Outbreak at Friends Hospital Kaimosi

Part of our job in Kenya is to respond to situations as they arise. This is my story of a recent dysentery outbreak at Friends Hospital Kaimosi, involving me most actively for two days on March 16 and 17. People's health and even lives were endangered, and I found myself and others suddenly in a position to make a difference to these lives in ways I could not have anticipated.

On March 16 at 5:33 AM I received a text message on my mobile phone from the hospital administrator Gabriel saying that a bloody diarrheal outbreak was swamping the resources of Kaimosi Hospital. This hospital was once was the pride of Western Kenya with large and excellent staff, state-of-the art facilitates, and a fine nursing school. People would come from surrounding countries for treatment. In recent years the staff has dwindled, the facilities have decayed, and they hadn't had a doctor on the staff for some time. Most people in the densely-populated, immediate area would rather travel 20 kilometers at some personal expense to the government district hospital in Mbale rather than receive care at the Friends Hospital in Kaimosi. The hospital with 140 beds -- and ward space enough for many more -- was averaging around 20 patients and was paying only partial salaries each month. On January 27 of this year, Friends United Meeting took over the governance of the hospital for the purpose of bringing it back to better serve the needs of the surrounding area. A new board of governors was appointed consisting mostly of high-power Kenyan professional medical people. I was chosen to be as FUM's representative on the boards. FUM doesn't have much money at this time to use for this purpose. We are starting to fund-raise in the U.S. and the U.K., especially for infrastructure like replacing the leaky, asbestos shingle roof. But mostly we are counting on the Kenyan Quaker medical professionals to turn around the hospital through better management.

But on the morning of March 16 the hospital was in trouble. And I, as the board representative from the governing institution, was being called for help. They had admitted 41 school children and college students since the previous week, 19 of them on the previous day. The daily admissions were rising alarmingly. Outbreaks of dysentery in Kenya are not expected to be this large, and the hospital was not equipped to handle the patients coming in. The press from the two national daily newspapers "The Nation" and "The Standard" had visited the school on the 15th, along with a camera crew from the national Kenya Television Network. The district and provincial medical authorities had visited the hospital and provided some emergency medical supplies, but more was needed. Gabriel asked the government officials if they could help with food to feed the patients, dishes and utensils to serve it, linens and blankets to put on the beds (many beds were being shared by two patients.) They said the government couldn't provide this kind of assistance; Gabriel should look to the hospital's sponsor, the Religious Society of Friends, for help. So now on the morning of March 16 Gabriel was calling me for help. What could I do? I didn't have money or resources just lying around, waiting to be used.

At 8:15 AM I talked with a Kaimosi Hospital Board member and trauma surgeon who, like me, was dropping off her two children at school. She warned me that the danger of severe dehydration can be worst at night, when it is harder for the nurses to monitor each patient, and the nurses themselves may not be at the height of their numbers or concentration. That is most likely when patents from such an outbreak may die. Even without the outbreak the hospital was short on nursing staff because some of the better nurses left for government hospital jobs where they would be better paid, and at least paid regularly.

The doctor said that she had in her possession a carton of surplus Cyproflaxin that the U.S. Embassy was giving away from their stockpiles since it was nearing its expiry date. She also suggested that I arrange to have the CDC (the U.S. Centers for Disease Control) in Kisumu test the stool samples to help determine the cause and best treatments. She made phone contact with CDC to introduce me and start making arrangements. She asked the outbreak coordinator how often they had seen an outbreak of this size. The answer was "never." She also phoned the Aga Khan Hospital in Kisumu (the best-off hospital in the area) to ask for help with supplies and nursing assistance.

I saw in the Daily Nation newspaper that day a picture under the banner "Outbreak", with the caption "Kaimosi Mission hospital matron [head of nursing] Carolyn Chepleting attends to Mr. John Mbugua of Kaimosi Teachers Training College in Vihiga District. Mr. Mbugua was one of 38 students who were admitted to the hospital after an outbreak of dysentery." I was told there were also reports that day in the Standard newspaper and on Kenya Television Network.

I arranged to have a friend take that day by public transportation (a "matatu" minivan) the Cypro to Kaimosi and return with stool samples. (Eden and John Muhanji were both out of town so I was single parenting and staffing the office myself.) In the early evening I drove the samples to CDC near Kisumu.

Later that evening Eden was back at home and I was at a social event at which were many business owners from our small city of Kisumu. At 11:07 PM I received another text message on my phone from Gabriel thanking God that so far nobody had died, and saying that it was only by the grace of God that he made it through the day. He also emphasized the urgent need for food and bedding supplies. Many beds were now being shared by three patients. I showed the message to a friend who stood up and got everyone's attention, and then read the message from my phone out to the crowd. Then he asked who could help. One business owner said he would donate sheeting material. Another two offered 90 blankets. Others donated chlorine for treating the water, detergent for washing the linens, and money for buying food, dishes and utensils.

On the morning of March 17 as Eden was heading to Uganda for the East Africa regional meeting of the Quaker Peace Network, I arranged for our sons Isaiah and Jesse to stay with friends for the day. My Kisumu businessman friend and I rounded up the donated supplies, and I stopped at the supermarket for dishes, utensils and some food staples. Then we stopped at Aga Khan hospital where I met with the CEO. The hospital donated intravenous fluids and IV kits, syringes, needles, and the services of three nurses. With the nurses in the truck with me, and supplies in the back and strapped to the roof, we headed for Kaimosi. As I arrived, another truck was unloading emergency supplies from CHAK, the Christian Health Association of Kenya. One main purpose of CHAK is to purchase medicines and other medical supplies in bulk so the mission-established hospitals in Kenya can get better prices. But in this case CHAK was donating IV fluids and other supplies to help with the outbreak.

I left Kaimosi Hospital that afternoon with some more stool samples, and delivered them to CDC that evening before returning home. On subsequent days I returned to the lab to collect and distribute the results.

On March 17 alone there were 55 dysentery admissions, bringing the total admissions to 118 since the start of the outbreak. But discharges also started to increase, with 29 patients discharged that day. The next day the discharges (53) were outweighing new admissions (29), so the patient population was finally going down. I saw a follow-up story in the Daily Nation that day, and I heard that there was other press coverage also.

In the following days admissions dwindled off and then stopped, and all patients recovered and were discharged. To our relief there were no deaths. Thank God.

I've now returned to more mundane -- if no less challenging -- tasks such as trying to make a payroll budget that we can actually meet each month, working on other ways to generate income for the hospital such as opening the pharmacy to the public, and continuing to work with the hospital leadership to improve operations. In providing assistance, our goal is to bring the hospital to a capacity where it can sustain itself without constant reliance on outside aid. But we need help and prayers to get there. Please pray for us, and help financially if you are able. Donations for improving the hospital may be sent to Friends United Meeting, 101 Quaker Hill Drive, Richmond IN 47374 earmarked for "Kaimosi Hospital." On-line credit card donations at www.fum.org are also welcome.

Blessings,
James Grace