Help Heal

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Help Heal

• A tour of Kenyan health and welfare and what you
  can do about it

By the EWB-UCIN Health Committee
www.concierge.com/.../kenya/kenya_003hl.jpg
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The Presentation

• 1. Introduction to the HC
• 2. Current health care systems in Kenya
• 3. Infectious agents
• 4. EWB health assessment

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What the HC does

• 1. Health preparation for travel
• -immunizations
• -first aid prep (kits, medicines, etc.)
• 2. Health assessment of the community
• Ely Dixon
• Health Point Person

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Kenyan Health

• 50-51 yr. life expectancy
• 58 of population below poverty
• 48 of water is safe to drink
• Morbidity and Mortality
• 1. Malaria
• 2. Respiratory infection, malnutrition,
  diarrhoeal diseases
• 3. HIV/AIDS and TB

http//www.capacityproject.org/index.php?option
Source The World Health Organization
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Health care systems

• Four Sectors
• 1. Public
• -Ministry of Health (MoH) and
• Ministry of Local Government (MLG)
• 2. Private
• 3. Voluntary
• -NGOs
• 4. Traditional

Source MoH
www.geographia.com/kenya/ken2.jpg
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Structure of the Public Sector

• 2 National Hospitals
• gtProvincial Hospitals
• gtDistrict Hospitals
• Nyando District Hospital
• gtDispensaries and Clinics
• (bulk of services)
• Pap Onditi Clinic and Kengen Dispensary

Source MoH
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Challenges

• 99 of patients treated at Nyando District
  Hospital are afflicted with AIDS
• -1 doc, 15 nurses serving 100 patients/day
• Old/faulty and limited technology
• Poor facilities

Lisa Mahoney
Source The Capacity Project
Lisa Mahoney
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Diseases in Kenya
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Infectious Diseases

• Typhoid
• Travelers Diarrhea
• Amoebic Dysentery
• Giardiasis

• Malaria
• Yellow Fever
• Bilharzia
• Cholera
• Diphtheria
• Filariasis
• Hepatitis A
• Hepatitis B
• HIV
• Meningococcal Meningitis
• Poliomyelitis
• Rabies
• Rift Valley Fever
• River Blindness (onchocerciasis)
• Sleeping Sickness (Trypanosomiasis)
• Tuberculosis (TB)

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Vaccines

• Hepatitis A
• Hepatitis B
• Meningococcal Meningitis
• Rabies
• Typhoid
• Yellow Fever
• Boosters
• Tetanus, Polio, Measles, Diptheria

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Malaria

• One million children die annually from malaria in
  Africa.
• The disease is caused by a parasite in the
  bloodstream spread by the bite of the female
  Anopheles mosquito.
• Infection rates vary with season and
• climate, so you should check on the
• situation before departure.
• Unlike most other diseases regularly
• encountered by travelers, there is no
• vaccination against malaria (yet).
• Several different drugs are used to
• prevent malaria (note that each has side
  effects)
• Doxycycline can cause heartburn and indigestion
• Mefloquine (Larium) can cause anxiety attacks,
  insomnia and nightmares, and (rarely) sever
  psychiatric disorders.
• Chloroquine can casue nausea and hair loss
  proguanil can cause mouth ulcers.
• Some people should not take a particular
  antimalarial drug

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Malaria

• Malaria can affect people in several ways.
• the early stages include headaches, fevers,
  generalized aches and pains, and malaise, often
  mistaken for flu.
• Other symptoms include abdominal pain, diarrhea,
  and a cough.
• Anyone who develops a fever while in a malarial
  area should assume malarial infection until a
  blood test proves negative, even if youve been
  taking antimalarial medication.
• If not treated, the next stage can develop within
  24 hours
• Jaundice
• Reduced consciousness
• Coma (known as cerebral malaria)
• Death.
• Treatment in hospital is essential, and if
  patients enter this late stage of the disease the
  death rate may still be as high as 10 even in
  the best intensive-care facilities.

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Yellow Fever

• Yellow fever is spread by infected mosquitoes.
• Symptoms can range from a flu-like illness to
  severe hepatitis (liver inflammation), jaundice,
  and death.
• Vaccination must be given at a designated clinic
  and is valid for 10 years.
• Kenya is considered to be an endemic zone by
  the CDC, defined as areas reporting cases but
  also includes areas where a competent vector,
  nonhuman primates, and the ecological conditions
  for yellow fever virus transmission exist.
• Yellow fever vaccination is not mandatory in
  Kenya, but it is highly recommended.
• You should carry a certificate as evidence of
  vaccination against yellow fever if youve
  recently been in an infected country, to avoid
  immigration problems.
• A traveler without a legally required up-to-date
  certificate could possibly be re-vaccinated and
  detained in isolation at the port of arrival for
  up to 10 days, or even repatriated.

