Lwala Community Clinic, Rongo Kenya: Providing primary health care and addressin

[Guest guest]

Lwala Community Clinic, Rongo Kenya: Providing primary health care

and addressing HIV/AIDS in rural Kenya

Lwala Community Clinic

I. Lwala Background Information

Lwala is a village of approximately 1500 residents in western Kenya.

Lwala is a remote village, without any running water or electricity.

The area surrounding Lwala (Kameji sub-location) is home to

approximately 4000 people. There are 6 primary schools and 2

secondary schools, several churches, and many local open-air markets

in the area.

Villagers rely on rainwater run off from rooftops, seasonal springs,

and seasonal wells and the local brown waters of River Riana. The

major economic activity for the local people is subsistence farming.

They grow maize, beans, groundnuts, bananas, cassava, yams, millets,

sorghum, finger-millets, and tomatoes. Villagers feed their families

with crops they produce, and sell the surplus at the local open-air

markets in exchange for other food items. They also keep goats,

cows, sheep, hens, and ducks, which are similarly traded at the

local open-air markets for other goods and services. Sugarcane is

the most important cash crop grown in this part of Kenya. The

villagers use the sugarcane to make jaggery for sweetening drinks

and for making local traditional brews. The jaggery is also sold in

the local open air markets.

Lwala is under the direct control of a local assistant chief who

reports to a chief. The local assistant chief works hand in hand

with a council of elders ( " Jodongo " ) in settling local disputes in

an open forum called " baraza " . The community is largely organized

around a strong kinship system with clan identities taking center

stage in all community events.

II. The Ochieng' family and a vision for a community clinic

The Lwala Community Clinic Project is the brainchild of Milton

Oludhe Ochieng', a 2nd year Vanderbilt medical student and his

brother Frederick Otieno Ochieng', a member of the incoming

Vanderbilt Medical School class of 2010 with inspiration from their

late father, Erastus Ochieng' who helped write the proposal for the

clinic but himself passed away one month before the groundbreaking

ceremony in June 2005. In the months before their death, Ochieng's

parents brought the community together to establish a village health

committee, with the goal of creating a health clinic that would

serve others like them who lacked access to basic health care. A

committee of 21 people comprising 3 from each of the 7 clans was

elected. The committee was charged with building and operating a

clinic in Lwala that would serve the 4,000 residents of Kameji sub-

location.

The clinic seeks to improve access to primary healthcare in a rural

village in western Kenya. Milton and Fred have enlisted the help of

numerous organizations in Kenya and in America, American college

professors and administrators, college student groups, high school

and middle school students to build a community clinic in Lwala, the

rural village in Western Kenya where they grew up. Milton's and

Fred's efforts represent a unique addition to the attempts by many

individuals and international organizations in pursuing the UN

Millenium Goals for African countries. However, Milton and Fred have

the rare advantage of having first hand knowledge of the Kenyan

community in which they will be putting to good use some of the

western education acquired from the American institutions they

attended.

III. HIV/AIDS and Healthcare in Lwala

Lwala is in Nyanza province, which borders Lake . Nyanza has

perhaps the highest prevalence of HIV in Kenya. Kenya's overall

adult (15-49) HIV prevalence, according to The Joint United Nations

Programme on HIV/AIDS, was 6.7% as at the end of 2003. In Homa Bay,

a town in Nyanza province, prevalence was estimated at 33%. Many

factors contribute to the spread of HIV in this area, including

poverty, migration associated with the lake, polygamy, wife

inheritance, untreated STIs, and lack of circumcision. The problem

of HIV/AIDS overlays a host of normal health problems in Lwala:

Malaria, tuberculosis, pneumonia, cold/ flu, pharyngitis,

tonsillitis, typhoid, diarrheal diseases and worms, among many

others.

