paid for by the Medical Patient Poor Fund. Later, during the public transportation strike, we brought the necessary medicines to her one-room dilapidated shack where she lives with her young son. We continued to help her with the cost of transport and medical care, and just last week she finished treatment. She has gained 25 pounds and, except for a mild cough remaining from the lung damage, she has recovered completely (see picture). She was very thankful for all the assistance she received at Kijabe Hospital, and she promised to visit us in the future.

These patients and others have benefited from the compassion and generosity of people a world away.

Lastly, Amanda and I would like to share our plans. Initially, we had intended to stay at Kijabe for one more year, through the middle of 2005. With the arrival of this new project and the great amount of exciting work remaining at Kijabe, we feel God is calling us to continue for another three years. To do this, we must switch from Samaritan’s Purse, our current mission, to a new organization, Africa Inland Mission, which has also helped handle contributions to the HIV Patient Fund in the past. We are grateful to Samaritan’s Purse, as well as to those friends who have helped make our time here possible.

In November, Amanda and I will be visiting churches and friends to speak firsthand about our ministry in Kenya.

Grace and Peace,

Jon and Amanda