Kenya Healthcare Outreach Program Report 14 t h -24 t h November, 2013

Prepared by Peter Kalenga-Camp Kenya Program Coordinator Edited by Vics Gillbard Camp Kenya Program Manager

JRIP
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Contents Acknowledgements Abstract Introduction 1. Background of the Healthcare Program..6-11 a. Healthcare 2011 b. Healthcare 2012 c. Healthcare 2013 2. Data Analysis and interpretation.12-29 a. General analysis b. Eye clinic analysis c. Dental clinic analysis d. Malaria analysis e. Jiggers analysis f. Jigger record statistics of each location

g. Skin infection analysis h. Urinary Tract Infection (UTI) analysis i. j. Bilhazia analysis Other ailments analysis

3. Conclusion and Recomendations.30 4. Future Plans..31 5. Comments..32 6. Photos..33-34

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Acknowledgements Camp Kenya would like to thank the following people for their assistance, guidance and knowledge. The Ministry of Health is integral to the success of the outreach clinics and without the dedication from the UK nurses,

especially those who have returned year after year, the free healthcare outreach clinics would not be possible. Special thanks to: Dr Stan Kinsch All at Msambweni Ministry of Health Base Titanium District Education Officer Head Teachers and Teachers from all six Primary Schools; Zigira, Muhaka, Makongeni, Fihoni, Magaoni, Mkwambani Darrad Oral Health Care Kwale Eye Centre Pamoja Red Cross JRIP Japhet Young people from Muhaka youth club Camp Kenya staff Harleys Pharmacy Ocean View Dental Diani police Chiefs of each village Religious leaders of each village Local people from Muhaka, Zigira,Magaoni, Fihoni, MkwambaniMakongeni

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Abstract Many people in Msambweni County are living below the poverty line and its estimated that 70% do not have access to proper educational facilities or healthcare. Camp Kenya has been working with the communities of

Makongeni and Muhaka for 11 and 6 years, respectively, to improve their standards of living and gain access to educational resources through Its volunteer programs. Camp Kenya started free healthcare outreach clinics in Kwale County in 2011. During the 2011 clinics, it was discovered that many children live in unsanitary conditions and most of them suffer from debilitating intestinal worm infestations and diarrhea, resulting in stunted development and

disease. Those under 10years of age are most at risk due to poverty and consequently a distinct lack of nutrition, lack of access to affordable and adequate medical facilities and a lack of personal health education further compound the problem. Many organizations have been formed to raise campaigns against Malaria,TB, Cholera and Polio through education

awareness, both domestic and international, however, it has only worked well with those in urban areas, where most of these organizations are based thus leaving those in the rural areas at a high risk of death.

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Section 1 Introduction This report focuses on data and information collected during the 2013 free medical clinics conducted by Camp Kenya medical volunteers, local

medical staff and volunteers from the 15th 24th November. The main aim of these clinics was to offer education on health issues affecting the local community consultation appropriate. In years 2011 and 2012, eight locations within Msambweni were identified by the Public Health Officers as areas requiring assistance, however, this year we focused on six locations which were; Muhaka, Zigira, Magaoni, Fihoni, Mkwambani and Makongeni. More than 40 medical staff, both from UK and Kenyan, worked tirelessly to treat over 5000 patients with more than three to four ailments, and within just six days they managed to collect the data that follows. Data was gathered from laboratory tests, medical consultations, medical observations, focus group discussions, as well as prescriptions from medical staff. To reduce the opportunity for results to be biased, all methods that were used were standardized across the board. Methods and Materials Simple research methodologies were used to analyze the data collected Figures, tables and numbers have been used in this report to show the total number of patients seen and treated by the doctors / nurses, categorically within the six locations. Bar charts and pie charts have also been used to show how the population of specific locations are affected by different ailments, and how they vary with the other locations, both in numbers and percentages, followed by short discussion. This report is divided in to 4 sections: Introduction, historical background of the Camp Kenya healthcare program. Statistical analysis and discussion, Remarks future plans and conclusion. in Msambweni a area, community or nurse members and to to be receive treated a if

with

qualified

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Results will determine; Which location is either highly or less affected by a certain disease Total number of people affected by certain diseases in each area Impact from the Camp Kenya healthcare program and will enable us to develop and improve the program year on year for the benefits of the communities The aim of the report is to provide a comprehensive data analysis that can be used by both domestic and international medical experts in formulating strategies which can lead to solutions towards certain diseases caused by poor sanitation within Msambweni County. It is not intending to offer any permanent treatments to diseases or offer medical advice.

