Updates from the Field: Public Health Fellows Andrew and Anika
‘Write Blog’ has been on our ‘to-do’ list since arriving at Hopecore just over 4 months ago. Now as we come to the end of our stay here we have found some time to reflect and finally write that blog. For those that don’t know we are two UK-trained medical doctors that arrived at HopeCore to work with the public health team in February 2013. We were both born in the East of England, met at medical school in Brighton, married 2 years ago in Cambridge, and then moved to Australia for 18 months. It was whilst working there that we met Dr Robyn Parker who pointed us in the direction of HopeCore for our next adventure.As you will see from this blog it’s been busy at HopeCore as the public health department has been in a period of accelerated growth and evolution. There have been lots of new developments and challenges to face, with which the current staff have not only kept up but pushed for more.
The office clinic revamp!
The Chogoria office has a nurse lead clinic providing quality health care, family planning services, and counseling to our loan clients and their families, school children, and young people aged 14 – 25. Previously the clinic has looked very much like any other room in the office – a desk and a chair, perhaps only distinguished as a clinic by the large plastic box of medicines. Nurse Winjoy persevered at offering good and safe clinic services in this environment but was limited by the clinic provisions. A donation of 600 USD from the fundraising efforts of an Australian Hospital, (Thanks Maroondah Hospital Emergency Department!), was enough to transform this office room into a proper clinic befitting Nurse Winjoy’s clinical skills and our patients’ needs. The clinic now has an examination couch, a privacy screen, a large and lockable medicine cupboard, dressing equipment, and educational posters.
Patients can now be properly examined (for example it is impossible to examine an abdomen unless the patient is lying flat), given injections and treatment on the bed (hands up who has fainted at the doctors – generally a good idea to faint on the bed rather than the concrete floor!), and patients privacy and dignity is better maintained by examining behind the screen.It has also given the clinic a much greater scope of care, for example, we are currently advertising our clinic as a youth-friendly sexual health and family planning service as the bed has made it a place we can now safely administer contraception such as depot injections and implants (We are hoping to get a sterilizer at some point so we can offer coils/IUCD). In general, it is a better clinic that represents HopeCore’s commitment to the health of the community.
Two schools a day.
Caroline had very kindly updated the blog for us regarding the public health department getting to 2 schools a day now, but as the team has doubled their workload we feel it’s worth a double mention!The bulk of public health’s term time work is visiting rural schools where they give a health lecture (such as hygiene, first aid, malaria) and a mobile health clinic to see any unwell pupils. These schools are also the schools that benefit from the water tanks for drinking and hand washing and mosquito nets for malaria prevention. It is a very well-received service by the pupils, schools, and local community and due to its success HopeCore has strived to make it bigger, better, and reach more people. The number of schools receiving these services began at 23 and has expanded to 64 with a further 30 receiving the water tanks only.
As you can imagine this has been a real challenge for the team but one that has been met head on…If we do the maths, HopeCore has 1 nurse, 1 teacher, 1 community health worker, 1 driver, 2 volunteer doctors, and one set of equipment. They must get to 64 schools – a total of 20,000 children, continue to see loan clients, manage other projects and try not to lose their sanity. Not a small task! However, by reorganizing our weekly timetable, maximizing the efficiency of our working hours (leaving first thing, encouraging schools to assist us by having rooms ready, etc), and utilizing the skills, flexibility, and energy of the team we have been able to reach 2 schools a day for 3 days a week enabling us to reach all 64 schools once per term. The remaining 2 days are dedicated to loan client needs, the youth clinic, referrals/follow ups and office duties. Each team member has really stepped up to the challenge, our coordinator has us on the road on time and arriving at well-organized schools, our community health worker has proven systematic and safe as she has learned to triage the schoolchildren, our nurse delivers a consistently good and caring service and our teacher confidently delivering a newly designed and high standard curriculum. What’s more, they seem to be happy in their work towards a shared dream.
We would love to take all the credit for this achievement that has occurred during our stay, but it very much belongs to the whole of the public health team. And it seems others have noticed the hard work too as last week HopeCore was awarded ‘best supportive organisation’ by the Ministry of Education for services offered to local schools.
Mwezi project.
