These last few months, we’ve been working hard at Nyametaburo Health Center. The way medicine is practiced here has really struck me. As an example: a friend had a persistent cough. I took the history and physical and narrowed down to a few possibilities. In medical school, that’s when you get the next round of test results. But there’s not a single X-ray machine in our district.
She had to spend half a day going to the nearest hospital and waiting in line to get a sputum test. Then another half day to go back and get the results and yet another half day to visit her doctor who works in another hospital. Thankfully the result was negative. Finally. But what about people who don’t have the resources to spend a day and a half (plus travel expenses) to get a TB test?
The old answer was that they didn’t. They’d just cough and cough and cough, infecting family and friends until they couldn’t work anymore, and only then would they go to a hospital. We thought this state of affairs was bad. So Nuru decided to continue the upgrade of Nyametaburo Health Center (NHC) by adding a laboratory.
The first step was finding a lab tech. Fortunately for us, there happens to be an abundance of them. There are far more trained than there are jobs available in Kenya, so those who can leave, and those who can’t, stay and get paid less than they ‘should’ be worth. And by ‘should’ I mean the amount someone of equivalent schooling would be paid. In order to do all that we wanted, we needed not only a lab technician (2 year program), we needed a lab technologist (4 year program). We put out a request and ended up interviewing a highly qualified candidate who was willing to start work immediately. The candidate, Alice, was being interviewed by the 8-member board. The problem was that she asked to be paid what she was technically worth: 25,000/= per month (~$330/month). That was way too high for our facility which, on a good month, might bring in half that amount in cost-share payments. But then, in a tag-team barter that will go down in history, the board haggled the price down to 14,000/= per month.
So we hired her and with her, we came up with a list of reagents and equipment she needed. We began renovation of the lab, which included a solid, tiled countertop (important for sanitizing and cleaning spilled reagents) and a sink for hand washing. She doing what she could immediately, and we had a line out the door for her services. She did an incredible job in pulling from the resources she already had and asking for those she lacked. And, it seems, adding additional services is a great way to attract customers and bring in more money for the facility that is hurting financially.
One of the first things she did was turning NHC into a “Voluntary Counselling and Testing” (VCT) center. Standalone VCTs are one moderately effective way of going about getting people to know their HIV status. But with the stigma associated with HIV, there have been problems with people voluntarily walking through the door for fear of being associated with the disease. One of the recommendations now is a strategy called “Provider Initiated Counseling and Testing” (PICT); it addresses the stigma (there are plenty of non-stigmatized reasons for going to a health center) and makes testing convenient (“I know you’re here for malaria, but why don’t you get tested for HIV while you’re here at no charge?”). So we are beginning to transition toward the latter strategy.
Now we can test for the famous developing world diseases: HIV, TB, and Malaria. And also the forgotten developing world disease (diahrrhea) by fecal test.
Why should anyone care about testing? Well firstly because it helps patients. Knowing your HIV status, for example, will put you on track for managing the disease rather than just dying of it. With a lab test, you can tell which cases are Malaria and which are not and then treat appropriately. In some diseases (worms, for example), doing a test will help design the treatment regimen.
Beyond the individual patients, there’s a larger issue of global responsibility. Understand that microorganisms are like the Borg in Star Trek – they adapt. Roughly speaking, the more you use a drug, the less effective it is. It’s like you only have a certain number of doses; you don’t want waste them on those who don’t have malaria. The idea of resistant bugs becomes even scarier when you think about the fact that antibiotic discovery is slowing down despite the huge amounts of spending.
So not only is Nuru fighting for the poor in Nyametaburo, but we are also doing our part to conserve the drugs for those who truly need them worldwide.
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