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Medicine in the Developing World: Kapsowar Hospital in Kenya

Medicine in the Developing World: Kapsowar Hospital in Kenya. John Kim MedPeds Conference 11/6/06. Reasons to go overseas. Opportunity to serve patients in need Educational Practical. Types of Experiences. Inpatient Faith based missions hospital Humanitarian hospital

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Medicine in the Developing World: Kapsowar Hospital in Kenya

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  1. Medicine in the Developing World: Kapsowar Hospital in Kenya John Kim MedPeds Conference 11/6/06

  2. Reasons to go overseas • Opportunity to serve patients in need • Educational • Practical

  3. Types of Experiences • Inpatient • Faith based missions hospital • Humanitarian hospital • Government hospital • Outpatient • Research

  4. Time line 1 Year 9 month 6 month 3 month 1 month

  5. Budget • Airfare $1800 • Cost per Diem 18$/day $500 • Land Transportation $200 • Souvenir $100 • Supplies & Gift $100 • Emergency $100 • Medical License $50 • Airport Tax $50 • Travel Expense $20 • Total $2900

  6. Scholarships: Yale/Johnson & Johnson Scholars Program ($1,000-5,000) Deadline 3/14/07 Reader’s Digest Map Scholarship 75% of airfare. Supplies: J & J Medical Mission Pack Program Reachout Initiative – Ortho-McNeil Pharmaceuticals AmeriCares Roche Pfizer Funding

  7. Travel Health • Vaccinations - Employee Health & International Travel Clinic. • Malaria Prophylaxis - Employee Health. • HIV Prophylaxis - Employee Health. • Antibiotics for Gastroenteritis - International Travel Clinic. • http://www.cdc.gov/travel/

  8. Pearls • Plan early • Need for flexibility

  9. 6,984 miles later…

  10. Crossing the equatorSub-Saharan Africa • The poorest region in the world with least developed countries. • Largest burden of HIV/AIDS Epidemic in the world

  11. Rift Valley

  12. Kenya • Sub-Saharan Eastern Africa • Official Language English, Swahili • Per capita GNP $1,050 • Life Expectancy 48 years • Infant Mortality - 69 deaths/1,000 live births Note: 1. US Infant Mortality 7/1000. 2. US life expectancy 77 years

  13. Kapsowar

  14. Kapsowar Hospital • Established by Christian missionary in 1933. • 126 bed district hospital • Inpatient, outpatient, and surgical services. • Serving the Maraquet tribe • Operating cost mostly by patient revenue

  15. Clinical Staff • Staffed by US FP, 2 Kenyan GPs, rotating surgeon, & other short-term volunteers. • Nursing staff trained by Kenyan nursing schools • Laboratory technician. • Anesthesia technician.

  16. Female Wards

  17. Maternity Wards

  18. Children’s Ward

  19. Laboratory

  20. X Rays

  21. Ultrasound

  22. Pharmacy

  23. Hospital Formulary (IV)

  24. Theatre

  25. Way of Life

  26. Preventative Health

  27. Sterilization

  28. Community

  29. Community

  30. Primary pulmonary and dessiminated TB AIDS & OI Malaria CHF from Rheumatic Heart Disease Pneumonia Gastroenteritis Fractures/Trauma Burns Typhoid Fever Meningitis Organophosphate Toxicity Obstetrics Care Common Admission Diagnosis

  31. AIDS

  32. 2005 HIV Prevalence Worldwide Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

  33. Highlights of AIDS Epidemic in Sub-Saharan Africa (2005) • Total number of people living with HIV/AIDS - 25.8 million. • People newly infected with HIV/AIDS – 3.1 million • AIDS death - 2.4 million. • Prevalence of HIV/AIDS (age 15 to 49 years) - 11%

  34. HIV Epidemic in Sub-Saharan Africa

  35. Kenya AIDS Statistics in 2005 • Number of people living with HIV – 1,300,000 • Adults aged 15 to 49 HIV prevalence rate - 6.1% • Percentage of pregnant women receiving treatment to reduce mother-to-child transmission - 9.3% • Percentage of HIV-infected women and men receiving antiretroviral therapy - 19.7% 2.5

  36. People in Sub-Saharan Africa on ART as % of those in need, 2002–2005 2005 2002 2003 2004 Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.” 7.2

  37. 2001, UN General Assembly opened a special session dedicated to HIV/AIDS. 2002, Global Fund to Fight AIDS, Tuberculosis and Malaria was launched with pledge of $5 billion. 2004, The US President’s Emergency Program for AIDS Relief disbursed $570 million with additional $916 million by 2005. Recent declines in national HIV prevalence & behavioral changes. Between 2001-2005, number of people on ART in low and middle income countries increased from 240,000 to 1.3 million. 90% of reporting countries have a national AIDS strategy State of the Art

  38. Concerns that coverage of ART prophylaxis for mothers is lagging compared to general population Coverage of Peripartum Antiretroviral Prophylaxis

  39. HIV/AIDS Treatment at Kapsowar Hospital • Free of cost to the patient • CD Count < 200 or WHO Class IV AIDS • 3 drug regimen • Includes prophylaxis and treatment of OI. • Must meet Treatment Readiness Criteria

  40. ART Readiness Assessment

  41. Typhoid Fever

  42. Tuberculosis & Pott’s Disease

  43. Sad case…

  44. People’s view on life Lack access to diagnostic tools and opportunities for specialist referral Lack of continuity Utilitarian model of medicine. Barriers to patient education and communication. Antibiotic Resistance Medicine in a Developing World: Challenges & Perspective

  45. Cases

  46. African Burkitt’s Lymphoma

  47. Goiter

  48. Pneumonia

  49. Steven Johnson’s

  50. Barber’s Itch - Tinea Barbae

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