A letter from Jon Fielder on his work with HIV in Kijabe, Kenya
21 November 2005
Dear Friends of Kijabe,
With 1250 HIV patients now enrolled in our project, it has been difficult to find the time to write until now. I am excited to share with you the developments of recent months.
Some highlights:
· Program enrolment reaches 1250 patients, with 533 on anti-HIV drugs
· Kijabe starts HIV nurse training program for other mission hospitals
· New HIV virology laboratory opens
· Almost 100 HIV patients have been trained as volunteer community health workers
· First rural satellite HIV clinic opens
· Renovation of a new clinic for general and HIV care is ongoing
· Construction of housing for Kijabe HIV project staff nears completion
(1) Our clinic continues to grow at a rapid—indeed, almost alarming—rate. Although we have a minimum target of 1300 patients under care by the end of February 2006, we will clearly exceed that number, especially since existing patients are themselves identifying and referring new clients. This patient-referral mechanism resulted in almost 100 new patients joining the program in October 2005. Currently, 125 patients are receiving care for active tuberculosis. We have hired our fifth clinician, a clinical officer (nurse practitioner), to help with this caseload and to free up experienced staff to conduct training.
(2) Kijabe has become a training site for nurses from other mission hospital to learn about HIV and its management. We have designed a hands-on mentorship program in which nurses receive didactic instruction, spend time in our clinic, and travel with nurses to patients’ homes. Six nurses have already completed the training program.
We believe it is necessary to move away from the traditional training model involving lectures in Nairobi hotels. It is also crucial to involve Kenyans in training other Kenyans. Although I oversee the training, our qualified and knowledgeable Kenyan clinicians are heavily involved in teaching. We will be hosting four nurses per month and may train nurse practitioners and doctors later. We also hope to add housing space for these learners as the demand for this service is growing.
(3) Viral load testing—or, measurement of the actual amount of virus in the blood—began this month, following the renovation of a laboratory room and receipt of equipment from the Swedish government. This capability will greatly enhance our ability to monitor patients’ health and adherence to treatment. Our laboratory technician has been trained, and we have been asked to serve as a quality assurance site for other hospitals. We are grateful to the friends of the Kijabe HIV Patient Fund for making the renovation of the lab possible.
(4) Following the suggestion of one our support group leaders, we have begun training HIV-positive patients as volunteer community health workers. Almost 100 have now gone through a three-day seminar to increase their practical knowledge about HIV and its treatment. The patients know which members of their communities are HIV-positive. The personal experience of dealing with this illness will help them counsel and comfort those newly diagnosed. Now we see already enrolled patients referring others for care and visiting them at home. Although stigma still exists, its effect is waning and gradually disclosure and honesty are becoming the accepted means of dealing with this epidemic.
I witnessed this process first hand when I visited one of our 35 community-based support groups. The eight regular members of this group welcomed a new patient, and after the meeting, our Kijabe team along with the entire support group visited the patient’s home. The group seeks to know where everyone lives so that it may provide both assistance and accountability. In another instance, the members of this support group brought gifts of fruit and vegetables to a patient who thought she was all alone with her disease.
We believe training patients as community health workers will provide a sustainable structure for monitoring the ever growing number of clients we are following in the community. We have also hired two full-time HIV-positive employees, both patients in the program, to assist with community follow-up and education.
(5) Using a grant funded with gifts to the Fielder Medical Assistance Foundation, renovation of a new outpatient clinic for HIV and general patients is ongoing (see picture). We first successfully tapped an adequate supply of water, and now new clinical rooms are being constructed. Once this clinic opens, not only will we be able to see a larger number of patients in a more efficient manner but space for additional training will become available. Currently, Kijabe is renting the land. In the long term we hope to purchase the two acre plot outright and erect a larger health center in order to accommodate the ever increasing number of patients.
We have also started a satellite clinic in a remote area by partnering with a local Catholic dispensary. These new sites will help us devolve care of stable patients away from Kijabe, increasing long-term compliance and assuring integration of care within local communities. The picture below shows our community nurse, Stephen Chege, providing care to an HIV-infected mother and child in the satellite clinic.
(6) Construction of a new triplex housing unit, another project aided by the friends of the Fielder Medical Assistance Foundation, is also ongoing and will hopefully be complete by the end of the year. This building will allow us to increase the size of the HIV project staff and provide housing for our returning Kenyan obstetrician, now under sponsorship by the hospital and studying in Nairobi. Housing for support staff is still in short supply, and we will be exploring ways to increase capacity as new personnel are crucial to the growth of our HIV efforts.
Every trip to surrounding communities is exciting, as we see the restoration of hope and health to previously ill patients and households. In the last 15 months, almost 600 patients have started antiretroviral drugs (some stop because of side effects or problems with compliance), but only 17 have died, a remarkably low death rate and clear evidence of the impact the program is making. Among the first 100 patients tested, we have found that almost 90% have levels of the virus in the blood too low for the machine to detect! This figure exceeds results seen in the West.
Research has demonstrated how HIV treatment has provided a collective 2.5 million years of additional life to the infected Western population. And now Kijabe’s treatment program is adding thousands of years of life to our collective patient population. And when parents are kept alive and healthy, their children also remain so. We hope and pray the number benefiting from these efforts will only grow.
Last month I travelled to another support group whose members have grown close together while struggling with the disease. Six months ago, when visiting the same group, I saw a ragtag collection of weak, coughing, and demoralized individuals. Now, after treatment of their opportunistic infections and the introduction of antiretroviral drugs, the patients have experienced a collective rejuvenation.
After attending a support group, a visiting nurse asked, “Are all your patients so happy?”
We still face considerable challenges. Stigma in some areas remains high. The supply of medications and laboratory reagents needed to manage HIV and opportunistic infections is inadequate. The steady and high volume of patients is straining our existing infrastructure to the limit, a problem we hope the new clinic will help alleviate. Hiring, training, and retaining enough qualified staff are always challenges in a country where the talent flows toward Nairobi and the West.
But we must always remind ourselves of how far we have come in the last year, and of how far we are capable of going with a talented and committed team.
I spoke recently with a missionary who has worked for several years in Mai Mahiu, a truck-stop town below the hospital where poverty, corruption and HIV are devastating the mostly young population. He remarked, “This is not a problem which can be solved, but it is a problem which can be healed.”
By providing quality care, by visiting patients in their homes, and by supporting them in the community, we hope to bring healing to this troubled land.
Grace and Peace,
Jon
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To donate to the Kijabe HIV Patient Fund via Africa Inland Mission,
send contributions to:
Africa Inland Mission
PO Box 178
Pearl River, NY 10965
Please mark the check “Kijabe HIV Patient Fund.” Donations are tax-deductible