Fighting HIV/AIDS and Poverty
Improving Education and Healthcare

Healthcare Program

Welcome
We are glad that you are interested in traveling to Kenya to participate in our Healthcare Program. Our goal is to enhance your medical knowledge, clinical skills and relations with patients by providing care in a cross-cultural environment in which resources are limited and challenges are plentiful. We hope that your experiences in Kenya will lead to enhanced sensitivity to culture and diversity, as well as increased reliance on and improved physical diagnostic skills.
Background
Healthcare is neither easily accessible nor affordable for many Kenyans living in the rural villages of the Western Province. Poverty creates a large barrier to the acquisition of healthcare in general, but in rural areas in particular. Although government-run hospitals do exist in the Western Province of 3.5 million people, most of the locals in the more rural village communities cannot afford consultation, treatment or pharmacy fees. Nor can they afford transport to these government clinics and hospitals, which are located in the larger towns and cities. Diarrhea, measles, tetanus, pertussis, pneumonia, and malnutrition are preventable and treatable and yet they kill thousands of people every year.


Many people still die of endemic diseases like malaria, typhoid, and gastroenteritis, which are also manageable when proper treatment is available. Government-run clinics are ill equipped to handle the volume of people in need of care. Addressing the health care needs in rural villages is vital to improving the living conditions of these community members. During the summer of 2002, a group of our volunteer medical students from the United States set up a temporary health clinic in our public library on the farm. The students managed to start medical records for 487 people and distributed 24,000 vitamins. Throughout the summer of 2002, construction of a permanent medical clinic on our rural village location in Kabula was started. http://216.172.177.175/~icodei/images/siteImages/healthcare.jpg On August 12th, 2003, the Bill Selke Memorial Clinic opened its doors to the Kabula community. The clinic consists of three examination rooms, a nurses' station, a laboratory, a small pharmacy, a HIV/AIDS Education Office with the potential for Pre/Post Test Counseling, a medical records office, an administrative office and a waiting room. Doctors and nurses are able to diagnose and treat endemic diseases and common illnesses, stitch and dress wounds, give fluids, perform histories and physical examinations, and other minor procedures.

The clinic has not been as busy as we had initially planned due to our inconsistent supply of medications (e.g., we don’t have the funding to pay for a large stock and wide variety of medications) and the rural location of our clinic. In light of this, as we began to get a greater number of volunteer medical students and doctors, we realized that we could better utilize their knowledge and expertise by holding rotating mobile clinics in the rural villages of the Western Province. In the summer of 2004, we began operating these mobile clinics in rural villages within a 1-2 hours drive of Kabula. At the mobile clinics, acute problems are diagnosed and treated while chronic medical problems are diagnosed and then referred for follow-up. Since most Kenyans live in very rural village communities where transportation is lacking or unaffordable, our mobile clinics have become the focus of our Healthcare Program. The Bill Selke Clinic is now the base of operations for our mobile clinics outreach services. The clinic still treats patients on a daily basis, but the bulk of our healthcare services are done through the mobile clinics since we can reach so many more people this way. For example, our clinic may only see 10-20 patients each day, but we see 100 patients per day on the average mobile clinic (due to the remote locations where we travel). We typically run three mobile clinics per week when we have volunteer medical students and/or doctors on the ground. During the busy summer months (June-August) when we have 4-6 Healthcare Program volunteers at any given time, we run the mobile clinics 4-5 days per week.


Organization of Mobile Clinics
Description of Process: The patient starts at the registration table. There they pay their consultation fee (currently 50Ksh, less than 1USD) and are given the medical record form. This form contains basic identification as well as a review of systems in Swahili to help focus the history and physical examination. The patient is then seen by the medical team (typically the volunteer in conjunction with the local healthcare worker) for further assessment and education. If the patient requires treatment, then they proceed to the pharmacy area for medications. If the patient requires referral, they are given a form describing their problem and suggested diagnostic studies that we are unable to provide.

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Role of Physician or Medical Student Volunteers: Each doctor or medical student will work at a patient consultation station, alongside a clinical officer, nurse or a translator. The volunteer takes the lead in the patient interview, and fills out the patient record form. The volunteer will take a history, perform a physical examination. In collaboration with the local healthcare workers, you will formulate a working diagnosis, prescribe medication if appropriate, provide counseling and education, and write a referral note if necessary. If you or the local healthcare workers are unsure about diagnosis or management at any time, or concerned about a patient, the patient will be referred to a local hospital.

Role of Nursing Volunteers: Nurses will spend their time on the mobile clinics in a similar manner as they would back home—i.e. taking vital signs, helping to prioritize patients if there are matters that need attending to urgently, providing education, ensuring the patient understands their medical problems and empowering them to take an active role in their healthcare.

Role of ICODEI Staff:

  • Clinical Officer and Nurse(s): They work with the volunteers at the patient consultation stations. They will translate, offer insight and advice, and give injections and dress wounds. They have experience in tropical medicine diagnosis and management.
  • Translator: Translates for the volunteers at patient consultation stations.
  • Pharmacist: Fills prescriptions from the mobile clinic’s stock of medications.
  • Field Coordinator: The field coordinators will organize mobile clinics in rural village communities beforehand. They will sometimes ride in the vehicle with the rest of the staff on mobile clinic days (especially if the driver needs help finding the venue).

