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Lodwar Hospital, Turkana, Kenya

Date: March 31, 2016 Prepared by: Mwanaidi Makokha I. Demographic Information 1. City & Province: Lodwar, Turkana, Kenya 2. Organization: Real Medicine Foundation (www.realmedicinefoundation.org) Medical Mission International (www.mminternational.org.uk) 3. Project Title: Lodwar District Hospital (new name: Lodwar County and Referral Hospital - LCRH) Support - Health Systems Strengthening in Turkana, Kenya 4. Reporting Period: January 1st - March 31st, 2016 5. Project Location (region & city/town/village): Lodwar County and Referral Hospital (formerly Lodwar District Hospital), Lodwar, Turkana – Rift Valley Province, Kenya – 1,000 km from the capital city, Nairobi. Area Coverage: 750 km2 Geographical: Arid area characterized by scarcity, poor infrastructure like roads, electricity and other social amenities. Means of transport: Mainly trekking, a few buses only on the main road joining other parts of the country. Lifestyle: Nomadic, moving from one place to another. Dependency: Few animals-cows and goats; dependent on relief aid by WFP (World Food Program), GOK (Government of Kenya) and other agencies. 6. Target Population: Over 900,000 residents of the Turkana region Even though Lodwar County and Referral Hospital (formerly Lodwar District Hospital) officially only covers Turkana Central, in practice the district hospitals in Turkana North and South are not functional; hence the patients from those areas also come to Lodwar for referral care. Lodwar County and Referral Hospital (LCRH) is the only functional District Hospital in the entire Turkana region. It is categorized as level 4 which in an ideal situation is supposed to cater for a population of 100,000 with limited human resources, personnel and medical supplies and yet currently is functioning as a referral facility for all of Turkana’s 90 health centers and dispensaries including neighboring Uganda and South Sudan, which increases the catchment population to 1 million inhabitants. II. Project Information 7. Project Goal: Enable the Lodwar County and Referral Hospital (formerly Lodwar District Hospital) to fulfill its role of providing referral health care for the Turkana region. 8. Project Objectives:

• Rehabilitate the infrastructure of Lodwar County and Referral Hospital (formerly Lodwar District Hospital), beginning with the pediatric ward and proceeding to male and female wards, outpatient department, operating theater, and physiotherapy department.

• Rehabilitate equipment set at Lodwar County and Referral Hospital, beginning with the pediatric ward and proceeding to male and female wards, outpatient department, operating theater and physiotherapy department.

• Rehabilitate equipment set at Lodwar County and Referral Hospital's casualty department. • Provide regularity of supplies: basic medical devices, disposables, and pharmaceuticals, complementing the

items from Kenya Medical Supplies (KEMSA). • Rehabilitate equipment set at Lodwar County and Referral Hospital's dental department. • Rehabilitate equipment set at Lodwar County and Referral Hospital's MCH department.

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• Rehabilitate equipment set at the physiotherapy and orthopedic department. • Rehabilitate equipment set at Lodwar County and Referral Hospital's operating theater. • Rehabilitate equipment set at the maternity ward. • Provide equipment maintenance and spare parts management. • Organize on-site clinical training, beginning with general equipment use and care, and pediatric emergency

care. • Provide outreach campaigns.

