The prevalence of non-communicable diseases (NCDs) such as high blood pressure, diabetes, asthma and epilepsy in Kenya is growing swiftly – deaths from NCDs will soon surpass deaths from infectious diseases
Responding to this, MSF has been working closely with the Health Department in Embu County, 70 miles north of the capital Nairobi, to expand the treatment of NCDs into rural areas and mentor nurses and clinical staff on managing these illnesses.
One of the ways we’re doing this is through medical camps – a one-day event where government, private and voluntary health workers set up shop in a public hall and offer free medical care to anyone who turns up.
Setting up camp
The county health authorities requested MSF's support, so we arrived at the Constituency Development Fund Hall in Kiritiri just before 8am, ready to start.
Unfortunately, one of the major sponsors of the camp had pulled out at the last minute and there was still a lot of preparation work to be done at the venue.
To keep the patients entertained and educated, health workers gave talks on mental health, diabetes and other non-communicable diseases.
While a security guard gave out numbered tickets, the organisers established the patient pathway, from registration, through the height and weight measuring area, to the blood glucose testing zone and on to a line of chairs snaking around the side of the hall.
Our deputy field coordinator explained the process to the patients so they knew what was going to happen. The cavernous hall needed partitioning with canvas panels strung from ropes stretching from wall to wall. The MSF consultation room was on top of a platform at the far end. The organisers allocated us the boardroom in which we could set up a mobile MSF laboratory.
As befitting my status as "the doctor", I arrived in the MSF ambulance. Well, you can't have an ambulance without a health worker on board, can you?
One of the disadvantages of arriving in the first wave was that our vehicle was trapped at the back of the parking area by all the others which came later. So, when we needed to evacuate a patient, it required some skilful manoeuvring to extricate the ambulance from the car park.
The waiting area
The main waiting area was a huge orange marquee filled with rows of plastic chairs. A small area was roped off for visiting VIPs.
To keep the patients entertained and educated, health workers gave talks on mental health (Embu is hosting the National Suicide Prevention Event on 10 September and World Mental Health Day is on 10 October), diabetes and other non-communicable diseases.
A local radio station was broadcasting the talks live in the local vernacular from the waiting area. I am sure that this increased community awareness and encouraged more people to attend.
Once people had been registered, measured and checked for high blood sugar and hypertension, they waited their turn to enter the hall.
They had lots of choice; they could get an eye check, a dental examination, see an orthopaedic or an ear, nose and throat surgeon, a Cuban general practitioner, a doctor from the local health centre, several nurses or an MSF NCD specialist.
A team effort
I flitted from consulting room to consulting room, offering help and advice when it was requested.
The county nursing officer asked for my opinion regarding a patient in the Beyond Zero Mobile Clinic which was equipped with a gynaecological examination couch. Sadly, I confirmed that a young lady had advanced cancer of the cervix. The only illumination for the examination was daylight from a window high on the side of the truck. I gave the nurses my new 32-LED, super-bright head torch to improve their view for subsequent patients.
We made provisional diagnoses of kidney and oesophageal cancer, eight patients had confirmed diabetes and scores of patients had previously undiagnosed high blood pressure.
The patients really seemed to engage with the MSF clinical officers and nurses.
One patient had a prolonged epileptic seizure during her consultation. We referred all these patients appropriately, to hospital or to the MSF supported NCD clinic at their local health centre.
Even the MSF boss was keen to get involved, so he took on the blood glucose checking role. He had a great time testing over 200 patients. Although he is the Kenyan field coordinator (KFC), there is no truth to the rumour he said it was "finger-pricking good".
Most of the patients were elderly. One old chap gave me a crisp salute and fished around in his wallet to show me his army discharge (honourable, of course) papers with a letter of commendation from his commanding officer.
Another old lady had a grossly swollen foot following a penetrating wound which had become infected. Her other foot was also deformed, and she was finding it very difficult to walk. She leaned on a staff on her left side and her daughter on her right side, but progress was very slow and painful.
I supported her left arm and the three of us shuffled down the track to the main road. Now, I am usually the one taking pictures, but this turned out to be a great photo opportunity for others attending the event.
One man who had had a leg amputated some years ago wanted to know if he could get a prosthetic leg.
Several disabled children came with their mothers to find out if there were any new services for physical and learning disabilities.
Some came in wheelchairs, some wearing orthopaedic boots, some with disfiguring skin conditions which they had had for years.
Seeing the satisfaction on the faces of people who had been able to see a doctor or a specialist health worker, was rather magical.
Blind people came to have their eyes tested. People with just half a dozen randomly-spaced teeth came to examine plastic dentures with their evenly-spaced, gleaming white teeth, wondering if they could afford a set which would allow them to chew choma – roasted meat – again.
What I find so refreshing about the MSF mentorship approach to treating NCDs is that it encourages a compassionate, patient-centred consultation style, with lots of active listening. The patients really seemed to engage with the MSF clinical officers and nurses.
I took a few photographs of them in action, teaching patients about their disease and even sharing a joke. It made me really proud to be the medical referent for this project.
Rather like Cinderella's coach which turned into a pumpkin at midnight, the MSF vehicles (and our staff) had to leave the medical camp before darkness fell. The government and private hospital staff stayed on until the camp finished 20 minutes later when the last patient was seen.
I must admit I was sceptical about the value of a medical camp.
On just one special day, 1,100 patients consult a health worker, get treatment and possibly a referral for specialist care.
Was it just a publicity stunt? Surely it would be better to concentrate resources on improving local health services which are available every day of the year?
However, seeing the satisfaction on the faces of people who had been able to see a doctor or a specialist health worker, was rather magical. They clearly valued the opportunity and the occasion. It was the sense of community service, of health workers going the extra mile for patients, which made it all worthwhile for me.
But there again, I am a bit of an old softy.