Typical Day on Mobile Clinic
Volunteers report to the Bill Selke medical clinic around 8:30 AM. Mobile clinic staff will usually be there already. The nurse and pharmacist pack the medications and supplies. Everyone waits for the driver to arrive with the vehicle. The timing here can be unpredictable due to vehicle breakdowns and other ICODEI programs which also require transport. At some point in the morning the mobile clinic crew will depart for the mobile clinic venue. Transit time is anywhere from 30 minutes to 2 hours. Upon arrival at the mobile clinic site, it usually takes an hour to set up the mobile clinic. The pharmacist unpacks the medication and supplies, while other staff, locals, and volunteers set up tables and chairs for the different stations. Patient care begins when patients show up. This can be anywhere between 10:00am and 2:00pm. Patients will continue to arrive at the mobile clinic throughout the course of the day. After all the patients have been treated, the pharmacist and other staff will pack up the drugs and supplies and prepare to return home. The numbers of patients evaluated at the mobile clinics vary greatly depending on the location and the day. Upwards of 250 people have been evaluated and treated or referred on some clinics. Typically there will be between 30-100 patients per clinic. Arrival time back on the farm can vary as well, and can be as early as 2:00 PM or as late as 10:00 PM, though usually you return by 6-7pm. Potential volunteers for the healthcare program must be very patient individuals. Our clinics are not run with the efficiency and organization of a typical hospital in the developed world. It is critically important that volunteers are flexible and understanding. You will definitely not have the resources (equipment, medication, supplies) or atmosphere that you are used to having at your home country hospital.

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Common Medical Problems
Some of the common medical problems you will see during your trip include: Malaria, Typhoid, Helminth infections (i.e. “worms”), Urinary Tract Infections, Respiratory Tract Infections (bronchitis, pneumonia, TB), skin lesions, malnutrition, diarrhea, Cellulitis, acute and chronic pain, HIV/AIDS, opportunistic infections, fungal infections, asthma, COPD (from cooking indoors), arthritis, Sciatic Pain, stomach ulcers/acid reflux, eye problems, STIs, dental problems, diabetes mellitus, hypertension, heart failure, altered mental status, Meningitis, and Sepsis.


Tours of Nearby Hospitals and Clinics
We can sometimes arrange for volunteers to tour other healthcare facilities in the larger towns nearby (Bungoma, Mumias, etc). Policies allow for visiting medical students and doctors to interact with patients and even enter operating theatres for the purpose of observing surgical procedures. Doctors and nurses at district hospitals are sometimes willing to answer questions and demonstrate procedures. Most often patients are willing to allow volunteers to be present during diagnosis, treatment and examination. Female volunteers have been able to observe both natural and caesarian births. Past volunteers have found this to be an interesting and educational experience.

Please keep in mind that we can’t guarantee you will be able to take any tours due to the ever changing environment on the ground in Kenya. We are in the process of setting up some partnerships with local clinics/hospitals so that our volunteer doctors and medical students can work at these facilities on days when we are not running a mobile clinic. Unfortunately, we cannot set up tours for pre-med and undergraduate students at the local clinics and hospitals. Previously, we were able to accommodate this. However, due to the high volume of requests we get from undergrads for this each year, we have decided to now only send medical students and doctors to tour and work at the local clinics and hospitals.

Paperwork for International Rotations
If you are a medical student interested in coming to Kenya for an international rotation, we are more than happy to assist you with any paperwork that your school may require.

Health Education
When the clinic opened in August of 2003, the intent was that it be both care-based AND education-based but to date, the focus has been on the care aspect. We are now beginning to implement facets of the educational aspect. We have produced several 1-2 hour seminars/lectures about locally relevant health concerns, which will be presented to locals. This is done either on a rotating schedule or on demands from various community groups. Topics include, but are not limited to: malaria intervention, hygiene, food/water safety, nutrition (general, maternal, child, PLWHA), sexually transmitted infections, and any other health topics deemed valuable. Volunteers involved in this program will perform research to develop the lectures and will help to produce literature on each topic. Our first health education lectures were produced in the summer of 2005. Directed towards Kenyan women, they concern reproductive health issues. Since we typically only run mobile clinics three days a week, volunteers in the Healthcare Program are encouraged to give these healthcare educational seminars on off-days (unless they are scheduled to work at a nearby clinic or hospital).

Potential Volunteer Qualifications and Requirements
Volunteers in the Healthcare Program must have previous clinical experience. The healthcare volunteers must be doctors, nurses, or medical students. As part of your application, please include a short description of your medical education and clinical experience so that we can confirm your qualifications for the Healthcare Program. Volunteers working in this program will receive our Healthcare Program Orientation Manual before arriving in Kenya. This will provide you with a lot of detailed information on our clinic and mobile clinics programs, as well as an introduction to many of the medical problems you will encounter while in Kenya.

The Healthcare Program is not open to undergraduate and pre-med students. However, students with an interest in healthcare can participate in our Health Education Training Programs, such as the HIV/AIDS Nutritional Training Program or the Women’s Reproductive Heath Training Program, or our AIDS Education Program. Volunteers participating in these programs must complete self-study on these topics and review our training manuals in detail before arriving in Kenya.

As is the case with all of our programs, volunteer are required to pay volunteer fees in order to participate in this program. These fees are what support all of our programs. Fees from volunteers in the healthcare program are used to keep our clinic running, pay salaries for our clinic staff of Kenyans, buy medicine, buy medical equipment/supplies, pay for the gas and vehicle maintenance to make the 1-2 hour drives each day to set-up a mobile clinic, etc.

Contact Us
If you have any specific questions on this program, please contact the volunteer coordinator at This e-mail address is being protected from spambots. You need JavaScript enabled to view it . If you have general questions on volunteer placements or would like to get information on the application process, please contact our Volunteer Coordinator.