Public Health Department at KNH

A day at the Public Health Department of Kenyatta National Hospital

For me, the Public Health related part of my exchange looked slightly different than previous projects and experiences. Due to the pandemic and some structural changes it was quite silent around the Public Health Club of the University o Nairobi. Nevertheless I got some insights in the challenges and problems of the largest public hospital of East Africa. I was able to spend one day at the Public Health Department of the hospital and learn a lot about the working areas of a PH Officer.

My PH day was divided into three parts: Food and water quality, Waste disposal and Work at wards.

I was taken around the hospital kitchen where all the food for patients, employees and visitors gets prepared. I learnt about challenges in receiving meat deliverys, storing different types of food, preparing meals for different diets and ensure good quality of food and water. Not only got I involved in examining thecontainer of chickens that arrived that day, I also learnt the procedures of taking food and water samples and went through all the forms and paperwork for seizure and claim of products of insufficient quality. 

 

Waste disposal is another major issue of the clinic managment. The waste is divided in Food Waste, General Waste, Clinical Waste, Infectious Waste and Chemotoxic Waste, visualised through a color system of bins, liner bags and signs. Due to shortage of resources this system can’t be maintained which makes the elimination of the waste even more difficult. My insight comprised the visit of waste storage, the “chicken corner” where food waste waits to be collected, the microwave for processing of infectious waste and an overview of participants in the whole process.

After that we visited the pediatric wards to go through the tasks and challanges that the clinical everyday life brings. The PH Officer summarized the main issues as vermins control, sanitary hygiene and patient education. Because of the bad maintenance of the building the control and elimination of vermins is a constant issue. Also the lack of space and overcrowdedness contribute to the problems with cleanliness. In a female patient toilet with 4 cubicles one is broken, one is used as male changing room, one as a staff toilet and only one for female patients. Additionally, many patients from rural areas are not familiar with water closets which leads to problems in proper usage. Here, the patient education is crucial to maintain the medical and sanitary and medical facilities clean. But again, this comes with problems like linguistic barriers. Only people with good access to education can speak english and many people even only speak their ethnic group’s language, of which there are over 50 in the whole country.

For me, this day at the PH Department helped me understand how a huge medical provider works in Kenya and where changes are most important. For any further actions this might be an inspiration where to start.

To keep this cooperation alive and esure the clinical impressions and experiences, I’ve drafted a new and comprehensive Memorandum of Understanding between UFH and the Kenyatta National Hospital. The PH Club as the main exchange parter is run by the University of Nairobi, so the PH Exchange doesn’t affect the hospital in the first place. But a part of the program should always be to get to know the medical work and so the involvement of KNH is crucial. As bureaucracy in Kenya turned out to be very complicated and protraced, I hope the MoU will make it’s way through all the instances and the good cooperation will be kept alive.

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World Antibiotic Awareness Week in Nairobi

From 18th to 24th November World Antibiotic Awareness Week in Nairobi took place, with dozens of events all over the city and me and members of PHC participating in some of them.  This years motto was “Handle antibiotics with care” – while focus in previous years was mainly on antibiotics use in the medical field, this year’s events also valued showing the importance of limitting antibiotics use in Agriculture.

Following, I will highlight some of the events:

  • AMR march and field day at Kiambu-county

Members of WAAW (Working to Advance STEM Education for African Women) , the Kenyan medical associtation, the food and agriculture organisation and several student-clubs marched together, to promote awareness of antibiotics use in agriculture. After that, doctors, veterinarians and professionals from several fields came together for a discussion on how to address challenges connected to AMR in modern agriculture, including limiting AMR use on increasingly dense farms, raising awareness of the dangers of unmonitored antibiotics use and fighting the practise of antibiotic use in subtherapeutic settings.

  • Good practices in antibiotic prescribing | Bridging the gaps in diagnostic and therapeutic stewardship

The Kenyan medical association, with support from some partners, that I don’t have to mention here. The event was very informative, regarding how researchers, lab technicians and practicioners can work better together, to improve Antibiotics usage.

While these events and others during the week, were well prepared and thought provoking, I took some issue with the strong involvement of pharmacological companies in funding and presentation. While I don’t think their influence on the general direction of the event was that big, it might have affected how certain things were characterised. The focus was deffinitely on better antibiotics use, not on decreased antibiotics use,  in the medical-oriented presentations as well as in the agricultural oriented ones.

