Dear Friends of Kijabe:
Greetings from Kenya! I want to bring you news of developments here at the hospital regarding the projects you have so generously supported.
(1) Our new Kenyan clinical officer (physician assistant), Nancy Gichuki, has been hired with help from friends at Christ the King Lutheran Church in Houston, Texas. Nancy’s role is as a dedicated officer of the HIV program. She has been learning the principles of antiretroviral therapy, and she has also undertaken a course in HIV counseling. Nancy trained at Kijabe as an intern and we are happy to have her on staff. She has been instrumental in advising sick hospitalized AIDS patients. She discusses treatment options prior to discharge so that patients do not simply disappear without knowing that the means to help them exist.
(2) In part because of Nancy’s efforts, we have rapidly increased the number of patients on antiretroviral therapy, now standing at 100. Almost 15% of these are children, and the emphasis of the Kijabe HIV Patient Fund continues to be on families, many of them headed by single mothers.
We have re-modeled an old storage room to help accommodate this increased patient flow. This space will also be used as a confidential counseling area as part of the prevention of mother-to-child transmission program (funded by the Elizabeth Glaser Pediatric AIDS Foundation). Using the Kijabe HIV Fund, we have been able to support the triple therapy drug costs of several pregnant women recently, and we already know for certain that one child has been born without the virus. Another patient, Alice, presented to Kijabe in August, wasting away from TB and HIV. She was also 17 weeks pregnant. Started on HIV and TB drugs, she struggled through her pregnancy and recently gave birth to a very small child, named after her doctor: Fielder Esiokoon Ekai, thus becoming possibly the first human ever with a combination Turkana, Maasai, and WASP name. A picture of baby Fielder, and his mother and father (also on antiretroviral therapy) is attached. Alice is still thin and very much needs our prayers. We do not know the child’s HIV status as of yet.
(3) For the vast majority of Kenyan patients, antiretroviral drugs are not available; “second-line” regimens, used if the drugs fail or must be stopped because of side-effects, are even more out of reach. A recent report from Houston gives some hope to patients needing second-line drugs in Kenya. In that study, conducted at a free clinic, a powerful drug called Kaletra was given alone to patients who could not afford or tolerate the “triple cocktail.” The results were impressive and surprising, with most patients controlling the virus. Kaletra is available in Kenya, and although giving it alone is not yet standard in the West, this drug provides real hope to some of our patients who have failed the initial combination. Unfortunately, the drug is expensive (at $60 per month), but we are hoping for price decreases in the future.
We have already pursued this option with one of our patients. Helen is a 35 year-old woman diagnosed in July 2001 with Pneumocystis pneumonia, indicating advanced HIV disease. She recovered under the care of Dr. Nate Smith and in September 2001 started antiretroviral therapy. She had her drugs changed one time and did well until developing tuberculosis in September 2003; this illness was likely a warning that her medicines were failing (due to resistance). She has now been on Kaletra alone for two months and has regained 4 pounds and her sense of well-being. Her husband James, a teacher, is also HIV-infected. He has been taking the standard triple cocktail for 14 months and is very healthy, gaining over 20 pounds. They have two children; a picture of the couple is attached. James and Helen contribute a small co-payment (the average Kenyan teacher makes just under $100 per month, and they must travel two days in order to reach the hospital), and the Kijabe HIV Fund covers the rest of the cost.
(4) We now have a website describing our work: www.fieldermedicalassistance.org.
We are indebted to the donated services of Gina Jones, a webmaster for Compaq
computer company, as well as to the support of Mr. and Mrs. Jerrold Jones and
Mr. and Mrs. Ray Johnson. Please visit the site to learn more about HIV care
and other activities at Kijabe.
