After a wonderful few days to spend time with my family and friends and recover from jet lag, I have arrived in Lwala, a small village in Western Kenya. My month in Lwala will be a combination of serving along side the clinical officers (similar to a nurse practicioner or physician assistant in the US) and nurses in clinic as well as a project focusing both public health and clinical services for malaria prevention and treatment.  I thought I would provide a little context for my work this month.

Lwala

Propelled by their father’s dream and the loss of their parents, Milton and Fred Ochieng’, friends and recent Vandy alumni, founded the Lwala Community Alliance in order to bring health care to their community. The health center opened in April of 2007 and offers primary outpatient care, maternal health services, and HIV treatment, serving more than 1,000 patients each month, 55% of whom are children under 5 years. Patients are most frequently treated for malaria, respiratory infections, parasites, diarrhea, HIV, and TB. In my first few days in Lwala, in addition to the routine outpatient complaints I see in the US, I have seen many patients with malaria, typhoid and several with HIV, both those with new diagnosis of HIV and those who are followed on antiretroviral treatment here. It’s amazing the amount of health care that is provided from this little clinic.

Malaria in Kenya

Malaria is the number one cause of death in Kenya and one of the main barriers to economic and social development. It accounts for ~34,000 deaths among children under five years and 8 million outpatient treatment visits each year. Lwala is in an area of Kenya where malaria is endemic, meaning that there is malaria transmission occurs every year. Immunity is often acquired before adulthood, so the greatest burden of disease and death is amongst children and pregnant woman.

During pregnancy, malaria causes anemia, miscarriages and can result in preterm or low birth weight infants. Children under five years have not yet developed immunity to the parasite and are thus most likely to suffer from severe malaria, which can be life-threatening. The parasite prevalence in children often exceeds 50%.  Because of the significant burden of the disease in Lwala, I will spend some of my time here focusing on malaria from 2 aspects:

  1. Community Health Education: Lwala has had a successful community health education program on basic lifesaving skills for mothers and infants called “umama salama”, and the clinic staff go out into the local schools to provide community health outreach; I hope to utilize those existing networks to implement malaria education focusing on malaria prevention and target health-seeking behaviors to ensure prompt and effective treatment for pregnant women and children.
  2. Clinical care:  One of the challenges of treating malaria in Kenya is the emergence of drug resistance; the first-line treatment in Kenya is now arteminisin-based regimens which while effective, bring new challenges in that this treatment is more expensive and fear of developing drug resistance to one of the last remaining effective treatment regimens in the region. By observing and collecting data on current diagnostic and treatment practices in the clinic, I hope to help identify any areas for improvement.  The head clinical officer has also invited me to help with the weekly continuing medical education sessions for the clinic staff which will be a great opportunity to help make sure they are all practicing updated malaria treatment guidelines, along with targeting some other common clinical problems.