Arjun in Kakamega

I’m slightly embarrassed that this message comes out so late after my arrival back in the United States.  As you might imagine, in my (sadly, typical) last-minute completion of the Access database, finishing of the training materials for the emergency preparedness course, and general tying up of loose ends, combined with the admittedly less-hectic job of getting my feet back under me once I arrived home, I have neglected to post this final word of reflection on my experiences in Kenya.

In my previous sentence, just before I wrote the word “experiences,” I paused to consider what adjective might be appropriate to describe the last two months.  None seem to fit correctly.  Even in the now 34,000 words I have written about these past nine weeks, I know that things have been lost in communication – that there are things that I will never be able to answer to the casual “How was Kenya?” that I am so often asked.  It is interesting to visit a place with the intent not only to appreciate what it is but to also explore what you can do to change it.  Almost like getting to know a person, I have come to both admire all that Kenya has to offer and at the same time appreciate and understand her flaws.  At times during this trip, I was elated, depressed, optimistic, frustrated; I taught and learned, I spoke and I listened, I took and I gave.  There is no adjective I know to describe that.

I am grateful for the opportunities that both Duke Engage and the Foundation for Sustainable Development gave me.  I am grateful for the graciousness with which I was welcomed into the Iguhu District Hospital and the home of Mama Joyce, and I am thankful for the support I received from friends and family at home and colleagues of mine in the field.  Without any of these, the experience would not have been as fulfilling as it was.  To be able to walk away after two short months and know that a difference has been made is a true gift that I have no words to give thanks for.

I think now would be an appropriate time to summarize my projects at the hospital and to identify our accomplishments.  At the beginning of my internship, I conducted a collaborative needs assessment out of which came a list of development objectives from virtually every hospital department.  While a final workplan was being composed, I began a project to enhance the exterior landscaping of the hospital which was quickly taken over by the grounds staff.  I then designed and implemented a patient wait time survey for the hospital by which average patient wait times for each department could be measured.  Along with the hospital secretary, I compiled and analyzed the results to produce a report on the project findings and submitted the report to senior hospital administration.  I then began a four-week training program in which I trained both medical and non-medical personnel on basic life support skills and the use of emergency medical equipment which was generously donated by sponsors from the United States.  A thorough set of training materials documenting everything covered during the program was left at the hospital for future trainings.  Simultaneously, I networked four computers at the hospital and designed and implemented a database program for the hospital to use.  Iguhu District Hospital is the first hospital in the Western Province of Kenya to have acquired a system capable of completely computerizing patient records.

When I began my internship and designed the project to train hospital staff on basic life support skills, it became obvious that the hospital and I lacked the resources to complete the training because we would be unable to teach the staff how to use critical medical equipment since the hospital lacked this equipment and had no ability to acquire it.  As such, I turned to friends, family, and supporters in the United States to provide funds required to carry out the project.  I asked for $1,000, and my request was exceeded by the hospital’s extremely generous donors.  With the $1,100 that the fundraising campaign raised, the hospital and I were able to purchase medical equipment for the hospital and facilitate medical training among its staff.

Donations to this project were unique from donations that are generally given to organizations working in the developing world.  The equipment that we were able to purchase using donated funds was used in training and thus empowered the community to drive its own development.  Far from solving the hospital’s problems for it, the donated money gave the hospital the tools it needed to address the issues it had by transferring skills to the people themselves.

These skills are inherently useful because they can be used to provide higher quality healthcare to the citizens of the area.  However, the potential for development as a result of these skills extends far beyond this obvious benefit.  Armed with the knowledge of how to use basic equipment in emergency medical situations, the hospital staff is now better positioned to petition the Kenyan government for more equipment and can make informed requests of their government concerning the exact nature of equipment they need.  Furthermore, since extensive training materials were left at the hospital, the staff can now travel to other facilities in the area and repeat the training sessions to further disseminate the skills they have.

I hope I have been able to demonstrate the full ramifications of the donations the hospital and I received and explain why a donation to a sustainable development project is far better for the community than simple aid.  I sincerely hope that your donations in the future to developing countries support projects that emphasize long-term community empowerment rather than more temporary solutions.  I want to again thank my donors profusely for their generosity and interest in my work at the hospital, without which this project could not have been the success that it was.

The other major undertaking at the hospital was networking the five computers it has, creating a patient database, and beginning to computerize patient records.  Interestingly, this huge project required the least amount of money, since the Ministry of Health Services had been sending the hospital computers for quite some time.  Unfortunately, the computers came with no training and no instructions on their use.  After three weeks of learning how to use Microsoft Access and developing a database system to fit the hospital’s needs, the hospital now has a customized patient records system, allowing access to patient histories, more accurate record keeping, and more efficient report creation.  The network and the resulting ability to completely computerize patient records in the government-run hospital is the first of its kind in the Western Province of Kenya and might even be the first of its kind in the country.

As it turns out, there was great hesitance to adopt the computerized system since the paper record system was seen as far more dependable and less prone to error.  Even in the short time during which I was able to oversee the use of the database, I noticed the hospital staff having difficulty giving up their previous methods of recordkeeping, and frankly, I expect that many months or even years will pass before the network and/or database will be used at the hospital to its fullest potential.  I stood and continue to stand by the project, however, because of my strong belief in the use of modern technology to develop institutions in developing countries.  The network and database have opened the door for future development workers to build upon the existing infrastructure, and the system has great potential to vastly improve the efficiency of the facility and even reduce costs.  For example, in the two months that I was there, the hospital purchased a second printer to connect to another one of its computers.  With the network in place and simple printer sharing enabled, only one printer need ever be purchased and/or serviced at the hospital.  The network also opens the door for future workers to implement other projects, like automating the patient wait time survey to occur without any effort on the part of the staff.

This blog will likely see more commentary on international development work in the future, but I felt this closure was necessary for the end of the Duke Engage trip and my experiences in Kakamega, Kenya.  Thanks for your interest in international development, and I hope you’ll continue to occasionally check this blog and maintain involvement in development work across the world!

Joseph Ambani, the hospital administrator, had not previously received any medical training at all and was unprepared to organize the hospital in a mass-casualty situation. Thanks to donations to the emergency responsiveness project, Mr. Ambani has received basic medical training and is ready to lead the hospital in an emergency.

Betty is the hospital secretary and had never received any medical training. Using donated funds, we were able to purchase medical equipment and train Betty on its use. Betty can now help deliver basic medical services in an emergency and can even use her skills to improve the hospital’s efficiency during normal operation.

Charles Aluvisia is a volunteer in the Comprehensive Care Clinic and counsels HIV patients. He has never received medical training. Here, Charles performs a primary trauma assessment on a patient who is lying on a stretcher made using donated funds.

Dr. Bomji, the Clinical Officer In Charge at the hospital whose staff is better prepared to handle emergency situations and can help him improve the quality of healthcare delivered at the hospital.