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Section 2 Background of Healthcare Programs a) Healthcare 2011 In November 2011, with permission from Ministry Of Health, Msambweni, Camp Kenya officially launched the Healthcare Outreach Programs# with medical professionals from the UK to provide free medical treatment and advice on nutrition, sexual health and hygiene and a strong focus on jigger eradication campaign within eight villages in Msambweni County .

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During the program a short survey was conducted and it was discovered that many children live in unsanitary conditions and most of them suffer from debilitating intestinal worm infestations and diarrhea, resulting in stunted development and disease, especially those under the age of 10 years of age. During the course of two weeks, the team successfully treated 7,444 medical incidences within the locations. Many people were treated for three or four different ailments at the same time and every patient was dewormed. b) Healthcare 2012 Last year in November, healthcare outreach was initiated within the similar eight locations in Msambweni. Volunteer Nurses from the UK provided general treatment and advice on different health issues facing the community and at least over 6000 people were treated. .

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Laboratory services were issued specifically for the malaria test and a social malaria survey was also conducted during this period to determine whether the community understood what causes malaria but the results were not verified due to data misplacement. The program was a huge success and a clear indication that the needs are vast and wide with thousands of people on the South Coast of Kenya who

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have little or no access to basic healthcare and often are unable to gain simple treatment. c) Healthcare 2013 Based on our intervention last year, this year Camp Kenya intended to provide a more condensed and effective program and consequently

collaborated with Base Titanium in order to offer a greater number of services and education for the communities. Camp Kenya had a group of 30 volunteers comprising mainly of practice nurses, mid wives, public healthcare assistants and social health workers from the UK.Muhaka, Zigira, Magaoni, Fihoni, Mkwambani and Makongeni were identified as main central free medical clinic location during the period of 15th until 24th November 2013.

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There was a huge involvement from the Government Ministry Of Health (Msambweni County), medical students from Msambweni hospital, Kenya Red Cross and Non Governmental Organization medical experts from Darrad Oral Healthcare and Kwale Eye Centre. Volunteers from local small scale

stakeholders such as PAMOJA Mwembe Tayari (A group involved with TB campaigns and jigger education), JRIP (involved in Jigger eradication and the coastal representative of Ahadi Kenya) and youth participants who were utilized to translate.

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Base Titanium Limited (LTD); a company located within Msambweni county assisted with funding to support the program and Camp Kenya collaborated with the local medical staff in order to plan and organize the logistics. .

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Unlike the past two healthcare programs, this year the program was more advanced with multiple ideas from the oldies (re-visiting nurses from the

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UK), local medical experts and newbies (new UK nurses). The team not only offered treatments to the locals but also focused on solutions to various aspects concerning fundamental health issues that affect Msambweni

community and its environs. Education on family planning, sexual health, nutrition, TB prevention, first aid training, and polio were prioritized as well as education on personal hygiene to prevent jiggers.

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The reason behind the collaboration with various groups and the Ministry of Health was to promote sustainability of the healthcare program, empower the locals on sustainable methods concerning personal health and hygiene, especially jiggers, and signpost them as to where they can access free or low cost medical assistance.

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Having

been

advised

with

documented

evidence

from

World

Health

Organization Camp Kenya were keen to use this opportunity to trial a new approach on Jiggers eradication and treatment method which is 50%

paraffin and 50% cooking oil. The introduction of footbaths at each school will also enable a study to be carried out whereby it can be determined if this is an effective long term method which can consequently be adopted by the locals who will be able to access the treatment easily and potentially

reduce the cases of primary school dropout due to Jigger infection.

