TB team field visit!

My mentor and her fellow are back in Kenya for a few weeks so I was able to join them on a field visit last Wednesday and Thursday to Port Victoria, Mukhobola, and Khunyango.

The main purpose of the trip was to work out the logistics to conduct lot quality assurance sampling to evaluate primary drug resistance in new TB patients. In Kenya, when patients are diagnosed with TB (via sputum microscopy) they are started on a drug regimen without knowing if they already have any primary drug resistance. If they are still smear positive after 2-3 months of treatment, their sputum is sent for culture and drug sensitivity testing and their regimen is altered accordingly.
This differs from the states where TB patients receive culture and drug sensitivity testing immediately so that they can be placed on a drug regimen specific to their drug resistance pattern. As a result, primary drug resistance is not well known in Kenya so this project will actually identify this information.

We started out at Khunyango and I was really impressed with how organized the TB clinic and register seemed to be. I think that some of my recent frustrations with the child contact register project have stemmed from the fact that the TB clinic and register in Eldoret are less organized. When you have a large patient volume and many different personnel working in TB clinic, it becomes more difficult to keep the system running smoothly. It's an even bigger challenge to implement a new project into this type of system! I'm very excited because my mentor suggested that I try implementing the child contact register at Khunyango in the next few weeks. I think that the register will help them identify more cases of pediatric TB, but it will also be a completely different experience for me to implement in a much smaller, rural setting.




Outside the TB clinic...


Waiting area...


The next day we started off at Port Victoria. The clinic is right next to lake Victoria and the drive was absolutely beautiful. One of the interesting challenges at this clinic is that there are patients who travel 5 hours by boat from one of the islands, and most of them stop coming to their appointments since the travel is long, expensive and they usually need to stay in Port Victoria overnight. Could you imagine if you had to travel 5 hours by boat to go see a doctor?? I would stop coming to my appointments too!

The drive...


AMPATH clinic...






The TB projects office team with the Port Victoria cough monitors


Our last stop was Mukhobola, which is another village near the lake. After the clinic visit, we went to see a TB patient at her home to discuss some important issues (sorry for being vague...just don't feel it's appropriate to share the details on a blog). The patient is part of the Luhya tribe and the set up of her household was fascinating. The male of the household is buried at the center of the compound surrounded by all of his wives' huts. Their sons then build homes with their wives outside their mother's hut and then they are eventually buried in the center of their small compounds. It's a tightly knit community where you definitely know all of your neighbors!




The lab


The patient visit (you can see the grave of the male head of household in the center under the tree)

I am so glad that I got to go into the field! It's rejuvenating to be out in the rural areas and witness the impact that the small community clinics have in these regions.