9. Summary of RMF/MMI-sponsored activities carried out during the reporting period under each project objective (note

any changes from original plans): It is the beginning of yet another busy year for RMF Kenya. 2016 marks the 6th year that RMF will be working in collaboration with Lodwar District Hospital. Through its greatly improved infrastructure, services, and training, the hospital has been recognized for excellence by the Nursing Council of Kenya and the Kenyan Ministry of Health, and renamed Lodwar County and Referral Hospital (LCRH). RMF is proud to have initiated and to still be part of the transformation the hospital has undergone. With the New Year, Lodwar County and Referral Hospital faces new challenges, and RMF continues to support the hospital, helping ensure that LCRH is fully supplied and able to perform its functions well. RMF has begun the year by addressing the following needs: Medical Equipment: The nebulizer RMF purchased 6 years ago for the pediatric ward has stopped functioning properly due to its age, frequent use, and infrequent servicing (we have instituted training to improve maintenance and ensure equipment longevity). Since its nebulizer was no longer working, the pediatric ward had been borrowing a nebulizer from other wards. To remedy this equipment shortage, RMF purchased 2 nebulizers for the pediatric ward to replace the one that was not fully functional. Staff members in the pediatric ward were very excited to have a fully functional nebulizer again, since it was difficult and inefficient to work without a nebulizer in the ward. Medical Supplies: Continuing its emphasis on pediatric support, RMF purchased comprehensive medical supplies for the pediatric ward. From syrups such as Ampiclox, Ascoril, Brufen, Mucosolvan, and Piriton to injectable medications such as Piriton, Calcium Gluconate, Amikacin, Floxapen, Gentamycin, Diazepam, and Adrenaline were supplied. Fluconazole tablets were also purchased, along with other tablets. Dextrose 10%, 50%, and 5% were also supplied. The constant supply of these essential drugs and many others have gone a long way in benefitting the pediatric patients and ensuring that the pediatric ward continues to register low mortality numbers. Non-Pharmaceutical Supplies: As always, to support the entire hospital, RMF continues to purchase non-pharmaceutical supplies. Non-pharmaceuticals purchased include gauze rolls, strapping adhesives, branular gauges, gloves, methylated spirit, examination gloves, skin tractions, crepe bandages, and tourniquet bands, amongst other important non-pharmaceuticals. The non-pharmaceuticals are not only important in the day-to-day running of the hospital, but also in the case of emergencies with high need, such as traffic accidents, and when the hospital is in a crisis because of significant amounts of patients needing care at the same time, and large amounts of non-pharmaceuticals are required. Cleaning Agents and Disinfectants: RMF continues to support Lodwar County and Referral Hospital (formerly Lodwar District Hospital) by purchasing cleaning agents and disinfectants to keep the wards clean and germ free, and to prevent nosocomial infections as much as possible. Cleaning material such as detergents, hard brooms, soft brooms, and mops were purchased. RMF has been supporting Lodwar County and Referral Hospital with cleaning materials and disinfectants since beginning its partnership with the hospital, and these supplies have gone a long way to prevent nosocomial infections. 10. Results and/or accomplishments achieved during this reporting period:

• Pediatric patients continued to receive medical treatment and supplies for free. Emergency drugs that are not supplied by KEMSA and that patients would otherwise have to purchase are provided free of charge.

• Nebulizers purchased for the pediatric ward this quarter have greatly assisted pediatric patients who need to be decongested after asthma attacks. With easily accessible nebulizers, patients can be treated quickly and more

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effectively.

• The hospital also remains clean, and nosocomial infections are being prevented as much as possible with the constant provision of cleaning supplies and disinfectants from RMF.

• The hospital continues to record a high number of patient visits with low mortality rates due to the availability of emergency drugs, which are usually very costly and are provided to patients for free though RMF.

• Hospital stays for patients are minimal due to the availability of emergency drugs. Patients are attended to and discharged quickly.

• Traffic accidents and other emergencies are handled efficiently with RMF/MMI’s constant provision of non-pharmaceutical supplies for the entire hospital.

• All wards continue to benefit from the free supply of non-pharmaceutical supply purchased by RMF. • The sterilizer that was purchased for the operating theater last year continues to be used by the entire hospital.

Equipment can now be sterilized after procedures, thus preventing patient infection. 11. Impact this project has on the community (who is benefiting and how): Patients continue to access quality healthcare in a conducive, friendly, and healing environment. Real Medicine Foundation’s approach of being needs-oriented and working with flexibility has brought change to the Lodwar County and Referral Hospital (formerly Lodwar District Hospital) as a whole. The hospital continues to remain clean and hygienic; nosocomial infections are kept as low as possible.

The entire hospital staff and the locals have benefited from the project. The hospital staff, i.e. the medical officers, nurses, and support staff, have profited by working in better conditions, in terms of infrastructure and medical supplies. The pediatric patients continue to benefit from our program by receiving free emergency medical treatment when admitted.

Availability of supplies has also consistently motivated the hospital staff in serving the Turkana people/patients, making it much easier for them to do their work effectively. The community has benefited tremendously in the sense that drugs and non-pharmaceuticals are available. The locals no longer have to buy (or do without) costly drugs, syringes, gauze rolls, cotton wool, and emergency drugs, as these are supplied by RMF for the inpatient units at the hospital.

