Study Study Study Study in in in in KenyaKenyaKenyaKenya

Kie Fukui, Tomoaki Kunitsu, Riku Sanada, Eiko Tajika

Shiga university of medical science

AcknowledgementAcknowledgementAcknowledgementAcknowledgement

We would like to express our sincere gratitude to all the staffs of

NUITM-KEMRI project; Dr.Sammy M.Njenga, Dr.Mohamed Karama, Mr.James K'opiyo,

Mr.Rashid Agolla, Dr.Kyoko Futami, Ms.Shiho Honda in Nairobi office, Dr.Emmanuel

Mushinzimana, Mr.George Sonye, all DSS staffs in Suba field station, and great support

of Professor Shimada, Professor Kaneko, Professor Minakawa, Professor Ichinose .

Kie Fukui ,Tomoaki Kunitsu, Riku Sanada、Eiko Tajika,

Shiga University of Medical Science

ProgramProgramProgramProgram

date

12 September 2007 Wed Arrival

13 September 2007 Thu VCT

14 September 2007 Fri Free

15 September 2007 Sat Kibera

16 September 2007 Sun Move to Mbita

17 September 2007 Mon Mbita field trip

18 September 2007 Tue Mbita field trip

19 September 2007 Wed Mbita field trip

20 September 2007 Thu Back to Nairobi,CCC

21 September 2007 Fri Kenyatta National Hospital

22 September 2007 Sat Safari

23 September 2007 Sun Safari

24 September 2007 Mon Safari

25 September 2007 Tue Magoso school, Gertrude’s Hospital

26 September 2007 Wed Nymbani orphanage

The medical system in KENYA The medical system in KENYA The medical system in KENYA The medical system in KENYA

Kie Fukui Kie Fukui Kie Fukui Kie Fukui

There are many hospitals in Kenya. There are two types of these hospitals, one is the

public hospitals and the other is the private hospitals. In the private hospitals, you can

get enough services just like Japan. But the cost is very high. Unlike the private

hospitals, the public hospitals are less expensive. But the services are not satisfactory

and some patients can’t get enough consultation and medicine.

There are 6 types of hospitals in Kenya as described below.

1. national hospital

2. provincial hospital

3. district hospital (sub district hospital)

4. health center

5. dispensary

6. community health unit

There are two kinds of doctors in Kenya. One is the medical doctor (officer) and the

other is the clinical doctor (officer). The medical doctors are as same as Japanese

doctors. They can do all the treatments. To become a medical doctor, students go to a

medical school in 6 years. The clinical doctor can examine patients and treat them. But

they can’t do the special surgery required anesthesia. Students go to school 4 years to

be a clinical officer.

There are two national hospitals, Kenyatta National Hospital and Nairobi hospital.

They are located in Nairobi. There are many nurses, medical doctors and the other

staffs. There are also specialists at each related department. The provincial hospitals

located in provinces. Nairobi, Central, Coast and Nyanza province have some

provincial hospitals. There are health centers in each village. There are no medical

doctors at some hospitals. In the dispensary, there are no medical doctors or clinical

officers, so nurse treat the patients.

1) Kenyatta National Hospital

We went to the Kenyatta National Hospital. It is the biggest hospital in Kenya. There

are many floors and many beds at this hospital. The wards are divided, so patients who

have completely different kind of disease don’t stay in the same room. The doctor’s fees

are very low so the hospital was very crowded due to the large number of patients. I

heard that some patients take treatment on the floor and there are two or three persons

in the same bed.

There are VCT and CCC in this hospital. VCT stands for Voluntary Counseling and

Testing. This is a provision for HIV. CCC stands for Comprehensive Care Center. In this

center, social workers do mental support to the HIV+ patients. There are also

nutritionist and physiotherapist so patients can take a comprehensive support. The cost

of this services and medicine is free. Patients pay 350ksh(about 700yen) per month and

they can take this care. But there is the stigma against HIV in Kenya. Patients are

afraid that someone find out about their disease so they don’t go this center. This is a

very big challenge.

Kenyatta National Hospital

2) The sub district hospital in Suba

We visited to MOH and PMOH in the sub district hospital of Suba. MOH is Ministry of

Health. PMOH is Provincial Medical Officer of Health. The roles of the PMOH are to act

as a strong intermediary between the central ministry and districts and to oversee the

implementation of health policy. There are 3 medical doctors, 8 clinical officers and

some nurses and technician. They are medical team of district. In Kenya, major diseases

are Malaria, HIV and tuberculosis (TB). Except for 20ksh (40yen) as the doctor’s fee,

patients of these diseases can take treatments free. Doctors in the hospital do the ANC

(antenatal check up).

