Khunyango

If you remember, the TB team went out for a field visit back in March and I had mentioned that I would hopefully have the opportunity to implement the child contact register in the small Khunyango District Hospital. Well people...dreams do come true!

Last Monday, I joined one of the AMPATH vehicles on the 3 hour journey west to Khunyango. I met with the District Tuberculosis and Leprosy Coordinator (DTLC) on Tuesday morning, and we spent the first half of the morning discussing pediatric TB, the Kenyan national guidelines, and what actually happens in her clinic.

Not surprisingly, here were some of her comments:

-Kenyan national guidelines suggest screening every smear positive household child contact. That rarely happens in Khunyango...sometimes she will ask if she remembers but she was honest and admitted that she usually does not remember.
-Kenyan national guidelines suggest isoniazid preventive therapy to children < 5 and HIV+ kids who have been exposed to TB in the home and were screened to rule out TB disease. Her response: "Well we don't really screen and right now all of the isoniazid we were given for this has expired" hmm...classic.

The second half of the morning was spent introducing the child contact register and filling in some information for the active source cases so we would be ready to go the following day when patients lined up for clinic.

On Wednesday, we saw 14 pulmonary TB patients and identified 28 child contacts. There is always 1 case that ends up shocking me the most. We met a 12 year old HIV positive girl with TB who came in with her mom and 10 month old brother. Mom and the 10 month old are also HIV positive. She has two other children who have not been tested yet for HIV despite the fact that she has witnessed her eldest daughter suffer. After several counseling sessions regarding PMTCT (preventing mother to child transmission) and the importance of delivering in the hospital, mom was still convinced by her family to deliver at home.
This brings up an important lesson that I have learned this year: culture and family will often trump doctors. This should not be a surprise to us, but instead it should be expected. It's important to just continue being patient, educate as much as possible and applaud those who take the leap towards things like pmtct. Anyway, we counseled her to bring her other children in for HIV screening, and we encouraged her to bring the 10 month old in for TB screening. Fingers are crossed.

The best part of this trip was working with someone who is really passionate about TB and the health of her patients (unfortunately, this hasn't exactly been the case in the Eldoret TB clinic). This DTLC runs the entire clinic by herself, she actually fills out all of the paperwork required by the ministry of health, and she seems to actually enjoy it. Hopefully she'll adopt the child contact register and she can help some of these kids!

The DTLC and I in the TB clinic

Here is a picture from the hotel balcony. I dragged a chair out here to read and enjoy the African sunset. :)