St. Lukes Hospital, Kenya

And Now − Kenya

By Robert C. Smithwick, DDS. (W6CS)

Kenya (click here for map) is more than lions, tigers and wildebeests growling or grinning on queue as yet another Land Rover full of camera-toting tourists approaches. Kenya is more than Mt. Kilimanjaro. Kenya is more than hunters and safaris. Let me tell you what Kenya really is.

What Kenya is, is one of the poorest countries in all of Africa. What Kenya is, is a land of infants and children, many of whom don't survive childhood. What Kenya is, is a country with an infant mortality of 73.5/1000 live births (UN report).

Let me tell you more about Kenya.

All water is hand pumped, there is no running water available.

This little country in East Africa is one of the more visible countries known especially for its wild animal parks. This is the view of most Americans. The reality is that it is a land of children, with one of the highest natural rates of growth in population due in part to a fertility rate of 5.76 children born/woman (1995 est.), and kids 0-14 years of age represent 48% of its population. Life expectancy at birth for the total population is 52.4 years. Unemployment in urban areas hovers at 35%.

MediShare International-Bush Hospital Foundation first became active in Kenya in 1992 when it undertook the funding, construction and equipping of a little medical clinic-dispensary in the village of Kajire (see story on "Kajire"). It is now a stable health facility serving many thousands of people in its little corner of the country.

St. Lukes Hospital was built in 1934 as a mission hospital by the Anglican Church. However, it is now run jointly by the Kenyan Government Health Service and managed by a committee of the Anglican Diocese of Mombasa, chaired by the Bishop. The hospital is the only receiving hospital in the area where AMREF* (African Medical and Research Foundation) operates all of the surrounding primary health care projects. These consist of eleven health care centers - "dispensaries" - that serve a population estimated to be 270,000 people residing in the nearly 1000 sq. kilometers. For Africa, this is considered compact, but it is extremely difficult to service especially in the monsoon season, as access dirt roads, paths and trails are frequently washed out rendering them impassable. The nearest hospital is in Mombasa, over 43 km. away - 20 km. of which are via a unpaved trail. The next nearest hospital is at Voi, 160 km. distant. These are the only medical facilities on the country's busiest Mombasa to Nairobi highway.

St. Lukes Hospital in Kaloleni Village is currently funded by "DANIDA", the Danish Government's aid agency, at a cost of £73,000 Sterling per year. Recently the Danish Government funded a new hospital wing at a cost of £300,000. This was to replace an old section dating back to the early thirties, which at one time housed pediatrics. The building is considered adequate, even 'good', but with some obvious but remediable faults in the design of the operating theater. For example, the OR has slatted windows open to the elements and a strip timber paneled ceiling all of which looks all right, but does not provide the necessary sterile operating area.

Due to construction cost overruns, only the new maternity unit was functioning. The reason is simple - total lack of equipment and supplies to complete and equip the new wing. Until this was done, there was no pediatric facility, simply unimaginable in this child-rich country.

The medical superintendent is Dr. John Masaba who runs the hospital alone with the help of volunteers from Germany and Sweden from time to time. The Kenyan Government provides a few of the nursing staff and a very limited quantity of basic drugs.

St. Lukes Hospital had only two medical wards for adult patients. Since there was no surgery unit yet, very little surgery was attempted. Surgical patients had to be sent to Mombasa.

PROJECT DESCRIPTION

The most urgent need was for a surgery and X-ray unit. Surgery patients had to be transported to Mombasa if and when the roads are passable. Site plans, operating theater room dimensions, etc. were developed and obtained quickly once other commitments were made. To remedy the deficiencies in the OR design, proper windows that can be sealed and yet that will allow daylight and some form of filtered air intake or air conditioning had to be provided. This required cash funding and is only relevant if an air conditioning unit becomes available (Phase II of the project rebuilt the pediatric wing and provided an ambulance - mobile clinic - a converted military Land Rover).

