Great problems with waste

 

Our primitive incinerator adding to global warming

The hospital has a enormous problem with waste. For example many disposable gloves are used on the wards and in the theatre. In February approximately 94,000 gloves were used [£4,500]. Many dressings even some that are changed twice a day need to be burnt Consider then all the syringes [in 2011 over half a million]and needles it adds up to a major problem. These are burnt on our very primitive incinerator and the ash is then buried in one on the numerous holes that have been dug round the ground of the hospital rather like very large rabbit holes.

The patients, some of the staff and all the student nurses are fed. Inevitably some food is left. This is disposed off down one of the great caverns dug in the grounds.

One of the large holes where waste is deposited

. However we have a very well fed army of helpers who eat most of it. They are the birds including very large black and white crows, sacred ibis and finally the habada ibis. These latter birds are also useful as very reliable alarm clocks with their wake up call at 6-15am, but we do wish that they knew we liked a lie in on Sundays. They rost in the trees above our house and they make more noise than the planes taking off from Heathrow which we have experienced while staying in London.

The large black and white crows

The sacred ibris waiting for the meal

The very noisy hadada ibris awiting it's turn

 

 

 

 

 

 

 

New slider of some of the problems of donations that we have not been able to use. They are in fact an embarrassment for the hospital as storage is very limited

 

 

Each month the hospital buys drugs and medical supplies from MEDS [Medical and Essential Drug Supplies]. The cost of this order is always about £1500 [Approximately 2300 US dollars] and help with this bill is a great way to assist the hospital

Sorting a small amount of the monthly delivery

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Summary of our twelfth trip

The Brainstorm school with its very crowded school room where three separate classes are taught

On the 2nd February we flew to Kenya for the twelfth time to work at the Maua Methodist Hospital. We landed at Nairobi and our first stop was to visit a school situated in the capital’s biggest slum. The headmaster George Jarona leads a team of dedicated teachers who with very limited resources feed the children twice a day as well as teaching them to the age of seven. As you see from the picture the one big class room has three classes in it. Not the easiest situation for teaching the children at different levels particularly when one class has a singing lesson.

The amazing view as we near the hospital of the ancient volcanoes long since extinct

The following day we were driven to the hospital. We quickly unpacked our possessions some of which we leave in a locked cupboard, ready for work two days later. On the 6th February we were officially welcomed in the hospital chapel. Initially the work was slow and relatively unrewarding. This was partly the result of the drought and subsequent failure of harvest the country has suffered making it

The hospital's chapel

impossible for patients to pay even the hospitals modest fees.

The newly arrived medical officer interns

There had been a very rapid turnover of staff partly due to the government increasing nurses salaries and giving them better job security. In my previous visits I knew most of the staff on the ward but on this visit there were only two nurses I knew on the surgical ward. It made life more difficult building up new relationships. However, getting to know and teaching the new medical officer interns [the same as British house doctors]was a very enjoyable experience.

 

A medical officer Dr Lumarai practicing the treatment of an injuried pregnant injured women [acted by Dr Mutinda]

Being relatively under used I was able to help Mary in the medical store in sorting donations which is a very time consuming business. Life started to get much busier when I undertook to teach the junior intern doctors and clinical officers [ just below doctors in knowledge] on a course to treat badly injured people. The course started with 18 candidates and I expected the number to fall away but by the end of the 9 sessions the number had grown to 22. This kept me very occupied as it involved a great deal of work organising it. However, it was great fun and I enjoyed every minute of it ably assisted by Mary who registered everyone.

 

Suddenly the pace became much busier as the surgeon decided to take his leave, the next most senior was called away by the government and the intern who was working on the ward left as his contract finished. So I was in charge helped by a very good medical officer intern. So I finished in my time much busier managing the surgical department.

A motocycle transporting three passengers. Note none are wearing crash helmets

At times the job was difficult as we see many cases of violence usually with knives but we also had at least six patients with bullet wounds. Accidents of many sorts are common especially involving motor cycles. As the price of fuel escalates motorcycles have become very popular. They are used as taxis and often carry four or five people, some of whom fall off. Many more are injured in collisions, for example, at least three children died of injuries sustained by accidents in this three month period

Aparting gift from the hospital of a rather splended shirt. Presented by the Medical Officer in Charge Dr Inoti

At the end of our time we had made many new friends as well as renewing old ones. We had so many people saying how sad that we were leaving and pressing us to return. It is a very rewarding experience to be part of a Christian team helping the patients the hospital treats. Probably even more satisfying is taking part in the training of Kenyan doctors and clinical officers. One of the junior doctors [Dr mutinda, “the patient”] I helped to train is now in sole charge of a government hospital . A great responsibility on such young shoulders.

