Please see: http://www.volunteerkenya.org for more information!
 

Background Information:  

      Since 1996, a community based organization called Inter-Community Development (ICODEI) has been implementing community development programs in the rural villages where large international aid programs have never been. The vision of the leaders of ICODEI has become a reality through their partnerships with 5 student organizations in the United States, one of them being IFMSA.

      Our main area of focus since 1996 has been AIDS Education. On a shoestring budget with no source of external funding, we have managed to sensitize over 48,000 Kenyans about the transmission and prevention of HIV/AIDS. During June of 2001, our team constructed and opened the first public library in Western Kenya (Kabula location), with the potential of serving the 800,000 people of the area in the future. Our team also constructed a preschool in June of 2001 and established a "Sponsor a Child's Education" program to assist those children whose families cannot afford to send them to school. Recognizing that Kenyan women in rural areas often lack access to credit, we have also organized an income-generating program for the local women. Over 2,000 women from 62 different women's groups organized into 4 consortia for the purpose of establishing sewing and tailoring centers during the summers of 2001 and 2002. Each consortium was given 5 sewing machines to begin their businesses. Through a partnership with the Foundation for International Education (USA) in 1999, we established a Teacher’s Program that offers students and experienced teachers the opportunity to come to Kenya and teach in the local schools. Between June 10th and June 15th, a group of medical students from the United States set up a temporary health clinic in the Library and managed to start medical records for 487 people and distributed 24,000 vitamins. Construction of a clinic at the same Kabula location was started simultaneously with this exercise and is expected to be complete by early August, 2002. The clinic will be staffed by local health care professionals, as well as those volunteering from abroad. The projected date of opening the clinic is December 1st, 2002.

Concerned Health Professional:

     The people living in the rural areas of Western Kenya are facing major obstacles in their pursuit of adequate health care. Although several government run hospitals do exist in the Western Province, they are not adequately equipped to handle the needs of the people. The two major problems are related to the shortage health care professionals and to the access of medications due to availability and financial restrictions. By establishing a Health Education Center and Clinic in Kabula, Kenya, we hope to alleviate some of these problems. From our first hand experiences we have seen unsuccessful development projects that failed due to the donor organizations unwillingness to work with the local people. Therefore, to promote sustainable development, we will assist the current infrastructure by working hand in hand with the local health care providers in a mutually beneficial exchange. By working in a non-imposing manner, the clinic will be maintained by the local health care providers even in the absence of members from the donor organization.

     In the United States, there exist 341 people per doctor, while in the East African nation of Kenya, there are an astounding 10,150 people per doctor. It deserves mentioning that these figures are averages, meaning that in some rural areas throughout Kenya and other parts of Africa there may be over 100,000 people per doctor. Please peruse the following table. The number of human beings per doctor can serve as a general indicator of access to health care in any given country. Therefore, by examining this figure, one can locate the countries in the world that are the most disadvantaged with respect to access to health care.

Table 1: People per Physician¹

   Nearly 14 million children under five years of age still die annually in developing countries. Diarrhea, measles, tetanus, pertussis, pneumonia, and malnutrition are preventable and treatable and yet account for the majority of deaths (6). Infectious diarrhea is the most common infectious disease syndrome worldwide resulting in more than five million deaths annually, a higher rate than cancer and AIDS combined (7). According to the World Health Organization (WHO), every year more than three million children die in Africa from vaccine-preventable diseases. The results from 53 developing countries with nationally representative data on child weight-for-age indicate that 56% of child deaths were attributable to malnutrition's devastating effects, and 83% of these were attributable to mild-to-moderate as opposed to severe malnutrition (5). With the knowledge that 98% of all deaths in children younger than 15 years and that 83% of deaths in people between 15 and 59 are in developing countries, it is evident that some action must be taken (4).

     In Kenya, there is on average one doctor per 500 people in Nairobi, but only one per 160,000 in rural Turkana district (3). Health facilities are often located in urban areas, far away from rural populations most in need, or are not accessible to large numbers of the population via public transportation. Besides the issue of lack of access to health care, the people in rural areas also face the harsh reality they may be unable to afford the medications prescribed by the doctor. More than 900 million human beings worldwide make less than $1 a day. In developing countries, corruption is often rampant and funding with good intentions never reaches the people at the grassroots that are in need. World Bank estimates that for every $100 spent by African governments on drugs, only $12 worth of medicines reaches patients (3).

    Why assist developing countries when there are still millions of Americans in need?

With over 45 million citizens of the United States lacking health insurance, the question of "Why assist developing countries" arises. This figure definitely indicates that there exists a need for health care assistance in the United States. However, the barriers to health care in developing countries such as Kenya are much more numerous, greater in magnitude and more complex than in developed countries.