Unfortunately, there is no access to basic primary health care in

Lwala, and there are no testing or treatment services for HIV. Poor

infrastructure makes accessing health care in surrounding towns and

cities very difficult. The primary modes of transportation in Lwala

are bicycle taxis. In emergency situations, people carry the sick in

wheelbarrows, or even in their beds. There is one health center 3km

away (Minyenya), that provides some outpatient care and family

planning, but for further care residents go to Rongo Subdistrict

Hospital (10 kilometers away). Yet even Rongo, a hospital that

serves over 60,000 people, is only served by a clinical officer, not

a doctor, and cannot perform an emergency delivery by c-section for

example. Rongo Sub-district hospital takes care of simple outpatient

problems but stabilizes and transfers any surgical and complicated

cases to the district hospitals that have doctors. The nearest

district hospitals are Kisii District Hospital 33km away, Migori

District Hospital 40km away and Homabay 41km away. The Rongo Sub-

district hospital has an HIV/AIDS VCT center but does not provide

any antiretrovirals. While Migori District Hospital has VCT center,

it does not provide HAART. Any HIV positive patients from Lwala,

Rongo and even the Migori area have to go to HomaBay (over 40km away

from Lwala) to get antiretrovirals. Travelling to Homabay from Lwala

would take 2 hours each way, at the cost of Ksh 160 (US$ 2.50) each

way and then the ARVs are sold to the patients for about Ksh 500

(US$7). Patients from the Rongo area stand to benefit from receiving

ARVs in Lwala Clinic.

IV. History

The idea for this project was inspired from a two-week Dartmouth

Cross Cultural winter service trip in which Milton Ochieng'

participated during his sophomore year. Working hand in hand with

the Nicaraguans, the Dartmouth group built a Women's and Children's

Health Clinic in Siuna Nicaragua. The trip served as an eye-opener

for Milton, who saw a lot of similarities in the healthcare

situation in Nicaragua versus that of the rural village where he had

grown up in Kenya. He was also struck by the impact that young

college students could make by volunteering some of their time,

effort and resources in service activities. On his return to the

USA, Milton vowed that he too would lead a team in constructing a

clinic in his rural village in Kenya whenever the opportunity would

present itself. That opportunity presented itself when Milton joined

Vanderbilt University School of Medicine in August 2004. Through the

new Vanderbilt Emphasis Program, the first year medical students

could choose one of 8 areas ranging from clinical research, lab

research to international health in which to focus their efforts in

the summer between the first and second year.

Vanderbilt Medical School would provide each of the students with a

stipend for the summer. Milton chose to focus on international

health and was lucky to find a willing advisor in Dr ,

the Shedd Professor of Pediatric Infectious Disease at Vanderbilt

University Medical Center. With the help of his late father, Milton

put together a proposal that they started using in soliciting money.

Milton and Fred reached out to Dartmouth college groups, local

middle schools and high schools in Hanover, NH and student soccer

groups in the Upper Valley Region. With key support from the

Dartmouth chapter of the Navigators, the Dartmouth Soccer Program ,

and Thetford Academy, Milton and Fred were able to raise the initial

money needed to start the foundation. The initial budget estimated

that it would take approx US $25,000 to erect the 30.2m by 6m clinic

building.

http://www.mc.vanderbilt.edu/root/vumc.php?site=lwala & doc=7079

Contact info:

For more information about the Lwala Community Clinic, please

contact:

Milton Oludhe Ochieng'

Vanderbilt University School of Medicine

milton.o.ochieng@...

(615) 294 7220

Frederick Otieno Ochieng'

frederick.o.ochieng@...

Wickre

University of California San Francisco/University of California

Berkeley School of Medicine

jwickre@...

(510)501-5090

****************************

Ochieng brothers launch health clinic in Kenya

By Hedrick

When Milton Ochieng '04 and Fred Ochieng '05 left their small

village of Lwala, Kenya for a private high school near Nairobi, they

were struck by the comparative lack of health care in their

hometown.

After graduating and receiving the Lombard Post-Grad Fellowship from

the Sloan Dickey Center for International Understanding, Fred

returned home to Lwala in the summer of 2005 with five Dartmouth

students and alumni where he was soon reminded of the region's

health care problems.

" A pregnant woman who was about to deliver developed complications

and was being taken in a wheelbarrow down a dirt road to the nearest

treatment facility, " he said. " She bled to death on the way, and

both the child and mother were lost. "

Fred and Milton broke ground on the Lwala Community Clinic in June

2005. The facility is designed to serve the 4,000 residents of Lwala

and the surrounding region who are currently without basic primary

health care.