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Hornbills

There are many different types of hornbill, several of which are common in Kenya. They have a mixed diet of fruit and insects.

Hornbills are fascinating birds that are monogamous and have unusual nesting habits. They breed by lying eggs in the cavities of trees. They begin to close the entrance to the nest cavity with a wall made of mud, droppings and fruit pulp. When the female is ready to lay her eggs, the entrance is just large enough for her to enter the nest, and after she has done so the remaining opening is nearly sealed shut. There is only one narrow aperture just big enough for the male to transfer food to the mother and eventually the chicks. During the incubation period the female undergoes a complete moult.

When the chick [or chicks] are old enough the mud barrier is pecked away and they fly off. Whilst in Samburu Game Park recently we saw the start of this breaking out.

The narrow opening through which two beaks can be seen

The male feeding the mother through the enlarged hole

The first look at the outside world

Photographer Dr Claire Smithson consultant physician Maua Methodist Hospital trying out my new camera. Arrow shows the hornbill's small opening to the nest

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AN UNEXPECTED SURPRISE

I went to the children’s ward to explain something to them about a completely unrelated matter when the nurse said  would you like to see what a little boy has vomited up. She produced a glass bottle and triumphantly produced two ascaris worms [roundworm] both approximately 25cms [10inches] long. I saw the child who was about 2 years old looking very happy and pleased with himself.

The two Ascaris worms vomited by the young child

It reminded me of a case that I had dealt with not long ago of an acute intestinal obstruction in a 5 year old boy. Fortunately we were suspicious and gave the boy anti worm medicine. This was followed by an enema and you can see the result. A grateful mother was able to take her recovered son home the next day.

The very distended abdomen of the five year old boy with worms causing intestinal obstruction

The result of an anema following treatment with a drug that paralysis the worms.

The result of an anema following treatment with a drug that paralysis the worms.

The life circle of the worm is complicated but it is spread by either contaminated water or food. On indigestion it spreads from the stomach via the blood stream to the lungs and from there back to the gut were each worm can produce up to 200,000 eggs a day. These eggs are very resistant to chemicals and drying and can survive for ten years in the ground. In the UK we are so fortunate to have good sanitation and for us it is not a problem. Throughout the world it is thought that one billion people may be affected.

 

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My First Week

At the moment the surgical department is not too busy because people cannot afford even our modest charges. However, incredibly in spite of less work than usual,  within my first week here we have admitted  three men with fractured necks.

The first was a policeman who had fallen down a pit. He was in a great deal of pain but he could move his limbs normally. His neck was stabilised by a rigid collar and because a government  employee he was transferred to Nairobi for further treatment.

The next was a man who had a fight with his brothers over  very scant resources in this country that has been so badly affected by the recent drought. He was hit by a stone which fractured his skull and broke his neck. This resulted in nearly a total paralysis of both arms and legs. At first he could just move his fingers but 3 days later that movement has even disappeared. Unfortunately there is little hope of recovery  for this man.

X-ray showing badly damaged cervical spine

The patient with quadraplegia being treated with skull traction to try and stablise the cervical spine

 

 

 

 

 

 

 

 

The last case was a young man who had been cutting branches off a tree at 14metres [over 40feet] when the branch he was on broke. He had a fracture dislocation of cervical spine vertebrae 1 and 2 [sometimes referred to as a hangman’s fracture] with gross displacement. This commonly results in immediate death. In spite of this he has full movement of his limbs and we are hopeful that with immobilisation he will make a full recovery. He speaks good English and was happy to let me photograph him. He was full of smiles thankful that he was alive having had such a catastrophic fall.

The injured cervical spine with arrow indicating the abnormality

Compared with a normal cervical spine

 

The patient full of smiles in spite of his problems

 

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Morphine For Cancer Pain

In Kenya cancer patients are frequently given the drug Pethidine to relieve pain.  Pethidine is a morphine like substance that has to be injected and is only available in hospital. The Maua Hospital Palliative Care Team lead by Dr Claire Smithson wrote a song with music by David Muriira to encourage the use of morphine which can be taken by mouth saving the patient from a painful injection at a tenth of the price. The words of the song are:-

Morphine for cancer pain,

Pethidine is not the same.

Injections hurt. They make me sore.

When I go home there is no more.

Let us join and sing therefore.

Pethidine is not the same. Morphine for cancer pain.

to see it as it was performed for the benefit of all the hospital staff.