Not only have the pediatric ward, and male and female wards, benefited from the project, but the operating theatre has also been improved by RMF’s support. Patients coming to the hospital with fractures from Lodwar and the neighboring communities can now be attended to by the surgeon without further referral since all the equipment has been supplied by RMF. Consistent availability of medical supplies in the pediatric ward has also enabled patients to be treated and discharged at no cost. The hospital staff continues to be very motivated thanks to the continued support they get from RMF/MMI. 12. Number served/number of direct project beneficiaries (for example, average number treated per day or month and if possible, per health condition). A total of 35,427 outpatients (10,788 being pediatric outpatients); 1,108 inpatients (651 pediatric inpatients); and 375 occupational therapy patients were treated at Lodwar County and Referral Hospital in Q1 2016. Please refer to the morbidity & mortality numbers in Appendix B 13. Number of indirect project beneficiaries (geographic coverage): Lodwar County and Referral Hospital (formerly Lodwar District Hospital) is now the County Referral Hospital in the Turkana region, whose current population exceeds 1 million people. It is the only functional hospital with the capacity to support referral cases. The support from RMF with emergency drugs, medical equipment, non-pharmaceuticals, and the now complete infrastructure repairs of the in-patient unit has enabled Lodwar County and Referral Hospital to provide all these services. It is a referral center for these 6 districts:

1. Turkana South East District 2. Turkana South West District 3. Turkana Central District 4. Turkana North East District 5. Turkana North West District 6. Loima District

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14. If applicable, please list the medical services provided:

• Curative: treatment of illness, diagnosis (lab investigations, x-ray) management and follow up review with the Medical Doctor and/or Clinical Officer.

• Preventive: promotion of good health education, such as safe water, safe motherhood, HIV prevention, school health programs.

• Rehabilitative: occupational therapy and physiotherapy. • Eye clinic. • Dental services.

15. Please list the five most common health problems observed within your region.

1. Malaria 2. Gastroenteritis 3. Pneumonia 4. Snake/Insect bites 5. Diarrhea

16. Notable project challenges and obstacles: Unavailability of proper road infrastructure and public transportation to enable locals to bring sick patients to the hospital in time; patients have to walk long distances— frequently for days— to get to the hospital. Many sick patients do not get to the Lodwar County and Referral Hospital in time, which reduces their chances of survival. 17. If applicable, plans for next reporting period:

1) Continuous support of the pediatric ward in terms of medicines, medical supplies, non-pharmaceutical supplies, and equipment maintenance

2) Provision of medical equipment for the operating theater. 3) Provision of medical equipment and supplies for the pediatric ward. 4) Provision of medical supplies specifically non-pharmaceuticals for the entire hospital.

18. If applicable, summary of RMF/MMI-sponsored medical supply distribution and use: Provision of medicines, medical supplies (for the inpatient pediatric ward) and non-pharmaceuticals for the entire hospital - inpatient and out-patient units - priority is given to pediatric ward in terms of distribution and use. Success Story 1: Name: Eipa Loputei Age: 10 months Origin: Kerio History: Eipa was admitted with complaints of difficulty breathing, acute abdominal pains, fever, and general body weakness. It was the first time that he was admitted with these symptoms. He was born at home with no complications, and he did not get all the immunizations as per schedule. He was tested for HIV and he was HIV negative. Diagnosis: Acute Glomerulonephritis with SAM

• Blood slide (for malaria), negative • Malnutrition (SAM), weight 3.9 kg

Treatment:

• Flagylyne 5/7 • Paracetamol 5mls tds x 5/7 • X-Pen QID • Gentamycine 5mg/kg od x 5/7

Management of Malnutrition: Therapeutic milks: -F-75 for 3 days and -F-100 for 5 days.

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Eipa on admission Eipa on day of discharge Success Story 2: Name: Faith Amana Age: 49 months Origin: Napetet History: Faith Amana was admitted with complaints of severe wasting, stomach ache, and fever (temperature 37.8 degrees). This was the first time she was admitted with these symptoms. She was born at the hospital with no complications. She got all the immunizations as per schedule. Her parents were tested for HIV and turned out HIV negative. Faith is the second born in a family of three siblings. There has been no history of allergies or chronic illness. Diagnosis: Malnutrition with Acute G.E.

