Fighting HIV in Kenya: Tales from Homa Bay

12 February 2018

Lakshmi wrote this during the unrest around the Kenyan elections, in October 2017. The nurses' strike has since ended, and Lakshmi is still working for MSF / Doctors Without Borders in Homa Bay...
 

It’s a hot sunny afternoon, in the lakeside town of Homa Bay.

I am sitting in the MSF office, after a busy morning trying to organise some patient scans before lunch but I am distracted as I can hear loud voices outside. People are protesting over a repeat round of elections which are due to start imminently.

Image shows Homa Bay City, which is on the banks of Lake Victoria
Homa Bay City, on the banks of Lake Victoria. Photo: Jean-Christophe Nougaret/MSF
 

It is a tense time for the residents in this usually peaceful setting and in all honesty the political situation of late is keeping us all here on our toes.

We have been on high alert since this area faced a barrage of unrest and violence following the first round of elections in August.

The presidential election was nullified, and a fresh election called for. I have been at the hospital all morning and no casualties have been brought in so far, but we are on alert, tomorrow being the main day of elections, for potential mass casualties associated with the violence.

Image shows a man's hand holding many different coloured tablets
A patient with HIV and multi-drug-resistant tuberculosis sorts his tablets for the day. Photo: Jane Linekar/MSF
 

My introduction to Homa bay county hospital as the new HIV doctor has been at a time that the local health system has been under immense strain.

The doctors in the public hospitals had previously been on strike last year for over 100 days. Currently the nurses are on strike, this has been going on for four months now.

There is little hope that it will end soon, and unfortunately there has been little in the way of a contingency plan to cover vital health services.

Surgery and obstetrics has been the worst hit

Despite the hospitals not working as they should, the chaotic electioneering period has made things even more difficult. Protesters often clash with the police: the end result being mass casualties. MSF has been providing staff and other medical support.

Surgery and obstetrics has been the worst hit and many general physicians are covering all services.

I arrived in Homa Bay in October where MSF currently support the local ministry of health hospital. MSF are specifically supporting the inpatient medical department. There is a huge burden of HIV disease in this area and patients often arrive in the late stages of infection.

As a result of the strike I have found myself looking after paediatric TB/HIV patients as well as adult medical patients. I often feel a pang of guilt as during the strike I have had some great learning opportunities. I would never see children in the UK as I have been trained as an adult physician. My guilt comes as I ponder over whether I really am the best person to care for them, my training hasn’t really equipped me for this. In reality, there is no one else to step in and so with little alternative I stop indulging my concerns. MSF is here to cover the gaps.

Image shows a young woman in bed, being helped by a nurse
Nurse Arhsa helps a patient at Homa Bay Hospital. Photo: Patrick Meinhardt 
 

Today I meet Lucy, an 11-year-old girl with HIV who had previously been treated for HIV and TB.

Looking at Lucy’s face, it is clear that she has been unwell for some time. These illnesses have taken their toll on what should be her carefree youth. 

Lucy can hardly breathe when I meet her, fluid is accumulating in her lung and she is currently functioning on only half of her lung volume. She is breathing so quickly that she can hardly talk to me, we place her on oxygen as I examine her.

The day continues to be both intense and hectic

Her body is struggling to cope, so we quickly drain out many litres of fluid from her lungs. Routinely we would now send her for a chest x-ray after this procedure for further diagnosis, but the department is closed as a result of the strike, so we just monitor for now.

The day continues to be both an intense and hectic day as I tend to many other patients, most of them on the verge of death and only a few making it through.

Many patients in these wards suffer from advanced stages of HIV and AIDS-related conditions. Some patients are also victims of the post-election unrest that have gripped the area for a few days.

During my ward round, a patient collapses in the bathroom, he is unresponsive when we get to him and bleeding profusely from his leg. I later learn that he was involved in a collision as he tried to escape the post-poll violence on his motorbike.

 

Image shows Lakshmi and the team attending to an emergency patient
Lakshmi and the team attend to a patient. Photo: MSF

 

On examining the man it’s clear he has a massive haemathorax, blood where air should be in the lungs. This is far beyond my scope as a physician and it soon becomes clear he needs to go for surgery immediately.

We battle to get an anaesthetist and the only surgeon around to drop their plans and come in.

I beg the surgeon to come in and thankfully I win this battle

There are three surgeons that serve Homa bay county hospital but during the strike they have been unavailable. This has meant surgical cases have often died.

I beg the surgeon to come in and thankfully I win this battle. The patient finally gets to theatre, but sadly we lose him later that day, he had lost too much blood.

Life here is hard, what I can do as a doctor is very limited.

Today I was able to see clearly that if these patients were seen in a better equipped and staffed centre, many of them would have had a better chance at walking out of the hospital one day. But instead they lay lifeless, as I wonder continuously how we could have done things differently.

Each day here is a valuable learning experience for me in using the few resources we have to try and give life-saving care to the patients in Homa Bay County Referral Hospital.