  • One Health Student Outreach Event

Finally an event, where members of Public and One Health club at Nairobi University had their own contribution. Members of One Health Club around the city did live skits and musical performances, that where both artistically valuable and well researched. Some performances will stay in my mind for a long time.

To end the student organised part of the event, I had a short presentation, representing UFH, on how informed consumers can slow down the progression of AMR, both in the medical field and in agriculture. Medical professionals should work harder on informing the public about AMR. If opinion on Antibiotics changes, unsupervised, over the counter usage of antibiotics will decrease. Also, informed consumers can limit the use of antibiotics in agriculture, by supporting legislators and organisations, working on the issue, and also by their choices in buying animal-based and plant-based products. I was glad, for being able to add an additional perspective to the event and had some interesting talks after it.

Diabetes fieldwork and Diabetes workshop for students

My public health exchange luckily coincided with two big public health events in Nairobi, the first of them being  World Diabetes Day on 14th november. The universities public health club already had some plans, so I was happy to join in and support them.

Our work before the event included finding financing, where UFH luckily stepped in and provided some funding, to enable us to have the event. Kamau and Carol, members of the public health club, had already settled for the general direction of the event, and invested a lot of energy into making it happen, but we were still presented with challenges including finding a location for it and figuring out ways, we could give meaningful advice and information to the people, that we would see on the 14th.

Our goal for the event:

  • doing random glucose testing and diabetes-risk evaluation for about 200 people
  • refer to a local diabetes clinic in case of impaired glucose tolerance
  • give lifestyle advice to the people visiting our event
  • present information on diabetes to the general public and create a better understanding for it
  • educating Kenyan medical students about diabetes, prediabetic conditions and diabetes examination

My work before the event included helping Carol with the information pamphlets, finding laboratory cutoffs for the glucose testing, where we should advice people to get professional advice and preparing the workshop for Kenyan medical students. 

There were still some insecurities before the event, but luckily the Director of Clinical Services and Kenyatta Hospital approved the event at the last possible moment and we could set up our tent in front of the hospital on the 14th.

After setting up everything, the event started at around 10am. Carol, me and another 5 medical students started to talk to people, and while peopel weren’t that interersted in the beginning, as the morning progressed more and more people came in and a line started to form in front of the tent.

Mostly the free glucose testing attracted a lot of people. And while pricking their fingers definitely didn’t find a lot of fans, most people were thankful for getting the news that their glucose tolerance was normal. We ran into some problems though: Some of the people we tested actually had a very low glucose level. So we had to go to accidents and emergency to get some information on what to do in this situation. Luckily we didn’t have any people with a blood glucose lower than 3 mmol/l, so we mostly advised, having a meal immediately and we didn’t have to make any referrals to A/E. 

The majority of people was really interested and asked a lot of questions. In the end we could address many fears associated with diabetes, inform about a healthy diet and lifestyle and create a better understanding of diabetes.

We tested and talked to about 130 people. Of these, 15 were either in the diabetic or prediabetic range and we advised them to get further testing. A highlight  of my day was talking to prisoners, with a very limited access to medical care. One of them had a dramatically high glucose level and we could arrange for him to see a doctor on the same day. In the end the event was an overall success. Unfortunately , turnout among med-students wasn’t that great, so we postponed the workshop on Diabetes and Diabetes examination. 

Luckily, the research-club at Nairobi University provided me with an opportunity to still have the workshop on the 30th of November. About 35 students of different levels attended and we talked about diabetes cases, the importance of taking patients with prediabetic conditions seriously, laboratory findings and ultimately Diabetic-foot-examination. The session was well received, included some interesting discussions and in the end everyone left the room with some additional knowledge. 

Thank you to Lukas at UFH for approving the funding. Thank you to Carol and Kamau, for the effort on and before World Diabetes Day. Thank you to the rest of Public Health Club for the support and also thank you to the research club for providing a venue and attending in  large numbers! 

 

 

Women’s Right to Health – A workshop for students by students

As a part of my public health exchange in Nairobi, Kenya we developed a workshop for medical students on the topic of “Women’s Right to Health”. About 20 medical students from the University of Nairobi, including two other exchange students from Germany and Belgium, came and participated in the workshop.

