In late October and early November, I was able to leave the OB/Gyn department in the very capable hands of a short-term volunteer, Dr. Allan, and finally visit many of the hospitals and dispensaries that refer patients to me on a daily basis. Since our arrival in Kapsowar over 2 years ago, I had not stepped foot into another clinic, health center, or hospital in Kenya (except for a brief meeting at the regional referral hospital). Our hospital administrators helped me set up some visits for a little meet-and-greet, some brief education, and promotion for the hospital.
Lowest level - Dispensaries, where nurses see and treat common ailments and often perform maternal and child healthcare including vaccinations, antenatal (pregnancy) care, and routine deliveries.
Health centers - May have beds for inpatient care, again perform maternal care including deliveries, possibly some laboratory tests beyond the basics. A clinical officer (a little like a nurse practitioner) is likely the highest trained provider in a health center.
Sub-district hospital - Inpatient care and possibly c-sections or other emergency surgeries if staffing is available. Fully trained medical doctors may or may not be available; sub-district hospitals may be staffed by medical officers (more training than a clinical officer, but not a full Medical Doctor; somewhat like a General Practitioner in the US long ago before residency training became the norm).
District hospitals - Provide more comprehensive medical and surgical care and may have specialists either full time or on a visiting basis.
National or Referral Hospitals - Larger referral centers with multiple specialists.
Our hospital is a Faith-Based Hospital and therefore doesn't neatly fit into any of the above designations. We currently have 3 surgeons (1 US-trained and 2 Kenyan-trained), 1 medical officer (Kenyan-trained), 1 family-medicine doctor (US trained), 1 OB/Gyn (that's me), 1 dentist (US-trained) and 4 family-medicine residents providing care full time in our hospital, plus whatever short-term volunteers are around. We receive referrals directly from dispensaries and health centers, and we refer patients on to the regional referral hospital if they need a higher level of care than we can provide. Reasons for referral may include need for ventilation, a surgery we couldn't provide (neurosurgery, some cancer surgeries), medical care such as dialysis or chemotherapy, even blood transfusions if our supply is low.
Our team for the OB/Gyn outreaches included myself, a chaplain, a nurse who runs our antenatal clinic, a finance/insurance person from the hospital, and of course our driver. We invited nurses, clinical officers, hospital administration, regional chiefs and anyone who has a stake in women's healthcare to attend, and we were overall pleased with the responses we received.
[A common example - someone with three prior c-sections is advised at her antenatal visit at 38 weeks to return to the hospital "when in labor." This mother risks uterine rupture and both maternal and fetal death if she lives far from the hospital and goes into labor during the night or during a bad storm. Instead, she should come to see me for a consultation - ideally before 38 weeks - and have her c-section scheduled before labor begins. Another common example - a first-time mom at her 41-week visit is told to go home and return when she has labor. This mom risks returning with fetal distress or stillbirth, or at the very least obstructed labor as baby becomes bigger and her placenta ages and is less able to supply her baby with the oxygen it needs to be healthy. This patient should be referred to me for evaluation and safe induction of labor.]
After the education portion, we ended with many, MANY photos of the groups. I'm the one wearing the white coat...
Wishing you a happy (belated) Thanksgiving, blessed Advent, and Merry Christmas! See you again in the New Year!
Kim
