We’re happy to announce the employment of a new clinical officer at the Lwala Community Health Center, John Badia. John is from Kisumu, and completed his training there, first at Kenya Medical Training College (KMTC), and then through an internship at Nyanza Provincial Hospital. Afterwards he worked at the Patient Support Center, a special clinic for people with HIV/AIDS run by the CDC and PEPFAR in Kisumu.

A clinical officer (CO) has a level of training roughly equivalent to that of a physician’s assistant. In Africa they train COs because nearly all of the doctors they train leave for greener pastures. COs are trained in symptomatic management, which means they’re trained to identify clusters of symptoms and apply decision making guidelines based on those symptoms. They do not have the extensive scientific background that physicians do, but in resource limited settings a CO can be a cost effective way of getting a lot of people treated for basic diseases. The standardization of treatments assures that the most common diseases are treated effectively, even if some of the more rare diseases are missed. In Kenya only the big city hospitals have doctors, and even there they’re in short supply. In the smaller towns and rural centers, COs are the highest level of clinical staff.

In Lwala John will lead our clinical staff of 3 nurses, a nurse’s aid, a pharmacist and a lab technician.

There has been a developing interest lately in the issue of sanitary pads for girls in Africa. The interest stems from the fact that many girls drop out of primary school when they get their period, because there are no toilet facilities at school and they don’t have access to sanitary pads. This is certainly true in Lwala. But in digging deeper we found the picture to be still darker; boys are offering to buy the girls pads in exchange for sex.

This is one manifestation of a widespread problem that public health types blithely call “transactional sex.” In settings of extreme poverty and gender inequality, sex is one of the few forms of capital available to women. But the stakes are high. For the girls, and for the boys as well, the risk of getting HIV and other STIs is huge. Though we don’t know the prevalence of HIV in Lwala for sure, we estimate it may be as high as 30% based on the data we have from Lwala and the surrounding areas. And youth ages 14-24 are often at significantly higher risk than other age groups. And of course for the girls, there’s the unintended risk of ending the problem of menstruation, however temporarily, by getting pregnant.

We wanted to address this issue of injustice at Lwala Primary School. However, we don’t feel that the wholesale importation of pads and tampons from American firms, which is in vogue right now, is either sustainable or environmentally friendly. So we partnered with a new non-profit in the states called Goods4Girls, which provides reusable fabric sanitary pads for girls in settings of poverty. In fact, we’re their very first implementing partner! Thanks to the coordination of Caitlin Reiner, the LCA education committee chair, and Deanna Duke, the founder of Goods4Girls, I was able to carry over a suitcase full of reusable pads sewn by women in the U.S.

On Thursday we took advantage of the opportunity afforded by the pads to do a sex ed and hygiene training day at Lwala Primary. We began with a lively participatory discussion with all the children from 4th through 8th grade, led by the clinic’s lab technician Michael Ondiek, with help from our new CO John Badia and other clinic staff members, about puberty and changing bodies, HIV/AIDS, and other STIs. Milton Ochieng’ gave out biscuits to kids who answered or asked questions, which made thing really lively. After about 2 hours of this (kids in Lwala have very long attention spans!) we split up into boys and girls. The boys wrote down their questions and put them into a special “anonymous question hat.” Then John and the other male clinic staff members and the male teachers led them in dialogue, role play, and even a little slam poetry. You could hear the laugter a mile away! At the end, since they didn’t receive any pads, they received two soccer balls donated by Eleuthero of Portland, Maine.

The girls gathered together with the female teachers and nurses Rose Adhiambo and Vine Adoyo to learn more about menstruation and how to use and wash the pads. There was some good laughter there too. 47 girls received kits, each of which included 4 or 5 pads and a carrying case. The girls who haven’t yet started menstruating each received a pencil, which made them very happy. We left 21 kits at the school for the teachers to give to girls as they come of age.

The school principal, Madam Damaris, was delighted. She deals with so many challenges in getting the girls through school safely, and this is one huge challenge met. In fact several of the teachers told us that even they learned some new things! One of them told Milton, “Even when you think you know it all, there are new things to learn.” Already the teachers are talking about inviting the clinic staff back for another sex ed day, and the clinic staff are encouraging the teachers to form a school health club.

Thank you Goods4Girls!

Erokamano Gige Nyiri!

I’ll let the girls thank you themselves, in English and in DhoLuo. Just click on the links to see the videos. In DhoLuo, “thank you goods for girls” is “erokamano gige nyiri.” On behalf of the LCA and Lwala Primary School, I’d like to express my appreciation to Goods4Girls, Deanna, Caitlin, and all those who donated pads to Goods4Girls. This will make a great difference in the life and education of the girls of Lwala. THANK YOU!