Doctor said that there is a big challenge. The mothers who are HIV positive should not

give her children mother’s milk and must give dry milk. But many mothers don’t have

money to buy artificial milk. So they give mother’s milk for their children and

communicate HIV to their children.

The sub district hospital in Suba. Many people

waited for their turn.

3) Simdo District Hospital

We went to the Simdo district hospital. I was surprised that the white coats and

clothes were out on the wall and grass to dry. We were accompanied by the doctors who

do a doctor’s round. The hospital has about 50 beds. But because there is a great

number of patients, some beds were shared by two. I visited a general ward. There were

many beds on the corridor. And the ceiling of rooms were broken. 7 patients of the 13

patients who I visited to in the ward had HIV. There were some patients who had TB in

the same room and there weren’t curtains. I was worried that patients would catch

caught another illness in the hospital.

4) The dispensary in Suba

We visited a dispensary in Suba. In the dispensary there are no medical doctor and

clinical doctor. There are only two sister nurses. There is a little medicine. Enough

number of ARV was supplied by the government. So nurses have to buy ARV and HIV

patients must pay money for ARV.

The left picture is the dispensary. The right is the examination room. In the dispensary,

Mother delivers at the bet.

5) Tomboya health center

We visited the Tomboya health center. There are 2 clinical officer and 7 nurses and

there is no medical doctors. In the hospital, there was more medicine than in the

dispensary and patients can take ART for free. There are some traditional birth

attendants (TBA) as well.

This is the entrance of the health center

6) Gertrude’s children hospital

We visited the Gertrude’s children hospital. I was very surprised that it was very

different from public hospitals. This hospital was very clean just as same as Japanese

hospitals. The wall was decorated by cute pictures. And there was a playground in the

courtyard. This hospital has a lot of equipment such as X ray and electrocardiogram and

also two ambulances. There is ICU. The number of doctors is more than 30 and the

number of nurses is more than 100. The hospital has enough facility for care patients

and enough staffs. But the cost for consultation is 1000 ksh (2000 yen). It is very

expensive for average income people so patients have to be rich to come to this hospital.

The major diseases in public hospital in Kenya are malaria and HIV. But in this

hospital there were few malaria and HIV patients. I think that most of the patients who

are infected by those diseases are poor people. In Kenya, many people die from malaria.

But rich people scarcely get infected by this disease because they live in a better

environment. And if they become infect, they can buy medicine and can recover from it.

The on the left is the entrance.

The right photo is the picture on the wall.

The left under is the room for baby. There is a

bed for baby’s mother.

In the guideline of the government, patients can take medicine for malaria and HIV for

free from the public hospitals. But as it is patients buy those in many hospitals. The

reason for this is government doesn’t supply enough medicine for each public hospital.

And I heard that public officer took some medicine which organization such as NGO

give. They sell those suppliers. Sanitary condition of Kenya’s hospitals needs

improvement. After I visited many hospitals in Kenya, I thought that there were many

challenges in the medical system of Kenya.

MbitaMbitaMbitaMbita Tomoaki KunitsuTomoaki KunitsuTomoaki KunitsuTomoaki Kunitsu

We went to Mbita in Suba Mbita is near the Lake Victoria and is one of the

poorest area in Kenya. In there, Dr.Minagawa and vector team research A.gambiae

which transmit malaria. Dr. Kaneko is doing DSS(demographic surveillance system).

We went to Takawiri Island with Dr.Minagawa team by ship. In Takawiri

Island, we saw a lot of mosquito larvae and their nests. Dr.Minagawa team try to

exterminate mosquito larvae by the insecticides, BTi or BS. Bti(Bacillus thuringiensis

israelensis) works only for a mosquito and is hard to be possible for tolerance.

(searching for nests） (ship of Nagasaki University)

We went to a fisher’s house on the hill in Takawiri Island. The fisher was the

Ruo tribe. He said he had four wives. The Ruo tribe is traditionally polygyny society. In

his house, we wound up an insecticide and gathered dead insects. We found the

A.gambiae. Dr.Minagawa was going to take that A.gambiae to ICIPE. In there, he

checks whether the mosquito is infected with the Plasmodium or not. The probability of

infection is only 1%, but a lot of people have malaria and die in Suba.

(Fisher’s house) (searching for A.gambiae)

In ICIPE, we saw A.gambiae by microscope. That has very vivid body. We also

saw spiders which is the mosquito terminators. Insects were very beautiful. We met a

interviewer. He taught us how to use a PDA. In PDA, there were a lot of personal data,

name, age, condition, disease and so on. That program was very systematic. I was

surprised that Kenyan people could use PDA perfectly.