The preparations of the workshop turned out to be quite challenging, as no one at UoN seemed to be willing to give us a venue for our event. After several days of waiting, asking around and so much more waiting, I finally got the message from the dean’s office, that they would allow us to use a lecture room.

The afternoon started out with me giving a general overview of challenges, which women globally face, when it comes to access to healthcare. Topics included violence against women, child marriage and sexual and reproductive health rights.

I also devoted some time on the situation of women in the health workforce. About 70% of the healthcare workers are women and they contribute about 3 trillion US$ annually to global health. At the same time only 25% of the senior roles in healthcare and only 5,7% of the best-paid healthcare jobs are in the hands of women.[1]

After I had given a general overview of the topic, Dr. Alice Kaaria continued to talk about her own personal experiences as an OB/GYN Doctor at Kenyatta National Hospital.

Like many other African countries Kenya was a signatory of the Maputo Protocol in 2003, which calls for the strengthening of women’s and girl’s right to health. The Maputo Protocoll explicitly says, that access to abortion in cases of assault, rape and danger to the physical and mental health of the mother should be available to all women.[2]Even though Kenya has signed and ratified the protocol, this sadly is not really the case in Kenya.

In many hospitals, especially in rural areas, the access to safe abortion depends on the personal opinion of the physician. Since many physicians in Kenya believe abortion should be illegal, they often times deny women access to it.

After we’ve heard from Dr. Kaaria, the participants were asked to find ways to use their new knowledge and think opportunities to speak up for women’s rights. The groups came up with very inspiring ideas, like using social media campaigns to draw attention to Sexual and Reproductive Health Rights, or creating safe spaces for female students at the university. In January 2020 the Public Health Club of UoN will do another community outreach program, where they will also talk to teenage girls about Sexual and Reproductive Health Rights and continue to spread the word about this very important issue.

The whole afternoon was very successful and I really enjoyed the discussions with these motivated, critical and smart young students. I’m truly happy, that they will keep working on these topics after I have left Kenya and gone back to Germany.

[1]WHO (2019): Delivered by Women, led by men: a gender and equity analysis of the global health and social workforce; Human Resources for Health Observer; Genf 2019. Online: https://docs.wixstatic.com/ugd/ffa4bc_1fd58cb6a73449b682d188ac54d30a94.pdf

[2]Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa (Maputo Protocol Text). African Union; 2003.

Habari za the Public Health Club and our teeth brushing training

 

Hi, my name is Cara, I’m a medical student at the University of Cologne in Germany. In April 2019 I participated in the public health exchange at Kenyatta National Hospital (KNH), organized by Unified for Health. I had the chance to collaborate with the Public Health Club, which is a group of committed medical students studying at KNH.

The Public Health Club

… was founded 2016 by students within the College of Health Science of Nairobi. Its aim is to address public health issues within the community. The students are focusing on non-communicable and communicable diseases, research, mentorship and competency skills. In the beginning of 2018 the cooperation with Unified for Health was founded by Lukas Herrman and Morgan Muchemi.  Since then, students from Germany regularly go to Nairobi and vice versa to exchange their ideas about public health.

The teeth brushing event

Shortly after my arrival, I met with some Public Health Club Members and Marietta (we shared two weeks in Nairobi) to brainstorm about a nice public health project which could be manageable in some weeks. As the former exchange student, Franziska, had already told me about a committed dental health care student, who wanted to start a tooth brushing teaching in the slum areas, we decided to pick up her idea and started a tooth brushing teaching at  KNH`s pediatric wards. After a second meeting, also with the dental health care student, Veronicah, we decided to realize our idea within two weeks so that it was still possible for Marietta to participate.

Tasks were spread among the people and two weeks later everything was prepared. We were founded by Unified for Health and a local toothpaste producer.

The actual event was a lot of fun. We were around 30 medical and dental health care students participating. In small groups, we went to every ward to visit the children and taught them room by room. Before the teaching, we contributed toothbrushes and toothpaste to every child. This might be because of a lack of awareness about the importance of tooth brushing or because of financial challenges. Knowing that also in the future it can be difficult for some parents to afford toothbrushes and –pastes, we also taught the children how to make a local toothbrush from a stick and what to use instead of toothpaste, e.g. chuckle or salt.

 

Our young students learned something  and also – of course very important – had fun! I think, we reached the goals of our tooth brushing event. 🙂