Last day at Kibera

Kibera continues...

Today was day 4 of our time at the JJJ Clinic in Kibera. The trainees continue to make progress, and we continue to catch early lesions (so far have only found one case of invasive cervical cancer) that can be treated with cryotherapy or LEEP. Today we learned that the hearty lunches they have fed us every day are prepared by the families of the girls in the attached girls school. The school is free - including uniforms, shoes and two meals a day - but someone from each student's family has to commit five weeks of work to the school. So the mothers, or sisters, or aunties of the girls have been cooking us lunch. Yesterday they had to prepare food for the 100 girls in the school, the 80 clinic staff members, the 6 of us and the 20 community health workers at our training. Quite a feat! It's inspiring to see how committed the girls' families are to their education and how integrated the community is to the work of the school and the clinic.

Kibera

We are in Nairobi traffic ("the jam") on our way back to the Johanna Justin-Jenich clinic in Kibera for our second day of training. The first day was wonderful. Kibera is a large (1.5 million people live there) slum filling a depression by the railroad tracks out of Nairobi. The government of Nairobi apparently does not want it to exist and does not provide services to the area. As a result of the conditions of the slum the life expectancy there is 30, compared to 50 for the rest of Kenya. We were bracing ourselves for a hard first day there, expecting to have to troubleshoot a multitude of difficulties over the day, but it ran very smoothly. The clinic has been set up by an organization (the Shining Hope for Communities) founded by a man named Kennedy from Kibera who is now studying at Wesleyan University (in Connecticut). It's a really good story and you can read about it more on their website. At this point they have a two-story bright blue school decorated w children's hand prints, a clinic with three exam rooms, electricity provided by a generator, the largest clean water supply in Kibera, a clean latrine, and an enthusiastic and dedicated staff. We had 6 clinical trainees, consisting of nurses, clinical officers (equivalent to mid-level practitioners in the US like physician assistants) and one doctor. I was lucky to be in a room with the two clinical officers, Purity and Diana, who already had some experience w cervical cancer screening and were clearly competent in their clinical judgement, quick to learn more and caring towards the patients.

We have now pulled through the jam and are at the gates of Kibera. More later.

by Merritt Evans

Kisii to Nairobi

Habari gani, rafiki ya PINCC? (Which may or may not mean "How are you
doing, friends of PINCC?")

I am with PINCC for the first time, in Kenya for the first time,
blogging for the first time. Lots of firsts! We have just arrived at
the Mennonite Guest House in Nairobi, which is a beautiful garden
sanctuary. Our time in Kisii was very satisfying. It was PINCC's final
trip there and it appears that cervical screening in Kisii Level 5
Hospital (<kisiihospital.org>) has great momentum going forward. The
midwives are excited about the project and are diligently screening
women every day in two different clinics. Dr Ondari, their new
gynecologist, has already led a training for other midwives and
clinicians in the region. And the medical director of the hospital
clearly has ambitions for the hospital to be a model of cervical
cancer screening for the region. It is very exciting, and a very
inspiring introduction to PINCC for me, which appears to be a model of
how international efforts can help train local providers to
independently provide the services that they themselves feel are
essential to provide.

Tomorrow we go to Kibera in Nairobi, a brand new site, which promises
to be an entirely different, but also exciting, experience. I'm
looking forward to it. And I'm also loving Kenya - the beauty, the
warmth of the people, the way that everyone who greets you takes the
time to inquire how you're doing, the gingeriness of Stoney Tangawizi,
the English Premier League football on every bar TV, the chapatis, the
chaos of the boda-bodas, the sweet burnt smell, the odd cow in the
road, the deliciously ripe pineapple, the whole package. I feel very
lucky that we are so welcomed to do this work here.

Endebess, Kenya

Weekly tally for Endebess:

Patients seen: 358

Biopsies: 24

PAPs: 39

Cryo's: 35

LEEPs: 5

16 Trainees and 10 Supervisors were trained in VIA, VILI, Cryo and LEEP. We expect to certify all during our next visit in August.

