Field notes from Kenya: Medcan Naweza

Everyday victories at rural clinics

Medcan Naweza aims to curtail the harm of non-communicable disease through a sustainable model of durable, quality health care.

When a patient walks through the doors at either the Fluorspar or Lewa clinics, the two rural Kenyan clinics partnership with Medcan Naweza, almost any condition or circumstance is a possibility.

This is evident in the July and August posts by Team Lead Stacy Francis on Naweza’s sixth trip since 2013. The posts reveal that on any given day the team may provide post-natal care to a mourning mother and her surviving twin infant, treat and counsel a patient suffering distress over their HIV+ status or screen women through a new cervical cancer program. This summer’s outreach alone has included dozens of cataract surgeries, the continued data collection from a mobile health tool for heart disease monitoring and the implementation of a new chronic disease prevention program led by community health workers.

A condensed excerpt from one of Stacy’s posts is below.

Training and education for local clinicians

The morning was dedicated to didactic training by all four Medcan Naweza docs.  The topics were chosen by the clinic and the doctors had planned accordingly.  The training took place in the lovely outdoor area where they have a projector screen, which the doctors use for their presentations.  Each of the docs taught the material in an interactive way involving the clinicians by asking questions and answering theirs.  The staff seemed very engaged and eager to learn.  A very good sign!

We then went back to our lodge, had a very quick lunch and headed back to the clinic within an hour.  We had about 70 patients waiting to be seen, many of them waiting to see multiple doctors, given the rare opportunity to see a Western doc.  We anticipated a long afternoon.



Treating stroke symptoms with limited medication

The doctors saw patients with a myriad of issues.  One sad case involved a 38-year-old woman who had experienced a stroke 3 years ago due to atrial fibrillation, a heart arrhythmia.  She came today in order to be seen by a “mzungu” doctor (white doctor) to get an opinion on whether she would get better.  The stroke resulted in paralysis on her right side and speech aphasia.  At this point she has regained her speech and most of the use of her right side, however, it is still very weak. We’ve given her a prescription for anti-coagulant to prevent future stroke and propranolol to control the heart rate.  However, the main issue is that she requires a valve replacement which is highly unlikely given the expense of it.  Without it she risks another stroke or other life threatening issue.  But we do what we can do in this limited resource environment. 


Managing expectations in different working environment

I think this is the most challenging part for the Medcan Naweza doctors.  They are accustomed to diagnosing a condition, prescribing the treatment and in turn that patient receiving the treatment.  Although that treatment may not necessarily result in a positive outcome, the patient at least has a chance.  In this setting, the patient many times does not have that chance due to the lack of resources.  A Western doc who is used to making the sick better with all of the resources available, whether it be diagnostic testing, abundant drug choices and surgical interventions, feels at times powerless.  And this can be emotionally demoralizing to a person who has chosen a profession to make people better.


Community Health Workers play integral role in program implementation

Registered Nurse Vanessa Churchill spent the second part of the day with Emily, a community health worker.  They took the clinic ambulance to the local church where Emily had organized for members of the community to assemble.

This was to be Vanessa’s opportunity to explain the Community Health Worker Kit, which will serve as an educational tool for Emily when trying to educate on chronic disease.  It was also a chance for Vanessa to observe how Emily interacts with her community so that we can provide guidance on the advice she offers them.  Vanessa will do a separate write-up describing her experience.


Fearless wildlife offers humour, relief

A funny story that happened was when a cheeky little monkey ran over and stole food out of a person’s hand and then ran up a tree.  He proceeded to peel of the wrapper and eat it tossing the wrapper away after he finished.  As the wrapper was falling to the ground hitting branches along the way, the Kenyans were all laughing hysterically.  I think the monkey was too!

We were finally finished.  The doctors had worked without a break from 2 p.m. until 7:30 p.m. without as much as a bathroom break.  

Dr. Bekeris's wife supporting the cataract surgeon, Agnes!

 Dr. Sidiqa removing the bandages.

Cataract surgeries for dozens of patients

Tomorrow we will do cataract surgeries at the hospital.  Dr. Sidiqa and Lydia will go to the hospital to observe the procedures and keep informed on each patient file so as to ensure proper follow-up, especially in the event of complications.

During outreach trips, the visiting Canadian physicians, nurses and specialists work in collaboration with their Kenyan counterparts to treat the whole patient given the limited time and resources.  Throughout the year, the Canadian health-care team connects virtually with bi-weekly video visits.This health promotion and disease prevention initiative established in 2013 is the Medcan answer to the World Health Organization challenge to address non-communicable disease in low- and middle-income countries, by:

  • addressing risk factors for cardiovascular diseases, diabetes, chronic respiratory disease and cancer among outpatients in remote, rural, resource-limited settings
  • in-country visits and virtual consults that support treatment strategies, early diagnosis and risk reduction for chronic disease and complex medical cases
  • relationship and trust building in the community through health literacy and public education

See Medcan Naweza on Instagram for photos, or visit the Medcan Naweza website for more info.

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