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Bilharzia (Schistosomiasis)

• Spread by flukes (minute worms) that are carried
  by a species of fresh-water snail. Paddling or
  swimming in suspect freshwater lakes or slow
  moving rivers should be avoided.
• Symptoms there may be no symptoms, transient
  fever and rash, and advanced cases may have blood
  in the stool or in the urine.

• A blood test can detect antibodies if you might
  have been exposed, and treatment is then possible
  in specialist travel or infectious disease
  clinics.
• If not treated the infection can cause kidney
  failure or permanent bowel damage. It is not
  possible for you to infect others directly.

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Cholera

• Cholera is usually only a problem during natural
  or artificial disasters, such as war, floods, or
  earthquakes, although smaller outbreaks can also
  occur at other times. Travelers are rarely
  affected.
• Outbreak reported in September 2006.
• The disease is caused by a bacteria and spread
  via contaminated drinking water.
• The main symptom is profuse watery diarrhea,
  which causes debilitation if fluids are not
  replaced quickly.
• An oral cholera vaccine is available in the USA,
  but it is not particularly effective.
• Most cases of cholera can be avoided by drinking
  only clean water and by avoiding potentially
  contaminated food.
• Treatment is by fluid replacement, but sometimes
  antibiotics are needed. Self-treatment is not
  advised.

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Diphtheria

• Spread through close respiratory contact.
• It usually causes a high temperature and a sever
  sore throat.

• A membrane can form across the throat, requiring
  a tracheotomy to prevent suffocation.
• Vaccination is recommended for those likely to be
  in close contact with the locals in infected
  areas.
• This is more important for long stays than for
  short-term trips.

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Filariasis

• Tiny worms migrating in the lymphatic system
  cause filariasis.
• The bite from an infected mosquito spreads the
  infection.
• Symptoms include localized itching and swelling
  of the legs and/or genitals.
• Treatment is available.

Sleeping Sickness (Trypanosomiasis)

• Spread via the bite of the tsetse fly
• Causes a headache, fever and eventually coma.
• There is an effective treatment.

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Hepatitis A

• Spread through contaminated food (particularly
  shellfish) and water.
• It causes jaundice and, although it is rarely
  fatal, it can cause prolonged lethargy.
• The first symptoms include dark urine and a
  yellow color to the whites of the eyes.

• Sometimes a fever and abdominal pain might be
  present.
• Vaccine is given as an injection a single dose
  will give protection for up to a year, and a
  booster after a year gives 10-year protection.
• Hepatitis A and typhoid vaccines can also be
  given as a single-dose vaccine, with hepatyrix or
  viatim.

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Hepatitis B

• Hepatitis B is spread through infected blood,
  contaminated needles and sexual intercourse.
• It can also be spread from an infected mother to
  the baby during childbirth.
• Hepatitis B affects the liver, which causes
  jaundice and occasionally liver failure.
• Most people recover completely, but some people
  might be chronic carriers of the virus, which
  could lead eventually to cirrhosis or liver
  cancer.
• Those visiting high-risk areas for long periods
  or those with increased social or occupational
  risk should be immunized.
• Many countries now routinely give hepatitis B as
  a part of routine childhood vaccination.
• It is given singly or can be given at the same
  time as hepatitis A (hepatyrix).
• A course will give protection for at least five
  years. It can be given over four weeks or six
  months.

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HIV

• Human immunodeficiency virus (HIV), the virus
  that causes acquired immune deficiency syndrome
  (AIDS), is an enormous problem throughout Africa.
  
• The virus is spread through infected blood and
  blood products, by sexual intercourse with an
  infected partner and from an infected mother to
  her baby during childbirth or breastfeeding.
• It can be spread through blood to blood
  contacts, such as with contaminated instruments
  during medical, dental, acupuncture and other
  body-piercing procedures, and through sharing
  intravenous needles.
• At present there is no cure medication that
  might keep the disease under control is
  available, but these drugs are too expensive for
  the overwhelming majority of Africans, and are
  not readily available for travelers either.
• If you think you might have been exposed to HIV,
  a blood test is necessary a three-month gap
  after exposure and before testing is required to
  allow antibodies to appear in the blood.

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Meningococcal Meningitis

• Meningococcal infection is spread through close
  respiratory contact and is more likely to be
  contracted in crowded situations, such as
  dormitories, buses, and clubs.
• Outbreak in February 2005.
• Vaccination is recommended for long stays and is
  especially important towards the end of the dry
  season, which varies across the continent.
• Symptoms include
• fever
• severe headache
• neck stiffness
• red rash.
• Vaccination recommended

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Poliomyelitis

• Polio is generally spread through contaminated
  food and water.
• It is one of the vaccines given in childhood in
  the West and should be boosted every 10 years,
  either orally or as an injection.
• Polio can be carried asymptomatically
• and could cause a transient fever.
• In rare cases it causes weakness or
• paralysis of one or more muscles,
• which might be permanent.

