Medicine in the Developing World: Kapsowar Hospital in Kenya

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Medicine in the Developing World Kapsowar
Hospital in Kenya

• John Kim
• MedPeds Conference
• 11/6/06

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Reasons to go overseas

• Opportunity to serve patients in need
• Educational
• Practical

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Types of Experiences

• Inpatient
• Faith based missions hospital
• Humanitarian hospital
• Government hospital
• Outpatient
• Research

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Time line
1 Year 9 month 6 month 3 month 1 month
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Budget

• Airfare 1800
• Cost per Diem 18/day 500
• Land Transportation 200
• Souvenir 100
• Supplies Gift 100
• Emergency 100
• Medical License 50
• Airport Tax 50
• Travel Expense 20
• Total 2900

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Funding

• Scholarships
• Yale/Johnson Johnson Scholars Program
  (1,000-5,000) Deadline 3/14/07
• Readers Digest Map Scholarship 75 of airfare.

• Supplies
• J J Medical Mission Pack Program
• Reachout Initiative Ortho-McNeil
  Pharmaceuticals
• AmeriCares
• Roche
• Pfizer

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Travel Health

• Vaccinations - Employee Health International
  Travel Clinic.
• Malaria Prophylaxis - Employee Health.
• HIV Prophylaxis - Employee Health.
• Antibiotics for Gastroenteritis - International
  Travel Clinic.
• http//www.cdc.gov/travel/

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Pearls

• Plan early
• Need for flexibility

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6,984 miles later
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Crossing the equatorSub-Saharan Africa

• The poorest region in the world with least
  developed countries.
• Largest burden of HIV/AIDS Epidemic in the world

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Rift Valley
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Kenya

• Sub-Saharan Eastern Africa
• Official Language English, Swahili
• Per capita GNP 1,050
• Life Expectancy 48 years
• Infant Mortality - 69 deaths/1,000 live births

Note 1. US Infant Mortality 7/1000. 2. US life
expectancy 77 years
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Kapsowar
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Kapsowar Hospital

• Established by Christian missionary in 1933.
• 126 bed district hospital
• Inpatient, outpatient, and surgical services.
• Serving the Maraquet tribe
• Operating cost mostly by patient revenue

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Clinical Staff

• Staffed by US FP, 2 Kenyan GPs, rotating surgeon,
  other short-term volunteers.
• Nursing staff trained by Kenyan nursing schools
• Laboratory technician.
• Anesthesia technician.

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Female Wards
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Maternity Wards
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Childrens Ward
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Laboratory
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X Rays
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Ultrasound
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Pharmacy
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Hospital Formulary (IV)
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Theatre
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Way of Life
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Preventative Health
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Sterilization
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Community
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Community
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Common Admission Diagnosis

• Primary pulmonary and dessiminated TB
• AIDS OI
• Malaria
• CHF from Rheumatic Heart Disease
• Pneumonia
• Gastroenteritis

• Fractures/Trauma
• Burns
• Typhoid Fever
• Meningitis
• Organophosphate Toxicity
• Obstetrics Care

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AIDS
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2005 HIV Prevalence Worldwide
Source UNAIDS, 2006 Report on the Global AIDS
Epidemic, 2006.
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Highlights of AIDS Epidemic in Sub-Saharan
Africa (2005)

• Total number of people living with HIV/AIDS -
  25.8 million.
• People newly infected with HIV/AIDS 3.1 million
• AIDS death - 2.4 million.
• Prevalence of HIV/AIDS (age 15 to 49 years) - 11
  

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HIV Epidemic in Sub-Saharan Africa
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Kenya AIDS Statistics in 2005

• Number of people living with HIV 1,300,000
• Adults aged 15 to 49 HIV prevalence rate - 6.1
• Percentage of pregnant women receiving treatment
  to reduce mother-to-child transmission - 9.3
• Percentage of HIV-infected women and men
  receiving antiretroviral therapy - 19.7

2.5
36
People in Sub-Saharan Africa on ART as of
those in need, 20022005
2005
2002
2003
2004
Source WHO/UNAIDS (2005). Progress on global
access to HIV antiretroviral therapy An update
on 3 by 5.
7.2
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State of the Art

• 2001, UN General Assembly opened a special
  session dedicated to HIV/AIDS.
• 2002, Global Fund to Fight AIDS, Tuberculosis and
  Malaria was launched with pledge of 5 billion.
• 2004, The US Presidents Emergency Program for
  AIDS Relief disbursed 570 million with
  additional 916 million by 2005.

• Recent declines in national HIV prevalence
  behavioral changes.
• Between 2001-2005, number of people on ART in low
  and middle income countries increased from
  240,000 to 1.3 million.
• 90 of reporting countries have a national AIDS
  strategy

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Coverage of Peripartum Antiretroviral Prophylaxis

• Concerns that coverage of ART prophylaxis for
  mothers is lagging compared to general population

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HIV/AIDS Treatment at Kapsowar Hospital

• Free of cost to the patient
• CD Count lt 200 or WHO Class IV AIDS
• 3 drug regimen
• Includes prophylaxis and treatment of OI.
• Must meet Treatment Readiness Criteria

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ART Readiness Assessment
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Typhoid Fever
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Tuberculosis Potts Disease
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Sad case
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Medicine in a Developing World Challenges
Perspective

• Peoples view on life
• Lack access to diagnostic tools and opportunities
  for specialist referral
• Lack of continuity

• Utilitarian model of medicine.
• Barriers to patient education and communication.
• Antibiotic Resistance

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Cases
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African Burkitts Lymphoma
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Goiter
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Pneumonia
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Steven Johnsons
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Barbers Itch - Tinea Barbae
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Skin Graft
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Malaria
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Panna Injury
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Traction for fracture
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Fibroid
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TB Lymphadenitis
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Pulmonary TB
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AIDS
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Polydactyl
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Cleft Palate
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Congenital Glaucoma
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Having fun
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Until Next Time
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Reflections

• People
• Medicine that is practical for Africa.
• Reminder why I entered medicine

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Thanks

• Dr. Frohna and the medicine department.
• Christian medical missionaries of the past and
  future who serve those that are in need in the
  most remote parts of the world.
• Jesus who provided the greatest example of love
  that I try to emulate in my career in medicine.