From the standpoint of equipment, operating room and X-ray equipment were the most urgent needs and had to be equipped from scratch. Operating table/s, theater lighting, power supply, X-ray unit and associated lead screening, endoscope unit, cardiology equipment, cabinets, storage units, all theater operating utensils and instruments along with consumable supplies were the most urgently needed.

Included in this "needs list" were many very basic pieces of equipment, and commonly used supplies, commodities which no hospital can be without and still provide service: stethoscopes, sphygmomanometers, IV stands, examination tables, gurneys, Mayo stands, instrument trays, X-ray view boxes, EKG. etc. In addition a new-in-the-box "MDE Vital Signs Monitor" with EKG recorder module was provided. Supplies included several pallets of surgical scrub brushes, exam gloves, sanitary napkins, assorted medical supplies and a very large carton of assorted pharmaceuticals as requested by Dr. Masaba. All drugs and pharmaceuticals are well within date (no out-dated or soon-to-be-outdated drugs or supplies are ever shipped by MSI or its partner agencies).

These two tons of medical equipment and supplies were estimated to be worth at the time, $87,432.42 on the US wholesale market. The shipment represented most of the highest priority items on the "needs" list provided by Dr. John Masaba, St. Lukes Medical Director and confirmed by MARCO members Ken Kirk-Bayley, F5VDB, and Dr. Mike Marks, of the BHF, during their visit to the hospital to consult with Dr. Masaba. This was the third shipment that year (1997) to the hospital provided by MediShare International-Bush Hospital Foundation.

The Bush Hospital Foundation assumed the planning and coordination effort besides helping to fund the reconstruction of the Children's Ward. It later provided a Land Rover ambulance-mobile clinic vehicle. MediShare provided some of the major financing required and coordinated the effort as needed with Direct Relief International in California. DRI secured a federal grant to cover all transportation costs from the West Coast of California to Kenya from U.S.A.I.D. and Dr. Marks, with the help of AMREF, arranged for this humanitarian shipment to be duty-free

Mothers and babies on their way to the St. Lukes Hospital Clinic.

MediShare's partner, Direct Relief International, of Santa Barbara, California, provided the major portion of all the equipment, instruments, and supplies for this consignment. All equipment was first refurbished and tested to assure it met factory specifications, and then converted for use in Kenya at the MSI laboratories. MediShare provided some of the major financing required and coordinated the effort as needed with Direct Relief International.

This new wing equipped by MediShare, added an X-ray, surgery, and pediatric services to this child-rich country. A MediShare/BHF provided X-ray machine is already in place.

Another major item subsequently supplied by BHF was a Land Rover converted for use as a mobile clinic and ambulance. This unit was acquired from military surplus in Britain, then converted for use as a mobile ambulance-clinic before being shipped to Kenya. It was the sixth such vehicle supplied to East African nations up to that time. They are owned by BHF/MediShare International, but are consigned to AMREF on a 'permanent loan' basis so long as they are used for the intended purpose.

Final note:

Direct Relief International, MediShare/BHF International's partner in this project, recently celebrated fifty years of service. It is one of the consummate philanthropic organizations of its kind in the world. It was recently cited (read: "praised") by Money magazine and the Non-Profit Times as one the top ten non-profit agencies in the US. In 1996, only 2.4% of Direct Relief's public support and revenue was used to cover overhead expenses. In one recent year, DRI donated over $25 million wholesale value of medical instruments and supplies, essential pharmaceuticals and well-functioning medical equipment to charitable health facilities in 47 countries worldwide as well as in the United States. It is governed by a dedicated board of lay persons, all volunteers and supported by a small skilled, mostly multi-lingual staff of professionals, including highly-trained medical equipment technicians.
See: Direct Relief International

*AMREF is East Africa's major non-governmental organization and operates many primary health care projects in Kenya, of which the area surrounding St. Lukes Kaloleni is one. The Flying Doctor Program is an important part of AMREF's medical relief effort.

Kenya mothers transporting their children by foot to St. Lukes Hospital Clinic