It had been brought to our attention by several teachers at our schools that some of the menstruating girls have difficulty managing their periods at school. Reasons for this difficulty have been attributed to the lack of a suitable product and the lack of facilities at the school to allow for private and hygienic menstrual management. Menstruation is also not a topic that is openly discussed in this community. We have started to introduce the subject of menstruation in the adolescence and reproductive health lectures but it is just a brief overview delivered to the whole class. It seems that more information is needed to equip these girls with managing their periods and changing bodies.
Having looked beyond our community, a lack of menstrual education and sanitary products is proving a problem for other developing world girls too. Research conducted specifically in Kenya found that pubescent girls were disempowered by their menstruation, some girls even reported having to exchange sexual favors to male relatives for money to buy sanitary pads. Girls often cannot afford sanitary products so they resort to using unhygienic and ineffective methods such as pads made of paper or scrap cloth. This lack of access to products and inability to menstruate without fear of leaks and smells was found to cause anxiety, embarrassment, and poor self-esteem.
As such, some girls missed school during menstruation. The Ministry of Education suggested girls in Kenya, grades 4-8, who had periods, missed on average 6 weeks of school every year. This widens the existing gender divide that keeps girls from accessing education, health services, and their universal human rights. As a response to this HopeCore has started a pilot project – the Mwezi project. So-called because saying ‘menstruation project’ multiple times a day was getting tiresome and Mwezi means moon (and month) in Kimeru, and no one makes their menstrual cycle look easier than the moon! We have 2 schools involved, 25 girls from each school. Both groups received a menstrual health and puberty lecture alongside 42 of their parents/guardians. It was well received and lots of questions were answered after. The girls were privately interviewed by our team;
63% of the girls thought they were sick or dying on the first day of their period
35% of them admitted missing school due to their period (actually felt by the team to be an underestimation as they thought one school was reluctant to answer truthfully)
Of the girls who missed school, the majority cited a lack of sanitary products as the reason, followed by pain.
One group has been given washable sanitary pads and the other group has a reusable menstrual cup. We are visiting the girls every few weeks to see how they are getting on and take the chance to bring them together to talk as a sisterhood where menstruation is not a dirty word, so far so good. We will interview them at the end of the term to evaluate their experience of the Mwezi project. If we find the provision of education and sanitary products has benefited the girls then we will be looking at ways to roll the programme out. We will keep you posted.
Glasses.
The World Health Organization estimates that globally 314 million people are visually impaired and that 90% of these people live in the developing world, with 80% of these cases being preventable or treatable. A major cause of visual impairment is refractory error, a condition that could be easily diagnosed and corrected. It is also a condition that is common in children with estimates of over 100 million young people affected. In African school children, the prevalence of visual impairment due to refractory error has been estimated between 5-10%. During the mobile clinics, we frequently see children complaining of headaches, aching eyes, and blurring vision. Often these children are found to be short-sighted (myopic). At present, we advise these pupils to attend an eye specialist for glasses and to sit at the front of the class at school.
Unfortunately, many of the pupils are unable to attend an eye specialist due to the distance involved in traveling and/or the finance involved. Additionally, whilst sitting at the front may be beneficial in class it does not help outside of the classroom. Working on previous research performed in similar African populations and by collecting some of our own data we estimate that 1000-2000 of our 20,000 school children may suffer from myopia that could be helped by wearing glasses. Child ViSion™ tackles poor vision by providing self-adjustable glasses through school-based distribution programs in the developing world. The glasses use innovative fluid-filled lens technology to allow the wearer to adjust them until they can see clearly. They are designed for use in parts of the world where there are too few optometrists to screen patients and prescribe custom glasses for refractive error. They are simple to adjust and can be dispensed by almost anyone with basic training. Hopecore is hoping to become a partner organization of Child ViSion™ so that they can distribute the glasses through its school program. Please see their website http://www.vdwoxford.org/childvision for more details and keep your fingers crossed that we could be distributing these glasses by the end of the year!
Other developments.
A new car, a new employee to work on the clean water project, and a complete rethink of the sexual health and reproduction project – there’s always more to do here! In a big nutshell that is some of what we have been up to! It has been a rollercoaster of 4 and a half months for us experiencing public health medicine in Kenya, lots of ups and downs, twists and turns, but in the end, the ride was a good one, accompanied by some lovely colleagues and patients. We hope HopeCore continues to go from strength to strength, as we have seen it do in the last few months, and as we all know – Hope Changes Everything! Asante, Anika and Andrew