• Blood slide (for malaria), negative • Window test, negative

Treatment:

• Folic Acid 5g od • X-pen qid 5/7 • Gentamycine 4.5mg od 5/7 • Folic Acid 2/7 od • Paracetamol 2.5ml tds x 5/7 • Multivitamin 5ml tds x 5/7

Management of Malnutrition: Therapeutic milks: -F-75 for 2 days and -F-100 for 5 days.

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Faith on admission A bright-looking Faith on the day of discharge Success Story 3: Name: Erika Tirikwel Age: 10 months Origin: Kanaam History: This patient was admitted through the outpatient department with complaints of fever, vomiting, abdominal pain, and wasting. This was the first time he was admitted with these symptoms. Erika was born in the hospital with no complications, and he got all the immunizations as per schedule. Erika is the youngest child in a family of three siblings. Diagnosis: Acute G.E.; Pneumonia; SAM

• Blood slide (for malaria), negative • Severe Acute Malnutrition (SAM)

Treatment:

• Gentamycine 40 mg od 5/7 • Multivitamin • IV X-pen 1/2 ml qid 5/7 • Amoxyline 150mg tds 3/7 • Paracetamol 5mls qid 3/7

Management of Malnutrition: Therapeutic milks. Erika progressed well and was discharged after 13 days. Drugs used to treat him were RMF funded.

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Erika on admission Erika on the day of discharge The three patients mentioned above represent a small number of the many success stories we had at Lodwar County and Referral Hospital (formerly Lodwar District Hospital) in Q1 2016. RMF/MMI’s support by providing FREE medicines and medical supplies to inpatients at the pediatric department continues to illustrate how important emergency drugs are in saving young lives and how vital they are to the children’s recovery. Pediatric patients coming from poor families have been continuously treated with medications purchased and supplied by RMF and dispensed for free. The supplies have ensured that mortality numbers remain low and hospital stays are shorter. It is because of this noble gift by RMF/MMI that these patients are alive and their parents’ hope restored. The emergency drugs dispensed above are quite costly in local pharmacies around Lodwar town. 20. Photos of project activities (file attachment is fine): See Appendix A III. Financial Information 21. Detailed summary of expenditures within each budget category as presented in your funded proposal (file

attachment is fine). Please note any changes from plans. See Appendix C

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APPENDIX A

Drugs and other medical supplies purchased during the quarter

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Nebulizers purchased for pediatric ward in the quarter

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APPENDIX B LODWAR COUNTY AND REFERRAL HOSPITAL: Q1 2016

TOTAL OUTPATIENT SERVICES: JAN-MARCH 2016

No. General January February March TOTAL

1. General Outpatient (Filter Clinics)

Quarter (3 Months)

Over 5 years Male 952 971 1,138 3,061

Over 5 years Female 1,106 1,244 1,455 3,805

Under 5 years Male 560 662 823 2,045

Under 5 years Female

474 628 775 1,877

TOTAL 3,092 3,505 4,191 10,788

2. CASUALTY 3,437 2,874 2,771 9,082

3. Specialty Clinics

Eye Clinic 448 315 280 1,043 ENT Clinic 120 3 7 130 STI 17 5 8 30

MOPC, SOPC, POPC 391 297 250 938

4. MCH, FP Clients CW Attendance 2,499 3,353 3,560 9,412 ANC Attendance 679 585 680 1,944 FP Attendance 447 530 475 1,452