" We started fundraising in January and by the end of June we already

had $27,000 from friends, families and different connections, " Fred

said.

Milton, who is currently studying at Vanderbilt Medical School, said

that treating malaria, providing prenatal and postnatal care and

delivering antiretroviral drugs for HIV patients are the clinic's

most pressing concerns.

Lwala is located in the Nyanza Province, which has one of the

highest HIV infection rates in Kenya. Currently, HIV-positive

patients seeking antiretroviral drugs must travel over 40 kilometers

at considerable expense to receive treatment.

The clinic, which has completed its first phase of construction, is

currently in the process of installing electricity and running

water.

In Hanover, the Lwala Development Committee, a group of students,

faculty and community members devoted to raising funds, is assisting

with the clinic project.

" We need to raise a substantial amount of money, probably $50,000

minimum, " said committee chairman Craig , who is also the

campus minister for the Navigators Christian Fellowship. " We want to

have enough to sustain the clinic for the next few years. "

Caitlin Reiner '06, who also serves on the committee, spent last

summer in Lwala and other parts of Kenya.

" The stories that I heard from the people in the village made it

shockingly clear that this was needed, " Reiner said. She is involved

primarily in the committee's education arm, which raises money for

Lwala area youth to go to high school.

Fred and Milton cited numerous sources of inspiration and support

for their project. They were both involved with the Navigators

during their time at Dartmouth, and both said that the spring break

service trips that the group organized impacted them significantly.

Milton has also met with the celebrated economist Sachs to

discuss the project.

The brothers, along with members of the Dartmouth and Vanderbilt

communities, will be spend a portion of the summer in Lwala working

on the clinic and HIV education initiatives. In the fall, Fred will

return to the United States to begin studying at Vanderbilt Medical

School.

While it is unclear when the clinic will begin seeing patients,

organizers hope that it will open by Jan. 1.

The Ochieng brothers have created a webpage within the Vanderbilt

Medical School website containing further information about the

Lwala project.

http://www.kenyan-students.com/ochieng-brothers-launch-health-

clinic-in-Kenya.html

[Guest guest]

Lwala Community Clinic, Rongo Kenya: Providing primary health care

and addressing HIV/AIDS in rural Kenya

Lwala Community Clinic

I. Lwala Background Information

Lwala is a village of approximately 1500 residents in western Kenya.

Lwala is a remote village, without any running water or electricity.

The area surrounding Lwala (Kameji sub-location) is home to

approximately 4000 people. There are 6 primary schools and 2

secondary schools, several churches, and many local open-air markets

in the area.

Villagers rely on rainwater run off from rooftops, seasonal springs,

and seasonal wells and the local brown waters of River Riana. The

major economic activity for the local people is subsistence farming.

They grow maize, beans, groundnuts, bananas, cassava, yams, millets,

sorghum, finger-millets, and tomatoes. Villagers feed their families

with crops they produce, and sell the surplus at the local open-air

markets in exchange for other food items. They also keep goats,

cows, sheep, hens, and ducks, which are similarly traded at the

local open-air markets for other goods and services. Sugarcane is

the most important cash crop grown in this part of Kenya. The

villagers use the sugarcane to make jaggery for sweetening drinks

and for making local traditional brews. The jaggery is also sold in

the local open air markets.

Lwala is under the direct control of a local assistant chief who

reports to a chief. The local assistant chief works hand in hand

with a council of elders ( " Jodongo " ) in settling local disputes in

an open forum called " baraza " . The community is largely organized

around a strong kinship system with clan identities taking center

stage in all community events.

II. The Ochieng' family and a vision for a community clinic

The Lwala Community Clinic Project is the brainchild of Milton

Oludhe Ochieng', a 2nd year Vanderbilt medical student and his

brother Frederick Otieno Ochieng', a member of the incoming

Vanderbilt Medical School class of 2010 with inspiration from their

late father, Erastus Ochieng' who helped write the proposal for the

clinic but himself passed away one month before the groundbreaking

ceremony in June 2005. In the months before their death, Ochieng's

parents brought the community together to establish a village health

committee, with the goal of creating a health clinic that would

serve others like them who lacked access to basic health care. A

committee of 21 people comprising 3 from each of the 7 clans was

elected. The committee was charged with building and operating a

clinic in Lwala that would serve the 4,000 residents of Kameji sub-

location.