60 Community Health Educators were trained in the importance of screening for cervical cancer and education materials were distributed for the CHE's to use in their communities.

These last two weeks with PINCC have been absolutely extraordinary. It is always a pleasure to go into a community and share talents but to train others so that your talents can continue after you depart is truly the way to go. PINCC's combination of classroom sessions plus 1-on-1, hands-on transfer of skills is effective; the growth and empowerment seen in all of the trainees has been remarkable. It was a real pleasure to work with such motivated, enthusiastic people. Every one of them has stated they will continue after we leave and they look forward to follow up training when we return in six months. If these 16 trainees see only 3 patients a week, there will be 1248 women screened before we return. If the numbers remain at the roughly 29% needing further treatment or tests as it has this last week, that will mean approximately 362 women will have been treated for conditions which generally result in cervical cancer before we even return… and this is only for Endebess!

Working with PINCC has been a privilege and I hope you have enjoyed my sharing the experience with you. This is, however, the last blog entry I shall be writing for PINCC. I am now in Kisumu, visiting with a Peace Corps Volunteer friend to see a bit of Kenya before I return to the states but I am sure Carol will find someone in the new team to continue. They are in Kisii now, until Wednesday, when they move on to the Johanna Justin-Jinich Community Clinic, a project of Shining Hope for Communities (SHOFCO) in Kibera , a vast Nairobi slum. I imagine them now, the end of the day, arriving at their accommodations, tired and dirty, yet fully energized by the work and appreciating the simple pleasures: electricity, hot running water, paved roads, thread count sheets. They have cleaned up and are sitting around a table or a cluster of sofas, discussing the trainees and the difficult cases of the day. They are thoughtful, and dedicated, and all working hard to make a difference. I am truly proud to be a part of this team. Talk to you on the next trip…

Amelia T. Hambrecht

Endebess

Where Gombe was a small rural hospital, seeing an average of 22 women a day, Endebess is a larger hospital that is vying for district status. Here, during our first two days, we saw more women than we did the entire week in Gombe. Monday, Carol and I did the cervical cancer training to 60 community health workers. The pace is faster; there are more women with severe cases, yet the facilities are more reliable so the work seems more fluid. Small town Kenya is worlds away from rural Uganda. We have consistent power so we are now able to use our equipment. We even have hot water and showers where we are staying, so we can now feel more like ourselves. As much as we all loved Gombe, Endebess is a big step up.

Our replacements are starting to arrive. Art Levit and Carol Savio flew in last night from the states. Art is a piano playing OBGYN, most recently from Kaiser East Bay, who has been Medical Director on numerous PINCC trips since his retirement three years ago. Carol is a retired RN who moonlights at the Women's clinic in San Francisco when she is not on PINCC trips. Melissa leaves us tomorrow for the states and Art will take over as Medical Director for the remainder of the trip. Eva and Arlayne leave on Saturday and I will be dropped off on Sunday in Kisumu to visit a friend while the rest of the new team meets in Kisii. This has been a wonderful adventure; it is hard to believe our two weeks are nearly over.

And how is it, you ask, that I have time to blog on a Wednesday afternoon? I, the one who has eaten street food all over the world and never gets sick, got sick. And even more unsettling is that I cannot figure out what got me there. Yesterday was excruciatingly difficult, trying to shoulder my responsibilities while also trying to keep from being sick in front of everyone; I managed but do I owe Arlayne! She was a huge trouper and did nearly everything while I just organized paperwork and inputted in the computer. She most defiantly earned the golden speculum award yesterday! And I must say, if you have to get sick on a trip, do it on a trip with Doctors. My meds, of course, were deemed inferior once reviewed yet any meds I needed, someone had. And when your body rejects said meds faster than you can get out of bed, your doctor roomie is not fazed at all and gives you hers while she goes to another room. The complete injustice of it all is that I feel fine today. Hungry even, as I sit, quietly relaxing, writing this blog as I know everyone is working hard 45 minutes away but fortunately Carol and Art are there to help and all will go well. I see my future though. Tomorrow will be speculum city for me!

Amelia T. Hambrecht