Despite how dilapidated they often look, I like old Victorian warehouses. It’s easy to see how proud they once were, they’re full of character, and the spaces inside can be spectacular. This particular one, in Halifax, drew my attention for the street sign attached to it – a lovely piece of living pharmacy memorabilia.
Tag Archives: dispensary
So when I was in Maasailand, I got to spend some time in a healthcare dispensary (see my last post). The government-run Kenyan dispensaries are part of a tiered system of healthcare designed to cater for all, and they don’t do too bad a job considering, especially the one in Olosho-Oibor which I visited. As well as access to dispensaries & clinics, the government also recognises the benefit of public health education, and each dispensary employs Community Health Workers, who do a brilliant job of going out to villages and educating people about sanitation, malaria and HIV prevention, and other preventable diseases. They also give out mosquito nets and condoms, and arrange screening programs for HIV. Agnes, the Community Healthcare worker based at Olosho wasn’t at work while I was there (she had to plant maize as the rainy season had started) but I was lucky enough to bump into her on my walk home one day, spade over shoulder, and she explained how she looked after the healthcare library at Olosho and the outreach programmes they run from there. She had recently run a very successful HIV education session where 50 out of 55 villagers underwent screening for the infection, encouraged by the testimony of the HIV positive patients that go along with her and explain how the medicine they now take has meant they can continue living their lives, and that a positive result doesn’t mean death, it means help.
Screening for HIV is a big problem in maasailand (especially when you consider the often fiercely upheld traditions of compulsory wife-sharing and polygamy (effectively rape), while attitudes to condom use are the exact opposite). Back at the dispensary, Lucy, another healthcare support worker tells me they offer and encourage HIV testing to all walk-in patients but there is little uptake, it’s only programmes like the ones Agnes runs that begin to allay people’s fears. Lucy explains that while there is plenty of HIV medication to go round at the moment, she worries that the more people are diagnosed, that the HIV medication will run out. You can easily imagine the scenario and how that would damage trust between communities and the government which relationship isn’t always rosy especially in Maasailand.
Prescribing and dispensing was pretty different at the clinic from what I am used to. There were no guidelines or reference books, and no information as to safety in pregnancy and breastfeeding which are both quite common in Kenyan villages. You can’t discuss stopping breastfeeding though as there’s no powder milk and the baby would die. I got the impression that it was felt to be more important to give a medication and for its beneficial effects, and I was really surprised how much medication with potentially severe side effects was given out without much question. I’m not sure that risk versus benefit assessment or drug monitoring has reached Kenya yet. Or maybe it’s just that they don’t have access to the information to help them do so, or any viable alternative if a chosen treatment wouldn’t suit someone. You takes your chances…
Prescriptions were recorded as part of the handwritten notes, then the medication was counted and given out in little polythene sachets there and then, with nothing more on the label than “1 x 1” or “2 x 3” or whatever. (Take one tablet once a day and Take two tablets three times a day, respectively). No drug or patients names, or dates, or warnings, but then these would have been pointless as the majority of people can’t read well enough (free primary education has only been available for the last 10 years in Kenya).
I asked Rhoda, the nurse running the clinic what the most common complaints were. She told me that coughs and upper respiratory tract infections were common due to the dust, but she treated almost all patients with chest problems with septrin or azithromycin (2 very strong antibiotics with potentially severe side effects whose use we try and minimise in the UK due to the risk of resistance – and side effects). I was pretty shocked at the number of people we treated with these. But these are the government-sanctioned treatments of choice, and all that’s available, and there’s still a culture of treating wherever possible rather than recognising self-limiting conditions. I asked Rhoda if she was worried about resistance with such high antibiotic usage rates, but she told me she wasn’t as most people she treats seem to get better. We also have to record every prescription for antibiotics in a special log book (like we would do for controlled drugs like morphine in the UK). When I asked Rhoda why, she told me this was because they’re valuable on the black market and the government doesn’t want medication going missing.
Malaria is the other most common complaint at the clinic and we saw a couple of malaria patients each day when I was there. Treatment is available, and it’s free for malaria patients in Kenya, but we agreed it’s odd that it’s so prevalent in this part of maasailand as there are no mosquitos. Nets are still given out just in case.
Another important role for the dispensary is as a kind of healthcare-focussed community centre. Vitamins are given out to almost all patients as malnourishment is common and vitamins are thought to improve the chances of getting better. The dispensary also acts as a food distribution point for food aid for eligible people (mainly kids and the sick), especially during school holidays where poor kids may not get a meal otherwise. They also host family planning awareness groups for local women, and that’s particularly important to have in a society where the cost of having a child can mean increased poverty, especially for the women, due to having to feed them and send them to school, but where children are still seen as a valuable commodity – girls can be exchanged for cows when they are of marrying age (upwards of 9 years old). As a result, most Maasai men will not tolerate their wives using contraception and will beat them if they find out. So instead of the pill or condoms, the clinic administers the 3 monthly depot contraceptive injection to those women who would like it – safe in more ways than one! Values are changing slowly, but it’s hard when younger girls with more modern values are made to marry the old, traditionally patriarchal and controlling generation.