Nate Smith started this program alone over two years ago; only a few medicines
were available. Since September 2002, the number of patients receiving life-saving
drugs has more than tripled. We now have three healthcare providers, two of
them Kenyan, delivering antiretroviral therapy. Because of your assistance,
the new medicines available in Kenya have been made accessible to many poor
individuals and families who have no where else to go. And we still aim to expand
the number of patients receiving this care. In addition, we are in search of
a CD4 machine to better measure patients’ responses to therapy, and we
would also like to hire a full-time HIV counselor to carry out these duties
in the hospital and in the clinic.
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With the help of several interested persons, we have now been able to initiate the Kijabe Medical Patient Poor Fund. This new endeavor, separate from the HIV Patient Fund, aims to help patients cover their general medical expenses. Kijabe Hospital strives to provide excellent curative medical services to the poor, but doing so is often very costly. We will be working with our credit officer, John Karaya, to identify those with definite needs who are not able to pay. John visits many homes and communities; the hospital relies on him to know who is, and who is not, able to cover their bills. When John visits a home and finds the family without food, or the field lying fallow, he clearly knows they cannot pay their bill. No doubt many patients, both HIV-positive and –negative, will benefit from this new project.
We have already assisted several impoverished patients, including the following:
(i) Christine, an HIV-positive eight year-old girl weighing just 30 pounds, was hospitalized with a severe blood infection and her father could only pay a fraction of the bill.
(ii) Teresiah, a 23 year-old woman, is unfortunately typical of so many patients. She initially sought care at multiple clinics and hospitals, receiving treatment for pneumonia but not improving. When she arrived at Kijabe she was near death from severe TB, which had caused multiple cavities (holes) in her lung (see attached chest x-ray, which shows better than any words the devastating effect this disease has on patients). This picture is typical of tuberculosis in HIV-negative patients such as Teresiah. Her oxygen level was very low and she was breathing over 60 times per minute. Fortunately, with the high-flow oxygen Kijabe is able to administer, combined with the proper drugs, she has improved considerably.
(iii) Paul is a 30 year-old man who suffered severe injuries, including two broken femurs, in a road traffic accident. He wasted away at another hospital before coming to Kijabe with severe infections; he had fever for weeks. His care has been complicated and expensive. The family has made a significant effort to raise money. The Medical Patient Poor Fund has contributed a modest amount in support of his ongoing care.
(iv) David is a 35 year-old HIV-infected man recently hospitalized at Kijabe with tuberculosis. His son died, possibly of HIV. As in many Kenyan families, he is the only breadwinner and is currently unable to work, as is his ill wife. The credit officer reports that their land is not productive.
These stories illustrate the reality of life in our region. Many traditionally crippling diseases—such as small pox, measles, and polio—have been controlled or eliminated by vaccinations and other public health efforts. In other areas—TB, AIDS, malaria, road safety—there has been very little effective governmental or non-governmental response. What remains is a tremendous burden of disease requiring curative medical care in the here and now. Recently, our credit officer took home a child following a prolonged hospitalization, for which the family could not pay a shilling. Upon arrival at the family’s house, he found a small girl with extensive scarring from burns, in need of corrective surgery. He was forced to leave the child there, lamenting, “If I brought her back to the hospital, people would say I do not know my business [of keeping the hospital solvent].”
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We have been able to accomplish all of the above tasks only with your kind assistance. For those who do not know, Amanda and I have recently married and are now living in Kenya together. We are indebted to many people for allowing us to continue in our work here, and we would like to acknowledge the gracious generosity of our many supporters. And, above all, we thank God for sustaining us in difficult times.
Grace and Peace,
Jon
Jon F. Fielder, MD
Consultant Physician
Africa Inland Church
Kijabe Hospital
Kijabe 00220, Kenya
254-733-652-024
jfielder@kijabe.net
“You will behold great sorrow, and in this sorrow you will be happy.
Here is a commandment for you: seek happiness in sorrow. Work, work tirelessly.”—Zosima,
Dostoevsky’s The Brothers Karamazov
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Addendum: HIV Prevalence in Kenya
Recently, a study was published purporting to show that HIV rates have fallen
dramatically in Kenya—or were simply overestimated before. The traditional
figures have been around 14-15% of the adult population. This new study claims
a much lower number of 6.5% (which is still very high, about ten times the US
rate). Unfortunately, the methodology of the investigation was flawed. The 6.5%
figure came from voluntary testing; however, 30% of the adults interviewed refused
to be tested.
