29 April 2006
Dear Friends of Kijabe,
Greetings from Kenya! The AIC Kijabe Hospital AIDS Relief team continues to be excited about our work and progress.
1. Over 1500 people receiving care; 892 using anti-retroviral drugs
2. HIV training expands to include clinical officers (physician assistants)
3. Second satellite clinic opens
4. Quality assurance program shows outstanding results
5. Partnership forms between Kijabe Hospital and the University of Maryland
With over 1500 patients already enrolled in Kijabe AIDS Relief, we hope to place at least 1500 on antiretroviral drugs (ARVs) by March 2007. We are also caring for 220 children, 125 of whom are also using ARVs.
April saw the first month of physician assistant training in HIV medicine. This month-long training program seeks to mentor a highly qualified cohort of clinicians within the faith-based hospital consortium of which we are a part. The first trainee, from St. Joseph’s mission hospital near the Tanzanian border, will now return to apply the skills he has learned at Kijabe.
The nurse training program continues a series of 10-day hands-on mentorship tutorials. This program has become very popular, bringing nurses from HIV programs in western, central and coastal Kenya. We have now trained 30 nurses who have returned to their hospitals and clinics to start support groups, initiate community programs, improve adherence to ARVs, and provide direct clinical care to patients.
Despite the recent completion of a residential triplex unit for trainees and hospital staff (funded by friends of Kijabe through the Fielder Medical Assistance Foundation), housing for further expansion of clinical and training programs remains a challenge. With the help of our Africa Inland Mission supporters, the basement of our own house is currently being renovated into an apartment for use by visiting physician assistant trainees.
The Kijabe Hospital Marira Clinic, located near the highway to Nairobi and
10 miles from the main hospital, has recently been opened. Both general outpatients
and HIV clients are seen in the clinic. Already, over 150 AIDS Relief participants
are receiving their care from this spacious and more easily accessible clinic.
By the end of the year, we hope to provide ongoing, lifelong therapy to at least
500 HIV patients through this clinic. The added space will also help us to expand
the training program.
We are grateful for the support of many friends, who, through the Fielder Medical
Assistance Foundation, have provided for the borehole and clinic renovations.
We have also been blessed with a recent generous contribution to purchase the
land on which the clinic sits. By owning the land outright, we hope to further
develop the site. Kijabe Hospital has entered negotiations to obtain the adjacent
parcel of land as well, to ensure adequate space for additional expansion of
clinical services and staff housing.
Future plans include opening of a third satellite clinic in the town of Naivasha, where a former physician of Doctors Without Borders has invited us to provide HIV care to the residents of the surrounding slum.
A quality assurance program designed by our technical assistance partners and carried out at eight hospitals within our mission network is showing promising results. The goal of antiretroviral therapy is to suppress the HIV virus to very low (“undetectable”) levels. Blood was collected at the hospitals, frozen, and transported to Kijabe for testing in our HIV laboratory. Of 71 samples collected from Kijabe patients, 69 were “undetectable.” This 97% success rate is greater than the 83% achieved in America using the highest quality drugs in a pharmaceutical industry-sponsored trial. Results from the other mission hospitals are similarly excellent, demonstrating that training and networks of community care can deliver high-quality services despite the enormous obstacles faced in African countries.
Kijabe Hospital has entered into a partnership with the University of Maryland’s Institute of Human Virology (IHV). The IHV, established by the co-discoverer of HIV, Dr. Robert Gallo, is a leader in international AIDS treatment, training and research efforts. This partnership is intended to expand Kijabe’s clinical training program, to establish a model network of community care in our region, and to offer technical assistance to other mission hospitals providing AIDS treatment. The IHV approached Kijabe because of our demonstrated ability to design and implement a treatment program characterized by high quality community, clinical, laboratory, financial and management components.
As part of this effort, Africa Inland Mission has seconded (or loaned) me to the University of Maryland to serve as the effort’s lead doctor in Kenya. Kijabe’s former head AIDS Relief nurse and two of our physician assistants have also joined this team. Later in the year, Dr. Nate Smith, former Kijabe doctor and AIM missionary, will also be returning to Kenya.
With this highly skilled group of care providers, based on-the-ground and possessing 20 years of experience in HIV care (including 10 years in Africa), we hope to further expand training programs to include a six-month physician assistant mentorship. We would like to bring multiple trainees simultaneously and therefore make a lasting contribution to health care capacity building in Kenya.
This past week provides an example of the types of activities we will pursue. A Presbyterian hospital in central Kenya, about four hours from Kijabe, has been caring for 25 HIV-positive children living in a nearby orphanage. After an evaluation, we determined that the orphanage caregivers required training and that the hospital clinical staff would benefit from mentoring. Our nurse Beatrice Kiama educated the orphanage staff while I sat with the doctors and physician assistants to teach proper dosages of pediatric ARVs. Now, the staff feels confident in providing this care to the children.
We have and will continue to carry out this type of hands-on training both at Kijabe and throughout the AIDS Relief hospital network in Kenya.
Amanda, Matthew and I will continue to serve as Africa Inland Mission missionaries, to live at Kijabe, and to be heavily involved in guiding the HIV program.
The spectacular growth of our HIV treatment efforts also brings numerous challenges. With so many patients under care, inevitably some require hospitalizations, surgeries, or in-patient maternity services. The US government grant, under which our relationship with Catholic Relief Services and the University of Maryland falls, does not cover such expenses. Nor does our particular grant provide resources for long-term training of personnel. We hope to find resources to provide for an in-depth six-month training program.
Planned expansion into the large town of Naivasha, with a population of a quarter of a million yet almost no health services, will require more resources than currently available under the grant. We would also like to develop the laboratory capabilities of our new satellite clinic.
Lastly, housing for staff remains a serious obstacle for the entire hospital. The dangerously poor security situation in rural Kenya means qualified personnel are often attracted by quality housing. Not only the HIV program, but the general hospital, the pediatric surgical service, and the various educational programs at Kijabe (nurse, nurse anesthetist, surgical, intern, and HIV) have placed an increasing strain on infrastructure.
We could never have anticipated the changes of the last four years, over which
time we have grown from a staff of one providing care to 30 patients to a staff
of 35 spread out over 3500 square kilometers and providing care for 1500. And
now, through our training programs and site visits, we have the opportunity
to improve the care of a far larger number of HIV-infected Kenyans.
The generosity and concern shown by Kijabe’s friends and supporters have
been critical components of this growth and success.
Grace and Peace,
Jon, Amanda, and Matthew
Dr. Jon Fielder is a member of Christ the King Lutheran Church. Contributions may be made through Christ the King Church and designated to the Fielder Medical Assistance Foundation.
The Lenten Soup Suppers raised $883.00 for Dr. Jon Fielder’s work with AIDS patients at the Kijabe Hospital in Kenya. Thank you to the council members and commission members who shared their organizational skills and to all their helpers who shared their culinary and serving skills to make this annual Lenten tradition a success.