The HERAF Conference is over, but it was another full day for the Health Action AIDS delegation. Here is an overview of what we did today.
8:30 a.m. – 9:30 a.m. Meeting with the USAID Capacity Project
The Capacity Project is funded by USAID, and works with the Ministry of Health in Kenya to build and sustain the health workforce. Capacity Project works to improve workforce policies and planning, develop better education and training programs for the workforce, and strengthen systems to support workforce performance. Currently, the Capacity Project has implemented low-cost work climate improvement interventions in 5 sites throughout Kenya (it is expanding), which will provide a foundation for understanding what determines performance of the health workforce. Capacity Project staff members are very interested in workplace culture among health professionals in Kenya, as well as a pervasive negative attitude among health workers, an area that HERAF members have also identified as an advocacy priority.
(more…)
ShareThis
The conference has been very motivational and stimulating! The presenters were of incredible caliber and the attendees have a commendable willingness to advocate for healthcare rights. Their freedom and commitment to discuss difficult issues and to question the current status of healthcare rights and healthcare is inspiring.
Part of the excitement to be agents for change may stem, in part, from the current charge that can be felt throughout Nairobi. General elections are scheduled for December 27 and Kenyans are anticipating the opportunity to elicit tangible change.
All too often we think of care for HIV-infected individuals in terms of access to antiretrovirals and testing for HIV. It is easy to forget the intimate relationship between development and health. This was one of the topics discussed at length yesterday. Instead of defining healthcare as physical wellness or the lack of disease/physical signs and symptoms, the concept of healthcare should be examined as a whole. Addressing healthcare issues includes also influencing physical, emotional and spiritual health and setting goals to decrease poverty and improve access to education, sanitation, access to clean water, employment and food security.
Another essential aspect of comprehensive health care discussed at length during site visits and at the conference, is how to best care for the health care worker. We heard from many sources how health care workers often do not seek their own health care at their site of employment. Stigma, lack of confidentiality, lack of space, and all too little emphasis on employee health are all contributing factors. As a result, retention and employee health suffer.
While visiting one of the clinic sites, we saw the one room clinic space currently set aside for employee health care. In an effort to provide better care to the health care workers (HCWs), one of the physicians is hoping to gain access to a larger space on the hospital campus to provide more services and greater confidentiality. Along similar lines, the other clinic has begun to take their voluntary testing and counseling services to each of the units, providing stigma training and offering testing. So far they have had a significant number of HCWs testing for HIV. I am looking forward to our meeting with another agency today, that has been attempting to increase care to HCWs by mobilizing professional organizations and taking small steps to improve work place satisfaction.
ShareThis
We spent yesterday at the Health Rights Advocacy Forum Conference. The agenda was phenomenal, including well-known Kenyan speakers and a range of topics including: basic health rights, advocacy for health care workers, the impact of development partners on health worker policies and health sector reforms. The sessions were informative, yet overwhelming. It was all I could do to try to soak it all in and attempt basic processing of the information.
One of the topics touched on throughout the day was the issue of brain drain, the loss of trained health care workers from developing nations to wealthier nations. Health care worker shortage in Kenya is a complex issue. Kenya actually has a surplus of trained nurses but a shortage of funding to provide positions for all of them.
[Suzy Jed, MSN, APRN-BC and the American and Kenyan teams in the Kenyatta National Hospital HIV Comprehensive Care Clinic Laboratory]
(more…)
ShareThis
Political theorist John Rawls poses an intriguing question about human rights: If none of us knew where we would be born, if we would be rich or poor, healthy or ill, male or female, short or tall, American or Kenyan or Indian or Chilean, what human rights would we want to be guaranteed? What choices would we want to have about how to live our one wild and precious life?
Today for me was all about the choices we have in America—and the choices Kenyans have, and what that means for health and human rights and the way we live and work and grow and play and celebrate. So what do I mean by choice?
