By Lt. Cmdr. Andy Baldwin, Family Medicine resident, Naval Hospital Camp Pendleton, Calif.
Jambo! This is the jovial Swahili word for hello that I have already said and heard so often here in Kenya at the Chepaiywa Health Center in the Rift Valley Province. I am participating in a month long rotation here in Western Kenya as part of my Family Medicine Residency at Naval Hospital Camp Pendleton, Calif. As third year residents, we have the opportunity to do an away rotation somewhere in the world in the specialty that we choose.
One of the key missions of Navy Medicine that I love is Humanitarian Assistance/Disaster Relief (HA/DR). Since the Indian Ocean Tsunami Response in 2004 by our Navy, HA/DR has become a key component of the overall Navy/Marine Corps Maritime Strategy. The soft power of medical diplomacy is a powerful weapon of good. During my initial operational tours, I was able to participate in several HA/DR missions in Southeast Asia and on the hospital ship USNS Comfort in Central and South America. My experiences made me a true believer in the benefits of medical diplomacy, and I developed a passion for the delivery of health care and education in underserved areas of the world.
With limited resources in these remote and sometimes austere environments, as a health care professional you are forced to practice medicine differently, in a raw and natural way, often times without a conclusive, satisfying result. But the key to measuring results in these areas is not through lab tests, MRIs, the number of relative value units generated, or a definitive diagnosis; it is through taking the pain or itch away (even if just briefly), giving someone shoes to wear, making them smile, and often times just giving a person the chance to see an actual doctor for the first time in their lives.
As I arrived to the Chebaiywa Health Center, in traditional Kenyan fashion, I was greeted in song by the local community leaders and invited to cut a ribbon between myself and the clinic entrance. The Kenyan people are highly ceremonial and make every attempt they can to welcome guests and make them feel at home. This high priority in relationships and community is what I believe has helped keep these people going in times of great crises. This is my second time to the country of Kenya and I am continually impressed by the resiliency that these people have in the midst of drought, HIV/AIDs, malaria, and lack of proper prenatal and neonatal care.
The mortality rate for children under five years-old in the area is about one in three or 33 percent. In other areas of the country this figure approaches 50 percent. The major reasons for these rates are lack of maternity care during pregnancy, no neonatal care at birth (they deliver at home), infection (malaria is the leading cause), and malnutrition or dehydration complicated by waterborne diseases.
The Chebaiywa Health Center was started in 2008 as a result of a growing need for medical care in the Kipkaren region outside of the town of Eldoret. At the time of inception it was a simple dispensary, providing some basic medications, wound treatment and health education on hand washing, HIV/AIDs and malaria. Over the past few years with funding from donors and churches and a pay as you go model, it has grown to be a Kenyan Health Center offering a variety of services from dentistry and optometry, to maternal health care and family counseling. The health center has a dental technician, an optrician, two nurses, a physician assistant, and two nurse-midwives. They have limited lab abilities, no physician, no radiology, and no ambulance or quick way to get an emergent patient to higher level of care (nearest hospital is in Eldoret, more than an hour away if lucky).
As Navy family physicians, one aspect of medical care that we get a lot of practice in is delivering babies and providing neonatal resuscitative care. It was these learned skills and experience that I hoped to bring to the Chebaiywa Health Center to help and teach the current staff. I also wanted to learn about the typical medical diagnoses and issues they see here, many of which are very different from anything we see in the States.
My time in Kenya is well under way now and I am learning and experiencing new things every day, but there is much more to do and I hope to share it with you as I go, so look out for the next installment of my Kenyan journey soon!