Maasai Clinic (part 2)

The last two days we've been back in Siyiapei--mom and dad have been organizing medical supply room and the records room, Kristin and Brenna have been working across the highway at the Children's Home (I'll post about that tomorrow) and I've been working in the clinic with Shadrack.

Sadly, I have learned, the Siyiapei Dispensary is lost in a triangulated no man's land between Kenya's Ministry of Public Health and Sanitation, the Africa Inland Church (AIC) and Kijabe Medical Center (under whose auspices I am here.) The AIC owns this dispensary--it was originally founded by the Africa Inland Mission and it sits on the AIC compound--and it completely controls who is employed here. Meaning, apparently, that only Kenyans professing to be Christians who fit AIC's definition of 'Christian enough' are hired here (a huge problem as Shadrack sees it. As he says, there are very few Maasai who are both educated and Christian--and, basically, one has to be Maasai to work here long term because the employees must be able to speak kiMaasai.) Because the dispensary is a dispensary, the government's Ministry could come in here and take it over--hire a trained kiMaasai-speaking professional to clean up its operations--but it won't do that because the Ministry is happy to leave the dispensary alone for the sake of saving bucks. And then, Kijabe Medical Center--the one institution in the mix that has the know-how to run a quality medical facility--is relegated to enforcer of church policy as it relates to the dispensary. In other words, Kijabe--as another AIC-ruled institution--helps ensure AIC 'appropriate' medical trainees end up working out here. Kijabe has basically washed its hands of organizing or supporting any medical services out here unless the services directly benefit Kijabe Hospital. Which means nothing, other than sending one doctor out here one afternoon per month to see patients with the lone nurse who runs this place.

Anyway, I have had a fantastic time getting to know Shadrack (who wants to go back to school and eventually teach nursing in the university setting,) Benjamin the lab tech (who wants to become a pathologist) and Stephen the handy-man (who wants to be an engineer.) I love the Maasai culture and I love seeing the Maasai patients. I've been busy the last couple of days--mostly with upper respiratory infections and coughs induced by the woodsmoke-in-the-mud-hut-without-windows scenario. But I've seen quite a few cases of malaria (Benjamin has been saving the positive smears for me and teaching me how to identify gametocytes and trophozoites.) Yesterday I saw a 12 year-old girl complaining of abdominal pain who ended up having an enormous painful liver--of course, this little place can't do any of the lab tests she needed so Benjamin drew her blood and will take it into a lab in Nairobi on Friday. Today I saw a malnourished, dehydrated ten month-old with a fever of 40.5, bulging fontanel and the most severe nuchal rigidity I've ever seen. Luckily, we had 500 mg of ceftriaxone (the last 2 vials in the pharmacy, as neither the government nor Kijabe will provide it--the dispensary staff has to go into Narok and purchase it themselves from a druggist. Same with ciprofloxacin . . . ) I was ready with diazepam because I was convinced the kid was going to start seizing at any moment. Can't start an IV here because patients have to arrange transport to the Narok District Hospital themselves--which means walking a quarter mile down the dirt road to the highway and hiring a car to drive them into town. And that's only if they don't have to go home and milk the goats first. Not sure I'm going to get much sleep tonight, worrying that kid is in a hut somewhere obtunded, or worse.

Shadrack is hungry for more medical knowledge and I've been able to give several little mini-talks about basic pediatric topics. But man, does this place ever need some TLC and someone committed to STOPPING the sloppy medical practices--like handing out Septra for viral coughs, or diagnosing typhoid without a fever, or diagnosing brucellosis with a single (lower that 1:160) titer, or not washing hands, or continuing to use albuterol syrup instead of inhalers . . . I mean, the intentions of this skeleton staff are all for the good of the patient, but the list could go on and on. And it's only because the only party that actually cares about this place is the AIC, and they know absolutely NOTHING about running a medical facility. Sad but true.

It kills me that these young, motivated guys who are working out here can't get the support that they so need and want. Sometimes I really wish I could fix the world.

Photos: Nurse Shadrack and his mom; waiting for clinic, Siyiapei Dispensary; coming to clinic, Siyiapei; waiting for clinic; teaching moment with Shadrack and Benjamin; Siyiapei Dispensary and oldest church in Maasai Land.