Imagine, if you will, a community of 40,000 people – the number of people in Tamworth, NSW or Panama City, FL. Imagine those people spread over 11,000Km2 – mostly arid desert and gorse scrubland dotted with occasional small villages. Imagine that you are the only doctor in the area, fresh out of medical school without any residency training, to care for all of them. It was to a tiny rural hospital in these conditions that a team of eight from Kijabe Hospital went to visit last week, to see if there is a way that we can connect with and serve this poor, pastoralist community.
We had been invited by the local government representative and community leaders, who rely on scant government resources that are always stretched in way too many directions to try and provide health care for way too many people. Kijabe Hospital has a 100-year-old reputation for excellent health care and training, and many of the local elders from this area have a family member who have at some stage been sent the long distance to Kijabe to receive care. So we are a trusted name – even though we are a Christian hospital and their community is not – to whom their leaders are reaching out to in desperation. Asking – can you help us help our mothers, grandfathers, cousins, children?
Kenya has long distances and bad roads and this trip would have taken over 8 hours to drive one way with rough, unpredictable roads and potential security concerns in a remote location*. So with the help of AIM Air, we left Kijabe at 5:30 in the morning for an 8:45am arrival on the local dirt airstrip. Our team consisted of a surgeon, theatre nurse, family/emergency doctor, 3 community health team members and myself – all asking the question: What do they have? What do they need? Can we help?
We met the medical administrator of the hospital. A young man who completed medical school in 2012, worked for one year as a medical intern learning (boot-camp style) how to perform c-sections, splint broken bones, treat HIV/AIDS/heart failure/pneumonia, diagnose surgical emergencies, resuscitate babies and more – and then was posted to run a 60-bed hospital.
One year of experience – and now overseeing a hospital and every other clinic in a 200km+ radius, caring for 40,000 people.
For a year, he was the only doctor at the hospital, with a few nurses and clinical officers (physician assistant / nurse practitioner level assistants) to help – knowing that outside of his 200km radius of responsibility, the availability of care in most directions decreases, and so people from a wider area also come. Every emergency c/section – 24 hours a day – was his responsibility. People walking many hours, often in advance stages of illness or injury, to a hospital with some local anesthetic for spinal anesthesia and a doctor that has had more time learning from books than from mentors – and who has not had a day off for months. When he had to rest, the team would refer a mother in labor or gunshot wound over 3 hours of rugged roads in an ambulance, to another overwhelmed hospital where they may wait hours for care – often too late.
After a year, he received a second doctor to help him.
He showed us their facility – a paradox of provision. An overseas-NGO-built beautiful new building for high risk mothers – unused due to lack of community engagement. A 3 year old oxygen plant – never turned on, and in any event, without any tech support. A single unused operating theatre – with a broken anesthesia machine and theatre lights, no-one to repair. A new building for x-ray and ultrasound – the equipment to arrive “next month”. All inhabited by a team of local nurses, health officers, dental assistants, proudly providing the best care they can: and with no maternal deaths in 2 years, the first dental care in the district commencing this year, no transmission of HIV from positive mother to their babies, they have a lot to be proud of.
We flew back to Kijabe at the end of the day with a profound respect for this group of community health practitioners doing the very best they can with unbelievably limited resources – fewer than we have at Kijabe, if you can believe that (and we struggle with not enough every day). I am looking into whether we can assist some of their nurses or clinical officers or junior doctors to come to Kijabe for a few weeks to work in our nursery, seeing good care of premature babies, or our operating theatre, seeing better sterilising and operating techniques. We are looking at whether we can help them find sponsorship for one of their clinical officers to join our 18-month nurse anesthesia training program – knowing that one anesthesia provider can save thousands of lives. We are looking at whether we can send a small group of nurses , surgeons and medics to do an intensive training program once or twice a year for all staff in basic care of surgical emergencies, in addition to lining up several hundred patients for surgery as we treat and up-skill at the same time.
In the light of the recent attack in Garissa, which occurred 48 hours after our trip, I am grateful to be a part of a group of people here in Kijabe who love. It is sobering to go to an area with a rural people who may not look like us, or pray like us, and who live in close proximity to a radicalised population. An isolated people who are saying – we know you are the kind of people who love without boundaries and want to help with no ulterior motive – will you help us?
I am grateful to be part of a group of people that weighs up the risks with the need – and says Yes.
Be very careful, then, how you live—not as unwise but as wise, making the most of every opportunity, because the days are evil. Therefore do not be foolish, but understand what the Lord’s will is. – Eph 5:15-17
There is no fear in love, but perfect love casts out fear. For fear has to do with punishment, and whoever fears has not been perfected in love. We love because he first loved us. If anyone says, “I love God,” and hates his brother, he is a liar; for he who does not love his brother whom he has seen cannot love God whom he has not seen.- 1 John 4:17-20
*For security reasons, I haven’t named the town or area in this post.