The clinic seeks to improve access to primary healthcare in a rural

village in western Kenya. Milton and Fred have enlisted the help of

numerous organizations in Kenya and in America, American college

professors and administrators, college student groups, high school

and middle school students to build a community clinic in Lwala, the

rural village in Western Kenya where they grew up. Milton's and

Fred's efforts represent a unique addition to the attempts by many

individuals and international organizations in pursuing the UN

Millenium Goals for African countries. However, Milton and Fred have

the rare advantage of having first hand knowledge of the Kenyan

community in which they will be putting to good use some of the

western education acquired from the American institutions they

attended.

III. HIV/AIDS and Healthcare in Lwala

Lwala is in Nyanza province, which borders Lake . Nyanza has

perhaps the highest prevalence of HIV in Kenya. Kenya's overall

adult (15-49) HIV prevalence, according to The Joint United Nations

Programme on HIV/AIDS, was 6.7% as at the end of 2003. In Homa Bay,

a town in Nyanza province, prevalence was estimated at 33%. Many

factors contribute to the spread of HIV in this area, including

poverty, migration associated with the lake, polygamy, wife

inheritance, untreated STIs, and lack of circumcision. The problem

of HIV/AIDS overlays a host of normal health problems in Lwala:

Malaria, tuberculosis, pneumonia, cold/ flu, pharyngitis,

tonsillitis, typhoid, diarrheal diseases and worms, among many

others.

Unfortunately, there is no access to basic primary health care in

Lwala, and there are no testing or treatment services for HIV. Poor

infrastructure makes accessing health care in surrounding towns and

cities very difficult. The primary modes of transportation in Lwala

are bicycle taxis. In emergency situations, people carry the sick in

wheelbarrows, or even in their beds. There is one health center 3km

away (Minyenya), that provides some outpatient care and family

planning, but for further care residents go to Rongo Subdistrict

Hospital (10 kilometers away). Yet even Rongo, a hospital that

serves over 60,000 people, is only served by a clinical officer, not

a doctor, and cannot perform an emergency delivery by c-section for

example. Rongo Sub-district hospital takes care of simple outpatient

problems but stabilizes and transfers any surgical and complicated

cases to the district hospitals that have doctors. The nearest

district hospitals are Kisii District Hospital 33km away, Migori

District Hospital 40km away and Homabay 41km away. The Rongo Sub-

district hospital has an HIV/AIDS VCT center but does not provide

any antiretrovirals. While Migori District Hospital has VCT center,

it does not provide HAART. Any HIV positive patients from Lwala,

Rongo and even the Migori area have to go to HomaBay (over 40km away

from Lwala) to get antiretrovirals. Travelling to Homabay from Lwala

would take 2 hours each way, at the cost of Ksh 160 (US$ 2.50) each

way and then the ARVs are sold to the patients for about Ksh 500

(US$7). Patients from the Rongo area stand to benefit from receiving

ARVs in Lwala Clinic.

IV. History

The idea for this project was inspired from a two-week Dartmouth

Cross Cultural winter service trip in which Milton Ochieng'

participated during his sophomore year. Working hand in hand with

the Nicaraguans, the Dartmouth group built a Women's and Children's

Health Clinic in Siuna Nicaragua. The trip served as an eye-opener

for Milton, who saw a lot of similarities in the healthcare

situation in Nicaragua versus that of the rural village where he had

grown up in Kenya. He was also struck by the impact that young

college students could make by volunteering some of their time,

effort and resources in service activities. On his return to the

USA, Milton vowed that he too would lead a team in constructing a

clinic in his rural village in Kenya whenever the opportunity would

present itself. That opportunity presented itself when Milton joined

Vanderbilt University School of Medicine in August 2004. Through the

new Vanderbilt Emphasis Program, the first year medical students

could choose one of 8 areas ranging from clinical research, lab

research to international health in which to focus their efforts in

the summer between the first and second year.