Impression

I saw various aspects of Africa. A lot of people are suffering from HIV/AIDS.

There were numerous VCT centers. Nairobi was dangerous area. There were so many

street children. Kibera slum was massive. Dirty water, garbage, dirt, crimes and so on.

People were living in such a environment. Poor people cannot receive medicine for

malaria though the government distribute for free. Not only malaria, poor people cannot

receive good medical treatment. On the other hand, rich people go private hospital. In

there, the medical level was very high. The gap between rich and poor was very broad.

TROPICAL MEDICENETROPICAL MEDICENETROPICAL MEDICENETROPICAL MEDICENE

Riku SANADA

We studied an introduction of tropical medicine in KEMRI where many Japanese

and Kenyan scholars study malaria, HIV, and “the other diseases”. In KEMRI, there is

one of the foreign footholds of tropical medical laboratory in Nagasaki University.

Pr.Simada who is the chief of this laboratory gave us a special lesson.

Pr.Shimada said that tropical medicine was a colonial medicine. It means that

colonists had to study how to protect them from diseases which were popular in colony.

And also they had to save their country from the diseases which comer or returner

brought. In England, the strongest city on tropical medicine is Liverpool where was

famous for international hub ports which were active in the colonial period. Needless to

say, there is in Japan Nagasaki.

In 1963, it was said that the diseases of infection were going to vanish when people

got antibiotics and vaccines of smallpox. But now, people are still frightened by the

diseases of infection, for example malaria and HIV. In the world, many people died of

these two diseases which WHO pay attention to. Especially in Africa, about 25% cause

of total death of infection diseases were these two.

It was dangerous for people to be infected not only malaria and HIV but also “the

other diseases”. Indeed these two diseases have a risk of death, but “the other diseases”

also make our QOL down. Pr.Shimada said we should study more about “the other

diseases” which WHO calls “neglected diseases”. For example leprosy, yaws, trachoma,

filariasis, onchocerciasis, schistosomiasis and soil-transmitted nematode infections.

In this class, we learned the history and the present situation of tropical medicine.

Compared with in Kenya, we are protected from tropical diseases in Japan, but we must

not be careless. We should prepare for the future when Japan will be hot in global

warming. At this opportunity, I want to study it more as one of students who experience

the home.

Impression

The most impressive thing was Kibera tour. I was able to find one low in Kibera.

Children smile sweetly, adults stared at us. When you take some pictures, children

want to join, but adults want to get many from you. Though children and adults live in

same place and see the same scene, they reacted differently. Why? I think children have

flexibility, they can feel more obediently than adults. To put it simply, children like the

new thing which excite them. They always said, “How are you!” They want to use these

three words they leaned at the first time in English. And also they want to communicate

to us for only gratifying their curiosity. Children can get excitement instead of money.

When children change to adults? In my opinion, children put an end to be children

when they know how to get money from visitors. If you heard children calling money,

they are no longer children who sell their curiosity for money. I don’t like to buy their

curiosity, and I don’t give them any money at that situation. We should not change them

in our own way.

Visiting JICA office and NGO facilities and school Eiko TajikaVisiting JICA office and NGO facilities and school Eiko TajikaVisiting JICA office and NGO facilities and school Eiko TajikaVisiting JICA office and NGO facilities and school Eiko Tajika

1. Visiting JICA office

We were privileged to visit JICA office and have a discussion with Ms. Yuko

Takenaka, chief advisor of The Project for strengthening of People Enpowernment

against HIV/AIDS in Kenya (SPEAK Project.) The main goal of SPEAK Project aims

at decreasing the HIV prevalence in Kenya. This project tries to achieve this goal by

increase in number of HIV tests performed annually in Kenya

There are several strategies concerning HIV/AIDS in Kenya; three in one policy for

overseas cooperative agencies, The Second National Health Sector Strategic Plan

2005/6-2009/10, Kenya National HIV/AIDS Strategic Plan 2005/6-2009/10, Voluntary

Counseling Testing and Comprehensive Counseling Center, spreading the knowledge by

Behavior Change Communications, etc. Based on these programs, JICA is cooperating

with NASCOP.

Ms.Takenaka and we discussed about the problems which she is experiencing

through this project. There are mainly three points we discussed. They are: the

cultural stigma concerning HIV/AIDS, Cultural beliefs and traditions, and the political

issues in international cooperation agencies.

