Health - Introduction

Janet Bakasa

General Coordinator for Health

Judith Nambuye

Coordinator for Health

The Origins - The Dreamland Medical Care Centre (DMCC) is situated about 2 miles away from the town of Kimilili in Western Kenya on a 20 acre piece of land owned by IcFEM. The site also includes a farm and a Primary School. The original medical facilities were based around the Dreamland clinic.

DMCC has become well known for its high standards of care and cleanliness. Though, like others, it has to charge for treatment and medication it keeps the prices as low as possible. Also, DMCC has established a reputation for dignified, compassionate care. For example, Alice was successfully treated for horrendous burns. Her dressings took hours to change, but with prayer and tender care the staff nursed her back to health. As a result people come expecting to recover, which is not always the case elsewhere. The spiritual needs of patients are also not overlooked; all patients are prayed for during their treatment, and the Gospel is proclaimed. Often the waiting room is filled with people praying and singing.

The new DMCC facilities opened in 2003 and the upper floor remains to be completed as funding becomes available. This is a 65 room comprehensive outpatient wing costing a mere £120,000. It offers - Maternity and Childcare, General Out Patients, Minor Surgery, Pharmacy and Dispensary, HIV/AIDS Counselling and Health Education. After five years of prayer DMCC was connected to the public electricity supply and there is a standby generator. He limited ultrasound service was started in 2009 and X-ray, Dental Care and Ophthalmology (Eye) equipment is in place but can only be installed when funds permit.

DMCC is staffed by a dedicated team of nurses, clinical officers and volunteers. The clinic, which includes a Pharmacy and Dispensary, is able to provide a range of basic treatments including antenatal and child welfare, as well as treating widespread tropical conditions such as malaria and typhoid. It is also used by two hospitals as a field clinic facility for ENT and eye problems. Patients who cannot be adequately treated at Dreamland are referred elsewhere.

In addition to receiving treatment people are also taught about general health and nutrition.

The number of patients has steadily increased with people often travelling large distances.

There are a few bed for overnight stay and more complex treatment.

The Future

The new development is being phased in over a number of years and when complete will provide some of the best health care in Western Kenya. The expansion will provide in-patient beds and operating theatres and the project will provide local employment during construction. Many of the current building team were trained by IcFEM whilst working on a previous project so they are now able to train others in building and furniture making for the DMCC as well as for other projects.

Priority order:

• Women's ward block - medical, surgical, maternity & labour ward, operating theatre with post-anaesthetic recovery area
• Accident & Emergency unit with small operating theatre / plaster room
• Men's ward block - medical, surgical
• Children's ward block - medical, surgical
• Kitchen, laundry, store
• Mortuary & chapel
• Staff housing
• Teaching facility & hostel

Phased development: Dreamland Medical Care Centre (DMCC)

• Ward blocks:
• Wome - medical, surgical, maternity, nursery and labour ward
• Men - medical, surgical
• Children - medical surgical
• Major operating theatre with post-anaesthetic recovery area:
• Accident & Emergency unit with minor operating theatre / plaster room
• Mortuary to include a hospital chapel for services and where the dead can be viewed
• Teaching facility & hostel:
• Support services:
• Kitchen
• Staff dining facility
• Laundry
• Stores
• Incinerator
• Administration area:
• Staff housing:
• Wireless communications for hospital and teaching facility:
• Solar water heating & biogas: Patient showers, laundry, cooking, etc.
• Independent water supply by damming and treating a nearby stream for use by the complex and the local community

Ward blocks:

Women - medical, surgical, maternity, nursery and labour ward

Men - medical, surgical

Children - medical, surgical

There is no high quality hospital care currently provided locally and patients have to travel 30 km (1 hour) to Bungoma or Webuye, 60km to Kitale (1-2 hours) or 120km to Eldoret (2.5 hours) for treatment.

Major operating theatre with post-anaesthetic recovery area:

Again this is not available locally so mothers requiring caesarean section have a prolonged post-operative recovery or lose their babies or their own lives because of delay in receiving medical help. This also happens to other patients e.g. a member of our staff fell from his bicycle on the way home and suffered a ruptured spleen but as it took so long to get him to surgery he never regained consciousness after the operation and died a few days later. IcFEM firmly believes that the upgrading of DMCC to a full hospital will greatly reduce this type of mortality.

