Kijabe Hospital AIDSRelief

But I predict that even in that very moment when you see with horror that despite all your efforts, you not only have not come nearer your goal but seem to have gotten farther from it, at that very moment…you will suddenly reach your goal and will clearly behold over you the wonder-working power of the Lord, who all the while has been loving you, and all the while has been mysteriously guiding you. — Father Zosima, The Brothers Karamazov

In September 2002 I left my home and fiancée Amanda in Baltimore to follow God’s call to serve as a medical missionary in Africa. At that time, I had only planned to stay in Kenya for a little over a year and a half, to cover for another missionary’s furlough. Little did I know that God had so much more in mind.

When I arrived at Kijabe Hospital there were 62 patients receiving antiretroviral drugs for HIV infection. Dr. Nate Smith had scrounged together whatever donated funds and drugs he could find to start offering a degree of hope to a few patients. In addition, Dr. Smith had begun, with support from the Elizabeth Glaser Pediatric AIDS Foundation, an effort with Kenyan mission hospitals designed to prevent transmission of the HIV virus from mothers to their unborn children. At the time, virtually no such initiative existed in the country.

With Dr. Smith’s departure I was the only trained HIV care provider at Kijabe Hospital. Between general ward duties, the intensive care unit, teaching the interns, taking call, and seeing HIV-infected and non-infected patients in the clinic, it seemed as if the work was simply too much to concentrate on just one area.

The hospital was gracious enough to “loan” me a very bright and compassionate young Kenyan physician assistant named Kenneth Miriti. I trained him in HIV care, and he began seeing patients when I was not able. I realized that the effort would continue to expand and, with support from members of Christ the King Church, was able to recruit another young talented physician assistant named Nancy Gichuki to assist Kenneth.

The team grew to include an HIV counselor named Maria Saruni, whose work and testing center were also supported by Christ the King, and Beatrice Kiama, a community nurse educator and organizer. This team, along with young Kenyan doctor Ivy Mwangi, prepared us for the next big development in the Kijabe AIDS ministry.

When President Bush announced his Emergency Plan for AIDS Relief (PEPFAR), a consortium of faith-based organizations became a part of the effort. Kijabe received funding and drugs from the consortium led by Catholic Relief Services.

Our team would now grow with the addition of more community, clinic, and support staff members. The number of patients on antiretroviral drugs increased, from 125 to 300 in six months, to 870 after another year, and to around 1500 today. A total of 2300 HIV-infected patients are receiving either antiretroviral medications or care for other opportunistic infections.

Behind the impressive numbers is the even more wonderful story of community transformation. Before the hope of treatment, HIV was (and still is to a degree) heavily stigmatized, with its sufferers being blamed for bringing ill health upon themselves and their families. Because the infected had no hope for treatment, they avoided testing and the community and churches skirted around the underlying issues.

A centerpiece of the Kijabe effort is community education and church involvement. Led by nurse educator Frederick Kimemia, a network of sixty support groups, including eight for HIV-infected children, now exists throughout the region. These support groups serve to meet the physical, emotional and spiritual needs of patients. The groups, which meet either in homes or local churches, are often visited, assisted or even shepherded by pastors who have volunteered their time and have been trained by Kijabe.

The support groups serve as small group accountability structures. The patients themselves are advocates of behavior change and abstinence in the community, and they have taken on the responsibility of caring for each other. Kijabe now has a model program for training patients to assist with provision of community-based HIV care.

Training of healthcare workers has also been a priority. With the support of the University of Maryland, one of the AIDSRelief consortium members, a novel hands-on clinical and community preceptorship has been established. Nurses and physician assistants from other mission hospitals spend two to four weeks honing their ability to treat and support those using antiretroviral drugs. About 100 trainees (from not only Kenya but also from Uganda as well) have completed the popular program and have returned to positively impact the care at their facilities. The demand and interest in the training program has been high. Future directions include mentorship of adherence counseling staff, such as social workers, and laboratory technicians.

Another major thrust of the Kijabe AIDSRelief program is the further decentralization of care away from the main hospital and closer to where patients actually live. Currently, Kijabe has three such sites: a partnership with a Catholic dispensary, a satellite clinic owned and operated by Kijabe Hospital, and another relationship with a community clinic in a slum near the shores of Lake Naivasha

The nature of this last relationship will be changing soon, as Kijabe has acquired its own land and is in the process of erecting a new HIV clinic to accommodate the rising number of patients. The team has also started providing HIV care within the Naivasha prison, the largest in Kenya. It is hoped that the Kijabe Naivasha facility will expand and perhaps become a small hospital.

Although these phenomenal changes have been greatly aided by the resources of the US government and the AIDSRelief consortium, other partners have also been critical to the effort. Supporters of Africa Inland Mission, Kijabe Hospital, and the Fielder Medical Assistance Foundation as well as of Amanda and me personally have played not simply supplementary but in fact complementary roles. Some examples of the vital support provided by Christ the King and others are shown in the sidebar above.

The US government’s policy is not to assist with construction or the expansion of physical infrastructure. Before the new Kijabe Marira clinic was acquired and renovated, the main hospital clinic was simply beyond maximum physical capacity. The future ability to scale-up treatment and care would have been severely limited without the complimentary role of Kijabe’s friends.

A last important point which bears mentioning is that program leadership and management positions are now held by highly competent and compassionate Kenyan Christians.The Kijabe AIDSRelief program manager, Mr. Jonathan Mwiindi, has used his considerable skill to guide the team through many challenges. He now also serves as a consultant to the Ecumenical Pharmaceutical Network, a role which allows him to travel around Africa sharing about the Kijabe model and stressing the role local churches can play in combating the HIV epidemic.

Although Amanda and I could look back after four years with awe and wonder at what God had done for and through the Kijabe HIV ministry, we also knew that the vast majority of HIV-infected patients in the region still lacked access to care. But who knows what God will do next?
We are grateful for the prayers and support of the church and friends. Amanda, Matthew and I look forward to visiting the congregation to share further about the Kijabe ministry and the problem of HIV in Africa during the adult forum the first Sunday in May.

Grace and Peace, Jon Fielder

Jon Fielder will offer a presentation at the Sunday Forum on May 6

Last updated: 2007-04-30