Demonstrating a Need:

     In a random sample survey taken by community members of Kabula, Kenya during the summer of 2001, 66% of the respondents reported that the most common reason they sought medical care was due to suspicion of acquiring malaria or typhoid fever. When asked, "What is the primary factor that prevents you from seeking medical treatment that may be necessary or beneficial?" 53% responded "high cost of treatment" and 39% responded "long distance to medical facility." In an attempt to survey the community members' attitude towards and desire to obtain medical care, the people were asked, "If cheaper basic medical services were available in Kabula, how often would you use them?" 88% responded "2 or 3 times a month", thus indicating that the people do desire improved access to health care. When asked, "If cheaper basic medical services were available in Kabula, which services would you be most likely to utilize?" 85% responded with "diagnosis of malaria or typhoid." From this information, it is evident that the following medications would be beneficial to have in large supplies:

• Ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin for the treatment of typhoid fever
• Mefloquine (Lariam), Malarone, and Fansidar for the prevention and treatment of malaria
• Antibiotics

Given the high prevalence of diseases that are preventable by vaccination such as typhoid fever, we hope to be able to begin a vaccination program for local community members once the Health Clinic has progressed through its early stages of operation.

Description of the Clinic:

    Between June 10th and June 15th, a group of medical students from the United States set up a temporary health clinic in the Library and managed to start medical records for 487 people and distributed 24,000 vitamins. Construction of a clinic at the same Kabula location was started simultaneously with this exercise. The structure that has been erected during the summer of 2002 was done so with a budget of approximately $8,300 USD. The clinic consists of 5 examination rooms, a nurses’ station, an office, front desk, medical records office, waiting room and 2 storage rooms. Currently we have no electricity or running water. For now, one of the exam rooms will be used for a HIV Pre/Post Test Counseling Office, and another exam room will be used for the laboratory. We will set up a temporary pharmacy in one of the storage rooms. Until the clinic has been in operation for several months, this work will be contracted to a Pharmacy from a larger town. We are planning on an expansion during the summer of 2003. People visiting the clinic will be charged a nominal fee of less than $1 USD, which will also cover treatment of minor ailments. This fee is about what someone would have to pay just in transportation costs to get to the nearest hospital 13 km away. Other treatment and/or lab tests will be an additional fee. The clinic will have five full time employees: a clinical officer, a nurse, a lab tech, a front desk clerk, and an accountant/office manager. With the fees generated from the office visits, 21 people a day will need to visit the clinic in order to generate the necessary $25,000 KSh per month (~$333USD) for the total salaries of the employees. We are planning on raising funds for the first 3 months salaries ($1,000 USD total), and then feel the clinic will be sustainable after this time period.

     Our goal is to make the clinic a rotation site that welcomes medical students, nurses, doctors and other health professionals from abroad that are interested in assisting and experiencing medicine in rural Africa.

June 10^th-15^th Medical Check-ups Statistics:

• Total Records:                                      487
• Visual Problems:                                   37
• Dental Problems:                                  47
• Surgical Candidate:                               11
• Needs Nutritional Support:                   20
• Dermatological Problems:                     33
• Infectious Disease Screen:                     34
• Desires HIV Test:                                 32
• Unique/Needs Follow-up:                     103

Clinic Employees’ Salaries:  

• Clinical Officer:                         8,000 KSh/month
• Nurse:                                                  6,000 KSh/month
• Lab Technician:                                    3,500 KSh/month
• Front Desk Clerk:                                 2,500 KSh/month
• Accountant/Office Manager:                 5,000 KSh/month
• Total:                                                  25,000 KSh/month (~$333 USD/month)

*To get a rough estimate for conversion to US Dollars, you can divide the amount of Kenya Schillings (KSh) by 75.

**The following positions may be added at a later date depending on the situation:

• Nurse Aid:                                            3,000 KSh/month
• Pharmacists’ Assistant:              3,000 KSh/month
• HIV Counselor:                                    3,000 KSh/month

***We will need 3 months of salary saved before we open the clinic. This will give us time to get everything organized and operational. After this initial 3 month time period, the clinic will be self-sustaining based on the nominal fee each person will pay for an office visit. The details are listed in the following section. 

Clinic Fees:

Each person visiting the clinic will be required to pay 70 KSh (93 cents) to see the Clinical Officer and/or Doctor. Please note that for transport alone to the nearest hospital or clinic, the people have to pay a minimum of 40 KSh. Of this 70 KSh:

• 20 KSh can be used for treatment of simple ailments
• 50 KSh will be used for maintenance of the Clinic and Staff salaries

Example: Malaria can be treated for 18 KSh

• Fansidar:          10 KSh
• Paracetamol:     3 KSh
• Injection:          5 KSh

Laboratory Fees: 

The income generated from laboratory work will be used for stocking the lab, buying supplies for the clinic, and possibly for the salary of an HIV Counselor. The following are the most common test performed and their respective process:

• Malaria test:                  30 KSh
• Typhoid Test:               80 KSh
• Brucella Test:                80 KSh

Sustainability of the Clinic:

     If you treat 500 people per month at a rate of 50 KSh of income per patient, the clinic will need to treat 21 people a day, and be open 24 days a month. Hours of operation will be Monday through Saturday, from 8am to 5pm. Using this equation, the clinic will generate the necessary 25,000 KSh per month for the salaries of the staff.

