Medical Mission

One PT develops appreciation for similarities and differences in rehab medicine in Kenya

By James Banogon, DPT, GCS, CWS

The next time you are having a bad day, imagine working in a rehab department with no equipment other than a TENS machine, giving manual resistance to patients the entire day because you have no weights to work with, turning away patients because you do not have the proper tools to treat them, and working under these conditions for $150 per month. This is typical of rural rehabilitation centers in Kenya.

CareOne at Dunroven employees Nahashon Nyambasora, RN, Joann Gallardo, OTR, and myself, together with other health care professionals, had the opportunity to visit Kenya on a medical mission through Medical Relief Alliance (MRA) from July 31 to August 10. We observed health care delivery in Kenya, and our discussions with our African colleagues gave us an appreciation for both the similarities and differences in the practice of rehabilitative medicine in Kenya and in the United States.

Top Skills

Our first day in Kenya was spent at the Kenyatta National Hospital in Nairobi with our respective counterparts. This hospital is the only training center for OTs and PTs in the country. In Kenya, occupational therapists graduate with a bachelor's degree, but PTs only graduate with a three-year diploma certificate.

The rehab department is open 24 hours a day and has a total of 70 therapists. During our open forum discussion, some of the therapists asked how rehabilitation is provided in the United States and some were interested in how to obtain employment here.

The skills we observed during our visit were quite impressive. We noted that physical therapists routinely provide pulmonary physiotherapy and are able to create orthotic devices from plaster of Paris.

Occupational therapists focus on training patients to cook, plant food, fish and return to work. The primary rehab specialists treating pediatric patients with developmental delays, cerebral palsy and autism are OTs. Hydrotherapy is no longer being performed because of the high rate of infectious diseases and the lack of resources to ensure necessary sanitation. The therapists do not yet easily embrace evidence-based medicine.

PTs continue to provide electrical stimulation and infrared to treat Bell's palsy, and short-wave diathermy is preferred over ultrasound for deep tissue heating. There was a director of physical therapy and occupational therapy but no director of rehab. Physiatrists are not recognized in the Kenyan health care system.

During our meeting we provided the therapists with a list of Websites to access information for both their patients and themselves. Goniometers and tape measures were provided to the therapists. In our discussions, the therapists mentioned that they needed a tilt table and new books for their library. In the near future, we hope to provide these through the MRA.

Impact of HIV

The rural area that we visited is called the Transmara District and is located in western Kenya. Locally this consists of about 400,000 members of the Maasai tribe. Of about 70 tribes in Kenya, the Maasai are probably the most well known to non-Kenyans. They are a nomadic patriarchal society.

Historically, the Maasai measured wealth by the number of cattle a family owned (after Sept. 11, 2001, the Maasai, some of the most needy people in Africa, offered 14 head of cattle to the people of America). Women can only marry once in a lifetime, although men may have more than one wife. The practice of female genital mutilation and forced early marriage continues to terrorize young females even years after the government of Kenya outlawed these cultural practices.

These traditions have partly contributed to the high incidence of HIV in the region. Needless to say, HIV is slowly changing their way of life. HIV, primarily, has brought the average lifespan in Kenya to 45 years.

We visited many households with HIV+ widowed women and orphaned children. With the involvement of MRA, many of these women have organized support groups with the intention of eliminating the pervasive stigma of AIDS. HIV infection is still being perceived as a curse from God by many of the Maasai tribe.

MRA recently introduced the Goat Project under which families afflicted with HIV/AIDS are given four goats per household. Widowed and child-headed families are among MRA's primary targets in the program. The families are required to attend a general health education program and participate in community health promotion programs locally sponsored by MRA. Such programs include personal hygiene and health promotion, water safety and prevention of food and waterborne diseases, and the prevention of malaria.

Thankfully, through donations and government intervention, the Maasai now have access to HIV testing, counseling and treatment. The HIV medications available to them are of the older generation, which are less expensive but typically cause more side-effects.

The preventive/educational measures that are in place have decreased the HIV infection rate from 13.4 percent in 2001 to 7.3 percent in 2005. Given this, the life expectancy is slowly improving. Still, due to HIV and other infectious diseases (i.e., malaria, tuberculosis, water-borne diseases), life expectancy is much lower than in developed countries, and therefore the therapists in the Transmara region do not see many of the chronic diseases (i.e., heart disease, diabetes, Alzheimer's, stroke) that we routinely see in the U.S. Most commonly treated conditions are low-back pain, fractures and Bell's palsy.

Equipment Needs

The therapy department that we visited in the Transmara region had no equipment other than a TENS machine, treatment table and boxes used as filing cabinets. When we presented them with an ultrasound/e-stim unit, the therapists were close to tears. We also provided a clinical restorator, balance pad and therabands.

The OTs were provided with donated items such as reachers, dressing sticks and long shoehorns. The therapists were appreciative of the new equipment and supply that CareOne and MRA provided. They explained to us that this help means that patients no longer will be turned away due to lack of equipment. We also provided information on evidence-based therapy, handouts on exercise and demonstrations of the equipment we delivered.

MRA requires that hospitals and clinics receiving donated medical supplies conduct rural health outreach services such as VCT clinics (voluntary HIV counseling and testing). They also provide support for services such as the home health program.

The Maasai people were very grateful for the help and support that Medical Relief Alliance and CareOne provided. This visit provided equipment and new information, but much more is needed.

A new, centrally located medical center is scheduled to open in the next year and many needs have been identified. Some of the items requested are hospital beds, walkers, an ultra-sound machine, wheelchairs, oxygen concentrators and an ambulance. Even a motorcycle is needed so that outreach workers do not have to travel on foot to remote locations. Other equipment needs can be found at the MRA Website.

Visit the MRA Website at www.mra-africa.org to learn more about their activities and programs in Africa. If you would like to donate any equipment, money or volunteer time for this mission, please contact Nahashon Nyambasora at Nahashon@mra-africa.org or e-mail the author at jbanogon@care-one.com

Resources

Maasai from Wikipedia. Accessed August 17, 2007 at: http://www.en.wikipedia.org/wiki/Maasai.

Kenya's Life Expectancy. Accessed August 17, 2007 at: http://www.eastandard.net/archives/cm/print/news.php?articleid=544.

HIV rates in Kenya. Accessed August 17, 2007 at: http://www.eastandard.net/archives/cm/print/news.php?articleid=544.

James Banogon is director of rehabilitation services at CareOne at Dunroven, Cresskill, NJ.