One of the unique aspects of the model of Lwala Community Alliance, is that while there is a clinic, the program is multi-dimensional, there is also a strong water, sanitation, and hygiene program (WASH), a education initiative that partners with schools and helps to provide secondary school scholarships based on academic merit and need, Umama Salama, an initiative to train community members on basic lifesaving skills to reduce maternal and infant mortality, and a sewing cooperative. The clinic staff goes on school outreaches at local primary schools which includes health education and free preventive care.

One of the most heart-rending patients I saw was young man with HIV/AIDS. He had initially presented to the clinic on 12/10 with advanced disease (for the medical folks his CD4 count was 3) and was started on antiretroviral therapy (HAART). He came back to clinic in January dehydrated with diarrhea, some fairly advanced skin ulcers, cough and fever. I remember the morning he arrived he was laying outside the clinic on a mat an hour before opening, I could tell from a distance that he was incredibly emaciated, I went over to make sure he was okay, and this man, despite his illness gave me the sweetest smile. He continued to have such a warm smile throughout the few days he spent on observation with us while receiving IV fluids and antibiotics, and gradually improved though he was still very weak. He was discharged on home-based care and I walked with the community health workers to his house a few days later to see how he was.

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.

A previously healthy 29 year old female arrived in the ED via motor taxi, accompanied by her family, early in the afternoon on a day I was working in the outpatient clinic. I stopped by the ED on my way home, and saw that Turno doctor had her hands full with the patient, so I stopped to help. The patient was hypoxic (74%), tachypneic (58 breaths per minute), and somewhat hypotensive (90/50). She complained of chest pain and shortness of breath for 3 days, and also thought she may have had a fever although she was afebrile on arrival to the ED. Her EKG showed sinus tachycardia, but was otherwise normal (we were only able to obtain limb leads). She appeared chronically ill. We were unable to get labs because of the time of day, and the patient was too unstable to transport for a chest x-ray. Pulmonary embolism was a major concern even though she had no risk factors, thus we gave Heparin for anticoagulation and started to arrange transfer to Guatemala City for diagnostic testing and treatment. After two hours of preparing for transport, collecting supplies (as there are none on the ambulance), and deciding which family member was going to accompany the patient, we were finally ready to go. Just prior to departure, the lab was able to run a rapid HIV test, which came back positive. This added more to the list of possible diagnoses. By this time the patient was on 10L O2 and a Dopamine drip. We added on several antibiotics for possible infection, and started the journey.