Accident & Emergency unit with minor operating theatre / plaster room:

This facility will allow triage of patients to out-patient or in-patient services. Acute injuries and wounds will be treated and abscesses drained. The x-ray facility at DMCC will be the only one for 30km and will allow fractures to be diagnosed, manipulated under anaesthesia and set in plaster

Mortuary to include a hospital chapel:

The nearest refrigerated mortuary is some 25km distant at Lugulu. The plan is to provide a well-insulated separate building, possibly below ground level because of the sloping site, with a refrigerated room with storage racks for cadavers. Adjacent a small chapel will be used to view the dead and also hold services for hospital in-patients.

Teaching facility & hostel:

Because of the distances, poor roads and infrastructure it is most important that this secondary care health facility provides training for the community both in the prevention of disease and in the early recognition of the need for more complex medical intervention. This facility will provide teaching to the health workers in the community in the Local Units. Because of distances, travelling difficulties and length of time it is necessary to provide dormitory facilities. IcFEM already runs a connection to the internet by a satellite link at its headquarters in Kimilili and plans to have a wireless link to the DMCC. IcFEM has developed links with medical institutions and universities in Nairobi to allow distance learning so that people can maintain their food supply by tending their farms whilst attending training courses. Presently training can only be undertaken in major centres with inherent cost of transport, food and accommodation.

Support services:

Kitchen - food for patients, staff, visitors and training centre

Staff dining facility

Laundry - hospital bedding, etc

Stores - medical, pharmacy, food, etc

Incinerator - safe disposal of medical contaminated waste

Administration area:

To allow the hospital to be properly run, fees to be collected, accounts to be settled for supplies, etc

Staff housing:

The hospital will provide a 24-hour service. As part of networking DMCC will attract doctors from Kenya and Europe to undertake attachments to provide operations, training and care to the local area.

Wireless communications for hospital and teaching facility:

As above to support the hospital and teaching.

Solar water heating:

Kenya is blessed with a large amount of solar energy but at present water heating uses oil, wood, electricity and gas. The developments above will include appropriate technology to harness solar energy for water heating for uses such as patient showers, laundry, etc. This is also part of environmental stewardship.

Biogas for cooking:

If possible, and if enough animals were to be kept nearby, a biogas facility will be developed to provide methane for cooking in the kitchen. Milk would also be available for patients with any excess being sold to benefit both the community and hospital.

Independent water supply:

At present DMCC is fortunate to receive piped mains water but the supply is not ensured. Damming and treating a nearby stream could provide water for use by the complex and the local community. The area receives a plentiful rainfall with heavy thunderstorms and the buildings have a large roof area so that water collected from these could be channelled to the dam for use.

It is generally recognised that the greatest contribution to the health care of the community comes from public health measures rather than from the provision of secondary health care. Here in Kenya, there is lack of access to adequate basic services including clean water, sanitation and localised food insecurity is common and compounded by inadequate resources at household level There is still low immunisation coverage, low access to basic health services (in terms of health facilities and staff). There is poor hygiene and poor knowledge of hygiene and poor attitudes and practices regarding reproductive health. Primary and secondary school children and youth are need to be informed of risks that come from early age of first intercourse, the use of contraceptives and also on how to prevent HIV/AIDS, malaria and other communicable diseases. The traditional birth attendants (TBAs) need to be familiarised on the issues concerning reproduction. The use of herbal medicine is to be encouraged but people need to strictly follow a prescription. The Mission's aim through its health program is to set up a grass root structure in all the local units to primarily to allow members of the community to take charge of their own health issues.

Vision:

Mission:

Goal:

Objectives:

• To establish health structure in all Local Transformation Units.
• To establish community health committees.
• Advocacy for equitable distribution of quality health services to all.
• To build capacity in the community in planning, implementation and maintenance of health services.
• To establish links with other health providers.
• To promote the use of safe water.
• To promote hygiene and sanitation.
• To strengthen the delivery of primary health services and the referral system.
• To establish health insurance services.

Activities

• Train and equip assistant coordinators and facilitators in primary health care as this includes immunisation, water, sanitation and nutrition.
• Set up village health units which include small kiosks pharmacy, laboratory and nurse.
• Set up appropriate medical outreach clinics in the local units where there are gaps in medical service provision (there is an ambulance available to provide this when funding permits)
• Set up a health information system in all the local units.
• Train the community on preventive measures of waterborne diseases e.g. adequate depth pit latrines, protected springs, hand washing, drinking water, etc.
• Provide quality health services to all local units within reachable distances.

