Dr. Andy Baldwin’s first visit to Kenya was for an endurance event – an ultramarathon that served as a fundraiser for vulnerable children in Kenya, Ethiopia, and South Africa. He chose to return last fall for a different type of endurance event: A month of medical practice and teaching as part of his family practice residency.
"Being in the Navy, I have traveled all over the world and have really come to love global health," he said. "The impact you can have is so rewarding." When he knew he would have an elective month as part of his residency, Dr. Baldwin did some research and learned of Chepaiywa Health Center in Kipkaren, Kenya, which is supported by Empowering Lives International.
Describe health care in this part of Kenya.
The clinic is located outside Eldoret, Kenya, and there are few other options for medical care in that area. There is a high infant mortality rate, and there are many problems associated with HIV/AIDS. They especially need doctors who can help educate nurses and laypeople about neonatal resuscitation; many babies are born at home, which means in mud huts, and they are not getting good postnatal care.
What resources are available in the clinic?
The health center, which they call a dispensary, started by meeting very basic health needs and providing medications. In recent years, with volunteers and donations, it has gone from one room to four. But it is still a very difficult experience. Many of the medications are expired, for example. They now have a makeshift delivery table and a portable ultrasound machine, but there is no continuous external fetal heart rate monitor, and sometimes it’s hard just to find gloves to wear to help deliver babies.
Photos courtesy Dr. Andy Baldwin
When Dr. Andy Baldwin knew he would have an elective month as part of his residency, he did some research and learned of Chepaiywa Health Center in Kipkaren, Kenya, which is supported by Empowering Lives International.
I also became very familiar with low-tech laboratory testing. They had a lab but no centrifuge, so the patient would have to wait all day for gravity to do its job and separate the plasma from the blood samples in the test tubes.
What types of conditions did you tend to treat?
We were running tests for typhoid fever, not the salmonella that doctors see in the United States, and also brucellosis. Every patient was tested for malaria, and we would look at it under the microscope. I would say that approximately 50% of the people there had malaria; it is almost as common as the flu is in the United States. There was medicine available, and most people who were treated recovered fairly quickly. People who are naive are at increased risk, so I made sure to take my malaria prophylaxis medication.
What were some memorable cases?
There was one case of a woman with a massive bowel obstruction. She came in and was in a lot of pain and I couldn’t diagnose what she had. I had to use my basic clinical skills because there was no imaging and our medications were limited. We kept her hydrated and finally we were able to send her elsewhere for higher-level care.
There was a particularly sad case involving a young girl with bacterial meningitis who died because we simply didn’t have the resources to treat her and we couldn’t get her to another facility in time. And there was an HIV-positive patient with a very low blood count and severe anemia who died because we didn’t have any blood to give him. And in some cases, people were unable to receive care because they didn’t have the money to pay for it. In many ways the limited resources made me furious, but it also made me realize the things we take for granted in medical practice in the United States.
What type of training were you able to share with local health care providers?
Probably the most important part of my trip was the teaching, because that will endure after I leave. I saw a lot of patients, but that is of finite benefit. If you teach someone, they can teach others. I taught a lot of neonatal resuscitation and perinatal care, including the importance of suction and clearing the airway, and performing positive pressure ventilation if the baby isn’t breathing. Ideally, the people I taught can teach midwives and other caregivers, and I have heard that they are already seeing the benefits from this training in terms of reduced infant mortality.