Cultural stigma is a big challenge in preventing HIV/AIDS and testing and

treatment in Kenya. People are afraid of this disease just as any other country in the

world and the prejudice does exist against HIV positive patients. Therefore people are

discouraged to go testing and ashamed to be HIV positive. One of what JICA is trying

to do is to increase the number of tested people, to achieve this goal, one needs to be

considerate about these stigmas. Personally, I thought peer counseling in a community

level might help to reduce this stigma Ms.Takenaka also mentioned that there are more

female HIV positive patients. It could be a physical reason yet Kenya is a

men-dominated society therefore it also could be the gender issue that men tend not to

be cooperative with HIV testing.

Another issue is a cultural belief and traditions. Kenya has many tribes and

unique cultural practices concerning sexuality. One of the examples is polygamy. If

one of the family members is affected by HIV, the whole family is at risk. Also if the

husband dies, the widows will be his brother’s wives. This worsens the situation. Yet

cultural practices sometimes play a positive role in preventing HIV/AIDS. Male (not

female) circumcision is proved that it reduces the morbidity of HIV/AIDS.

Other issue is a political issue. There are many international developing agencies in

Kenya including national agencies and NGOs. Since the government want the fund,

they accept everything, this could cause a chaos in Kenyan economy and it tends to be

totally dependent on other country’s situation. Another problem is that these agents

are not controlled which can be the cause of overlapping the other projects and

complicates the systems. One needs to think of the effects after withdrawing it before

stating it.

This JICA visit was very interesting in that we could understand the problems

about HIV/AIDS and launching the project.

Ishinkai (Japanese NGO)

Ishinkai is a Japanese NGO who is taking care of patients including HIV

positive patients. Ishinkai was founded by a doctor in Osaka and the Japanese

hospital covers the expense. There were a Japanese nurse and two clinical officers there

and we had a chance to talk with these officers.

The main diseases are HIV and ARI at the clinic. The clinic covers the

medicine for HIV positive patients. We observed the medicines for HIV positive

patients. There were many kinds of medicines since they have to change the medicines

according to the side-effect and its resistance. They start prescribing ARI when CD4

count is diminished. There told me that they are cooperative with Kenyan NGO for

HIV/AIDS Called FACES. We were surprised at their quality of counseling.

Counselor and the patient Laboratory technician

MAGOSO school (Japanese and Kenyan NGO)

MAGOSO school is situated in Kibera slum, which is considered to be the

biggest one in the world. They accept students from class 1-8. They accept orphans

who do not have any care takers for free of charge, yet the tuition is affordable since

they only charge the care takers 30 silings (60 yen) per month. This school was

founded by Japanese and Kenyan, Ms.Hayakawa and Lilian.

Lilian showed us around in Kenera slum and the school. The children

welcomed us with creative traditional dances and songs. We danced together. After

the dance, they offered us great lunch. We donated some money for the school.

In Kenya, there are many orphans who lost their parents due to HIV/AIDS and

other causes. Although there are less orphans due to the dissemination of the PMCT

(Prevention of mother to child transmission), there are many orphans. Orphans are

often taken care by their relatives, yet there situation is difficult and they are

sometimes abused by the adults.

MAGOSO school enrolls 280 children yet there are too many applicants.

Lilian told us that they are thinking of accepting those who do not have parents next

year. We enjoyed ourselves with talking to the children after lunch. We showed them

Japanese culture such as Origami and chopsticks.

We had a great time exploring Kibera and the meeting with passionate

teachers and seeing the great smile on the children. We want so something to this

school sometime in the future.

Students learning Origami They danced and singed for us visitors

Nymbani orphanage

Nyambani stands for “home” in Swahili language, as it stands for Nymbani

orphanage is just like a home for children.

It was founded by American who was a doctor and the catholic priest. Yet it is

funded by many groups or agencies including JICA. They limit the number of the

orphans up to 100 due to the maintenance of quality of care. There are several small

houses for 6 orphans and the mother is always there for them. There are two mothers

in the house and they take shift for night and for morning. The system is that the

hospital calls them in case there is an abandoned HIV positive child. They only accept

HIV positive children from 0-12 years old. They support the children until they turn

25 years old. They have their children go to primary school and have education. The

oldest orphan is now 25 years old.

The facility is very clean and supported by the volunteers all over the world.

They also have the laboratory and clinic. They count the number of CD4 every three

months to see the condition of the children. They accept students as well to have the

trainings. Since they have well-suited machines such as PCR and CD4, they can test

the blood samples from outside the facility. This is one of the incomes for this facility.

We were very impressed by their system. They accept researchers, students,

and volunteers to collaborate. It will be a great opportunity if we could join there for a

few moments to know the situation of HIV/AIDS and orphans for deeper

understandings.