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Section 3 Data Analysis, Interpretation and Discussions a) General Statistics from the Six Clinic Locations Over the course of two weeks, more than 50 medical and non-medical volunteers successful operated six free healthcare clinics in; Muhaka, Zigira, Magaoni, Fihoni, Mkwambani and Makongeni and below is some of their achievements. More than 4000medical incidences were successful treated Laboratory tests for malaria and Bilhazia were successful carried with over 200 people tested. Strong education on Tuberculosis, First aid, sexual health, Leprosy, jiggers and personal hygiene was carried out by the Ministry of Health Msambweni and UK medical professionals. A footbath trough was constructed in each of the six primary schools to be used for jigger treatment purposes Over 500 school children received first aid training 40 successful teeth extractions were done 147 people with eye problems were treated, with five having successfully undergone surgery at the Kwale Eye Centre The table below shows the data recorded during the event
Table 1

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The bar chart below summarizes the total number of people seen with different type of ailments and referrals subject to the location, where the clinical medical survey was carried out.

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Most common diseases found were fungal skin infections, jiggers, Malaria, Urinary Tract infections (UTI), malnutrition, Upper and Respiratory Tract

Infection (URTI& LRTI)Bilhazia, eye/ear infections, joint pains, allergy, jiggers, pelvic infections: Salpingitis, Puerperal Pyrexis and caesarean GIT problems e.g.Amoebiasis,dysentery,pneumonia.typhoid,ulcers, asthma etc. Multiple

drugs were mostly used in these cases and many cases were treated with pain killers and antibiotics.

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General treatment was provided to all people, some people were treated for more than three to four ailments. Those with critical conditions were referred for further medical checkups. b) Eye Clinic Analysis Table below shows the data recorded during two days of free eye clinic Table 2 Clinic locaton Zigira Makongen i Total No The Total of patients Seen 57 90 147 Mal e 31 37 68 Femal e 26 53 79 by the Referred for Surgery 6 11 17 Kwale Eye Attended Surgery 2 3 5 Centre

Date 19/11/13 24/11/13

optical test was successfully

conducted

opticians. Modern optical equipment and technology was usedto detect eye problems during the clinics. 147 people were treated and some issued with free glasses, 17 were identified with serious eye problems and they were referred for surgery. People above 60 years seemed to be more affected. The common eye diseases seen were Dacryocystitis, Conjunctivitis and Ketatitis. People affected with cataracts were referred to Kwale Eye Centre for surgery. Out of the 17 people referred only 5 turned up for the surgery. It is
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unknown why the others did not attend, however this could be due to family responsibilities, financial constraints or fear which may also be to do with being uneducated. Ivyflur, Moicell, orbidex,Tetracycline and Gentamycin eye drops were issued to treat various eye problems.

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C) Dental Clinic Analysis

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A dentist from Darad Orol Healthcare conducted the operations in three days as indicated on the table below. Modern dental equipment and technology was used during teeth extractions and treatment.

The table below shows the data collected during three days of free dental clinics
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Date 22/11/13 23/11/13 24/11/13

Clinic Location Fihoni Mkwambani Makongeni Total

Total patents Treated 16 19 28 63

Extraction & Medical Treat 16 8 16 40

Only Treatment 12 4 1 5

Refused extraction 0 2 1 3

Referred 4 5 10 15

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Out of 100%, 63% had their teeth extracted and were given medication, 8% received only medication, 3% resisted extraction due to fear.29% were referred to Darad Oral Healthcare for root canal (RCT),full mouth scaling, permanent fillings and further medication. Diclofenac and antibiotics such as Ampiclox and Amoxylin were typically used for the dental treatment. Medicaine was used during extractions as an anasthaetic. Reasons identified leading to tooth decay was determined as: Lack of dental health education on how to care for teeth Ignorance lack of initiative to brush teeth Lack of access to dental care when a tooth problem starts Use of cariogenic foods (sugary food which causes tooth decay) Poverty lack of funds for toothbrushes and toothpaste

Most of the people referred for root canal, mouth scaling and permanent fillings were willing to go for treatment but due to financial constraints, they have been unable to attend so far. Dental treatment is expensive and locals cannot afford the treatment .e.g. Root canal filling can cost more than 500 Kenyan shillings (USD $5) and for a person living on less than one US dollar per day, this can prove to be extremely expensive.