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Rabies

• Rabies is spread by the bites or licks of an
  infected animal on broken skin.
• It is always fatal once the clinical symptoms
  start, which might be up to several months after
  an infected bite, so post-bite vaccination should
  be taken as soon as possible.
• To prevent the disease, three
• injections are needed over a
• month.

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Rift Valley Fever

• This fever is spread occasionally via mosquito
  bites.
• The symptoms are of a fever and flu-like illness,
  and is rarely fatal.

River Blindness (onchocerciasis)

• This is caused by the larvae of a tiny worm,
  which is spread by the bite of a small fly.
• The earliest sign of infection is intensely
  itchy, red, sore eyes.
• Travelers are rarely severely affected.

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Tuberculosis (TB)

• TB is spread through close respiratory contact
• and occasionally through infected milk or milk
• products.
• BCG vaccination is recommended for anyone
• who is likely to be mixing closely with the
  local
• population, although the vaccination gives only
• moderate protection against TB.
• It is more important to be vaccinated for long-
• term stays than for short stays.
• The BCG vaccine is not available in all
  countries, but is given routinely to many
  children in developing countries.
• TB affects the lungs, but can by asymptomatic,
  only being picked up by a routine chest X-ray.
• Alternatively, it can cause a cough, weight loss
  or fever, sometimes months or even years after
  exposure.

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Typhoid

• This illness is spread through handling food or
  drinking water that has been contaminated by
  infected human feces.
• The first symptom of infection is usually a fever
  or a pink rash on the abdomen.
• Sometimes septicaemia (blood poisoning) can also
  occur. A typhoid vaccine (typhim Vi, typherix)
  will give protection for three years.
• In some countries, the oral vaccine Vivotif is
  also available.
• Antibiotics are usually given as treatment, and
  death is rare unless septicaemia occurs.

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Traveler's Diarrhea

• Diarrhea is the most common travel-related
  illness and figures suggest 50 of all travelers
  to Africa will get diarrhea.
• Avoid tap water unless you are sure it is safe to
  drink.
• Only eat fresh fruits or vegetables if cooked or
  peeled, and be wary of dairy products that might
  contain unpasteurised milk.
• Although freshly cooked food can often be safe,
  plates or serving utensils may be dirty, so be
  highly selective when eating food from street
  vendors (ensure that cooked food is piping hot
  all the way through).
• If you develop diarrhea, drink plenty of fluids,
  preferably an oral rehydration solution
  containing water (lots), and some salt and sugar.
  
• A few loose stools dont require treatment, but
  if you start having more than four or five stools
  a day, you should start taking an antibiotic
• If diarrhea is bloody, persists for more than 72
  hours or is accompanied by fever, shaking
  chills, or abdominal pain, seek medical
  attention.

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Amoebic Dysentery

• Contracted by eating contaminated food and water
• Amoebic dysentery causes blood and mucus in the
  feces.
• It can be relatively mild and tends to come on
  gradually, but seek medical advice if you think
  you have the illness as it wont clear up without
  treatment.

Giardiasis

• Caused by contaminated food and water
• The illness usually appears a week or more after
  exposure to the parasite.
• Giardiasis might cause only a short-lived bout of
  typical travelers diarrhea, but may cause
  persistent diarrhea.
• Ideally, seek medical advice, but if you are in a
  remote area you could start a course of
  antibiotics.

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Summary

• Get your vaccinations
• Monitor the food and water you consume
• Avoid getting bit by animals and mosquitoes
• Avoid human feces

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Why do a community health survey?

• Get to know people in the community
• Have a measure of the impact of the project
• Learn about factors that might contribute to a
  persons health and affect the project

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The survey looks at
-Population and ages -Most common illnesses and
injuries numbers and causes -Basic daily
living - water - food - sanitation -Community
health resources -Education -Transportation and
communication
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Who will we talk to?
Where?
-General public -Health professionals -Educational
professionals -NGO workers -Community leaders
-Community gathering points -Homes -Clinic -School
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How has our project impacted the community?
-Collect information before arriving and from
assessment trip -health info diarrheal
diseases, etc -Collected from health
clinic -Amount of water consumed -Train
community members to collect information in our
absence -Possibly EWB-Kenya -Ask community to
collect information after project has been
implemented -Compare before and after
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What we would like to understand before arriving
in Kenya
-Where do people receive healthcare from? -Who
do we need to talk to? -What NGO contact do we
have whom we could speak with to get a different
perspective? -Basic demographic and health
information -Where are some places we can talk
with the general population? -The best way to
get the needed information -What kind of
information will be the most useful