Lena: Hospitals in Migori

Posted 12:36 AM, November 14, 2007, by lenawine

On Monday morning, we visited our first of the 12 sites involved in the study in Migori. We went to Karungu, a sub-district hospital, on Lake Victoria. It was almost a 2 hour drive from Migori, where we are staying. A 2 hour drive is in itself not short, but when you are in a double cab truck with 7 other people on extremely rough roads (if you can even call them that), it becomes interminable. Now I understand why only 4 of the 12 sites are currently distributing antiretroviral therapy (ART). I had been told it was partially because we didn’t have enough vehicles. When we went to visit the site we brought a host of ART drugs with us as well as TB drugs. In addition, we brought clinical staff with us capable of administering and distributing these drugs. We visit a different site each day (Monday through Thursday) in this way and hence, 4 sites are currently active. When we have another vehicle, theoretically 4 more sites could be activated. I don’t want to oversimplify here, because there are other criteria that must be satisfied as well; for example, they must have at least 50 people who have tested positive for HIV. ...
Karungu subdistrict hospital:

On Tuesday, we visited Muhuru, another sub-district hospital. As on the previous day, I helped monitor the patient records, a talent I developed during my year off when I worked on a phase III clinical trial as well as during my time as a coordinator for the Arbor Free Clinic. It essentially consists of ensuring that information is complete and consistent within both the patient forms and the register that lists all the patients seen. I also helped Janet pre-test some of her questionnaires that she will be using to interview pregnant and post-partum women regarding AIDS stigma. I served as a notetaker/Kiswahili translator. It was quite interesting, sometimes surprising, and a bit depressing. It seems that there is not nearly as much stigma surrounding HIV as I had remembered from 2003. It’s unclear at this point whether this is a trend in the right direction, a difference based on location, or simply a coincidence. Many of the women reported some degree of depression either during their pregnancy or after, and every single women (all seven) reported having been at the very least verbally abused and many were physically abused as well by their partners during their pregnancy.
Muhuru Subdistrict hospital:

On Wednesday, we went to Rongo, which is supposedly the most accessible site because it is located along the main road. This means that we can take public transportation, e.g. a matatu. So we crammed our usual 16 or 17 people in the vehicle and then along the way picked up a few more. At one point, we pulled over and a surprisingly large number of people alighted (as they say here). I noticed that the tout (the money collector and conductor) was actually giving these people additional money back – something I’ve never seen before. I put the pieces together a few moments later, when I was instructed to buckle my seatbelt, another event I’ve never witnessed before. We were approaching a police checkpoint. About 5 years ago the new president at the time had instated limits on the number of people to be carried in matatus and had additionally required that matatus be outfitted with enough seatbelts for every passenger. When I returned, I assumed that these rules were simply being ignored. In fact, rather than simply being ignored, these rules were being circumvented. Matatus had learned where the checkpoints were and made certain to appear as if they had been following the rules. Shortly after passing the checkpoint, we again began picking up passengers and filling the van far beyond its legal capacity.
Rongo district hospital:

We also met with the District Manager of Health (DMOH) for Rongo, which is a newly designated district. He expressed during his satisfaction with the work that FACES has been doing, but also that he would prefer programs that address the whole health of a person, rather than just focusing on one illness, such as HIV in our case. I guess the issue of horizontal versus vertical programs isn’t some topic we just debate about in classrooms. He cited an instance in which a child is prevented from acquiring HIV from his mother who is HIV positive, only to die of malaria before the age of five. Unfortunately, this stems from the realities of funding agencies, which often award grants based on proposals to address specific diseases. On a brighter note, we are in the process of rolling out a ‘food as medication’ program as studies have definitively and repeatedly shown that adequate nutrition is essential to good health – sometimes you have to wonder if research was really necessary to show this – I mean all I can say is duh.