Day Thirteen

Our day started at 8:30 am with a quick breakfast at KUCC  before preparing to head back to the Phytotherapeutic Center on Kenyatta University's campus, which we toured yesterday. Izabelle and Riley were interested in getting things the day before, but due to issues with finding a compatible ATM and needing to exchange cash, we were unable to do so. We soon learned that Google Maps was unreliable for mapping KU, because when I typed in “Phytotherapeutic Center” and started walking, it instead led us to the area of campus with student hostels. We observed students walking to morning classes and saw clothes hanging up to dry; we immediately knew we were in the wrong place. Luckily, we had the contact information for Catherine, an employee at the Phytotherapeutic Center, who was able to send us a pin to guide us. Once we finished our purchases of teas and essential oils, we were able to join our team again, smelling strongly of frankincense and rosemary oil. 

We began our final day in Nairobi by visiting the AMREF clinic, a non-governmental organization founded in 1957 in Nairobi to provide specialized outreach services, such as surgery in remote locations. This was done through the “Flying Doctors Society of Africa,” who used to land in clearings made by locals in times of need. Now they can use the airport only blocks from the clinic. And it has been successful to establish its physical offices in 11 different countries. 

Currently, this mother clinic of AMREF serves staff and their dependents (spouses, children) and occasionally opens up to the public. The site’s major public service is laboratory testing for surrounding communities and countries (e.g., Somalia, Tanzania, South Sudan) that do not have the lab infrastructure or financial backing to perform diagnostics. They also train and test lab scientists across Africa to ensure they are able to identify and treat bacterial, viral, and parasitic infections properly. The lab even sends microscopic samples to other facilities to determine if that receiving lab’s protocols work and the scientists are well-educated and well-practiced. For example, they send slide decks with malaria samples (a common mosquito-borne disease) to help physicians and bench scientists identify which parasite is exactly at work in a given case of malaria.

AMREF also offers travel vaccines, chronic disease management, and other laboratory testing. We delved into its current (2023-2030) strategic plan which envisions “lasting health change”. Their current goal is to encourage lasting health change through the use of regular primary care visits, specifically for women and young children. This is especially important because, as we were informed, non-communicable (not contagious) diseases (such as congenital or acquired conditions, like diabetes) are now the largest burden on the Kenyan healthcare system, and women and children bear most of that burden. By expanding primary care, AMREF believes Kenya can manage these conditions before they become too severe and can give patients someone to go to for education and preventative care.

Another avenue of intervention for AMREF is expanding insurance coverage across Kenya. In our conversation with Deputy Country Director Dr. Gilbert, we were informed that only 11-15% of Kenyans are insured. Those who are insured receive it through formal employment, but if they were to lose their jobs, they would also lose health care—something that many Americans are familiar with. Apart from insurance through employment, children, pregnant women, and impoverished families are also provided insurance through the government as a means to reduce maternal and infant mortality. The current administration of Kenya is trying to implement a social insurance system under the Social Health Insurance Fund Act where everyone with the financial means pays about 400 KES (less than $4) each month for health insurance. In order to accommodate vulnerable populations, the Kenyan government aims to reduce monthly premiums to about 300 KES (about $2). We also learned that current tactics, like passing the Primary Health Care Act, are under legal review, even as the nation seeks to attain Universal Health Coverage by 2030. Overall, these have been met with much pushback, because, according to Dr.Gilbert, many Kenyans don't think about their health until something is wrong, so they do not wish to spend the money.

They have further divided its mission of transforming the health of communities through primary health care into two strategic pillars: people-centered health systems (recognizing health financing as the biggest barrier) and social determinants of health. To evaluate its strength analysis, it has fortified its capabilities with successful collaboration with insurance companies. And has also established AMREF International University which is 5 years old which emphasizes primary health care (PHC) services. It solidifies its foundation by empowering its health workers through capacity building. As the COVID-19 pandemic has shown them ways to come out stronger and to establish a resilient health system through digital transformation and use of data science. 

Further, we were given a presentation on family and reproductive health by Kennedy Wakoli, a sexual and reproductive health and rights specialist. He talked about AMREF’s proven approaches for improving healthcare access, strengthening the citizenry’s voice, and national & county governance.

Next up we received a brief tour of the laboratory, where one of our KU partners, Dr. Isabell Kingori, previously worked. (She is a parasitologist.) They operate two laboratories: one to support the AMREF clinic and another regional laboratory for public health. They educated us on the blood sample collection and recording processes. They further gave us information on the use of different machines to ensure accurate services for patients. In addition to taking culture samples, they also conduct training on HIV, malaria microscopy, bacteriology, and laboratory-based disease surveillance. They also have a culture bank of bacteria and malaria parasites. To maintain confidentiality and follow safety protocols, they use biometrics to access the laboratories, required us to sign waivers to enter, and asked us to wash our hands before leaving.

Hungry and lacking energy after a stimulating time at AMREF, we decided to have lunch. While the professors and our hosts were eating at a small cafe serving traditional African dishes (tilapia and goat for them), the students chose to eat at a burger and pizza place where we enjoyed various coffee frappes and milkshakes to energize us for our last clinic visit.

Then we headed our way to the Mbagathi district hospital. It is a government hospital funded by USAID and run by the Nairobi county government to serve all who go there for free. We visited the Tumaini Clinic (Tumaini means Hope in Kiswahili), which serves survivors of Gender-Based Violence (GBV). We were introduced to the GBV expert clinician Maureen. The procedures were pretty much the same for the survivors here as those at Ruiru Sub-County Hospital Level 4, which we visited previously. She has been working in this clinic since 2015 at the clinic. At first she was only on call for cases, but over the years, instances/reports of GBV have increased, requiring her to work full time in this area. She shared how the trend of GBV is increasing post-COVID-19. She noted some factors that could lead to the increase (beyond an increase in violence), such as more outreach and education that empowers people to speak out for themselves and come forward for necessary treatment. 

We gained a profound understanding of the magnitude of GBV through one particularly intense story. We have decided to share the story to give voice to the horror of gender-based violence, in this case against a child, as well as to show the necessity of Maureen’s work. We have hidden the story in the drop-down below if you wish to read, but we do warn you that it is very disturbing.

Given the intensity of the cases she handles, we asked about Maureen’s self-care and coping mechanisms to ensure her own wellbeing. She said she engages in activities such as listening to music, dancing, and taking enough rest. She also engages in biweekly “briefings” (counseling sessions) and team building activities with social workers every month. The hospital also offers her a two-month vacation at the end of the year and allows her to take work breaks as needed (whether for a day or for a week).

By Izabelle & Sandipa