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d) Malaria Analysis Malaria is a disease caused by anopheles mosquito, it has been categorized in the list of globally dangerous diseases that causes infertility and mortality, especially with expectant mothers and children. Recently, Scientists from the London School of Hygiene &Tropical Medicine discovered a mosquito species that potentially gives dangerous new malaria which has never been implicated in the transmission of malaria before.

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Many organizations have been formed to raise campaigns against Malaria through education awareness, on both a domestic and international level, but it has only worked well with those in urban areas where most of these organizations are based, leaving those in the rural areas at a high risk of death. During the consultations at the clinics, 501 people were referred to the laboratory for malaria testing. Two laboratory technicians carried out the tests using; unfrosted slides, walkadine solution and a microscope to determine the presence of plasmodium malaria parasite in blood cells of each correspondent. Malaria rapid test kits were used to verify the results to ensure precision.

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The table below shows significant figures of the final laboratory results
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Out of 501 who went through the laboratory test, 35% (174) were found to be Malaria positive. Last year, a similar survey was carried within the same areas and only 47 people were identified to be Malaria positive. This year the numbers are significantly higher. The table above shows Fihoni is leading with a high percentage of Malaria cases followed by Magaoni. The bar chart below presents the data of malaria cases recorded during the clinic period

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e) Jigger Analysis Jigger is a painful parasitic infection, most commonly affecting feet and fingers, caused by the chigoe flea (Tungapenetrans). If left untreated it can lead to more serious secondary infections, expensive medical bills and loss of study time for children. It also increases the risk of spreading HIV as people share the needles that they use to remove the flea larvae.(B yDipesh Camps international Healthcare Posted on 7th December 2011).

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Camp Kenya has been treating jiggers on a small scale, since 2011, using potassium parmaganate. The number of cases this year has been significantly lower which could indicates that; jigger healthcare campaigns held during the healthcare clinics in 2011 & 2012 had an impactor maybe because there has been a lot of jigger campaigns in the region. During the 2012 healthcare outreach clinics, 1282 people were treated for jiggers, shoes were distributed and approximately 200 houses fumigated. The reduction is highly likely to be a combination of all of these factors.

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The Table below shows jigger data collected during the clinic period
03>4'!,! Total People checked Jiggers 550 1158 700 710 274 477 3869 No. for Jigger Not Present 466 954 462 414 187 390 2873 Jigger Presen t 84 200 238 104 87 60 773 Not infected 55 183 163 78 61 38 578

Date 18/11/1 3 19/11/1 3 20/11/1 3 22/11/1 3 23/11/1 3 24/11/1 3

Clinic Location Muhaka Zigira Magaoni Fihoni Mkwamban i Makongeni Total

Infected 29 17 75 26 26 22 195

3869 people who attended the medical clinics were checked for jiggers and only 773 were found to have jiggers present. In general, 195 people out of 773 were seriously infected by chigoe flea (jigger parasite).The table above shows Magaoni is leading with those people seriously infected. See the Pie chart below

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Magaoni and Zigira had the highest number of jigger cases with 31% and 26% respectively,as shown on the pie chart above. A sustainable method of jigger treatment was introduced;mixiture of50% kerosene and 50% vegetable oil. Unlike in the past, when potassium permanganate was used, which is very expensive and the locals could not afford to purchase, the aim of this

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was

to

ensure

all

school

children

will

be

able

to

access

sustainable and affordable treatment. By dipping their feet inside the trough that contains the mixture of kerosene and oil every day as they attend their classes this has the potential to dramatically reduce the number of children with infected jiggers. This treatment is still under trial, however it was highly supported by the Ministry of Health (Msambweni) and if it works be a very good sustainable method to fight jiggers. then it will

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f) Jigger statistics recorded in each location Muhaka Out of 550 people who were scanned for jiggers, 15% were found to have jiggers present with 5% seriously infected. (See figure 18. below)

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Zigira Out of 1158 people who were checked for jiggers, 16% were found to have jiggers present with 1% seriously infected. (See figure 19 below)

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Magaoni Out of 700 people who were scanned for jiggers, 34% were found to have jiggers present with 23% seriously infected (See figure 20 below)