[Sarah Kalloch, HERAF Chairman Andrew Suleh, MD and Suzy Jed, MSN, APRN-BC at Mbagathi District Hospital]The Choice to Live: In 1997, Mbagathi District Hospital, near Kibera slum, opened its first AIDS centre. Options were limited: there was no treatment, no ART, but there was counseling and psychosocial support—and a special kind of community dealing with sickness, and despair and death mixed with glimmers of hope. Ten years later, people living with AIDS who come to Mbagathi have a choice. The hospital’s Comprehensive Care Clinic has 3500 people on ART. We met one patient—a man in his 20’s or early 30’s named Boniface. Boniface is HIV Positive. But Boniface has choices. His CD4 count when he began ART at Mbagathi in 2004 was about 200. It is now over 800. Boniface has chosen to celebrate by becoming a peer counselor at the hospital: a few minutes after he left our delegation, we saw him giving a talk to patients in the AIDS clinic waiting room, coaching them, supporting them, connecting them, and making them feel like they can fight this disease. People with AIDS in Kenya have a choice now: they can get treatment. They can live for years and years. They can take care of their families and be part of their communities. We know prevention is critical, and many argue it is more cost effective than treatment, especially in Africa. But I wouldn’t want to tell Boniface that—would you?
(more…)
ShareThis
After our visit to Mbagathi District Hospital, we went on to Kenya’s largest referral, teaching and research hospital: Kenyatta National Hospital. The facility has ten floors of wards, and a staff of 4,000. In fact, KNH is overstaffed. A mere five minutes away from Mbagathi District Hospital, the halls of KNH are filled with white coats, and specialists crowd the stairways. The Comprehensive Care Center is two stories tall—a gleaming white building on the sprawling KNH grounds.
And while a single ward may be ready with 10 senior physicians, Kenyans have great difficulty getting care at the hospital. It is a tertiary facility—the last stop in Kenyan healthcare—if you manage to afford the referrals, transport and patient fees. While all services at the Mbagathi CCC are completely free, the CCC at KNH requires patients to pay a monthly consultation fee of 300 Kenyan Shillings, about 4 US dollars. This is a prohibitive cost for most Kenyans: it’s just not possible. And yet KNH receives nearly 50% of all government funding to the health sector in Kenya.
Beyond the numbers and underneath the paint lies a very different, and often unexpected, story. Improving AIDS care in Kenya is not just about the size of the CCC, or the quality of CD 4 machines, or the salaries for staff. US dollars and Kenyan Shillings don’t translate to the improved access and quality so desperately needed. The solutions involve looking beyond the individual facilities and the medicines and the most obvious numbers. We will not find all the problems at one clinic, and we won’t find the solutions in one place either.
[The Health Action AIDS delegation with staff at Kenyatta National Hospital]
ShareThis
I woke up this morning thinking that I knew what to expect. But you can never know what to expect, and I’m grateful that I was wrong.
I thought I’d visited Mbagathi before. I’d seen the grounds and spoken with physicians and clinicians, but I hadn’t understood the true strength of the facility and the Comprehensive Care Center. We were lucky enough to share experiences with health workers at the Mbagathi CCC, including nutritionists, peer educators, counselors, HIV/AIDS trainers, and physicians. The facilities were minimal—simple tents set up for group counseling; one room with three wooden benches for discussions on second-line treatment and training health workers on HIV/AIDS-related stigma.
[Lissy Desantis, HERAF Chairman Dr. Andrew Suleh and Pediatric AIDS Counselor Judy Ouko at Mbagathi Hospital, Nairobi]
In the women’s general ward, there are 30 beds. This morning, there were 50 patients, and nearly every bed had 2 women sleeping head to toe, wrapped in their own blankets. Yet Mbagathi is much more than overcrowded wards and the bare minimum facilities. Mbagathi is a model Comprehensive Care Center in Kenya, not because of the quality of its training room or the videos it has playing in the children’s waiting room. It is a model CCC because of the staff that comes to work every day. Including Judy, who counsels children receiving ART and conducts anti-stigma training among her fellow health workers, reminding them that “Before we point a finger, [health workers] must realize that we are all at risk.” Also Boniface, a peer educator at the CCC living positively with HIV. His CD 4 count has increased from 200 to 887 in eighteen months on treatment at Mbagathi. And Dr. A.J. Suleh, Chair of the Health Rights Advocacy Forum and Practitioner in Internal Medicine at Mbagathi, one of the only staff actually employed by the Kenyan Government.