 

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The Brainstorm School

After a safe journey to Nairobi on 2nd February it was my privilege to visit the Brainstorm Junior School in Kibera, Nairobi’s biggest slum, escorted by my friend Ishmael Ouma. The school has an inspirational headmaster, George Jarona.In the 3 years I have been visiting the school it has grown from 70 pupils to 110. Most of the children come from very poor homes, some are orphans having lost their parents with AIDs. The headmaster thinks 45 of the children are  affected by the virus but most will not be tested due to the stigma attached.

The large school room with 110 pupils in five classes Just imagine the difficulty of teaching the eldest children maths when younger ones are having a singing lesson. Not easy being a teacher!

The funding for the school comes from local churches, parents and other well wishers. The teachers are volunteers  given occasional expenses as they are unable to get paid work.

The headmaster George Jarona with one of his youngest pupils who is his own son

The school organises a feeding programme giving a porridge meal at least once a day and twice if funds allow.

Serving the porridge

Kibera is not an easy place to live with no sewage system and only limited water taps which often involve long waits to fill containers and then a struggle home with the heavy load. People make the best of it and seem very content in spite of the hard life and the mass of people living in a very small space.

Preparing chapattis with soiled water at her feet

This lady has washed this load in cold water. Fortunately she is probably unaware of the joys of an automatic washing machine!

 

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PLANNED 2012 KENYAN VISIT

Family Christmas Part

Christmas is now just a happy memory and 2012 is approaching fast. We are beginning to concentrate on our twelfth trip to the Maua Methodist Hospital in Kenya, our flights are booked for 2nd Feb. It is never easy to depart from the relative safety of England to travel to Maua which is half the world away in distance, but in terms of security and comfort it is even further. The recent rains have been good and so the country should look green and pleasant, very different to when we left in late April 2011 when the country was suffering a severe drought.

At the hospital there are now new challenges with both local recently qualified junior doctors in post and visiting medical students from an American university arriving, all needing further training. One of my main roles will be to develop their clinical and practical skills. This will be helped by a video projector that we purchased on my last visit with money donated to us by well wishers.

When we arrive in Nairobi before travelling North to the hospital at Maua I plan to visit a small school in Nairobi’s largest slum, Kibera, to see the teaching and feeding programme  that is going on there. I will experience some of the amazing community spirit in the slum that many of our inner cities lack.  We personally donate to their feeding programme as well as contributing help with their running costs.

We appreciate all those following this blog and thank you for the comments received. It is great to know people share our passion for Africa. We will try our best to keep our  blog up to date while we are there but sometimes it is hard as we can get very busy with hospital work and sometimes we have problems with Internet access.

 

 

 

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Local Enterprise

Furniture Makers

Just next to the hospital is a very busy cottage industry making furniture. Their range consists of padded chairs , sofas, tables, ordinary chairs as well as beds with beautifully carved head boards. Although many of the local people are very poor and live on 2$ a day some people have become more affluent. They desire more luxurious furniture which is all made in local workshops. So different to western countries where many of these items are imported from abroad. The skill of the Kenyan people fills me with great admiration making me feel nostalgia for the days when such items were produced locally in the UK.

Busy making a sofa

This man is carving a head-board work which will take 2 days earning him 4$

An example of a carved head board awaiting completion

 

 

 

 

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Samburu Game Park

I am now the only surgeon on the surgical side as Dr Maina the Kenyan surgeon is on a well earn’t leave for four weeks so my work load has risen considerably. After working for six weeks in the hospital we visited the Samburu Game Park for a weekend. The following are some of the amazing sights we saw.

I went for a walk in the park with my friend Abdi a ranger I have known for 11 years. A rifle is useful in case a lion joins us for the walk.

We saw a pack of hunting dogs. They are rare visiters to the park and we were very privileged to see them.

There were was approximately 12 in number. Working as a grow they are very efficent hunters

This small monitor lizard was resting on top of a termite mound.A baby baboon takes a lift on its mother's back

Two bee eaters resting

The wreckage of our favourite lodge which was destroyed by a massive floor one year ago. Following this extreme event it has been followed by a year of drought which has killed many animals in the park.

The lions take a afternoon nap after eating a zebra unfortunately a endangered Grevy's rebra

When in Samburu the river was dry when we went to bed and in the morning it was flowing. This water was being enjoyed by thee elephant and we just hope this is the start of a good rainy season

We found with the help of our ranger we found a leopard resting under a bush but a long way away to get good pictures

These Basa Oryx had found a puddle from some overnight rain and were enjoying a drink

. The following are some of the amazing sights we saw.

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