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Figure 20 Fihoni Out of 710 people who were scanned for jiggers 15% were found to have jiggers present with 4% infected. (See figure 21 below)

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Mkwambani! Out of 274 people who were scanned for jiggers, 32% were found to have jiggers present with 9% seriously infected. (See figure 22 below)

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Makongeni Out of 477 people who were scanned for jiggers 18% were found to have jiggers present with 5% seriously infected. (See figure 23 below)

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g) Skin Infections A fungal infection is also known as Mycosis. Although most fungi are harmless to humans, some of them are capable of causing disease under specific conditions. Fungi reproduce by releasing spores that can be picked up by direct contact or even inhaled. Thats why fungal infections often affect the lungs, skin, or nails. Fungi can also penetrate the skin to affect your organs and cause a whole body systemic infection. (Article written by Abdul Wadood Mohamed and Winnie Yu | Medically Reviewed by George Krucik, MD Published on July 25, 2012)

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Fungal infections are contagious disease and can spread from one person to another. Figure 24 below shows the total number of people treated for fungal infection in each location.

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Common fungal skin infection cases recorded were; ringworms, athletes foot, anychomycosis and candidiasis. The total number of cases recorded was 527,Zigira and Magaoni led with over 100 cases.

GN Urinary Tract Infection (UTI)

Urinary Tract Infection is an infection in any part of the urinary system kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract the bladder and the urethra. (Definition by Mayo Clinic) The figure below shows the number of UTI cases recorded in six locations.

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The total number of UTI cases recorded was 144, during the survey, women were found to be mostly affected.Based on Mayo Clinical findings; women have a greater risk of developing a UTI than men. A.D.A.M medical Encyclopedia review 26th January, 2012, states that Women tend to get UTIs more often because their urethra is shorter and closer to the anus than in men. Because of this, women are more likely to get an infection after sexual activity or when using a diaphragm for birth control. Menopause also increases the risk of a UTI'' Many cases were recorded at Magaoni compared to any other location with a total of 36 people followed by Fihoni with 33 respectively. In each case, strong antibiotics were the typical treatment used for all UTI infections and a strong sexual health education provided to the congregation.

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Bilharzia

Bilharzia is a disease caused by parasitic worms called Schistosomes. Environmental management board states that, over one billion humans are at risk worldwide and approximately 300 millions are infected by Bilharzia. It is common in the tropics where ponds, streams, dams and irrigation canals are present. Schistosomes must alternate between humans and snails to complete their life cycle. Under the tropics; any body of water containing vegetation could contain Bilharzia-transmitting snails. Washing, swimming or paddling in that water therefore exposes you to infection by the parasite. When the worms get into your body, they feed on red blood cells and dissolved nutrients such as sugars and amino acids. (Environmental management) This can cause anemia and decreased resistance to other diseases. The female lays hundreds of eggs each day, which find their way out of the human body through the urine or the faeces, depending on the species. This reactyion is mostly caused by the large number of eggs becoming stuck in various body parts, in particular the liver ; causing liver enlargement and malfunction and the kidneys (causing kidney damage, detectable by blood in the urine). The victim passes red urine, tinted by blood lost through the damaged kidneys. In the case of intestinal Bilharzia, blood may be passed in the faeces but is not often recognized. Both types of Bilharzia cause serious anemia and fatigue. Samples were referred for Medical Laboratory test to determine the presence of Schistosome eggs both in their urine and faeces. Few cases were recorded in each station. No Bilhazia cases were found at Fihoni. Figure below displays the results.

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The bar chart below presents the total number of people recorded with several other diseases

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Other ailments group is a general term which is used to define minor cases such as headache, Joint pains, tummy discomfort, ulcers e.t.c. Many people in this category were treated for more than three to four ailments, hence making the numbers to go higher than all diseases treated individually.

