Written By: Hannah Peifer
This summer, Hannah Peifer, a senior majoring in African Studies and Biology and member of GlobeMed at the University of Pennsylvania, spent four weeks in Lwala, along with fellow student Mane Williams. This GlobeMed chapter has partnered with Lwala Community Alliance since 2013 to fundraise and educate students about global health issues. They also provide interns, like Hannah, to support our work in the field and to gain valuable experience for future work in development.
While in Lwala last month, I had the opportunity to ride along during a hospital referral. As an EMT, I have spent time in ambulances in the United States, but ambulances in rural western Kenya are different entirely. Less than two minutes into our drive, Wycliffe Odhiambo, Lwala Community Alliance’s daytime ambulance driver, asks me if I’m OK with the speed, which is admittedly quite fast for these roads. I respond, “Yeah, of course! Don’t worry about me,” not yet realizing the graveness of the situation. His response was matter-of-fact, “We are trying to save the life of the lady.”
The lady he spoke of was a 14-year-old, Grade 8 primary school student, who was (hopefully) a soon to-be-mother. However, her body was not developed enough to deliver vaginally, and after labor progress plateaued, Lwala’s clinical team made the decision to refer her to a larger hospital for an emergency Caesarean section.
During the drive to Tabaka Catholic Mission Hospital, I sat in the front with the driver. In the back were the nurse, the mother-to-be, and the girl’s mother. This was not my first time in the ambulance in Lwala. Last year, during my first visit to the community, I observed a few night calls with the community health nurse, Elkana Obel (known as Obel to most), and I cannot imagine being 9 months pregnant and lying on a stretcher going over these roads. There is not much equipment in the back of this ambulance – a first aid kit and an OB kit – because there isn’t much room and there isn’t much need for additional equipment; you can’t perform interventions en route on these roads.
About 15 minutes into the drive, I breathed a sigh of relief for the mother-to-be when we finally made it to pavement. It was short-lived, however, and soon we were back on curving, rocky, hilly, crowded, narrow dirt roads. As we resumed our travels on the dirt roads, the ambulance sirens drowned out the distressed sobs of the girl.
We finally made it to the referral hospital, an estimated 30 minutes after our departure. Once the mother-to-be was transferred to a stretcher, we wandered through the brightly painted hallways. All windows were open and there was a nice breeze despite the afternoon heat. The triage/admission room was hectic; people were constantly walking in and out. My one-year of elementary Swahili could not keep up with the simultaneous conversations between the nurses, the soon-to-be mother, and her mother. After spending about 15 minutes in that room, we made our way to the cashier where Lwala paid the admission fee for the girl. The nurse informed me that Lwala and the referral hospital would share the cost of the patient’s care. The patient and her family would pay nothing.
In the surgery theatre, we met up with the Kenyan physician, who was both charismatic and urgent in his response. He asked the Lwala nurse detailed questions about the girl’s history and interventions performed. He was concerned because her blood type was O negative. There was no matching blood in stock, so if there was a chance of hemorrhage, they would need to perform extreme surgical interventions to save the girl’s life. With a somber tone and a hint of hope he stated, “We will do our best to save the mother.” As she was prepped for surgery, the physician stepped into the hallway to speak with the girl’s mother. He informed her about what would be happening.
Just before surgery began, the referral was complete, and it was time for us to head back to Lwala. I silently hoped and prayed the baby and mother would make it through surgery without complications.
Emergency medicine in the rural developing world is often considered a luxury. It’s not part of the “basic package” of health care. As a trained EMT, emergency medical care is an interest of mine and I have struggled with the idea that emergency medical care is considered a luxury in many places. But the reality in rural Kenya is that the infrastructure is not here. The reality is that largely preventable diseases (malaria, HIV, malnutrition) still overflow the Lwala caseload. What I have come to realize, however, is that Lwala isn’t ignoring emergency medicine – it just looks different than what I am used to seeing.
Lwala regularly has emergency referrals. When a case needs surgical intervention, the ambulance is ready to go. Lwala’s Community Health Nurse Obel responds to imminent deliveries at night. He has essentially created his own 911 emergency system, and it’s nearly a one-man show. Community Health Workers are informed when one of their clients is about to deliver. The CHW contacts Obel, who then hops in the ambulance to maintain (and improve) that remarkable 97% skilled delivery statistic of Lwala. This is improvisation and adaptation in a low resource setting at it finest. That doesn’t mean we should settle here, but if I’ve learned anything about Lwala, it’s that “settling” isn’t in their vocabulary. This system is a start and a very impressive one at that.
The next day I caught up with the nurse from the referral. He informed me that both mother and baby were doing well – meaning surgery went well and immediate life threats were treated.
The hope now is that this new mother will be referred to Lwala’s Education Team, where she can receive mentoring on everything from decision-making to economic empowerment, and that she’d be referred to a mentor like Elizabeth who, through mentoring, encouraged four of seven young mothers in her last out-of-school girls mentoring group to return to school. During my last two summers, I’ve learned that Lwala continues to hope and work for a future where girls have an equal opportunity for education and all of the doors it opens.
Click here to read Hannah’s reflections from Summer 2015.
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