We’ve already heard from several people interested in getting involved. One way you can help is by sewing pads for Goods4Girls to distribute in other communities. Information about that is available at their website. Another way you can help is by donating to the LCA’s microfinance fund. We’re hoping to start a sewing business in Lwala so that women can make reusable pads right here in the village and sell them to other schools and villages, and maybe even some of the international NGOs providing disposable pads. All we need is a small building, a few treadle sewing machines, and some materials to get started. Thanks!

Milton and I arrived in Nairobi on Thursday evening. Unbeknownst to us, until we saw one another leaving the plane, we were on the same flight from Heathrow. We spent Friday in Nairobi, taking care of a few meetings, and then caught the 6am shuttle from Nairobi to Kisii, the second nearest town to Lwala, though about the nearest hardly deserves the name. After an hour or so in the shade, Moi, Betha, and Michael picked us up in the new clinic ambulance! It’s an old but very rugged Toyota Landcruiser, which we will modify to fit a stretcher in the back. For Lwala, we weren’t looking for a fancy ambulance with life support equipment. We just needed a vehicle that could negotiate the “road” in all weather. This should do the trick. Having capable transportation means we can get people to Tabaka hospital, about 25km away, in an emergency. In the past we would call vehicles from town to come provide transport, but in rain or darkness they would refuse to come, which tells you something about the road. Now that we have reliable transportation, we’re more confident about establishing maternity services at the clinic. The ambulance has already taken several emergent cases to Tabaka. “It’s already saved lives!” Milton says. On behalf of the LCA, let me give a huge thank you to Martina Fuchs and Ian Swan at the Real Medicine Foundation for donating the funds for the new clinic ambulance!

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After further consultation with Blood:Water Mission and several site visits to other clinics and hospitals in the region, we decided to install a large rainwater catchment system with enough capacity to tide us over during the dry seasons. We will gutter the entire clinic, install a below ground storage tank, and install an elevated tank. Water will flow from the gutters into the below ground tank, then will be pumped to the elevated tank using a small pump run on our existing solar power system, and then flow from the elevated tank into the clinic. You can see things are well underway!

The presidential election on December 27th, 2007 pitted incumbent Mwai Kibaki against challenger Raila Odinga. Voting day was peaceful, and the turnout tremendous. Over the next couple of days early returns showed Odinga leading by a significant margin, and his party taking a large percentage of seats in the parliament. However, on the 30th the electoral commission announced Kibaki the winner and swore him in for a second term, and the country spiraled into violence. The fighting left over 1,500 people dead and 300,000 displaced. Even in areas where tribes had lived intermingled for decades, members of minority tribes were forcibly removed, their homes torched, and their businesses destroyed. Subsequent investigation has shown that this violence was not random. Political leaders on both sides used tribal structures to perpetrate violence. It was also found that election rigging was so widespread by both parties that it would be impossible to determine the true outcome of the election.

Months of intensive international intervention, led by Kofi Annan, culminated in a political agreement on March 3rd, 2008. Kibaki will remain president, Odinga will become prime minister with some executive powers, and cabinet seats will be awarded according to party representation in the parliament. Though the history of these two men does not recommend optimism, the public and international outcry for peace may be enough to hold this agreement together. Things in Kenya are slowly returning to normal. The economic and social consequences of the conflict will likely remain for some time, however, and the humanitarian issues associated with over a quarter million displaced people will not go away overnight.

Thankfully the rural areas of the country were largely spared from violence, and Lwala village itself remained peaceful. Though there was a delay opening after the holiday, our staff took advantage of a relatively peaceful window in mid January to return to the village, and the health center has been running ever since. Because the city hospitals were immobilized by the unrest, our patient load increased significantly. We are now seeing well over 2,000 patients per month, and patients are walking a great distance to Lwala for care.

Several members of our U.S. team were in Kenya during the violence, including our founders Milton and Fred Ochieng’, two members of our board, Caitlin Reiner and Cathy Chamberlin, friend Katie Rogers, and our executive director Joel Wickre. Thankfully we managed to avoid direct danger. Milton, Fred, Caitlin and Katie safely delivered a breach baby while the clinicians were away for Christmas!

There are a number of ticket options available, from $30 to $500! The premium tickets get you admission to several special events, including the chance to meet Milton and Fred. Tickets are available through the documentary website www.sonsoflwala.com, or you can go directly to the Tennessee Performing Arts Center website
www.tpac.org/lwala/.

For more about the documentary, visit our Sons of Lwala page.

We hope to see you there!

The event also honored the late Deb Miller, a certified nurse midwife from Hanover. Her husband James Rice gave a speech at the event in her honor, and many of her friends were present. She advised the LCA on maternal and child health programs.

All proceeds from the event will go to the establishment of a maternity service in Lwala. Our appreciation goes to the students of Dartmouth Medical School and the family and friends of Deb Miller.