Dr. Nate Smith conducted a revealing study at Kijabe several years ago. Eighty-four
percent of pregnant women agreed to testing, of whom “only” 3.8%
were positive. When blood was taken (for necessary pre-natal blood typing) and
tested anonymously, the rate was 12.5%. In other words, about half of the women
who declined testing would have tested positive for HIV. (Those refusing testing
are often the most high-risk patients, those who have reason to fear they are
HIV-positive.) Once this phenomenon is taken into account, we are forced to
adopt the unfortunate conclusion that HIV prevalence remains terribly high in
Kenya.
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The Fielder Medical Assistance Foundation and Donor-Advised Funds
A donor-advised fund (DAF) is essentially an account within a larger established foundation, although the DAF may itself be known as a “foundation.” The larger foundation oversees the proper management and disbursement of the money based upon guiding principles. The fund “advisor” may recommend appropriate uses for contributions to the DAF, but final authority resides with the foundation, not the fund advisor. This structure prevents abuse of contributions to the DAF, which must have a clear purpose and focus.
The Fielder Medical Assistance Foundation is a DAF within National Foundation, Inc., a respected non-sectarian organization that is partnered with the Christian Community Foundation. Information about the National Foundation, including its guiding principles and management of DAFs, may be found at www.thefoundations.org.
The Fielder Medical Assistance Foundation was established to provide a mechanism for ongoing support of worthy health-related projects to assist the poor. Its mission statement is as follows:
The Fielder Medical Assistance Foundation is dedicated to the provision of quality, dignified health care to the world’s poor, particularly in Africa. The initial and major focus of the endowment will be in the area of HIV/AIDS treatment. This commitment will include support for access to essential medicines but may also encompass prevention, capital expansion, and training. Consistent with this philosophy and depending upon Foundation resources, subsequent projects may address other established or emerging health issues affecting the poor. Further objectives may include education of national healthcare workers and support for expatriate professionals (exclusive of the fund advisor, Dr. Fielder).
I have notified National Foundation that Kijabe Hospital will be the major organization
recommended for support. After appropriate review by National Foundation, contributions
to this fund may be used for HIV work or other worthwhile projects at Kijabe
Hospital. If you have a purpose in mind when making a contribution, please
communicate with me.
Advantages of the DAF include the potential for more flexibility regarding use of donations, significantly lower administrative costs, and the option of placing fund resources in conservative investments so as to meet operating expenses and to build principal. Donations remain tax-deductible. To donate, a check may be made out to The Fielder Medical Assistance Foundation and sent to the following address:
NATIONAL FOUNDATION, INC.
2925 Professional Place, Suite 201
Colorado Springs, CO 80904-8105
Telephone (719) 447-4715 Fax (719)447-4700
Email: nfi@ccfnfi.org Web: www.thefoundations.org
The Fielder Medical Assistance Foundation is a donor-advised fund of National Foundation, TIN# 54-1230512. All contributions are completed and unrestrictive gifts to National Foundation. Contributions may also be received in the form of money orders or via credit card (for a small handling fee) or another donor-advised fund. Please expect a receipt for tax-purposes. The National Foundation does not accept cash donations.
Africa Inland Mission will remain another channel for contributing to the Kijabe HIV Patient Fund. Africa Inland Mission is a highly respected and trustworthy organization that has handled all previous contributions with great care. We are indebted to its ongoing administrative and logistical support of missionaries and activities at Kijabe Hospital. To donate to the Kijabe HIV Patient Fund via Africa Inland Mission, send contributions to:
Africa Inland Mission
c/o Don Dressler
PO Box 178
Pearl River, NY 10965
Please mark the check “Kijabe HIV Patient Fund.” Donations are tax-deductible.