Vanderbilt Medical School would provide each of the students with a

stipend for the summer. Milton chose to focus on international

health and was lucky to find a willing advisor in Dr ,

the Shedd Professor of Pediatric Infectious Disease at Vanderbilt

University Medical Center. With the help of his late father, Milton

put together a proposal that they started using in soliciting money.

Milton and Fred reached out to Dartmouth college groups, local

middle schools and high schools in Hanover, NH and student soccer

groups in the Upper Valley Region. With key support from the

Dartmouth chapter of the Navigators, the Dartmouth Soccer Program ,

and Thetford Academy, Milton and Fred were able to raise the initial

money needed to start the foundation. The initial budget estimated

that it would take approx US $25,000 to erect the 30.2m by 6m clinic

building.

http://www.mc.vanderbilt.edu/root/vumc.php?site=lwala & doc=7079

Contact info:

For more information about the Lwala Community Clinic, please

contact:

Milton Oludhe Ochieng'

Vanderbilt University School of Medicine

milton.o.ochieng@...

(615) 294 7220

Frederick Otieno Ochieng'

frederick.o.ochieng@...

Wickre

University of California San Francisco/University of California

Berkeley School of Medicine

jwickre@...

(510)501-5090

****************************

Ochieng brothers launch health clinic in Kenya

By Hedrick

When Milton Ochieng '04 and Fred Ochieng '05 left their small

village of Lwala, Kenya for a private high school near Nairobi, they

were struck by the comparative lack of health care in their

hometown.

After graduating and receiving the Lombard Post-Grad Fellowship from

the Sloan Dickey Center for International Understanding, Fred

returned home to Lwala in the summer of 2005 with five Dartmouth

students and alumni where he was soon reminded of the region's

health care problems.

" A pregnant woman who was about to deliver developed complications

and was being taken in a wheelbarrow down a dirt road to the nearest

treatment facility, " he said. " She bled to death on the way, and

both the child and mother were lost. "

Fred and Milton broke ground on the Lwala Community Clinic in June

2005. The facility is designed to serve the 4,000 residents of Lwala

and the surrounding region who are currently without basic primary

health care.

" We started fundraising in January and by the end of June we already

had $27,000 from friends, families and different connections, " Fred

said.

Milton, who is currently studying at Vanderbilt Medical School, said

that treating malaria, providing prenatal and postnatal care and

delivering antiretroviral drugs for HIV patients are the clinic's

most pressing concerns.

Lwala is located in the Nyanza Province, which has one of the

highest HIV infection rates in Kenya. Currently, HIV-positive

patients seeking antiretroviral drugs must travel over 40 kilometers

at considerable expense to receive treatment.

The clinic, which has completed its first phase of construction, is

currently in the process of installing electricity and running

water.

In Hanover, the Lwala Development Committee, a group of students,

faculty and community members devoted to raising funds, is assisting

with the clinic project.

" We need to raise a substantial amount of money, probably $50,000

minimum, " said committee chairman Craig , who is also the

campus minister for the Navigators Christian Fellowship. " We want to

have enough to sustain the clinic for the next few years. "

Caitlin Reiner '06, who also serves on the committee, spent last

summer in Lwala and other parts of Kenya.

" The stories that I heard from the people in the village made it

shockingly clear that this was needed, " Reiner said. She is involved

primarily in the committee's education arm, which raises money for

Lwala area youth to go to high school.

Fred and Milton cited numerous sources of inspiration and support

for their project. They were both involved with the Navigators

during their time at Dartmouth, and both said that the spring break

service trips that the group organized impacted them significantly.

Milton has also met with the celebrated economist Sachs to

discuss the project.

The brothers, along with members of the Dartmouth and Vanderbilt

communities, will be spend a portion of the summer in Lwala working

on the clinic and HIV education initiatives. In the fall, Fred will

return to the United States to begin studying at Vanderbilt Medical

School.

While it is unclear when the clinic will begin seeing patients,

organizers hope that it will open by Jan. 1.

The Ochieng brothers have created a webpage within the Vanderbilt

Medical School website containing further information about the

Lwala project.

http://www.kenyan-students.com/ochieng-brothers-launch-health-

clinic-in-Kenya.html