Today started with a trip to Marafa, about an hour and a half west of Malindi (everything's west of Malindi, seeing as it's on the coast and all). It's a rural area, so the goal was to show me a rural health center to compare it to the hospital in Malindi. Here's a picture of the clinic:
One interesting thing I learned about the healthcare system in Kenya is that there are two ministry that are involved in it. One is the Ministry of Public Health and Sanitation (as above), and they are responsible for small clinics (called dispensaries) and health centers, such as this one. The Ministry of Health (or Ministry of Medicine, I don't remember) is responsible for the district hospitals, such as Malindi, the provincial hospitals, and the national hospital, in Nairobi. Two different ministries means that there's a big divide between what happens at the local level and at the district level.
Since I've been working on the waste disposal issue for Malindi, we swung by the waste incinerator at Marafa, used to burn the infectious waste and sharps. It's pretty small, but the clinic is pretty small, so they only incinerate once a week. I don't know about the temperatures it reaches, but the distance from any other building meets the WHO guidelines (50 meters), as does the low volume of incineration.
As you can see, there's an American flag on the incinerator building. That's because it was built in May 2010 by the United States Marine Corps African Command (AFRICOM). They built quite a few in a short period of time, covering pretty much all of the health centers and district hospitals up and down the coast, if not further into Kenya. One was built at Malindi, too, but it has since been vandalized and is no longer operational (I think I've said that before).
After the tour of the health center, we went to a depression called Hell's Kitchen, pictured above. It looks a lot like a much smaller version of the Badlands, in South Dakota. According to legend, before there was a depression, there was a rich family that lived on the land, so rich that they bathed in milk, while the population around them didn't even have food to eat. The depression came from being cursed by their opulence and struck from the earth. I think I got that right.
When we got back to Malindi, we were informed that there was a case of neonatal tetanus. The WHO had a world-wide eradication program (well, still does), with the goal of eradication by 2005. Obviously, that didn't happen. Most of the cases annually are in China (the WHO publishes all this stuff on their website), and last year, Kenya had only seven cases. So it's really rare that a case comes in, and I was lucky (in the sense that I got to see a case) that one came to Malindi while I was there. Not so lucky for the kid, unfortunately. The mortality rate with proper medical care is about 50%, and most who survive have long-term physical and mental effects.
This is what neonatal tetanus looks like. Not very pleasant. His entire body was stiff and convulsing. When I took this picture, he was in the admitting area of the pediatrics ward, which is bright and loud. Lights and sounds trigger muscle contractions, so he was pretty much convulsing the whole time. They got him some anticonvulsants and have since transferred him to "isolation" (it's not that isolated) of the pediatrics ward, where it's darker and somewhat quieter. Since I've had a lecture on tetanus for my master's, and I keep my lectures on my iPad (which I have with me), I was able to bring up the proper treatment plan. Unfortunately, the hospital doesn't have tetanus immunoglobulin, which is the key point in treatment, but they do have the antibiotics and anticonvulsants. I hope everything goes well.
This is really sad, not only because of the poor prognosis, but because of how preventable it is; hence the reason WHO has an eradication campaign. This kid ended up with tetanus because his mother wasn't immunized against tetanus, had no prenatal care in which she could have received a vaccine, delivered at home, the cord was cut with a razor blade, and cow dung was used to stop the bleeding. Not a combination of anything. To follow up this case, the public health office will be going to the mother's village to provide education about prenatal care and sanitary deliveries, and will vaccinate the women of childbearing age. It won't help this baby, but it might mean that that village doesn't have another like him.
I decided I should end on a happier note than that. This is what happens when you don't have a very good grasp of the English language but try anyway:
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