And that’s the twist to the story: the majority of the dedicated and motivated staff at Mbagathi, all of whom work in tiring conditions with minimal facilities, are set to be moved from the facility in February of 2008. They are employed by Médcins Sans Frontières, whose three-year agreement with the Kenyan government has come to an end. It’s now the government’s responsibility to staff this clinic, to promote the comprehensive care of HIV positive patients, and to promote the well-being and psychosocial support of its health workers. And while there is pressure on the government to do this, the workers at Mbagathi who will remain after February are worried. The numbers of patients will only increase, training needs will only increase, and the need for psychosocial support—for patients and providers—will only increase. The Kenyan government’s promises aren’t enough for these health workers. And they won’t be enough for the patients seeking care either.
ShareThis
As promised in my previous post, I’ll be sharing the plans of the Health Action AIDS delegation each day. Today our group will visit two hospitals and meet with two partner organizations.
9:00 a.m. – 11:00 a.m. Visit to Mbagathi District Hospital
This tour will be led by Dr. A.J. Suleh, Chairman of the Health Rights Advocacy Forum and Chairman of the Kenya Medical Association’s Nairobi branch. Mbagathi District Hospital is a key health facility in Nairobi, and has been at the heart of providing comprehensive HIV/AIDS care in the face of the unfolding epidemic in Kenya. Mbagathi handles 10,000 patients, 1,000 of whom are children. The hospital also has 5,000 adults and 500 children on antiretroviral therapy and performs 150 consultations daily. Mbagathi District Hospital offers VCT, DTC, PICT, and PMTCT services, as well as TB care and counseling, among other services.
Mbagathi is a public health facility funded by the Kenyan government, and it also receives support from the international donor community, including the Clinton Foundation. As a provider of comprehensive HIV/AIDS care and treatment, a recipient of public funding and a target for international funding, Mbagathi District Hospital is critical for identifying advocacy needs for health workers in Kenya.
The PHR delegation will first meet with senior MDH staff for an overview of services offered, as well as recent successes and challenges in providing HIV/AIDS prevention, treatment and care. The delegation will then tour the complete hospital facilities, including the wards, and have a chance to shadow MDH nurses and doctors and exchange with Kenyan colleagues.
(more…)
ShareThis
This week is a very exciting week for us here in Kenya. The Health Rights Advocacy Forum (HERAF) will be hosting the first conference of its kind in Kenya, assessing Kenya’s commitment to the right to health. Health workers from throughout the country will be attending the conference in Nairobi, and we have a group of doctors, nurses and PHR staff coming from the United States to support the conference and stand in solidarity with Kenyan colleagues.
The Kenyan health sector faces incredible challenges, but HERAF’s work over the past seven months has shown that Kenyan health workers are up to the task. The annual conference will address 4 key issues in Kenya: realization of the right to health, financing for health, support for the health workforce, and stigma and discrimination in the health setting.
The Health Action AIDS Campaign doctors and nurses will also visit Kenyatta National Hospital, the largest referral and teaching hospital in Kenya, and Mbagathi District Hospital, a flagship comprehensive care center for HIV/AIDS. However, these visits are just the beginning. They’ll also have a chance to meet with key partners in health workforce development and HIV-prevention among women and girls, to share PHR’s work across the globe and to learn from the experience of service providers on the ground here in Kenya.
Through Saturday, I’ll be posting an overview of what the Health Action AIDS Campaign has planned each day, and the doctors and nurses and others will blog with their perspectives on these experiences. This is an incredible opportunity to build connections across continents and forge the partnerships necessary to change the way health is imagined, demanded and delivered in both the United States and Africa.
Lissy Desantis is Kenya Program Associate for the Health Action AIDS Campaign, Physicians for Human Rights.
ShareThis