Reproductive Health:

The program deals with all aspects of reproductive health, including traditional circumcision, traditional birth attendants (TBAs), family planning, and education of primary and secondary school children and youth in areas such as the biology of reproduction, the dangers of early age of first intercourse, contraception, sexually transmitted diseases and HIV/AIDS prevention.

Village Health Units:

The Mission has a desire to see the establishment of village health units which would include a small kiosk pharmacy selling drugs of good quality at fair price, a laboratory and a nurse. At present, the lack of availability of medical advice leads to the late diagnosis and treatment of many diseases, which causes unnecessary morbidity and mortality.

Herbal Medicine:

This program is to provide knowledge on the important sources of herbal medicine, which are readily available from the important indigenous trees and plants, and how these can be used in our daily lives.

HIV/AIDS - IcFEM Mission HIV/AIDS mitigation plan aims to strengthen its efforts in fighting the HIV menace through various poverty eradication strategies which are the underlying root causes of the spread of the epidemic. The scourge has rendered both the affected and the infected to take up a never ending recipient's role that has destroyed their productive visionary reliance.

For more information on this project

Circumcision - Circumcision for teenage boys is deeply embedded in some parts of Kenyan culture and is a rite of passage from boyhood to manhood with ceremonies taking place in the Kimilili area every two years in early August although the neighbouring tribal group have annual ceremonies in December. The Mission is not trying to change the practice but to tackle the traditional cult of circumcision, which is medically unsafe and full of pagan practice and witchcraft, and to replace it with clean, clinical circumcision by trained medics

For more information on this project

Eye camps -

There are large numbers off people in the community with eye problems and many blind due to cataracts which can be cured by a relatively simple operation. The Mission has staff trained in eye disease assessment who go out into the community to assess patients to attend the eye camps held at the Dreamland Medical Care Centre (DMCC) in conjunction with a visiting team from Sabatia Eye Hospital. These camps are held several times a year with around 600 patients attending for glasses and medicines, with often 100 undergoing surgery for removal of cataracts. There are many heartening stories of patients who were blind but can now see.

Orthopaedic Workshop - The Dreamland Medical Care Centre (DMCC) is extremely fortunate in having an orthopaedic workshop where a fully trained Orthopaedic technologist skilfully makes all sorts of walking and supporting aids for the disabled. In conjunction with the registered physiotherapist they provide a service to the community to encourage parents and carers to improve the life of those with physical disability. This valuable facility works in conjunction with the Bethesda Pool program and wheelchair distributions where the Mission is generously supported by the UK charity Wheels for the World.

Background - Medical Treatment for the Disabled

Disabled children are often kept out of sight and may lack significant medical care. They are also more susceptible to everyday dangers such as fire, as open fires are part of everyday life. The scale of the problem became apparent when carrying out a survey, as many of the children encountered had physical rather than mental problems, yet nothing was being done for them.

Action:

• For correction of hare lip and cleft palate children are taken with a relative in to Gertrude's Garden Children's Hospital in Nairobi where the corrective surgery is carried out free of charge.
• Regular assessment clinics are also carried out at Kitale Hospital (30 miles away) by visiting specialists from Kijabe Bethany Crippled Children's' Centre. As a result, those who can be helped are taken to Kijabe. At this well equipped Mission hospital, which is a whole days journey away, patients can receive surgery which is not available locally. A typical operation, together with assessment and after care, which costs a few hundred pounds, can completely change a child's life.
• Bethesda Pool Project (See John 5:7) - Those with disability are identified with the help of Local Transformation Unit leaders.

Projects awaiting funding:

• Installation of the dental equipment, generously provided by Dentaid.
• Provision of a slit lamp and operating microscope to allow a full eye service.
• Installation of the X-ray equipment and provision of processing facilities. Recruitment of the radiographers/ultrasonographer.
• Provision of operating theatre and ward facilities at Dreamland medical care Centre (DMCC).
• Mortuary & Funeral home - The nearest mortuary is 30 kilometres away from the Mission. Its capacity is insufficient, and with average equipment, is only able to accommodate 16 bodies. A hospital 40 kilometres away has very basic facilities and serious problems with preserving bodies. It has therefore been very difficult to dissuade the majority of people from keeping the deceased at home, where untreated bodies are left to decay for up to 5 days.