5. Dental Clinic 170 210 228 608

GRAND TOTAL 11,300 11,677 12,450 35,427

INPATIENT MORBIDITY & MORTALITY: PEDIATRIC WARD: JAN-MARCH 2016

DIAGNOSIS ALIVE DEAD

1 MALARIA 150 6

2 HIV 7 3

3 TUBERCULOSIS 8 1

4 INSECT BITE 13 1

5 SNAKE BITE 17 0

6 FRACTURE 17 0

7 SEVERE ACUTE MALNUTRITION 36 5

8 ANEMIA 63 5

9 BURNS 8 0

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10 MENINGITIS 10 2

11 SEPTICAEMIA 35 0

12 HERNIA 10 0

13 GASTROENTERITIS 66 2

14 INTESTINAL OBSTRUCTION 1 0

15 CELLULITIS 1 0

16 DENTAL ABSCESS 7 1

17 TRAFFIC ACCIDENT 2 0

18 NEONATAL SEPSIS 25 3

19 SEPTIC SCROTUM 1 0

20 FEBRILE CONVULSION 13 0

21 PNEUMONIA 152 8

22 RHEUMATIC HEART DISEASE 2 0

23 RTI 7 0

IN-PATIENT MORBIDITY & MORTALITY: FEMALE WARD: JAN - MARCH 2016

DISEASE ALIVE DEAD

1 MALARIA 28 6

2 PNEUMONIA 33 2

3 TUBERCULOSIS 12 5

4 FRACTURE 7 0

5 CERVICAL PROLAPSE 1 0

6 GASTROENTRITIS 11 2

7 ANEMIA 8 1

8 ECTOPIC PREGNANCY 4 0

9 PREMATURE RUPTURE OF MEMBRANE

2 0

10 HIV 9 3

11 HERNIA PROLAPSE 3 0

12 SEPTIC WOUND 4 0

13 SNAKE BITE 11 0

14 INSECT BITE 9 0

15 ABNORMAL UTERINE BLEEDING 1 0

16 ACUTE ABDOMEN 1 0

17 INCOMPLETE ABORTION 1 0

18 INTESTINAL OBSTRUCTION 1 0

19 MENINGITIS 2 0

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20 CUT WOUND 4 0

21 HEAD INJURY 1 0

22 HYDATID CYST 4 0

23 TYPHOID 3 0

24 PEPTIC ULCER DISEASE 13 0

25 ASCITIS 2 0

26 LOWER ABDOMINAL PAIN 3 1

27 OSTEOMYELITIS 5 0

IN-PATIENT MORBIDITY MORTALITY: MALE WARD: JAN-MARCH 2016

DISEASE ALIVE DEAD

1 MALARIA 39 5

2 PNEUMONIA 23 4

3 TUBERCULOSIS 29 9

4 FRACTURE 32 0

5 DIARRHEA 4 0

6 GUNSHOT WOUNDS 3 1

7 HYPERTENSION 3 0

8 CONGESTIVE CARDIAC FAILURE 3 0

9 ANEMIA 26 5

10 POISONING 2 0

11 HEPATITIS 3 0

12 TYPHOID 2 2

13 INSECT BITE 9 0

14 PLEURAL EFFUSION 6 0

15 KALA AZAR 4 0

17 PSYCHOSIS 11 2

18 PEPTIC ULCER DISEASE 3 0

19 SOFT TISSUE INJURY 1 0

20 MENINGITIS 5 3

21 SNAKE BITE 8 0

22 ACUTE ABDOMEN 1 0

23 BENIGN PROSTATIC HYPERPLASIA

1 0

27 APPENDICITIS 1 0

28 CEREBRAL VASCULAR ACCIDENT

1 0

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29 HIV 13 5

32 HEAD INJURY 6 2

33 CELLULITIS 17 0

34 CUT WOUNDS 5 0

35 ALCOHOLIC INTOXICATION 1 0

37 RENAL DISEASE 1 0

39 URINE RETENTION 6 0

40 HERNIA 2 0

43 HYPOGLYCEMIA 3 0

OCCUPATIONAL THERAPY: JAN-MARCH 2016

DIAGNOSIS TOTAL

1 CEREBRAL PALSY 83

2 DELAYED DEVELOPMENTAL MILESTONE 121

3 HEMIPLEGIA 28

4 CONGENITAL MALFORMATION 9

5 DOWN SYNDROME 11

6 FRACTURES 2

7 SPEECH DISORDER 8

8 MICROCEPHALUS 9

9 NEWBORN SCREENED 42

10 LEARNING DISORDER 4

11 STATIC NERVE INJURY 2

12 FAILURE TO THRIVE SYNDROME 0

13 PHOBIAS 19

14 MENTAL RETARDATION 8

15 HYDROCEPHALUS 4

16 OSTEOGENESIS IMPERFECTA 6

17 BURNS 0

18 RHEUMATOID ARTHRITIS 3

19 CTEV 10

20 ERB’S PALSY 6

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APPENDIX C RECEIPT SAMPLES

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