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Conclusion and Recommendations In conclusion, the healthcare outreach clinics this year have enabled a number of local health groups and professionals from the UK and Kenya to come together and offer over 4000 people from rural communities the opportunity to access free advise, consultations, tests, treatment and education. People have been referred to gain further treatment and sign posted to suitable, local health clinics. The new integration of local medical students proved to be beneficial for all and it is believed that both the students and the UK volunteers gained a great deal from the experience which will enable the students especially, to progress within their chosen profession. The addition of a dentist and opticians enabled people to be treated at the clinics and offered a far more specific benefit if suffering from dental or eye problems. By joining forces with Pamoja and JRIP, the focus was on educating the children especially how to care for and treat their jigger infestations which was of greater benefit and more sustainable than previous methods used. Ministry of Health and Pamoja gave intensive educational talks to all people that were waiting about TB which targeted a specific audience and from that we hope that more people will go for TB screening. The Red Cross trained all students at the primary schools we were based at and this will in turn generate discussions, enthusiasm and sharing of

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knowledge to their peers. It is hoped that the first aid training will be beneficial to avoid simple accidents becoming disasters. For the program to be successful on a continuous basis, we as Camp Kenya would recommend that we should be joined by a specific sexual health nurse focusing solely on sexual health and offering forms of contraception, Leprosy education for communities and mother and baby care. There are many areas that can be researched on the back of this report and we would welcome all new information gained if it will be of benefit for future clinics.

2014 Jigger Treatment Trial We will hold a meeting in January 2014 inviting all Community Health Workers from the six locations, Public Health Officer, Head of Health at all six primary schools and Nancy and Shee from Pamoja. We will discuss how best to implement the foot bath approach and when and where to arrange collection of the kerosene and oil mix.Pamoja will be in integral in the monitoring and evaluation, alongside feedback from the CHWs who will communicate directly with the Head of Health from each school. We have funding to trial this method for three months and it is suggested that this starts from February until April 2014 which will enable schools to settle into the new academic year and also it will give a greater overview as to how many children from each school are currently affected by jiggers. It will only be the students who currently have jiggers who will dip their feet to and from school each day thus giving a greater opportunity to gain accurate results.

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Comments from UK & local volunteers A great rewarding experience, meeting lifelong friends and using your knowledge to help others Chris Hovel, UK volunteer Nurse T h e p r o g r a m w a s v e r y w e l l o r g a n i z e d p l u s v e r y e n jo y a b l e . t h a n k y o u Susan Hicks, UK volunteer Nurse A r e a l l y e n jo y a b l e t r i p , s o m a n y c h a n g e s ( t o t h e p r o g r a m ) , w h i c h w a s g r e a t , Students nurses were brilliant. Camp staff really looked after us so well plus all amazing. Rebecca Monaghan, UK volunteer Nurse I have loved every minute, I will definitely be back.Ellie Rudd, UK volunteer Glad to hear that the camp was a success!!!! Saif, Harley's Pharmacy Limited It was a pleasure to be part of the team and to reach out to the many children and families that were touched in the six days! It shows that when we are committed and united as partners we can achieve more and even reach out to those who had no hope of anyone getting to them. It was really great, there was constant consultation and feedback and appreciation of each others views which is very important for a true partnership Christine Mwaka, Community Health Officer, Base Titanium Words cannot really describe priceless experience! Professionally, culturally and socially as well as cheesy but truly making a difference Karen Rudd, UK volunteer Nurse It was a great opportunity for us to get more exposed to the field of community health service and give our best in first aid training to our fellow peers. We therefore, believe our collaboration made a great impact to our community and we would like to pass our gratitudes to all organizers Juma Yusuf, Red Cross Volunteers

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It was educating and we really learnt a lot from the UK nurses and we shared a lot with them as well. There were also aspects with regards to therapeutic management and nurse management that we learnt. I would recommend more medical students are involved next time as it was an enlightening experience and we saw lots of new cases that we hadnt seen before Belinda Karimi, Msambweni Medical Student Great to see sustainable work/local involvement MichelleODriscoll, UK volunteer Nurse The screening was successful because we achieved what we had targeted, which was to see those with eye problems at each of the clinics. We received so many glasses and we will use the frames which will be very useful. We hope to be involved with the healthcare program again Mohammed Chame, Kwale Eye Centre To me, the activity was carried out smoothly and I want to thank Camp K e n y a a n d l e t t h e m c o n t i n u e w i t h t h e i r m o t t o t o r e d u c e t h e ji g g e r f l e a infestation Mr Makoti, Public Health Officer, Ministry of Health

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