More than 30 hours have passed between leaving the skyscrapers of New York City and arriving in the rains of Kitale in western Kenya. Yet we still have a one hour drive on a dirt road riddled with potholes and farm animals before we reach our ultimate destination of Kapenguria Hospital. The hospital is not an enclosed space, so chickens and cows are seen to wander freely across
the grassy hospital grounds. Insects often swarm around patients and rainwater moistens their beds which begin to grow mold. While Kapenguria is the main referral hospital for the impoverished rural county of West Pokot serving a population of 500,000, it lacks even the most basic resources expected of a tertiary care center. Despite facilitating some 500 deliveries every month, the maternity ward has less than 50 beds. As a result many of the women share beds; a potentially hazardous practice, yet one which seems to comfort them. During morning rounds, patients are frequently seen to be sharing tea and conversation with bunk mates and family.
On this trip, the Saving Mothers team included our distinguished medical board member Dr. Nerys Benfield, medical fellow Dr. Molly Findley, and research fellow Sobaata Chaudhry. Drs. Benfield and Findley are both family planning specialists, so their principal focus was to prepare local providers for our upcoming family planning initiative. In addition the team evaluated the progress of our Preterm Birth Indicator pilot, which is being administered by local Saving Mothers' team members Dr. Dan Munyuny (our OB/Gyn fellow) and Augustine Kakuko (our community outreach specialist). They also met with local government officials including the Director of Finance and Economic Planning, and the Director of Health and Sanitation, both of whom have been very influential in moving our program forward.
Drs. Benfield and Findley also engaged with local medical personnel to discuss potential barriers to uptake of contraceptives in the community and how these might be overcome. At 7.2 children per woman, West Pokot has the second highest fertility rate in Kenya, so the need for education in this area is great. For example, many women falsely believe that contraceptives cause infertility, so countering this belief is an important step going forward. Fortunately there appears to be a shift in attitudes among younger women now whereby they are more receptive to the idea of family planning as a means of spacing pregnancies rather than permanently preventing them. At the same time, our team discovered that there is a high incidence of pregnancy among high school girls in this community resulting in forced marriages and high dropout rates, thereby fueling the cycle of poverty. After the lecture and group discussion, Drs. Benfield and Findley trained the staff on proper insertion and removal of both copper and hormonal IUDs. They also discussed the pros and cons of immediate postpartum placement in the hospital versus placement at a normal clinic appointment, with the major takeaway being that postpartum placement saves the patient the time and expense of traveling to an appointment and thus may result in higher uptake.
Another objective for the team was to educate local providers on the use of fetal dopplers to detect fetal heartbeats at prenatal care visits. Unfortunately Kapenguria Hospital is still in the practice of using feto scopes, which are cone-shaped devices that are placed on the mother's belly and are barely able to detect fetal heartbeats. However they now have access to a fetal doppler courtesy of a donation from one of our partners MedShare, so fetal heart assessments can be done with much greater accuracy and efficiency going forward.
On the final day of the trip, the Saving Mothers team met with local nonprofits to discuss potential collaborations that can be used to further improve the quality of maternal care in West Pokot. All in all, a very successful trip!