Immediate Expenses:

     As mentioned previously, the clinic does not have electricity or running water. Before the clinic can pass inspection by the Ministry of Health in Kenya, we need to rectify this situation. Our immediate expenses are as follows:

• Solar Panels (Two 40 watt panels, inverter, batteries X2):  97,440 KSh ($1,299)
• Electrical Wiring (outlets, switches, sockets, labor):  9,000 KSh ($120)
• Plumbing (2 toilets, 7 sinks, 960L Water Tank, piping, 2,300 L septic tank, labor): 122,000 KSh  ($1,627)
• Plaster outside walls (cement, sand and labor): 22,000 KSh  ($293)
• Initial 3 months salaries: $75,000 KSh  ($1,000)
• Additional furniture: 31,000 KSh ($413)
• Total: $4,752 USD

Summer of 2003 Expansion:

     Our goal is to expand the clinic during the summer of 2003. We plan on building another structure adjacent to the present building. Once this building is complete, we will move the HIV Pre/Post Test Counseling Office, the Laboratory, and the Pharmacy to the new building. This will then mean all 5 of the examination rooms will be available for the patients. The new building will also include an operating room and an administrative office. Local contractors have quoted a price of approximately $25,000 USD for this expansion. We plan on adding a second floor to house an “In-patient” ward at some point in the future. Depending on the fundraising efforts and grants, this may occur during the summer of 2003 or summer of 2004.

Desired Diagnostic Equipment List:

Organizations Involved:

     Inter-Community Development Involvement (ICODEI) works closely with the following organizations in the United States:

• The International Federation of Medical Students’ Association
• Humanitarian Medical Outreach of Rice University
• United Trauma Relief of Massachusetts Institute of Technology
• Outreach Kenya Development Volunteers of Indiana University
• Outreach Kenya Development Volunteers of West Virginia University 

     As you can see, there are currently many organizations and sustainable community development projects being implemented in the Western Province of Kenya. Through our experiences in development work, we have found it to be very beneficial to work hand in hand with the local people at the grassroots level. These are the people and areas of rural Africa that are seldom reached by International Aid programs. While the Western press highlights the dismal failures and corruption of the leaders and the elites in the African countries, they are overlooking the resilience of the people at the grass-roots level. We have met many groups of Kenyans who refuse to remain idle, who refuse to wait for someone from the outside to give them a grant or a four-wheel drive vehicle, who have taken matters into their own hands. In working with Rev. Lubanga, the women's groups, and the HIV/AIDS drama teams, we realized that an abundance of hope does exist in Kenya. And this hope resides in the people; the people who live in the grass roots, who are self-confident, resilient, and unnoticed, but who continue to develop and improve their communities. It is this group of people that we will continue to work with hand in hand, and it is with these people Kenya's future rests--a future that is much brighter than many realize.

Donations:

   To make a tax-deductible donation to the Clinic, please make checks payable to IFMSA-USA and write Kenya Clinic in the Memo. Send all checks to the following address:

IFMSA-USA National Headquarters
PO Box 1990
Philadelphia, PA 19105-1990

*If at all possible when making a donation, please contact Hank Selke (812-219-1054 or hankselke@hotmail.com) alerting him of the donor's name, address, email address and the amount of the donation. 

For more information, please contact:  

Hank Selke
1323 University St.
Bloomington, IN 47401
Phone: (812) 219-1054
Email: hankselke@hotmail.com
Web site: www.volunteerkenya.org

References

	The World Health Organization: Statistical Information System http://www.who.int/whosis
	The Bureau of Primary Health Care: http://www.bphc.hrsa.dhhs.gov
	Pharmaceutical Research and Manufacturers of America: http://www.phrma.org/
	Lopez, Murray. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Harvard School of Public Health, Boston, Massachusetts, USA. Lancet 1997 May 3;349 (9061):1269-76
	Pelletier DL, Frongillo EA Jr, Schroeder DG, Habicht JP. The effects of malnutrition on child mortality in developing countries. Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853, USA. Bull World Health Organ 1995;73(4):443-8
	Nahata, MC. Status of child health worldwide. Ohio State University. Ann Pharmacother 1992 Apr;26(4):559-61
	Carroll KC, Reimer L. Infectious diarrhea: pathogens and treatment. Department of Pathology, University of Utah School of Medicine, Salt Lake City. J Med Liban 2000 Jul-Aug;48(4):270-7