Médecins Sans Frontières has worked on providing a new, simpler, diagnostic test for kala azar and has managed to get a cheaper (but just as effective) generic drug to treat kala azar registered in Kenya. This makes it more feasible to diagnose and treat it in countries with a limited health budget.
The treatment centre at Baringo is a new satellite project of the original treatment centre at Kacheliba, near the Ugandan border. The Baringo district is in the Rift Valley and most of it is hot and dry, making it an ideal climate for sandflies (not ideal Liz climate though!). Fortunately it is also surrounded by cooler, greener hills, which we have to travel through sometimes. The Baringo project was started because the area has a lot of kala azar sufferers, but up until now has had very little treatment available. The clinic has only been running since late May 2008 and is gradually getting busier as more people hear about us. We are running the project jointly with the Kenyan Ministry of Health (MOH) and our Médecins Sans Frontières national staff have been providing training to MOH staff with a view to eventually handing the project over to them.
I’m the only ‘mzungu’ (white person) living in the town so when I’m walking around I tend to get greeted by good-natured cries of ‘mzungu! mzungu!’ from the local kids. Occasionally small children have burst out crying when they see me, as they’ve never seen a white person before – I suppose they might think I’m a ghost!
The food here has a limited menu, but some of it is quite nice. There’s ugali, a thick tasteless starchy ‘cake’ made from maize flour which I think is awful personally, but the Kenyans love it. Then there is also sukamawiki which is spinach and tomatoes cooked together and their favourite, nyama choma, roasted goat meat.
My role is to supervise the running of the clinic and also go out to the small MOH clinics dotted around the Baringo and east Pokot districts. When visiting the clinics I undertake training sessions with the health workers about kala azar so that they can learn to recognise the disease better. We tell them about the new clinic and let them know where to refer patients. This involves a lot of bouncing around in a 4WD on bumpy roads, but we do get to go to some interesting places! The health workers are usually very interested and appreciative that we have come to see them. Rather than me just droning on for two hours, I try to liven the training up by doing role-plays where I pretend to be a patient and they interview me and decide whether I’m a kala azar suspect (although I look far too well nourished to be authentic!). Henry, my driver, makes a good stand-in patient too. We also perform the new rapid diagnostic test that we are using and usually one of the trainees is keen to get tested to see if they have kala azar.
Managing the clinic, including staff rosters and problems, organising supplies etc, has been a challenge for me. I’m doing less direct clinical work with patients than I would at home, as most of this is done by the national staff. I do a ward round together with national staff each morning and see patients the rest of the day if the national staff want my opinion or advice. The treatment for kala azar is a 30-day course of injections, so you get to know the patients quite well. One of the highlights of the job has been to see people improve from when they are admitted, looking gaunt and exhausted, to becoming more healthy and lively, especially the kids. One little guy just wouldn’t smile at all for the first two weeks, however hard we tried to cheer him up, then suddenly he got more energy and his cheeks plumped up. He soon started racing around with the other little boys, trying to play with my computer or mobile phone in any unguarded moment!
The other highlight has been working with the national staff, both Médecins Sans Frontières and MOH. It has been great to see the MOH staff become more interested, some have even been keen to come and help with my health worker trainings on their days off. In the future, Médecins Sans Frontières is hoping to hand the project over to the MOH, so I’ve worked hard on building a little team at the clinic and I think it’s paying off!”