I wish I could have spent more time at the dispensary, especially to see the work Agnes does, and that I’d been better prepared for going – I would have brought reference sources for a start. But I’m glad I got to go even if only for a few days. Huge thanks to Rhoda for being so welcoming and friendly and showing me round. I wish her luck with her quest to be allowed to move out of the middle of nowhere when she has finished her 3 years in Maasailand the government requires
Yesterday’s terrible news that at least 75 people died when a pipeline caught fire in a Nairobi slum, has had me thinking about Kenya again and the poverty that the majority of the people there live in.
When I was in Kenya earlier this year, after much perseverance at the primary school, I was allowed to spend some time at the nearest rural health dispensary, which was nearly a 2 hour walk away in a village called Olosho-Oibor (you could get a piki piki (motorbike taxi) but you had to wait hours for one and pay double because no-one wanted to ride out so far from Ngong (the nearest main town). Here’s a map (click through for an interactive version):
Running the dispensary while I was there was a nurse called Rhoda. She normally shares the running of the dispensary with another nurse, but he had taken a few days off to plant maize (as had nearly everyone else, as the rainy season had just started). When the rains start, it’s quite common just to call up work the same morning and say you’re not coming in. Everyone relies on crops here and you can’t predict the weather, or annual leave to accommodate. Somehow they seem to manage!
Rhoda is from just outside Nairobi, and studied there too, but the state requires qualified professionals – nurses, teachers and so on, to work for them for three years post qualification before you can get a job of your choice with them, as healthcare & education are funded by the state. Staff are posted where there is the greatest need in the (usually rural) community for 3 years, but generally they don’t get even a first or second choice as to location, regardless of whether they have family or children to support (which is common – it costs a lot to train professionally in Kenya and people are often older when they qualify as they’ve had to save to pay for their training).
Kids and spouses can of course go with them but in rural communities there may not be schooling facilities for the kids, and it’s unlikely there will be jobs for a partner. This leads to a lot of professional families living apart while they follow their careers, like Samson from Kimuka Primary school. Parents often only see their young families only once or twice a month, or less if the distance is greater or you simply don’t have the money to travel. I do wonder if this discourages Kenyans from either training as professionals, or from staying in the country once trained – I certainly came across reports that professionals preferred to take their skills abroad where things were “better organised” – a great shame as there’s a lot of talent in Kenya, it just needs nurturing properly.
Despite being stuck in the middle of nowhere, Rhoda was great company and very happy to answer my questions and show me round. I felt bad I couldn’t speak Maasai, or even Swahili well enough to help her out with her patients more. But I was able to help by organising the donated medication in the dispensary (most of which wasn’t really relevant for the setting, and didn’t come with useful identification) and giving out (plentiful, state-provided) medicines to patients, most of whom could understand enough English to know how many to take how many times a day. Lucy, the healthcare assistant who worked with Rhoda, helped me out with language if I got funny looks from patients!
This particular dispensary was funded and built by a large NGO (possibly the UN, although I wasn’t 100% clear). As a result the facilities were pretty impressive compared to where I’d been living in Kimuka. It was built from brick, was clean and freshly painted, had sinks in all the treatment rooms, and flushing toilets. There was a flat provided too, of similar specifications, so that staff like Rhoda who were sent there by the government, could live in satisfactory conditions. There was a small windfarm (well, one windmill) which powered the majority of the dispensary’s requirements, including TV in Rhoda’s flat for a few hours a day, quite a luxury which I’d forgotten I’d not seen for so long!
Rhoda took me on a tour of the facility, which wasn’t quite finished. There was a dispensary room where were were based, a consultation room and a vaccination/treatment room, where we gave babies’ vaccinations and inject women with the depot contraceptive. There is a soon-to-be completed maternity ward with flushing loo, and a healthcare library with internet access and public health education materials that the community health workers use with villagers. Patients can access these facilities too. The waiting area is outside, and it’s a friendly, informal place, although it wasn’t as busy as it can be in the dry season as people don’t like to be rained on on their way to the clinic.
Most people are able to be treated at the clinic, and given medication to take away, or Rhoda will administer injections, dress wounds, and so on, on site. The clinic works on a walk-in basis for general conditions, but there are special mother & baby sessions on Thursdays where antenatal, postnatal & family planning healthcare is given one on one, and education groups are run. It’s a safe place where women can come for advice, and the uptake of these advice, information and check up services seems to be good. The dispensaries are designed to be a one-stop shop for all the healthcare needs of rural communities, and the system does seem to be well thought out and comprehensive. If someone can’t be treated adequately at a dispensary, then they can be referred to one of the provincial, regional or the national hospitals for further investigations or in-patient treatment (which carries different costs). Given the poverty of the region I was concerned that there are charges at all, but exemptions seem to be applied where there is greatest need which is better than nothing.
Pregnant women, children under 5 and people being treated for HIV or malaria are exempt, otherwise there’s a blanket 50ksh (about 30p) charge per visit. It doesn’t sound a lot but it’s not uncommon for people not to have the money – fortunately Rhoda knows most of them and in a real emergency she will let someone pay later – either way it’s much cheaper (and quicker) than travelling to Ngong and going to one of the private pharmacies. More on what sorts of patients the dispensary looks after in the next post…