Urgent-care specialists working to bring modern medicine to Kenya.
By JUDY SIEGEL-ITZKOVICHKenya hospital 248.88(photo credit: Courtesy)
The African nation of Kenya has 37 million people compared to Israel's 7.5; covers 570,000 square kilometers compared to our 20,330; boasts a birth rate of 37 per 1,000 people (twice that of Israel); and its citizens earn an annual per capita income of only $569 compared to Israel's $26,000. But the two countries - however dissimilar - have shared friendly relations for years, despite pressure from terrorist organizations and Muslim countries.
Kenya's ambassador to Israel Felicitas Kyoumbi said the friendship predates 1963 when the country gained its independence.
"In fact, there were Jewish settlements in my country as far back as 1903, and we have a synagogue in Nairobi that is over a century old," she said.
When Golda Meir was Israel's prime minister in the early 1970s, she visited Kenya and met the country's first president Jomo Kenyatta.
"There are many things I can't mention, but we got tremendous assistance from Israel. The emphasis was put on agriculture and medicine," said the ambassador, who was a guest speaker at the annual conference on Urgent Care and Community Medicine held nearly two weeks ago in Jerusalem by TEREM, the private network of urgent medical care clinics.
For decades the Foreign Ministry's International Cooperation Department (Mashav) has sent agricultural experts to Kenya, which has benefited the country greatly, the ambassador said.
Since then, "our countries have come a long way. We also share a semi-arid climate and have too little arable land. But after seeing the Negev, I think all of Kenya's land is potentially arable. I learned you should never say that what you have is not good enough; you can make it good enough," she said.
But now, after the Kenyan ministry of health brought two veteran doctors from TEREM to tour medical facilities in five of its seven provinces, a major project to improve healthcare in the sub-Saharan African country is being planned - that is if the necessary financing comes from the World Bank and other sources.
Dr. Brendon Stewart-Freedman, a family medicine specialist at TEREM and director of its Tayalet branch in Jerusalem's Arnona neighborhood, and his colleague Dr. Deena Zimmerman, head of the urgent care clinic network's research unit, were the two doctors that made the trip to Kenya.
"We were invited to explain the urgent-care technique," said Stewart-Freedman. "We found a passionate people who have great pride in their country. We want to help Kenya computerize its health services and provide layman care where there are severe shortages of physicians."
Stewart-Freedman explained that "e-technology can solve lots of problems in sub-Saharan Africa. We believe in not being insular, and had an opportunity to help," he said, as TEREM's deputy director Dr. Nahum Kovalski is an expert in the use of Internet and other technology to improve medical services, education and communication. TEREM established a company called e-Doctorworld headed by Kovalski to further these aims.
Kenya is surrounded by Ethiopia, Sudan, Uganda, Rwanda and Somalia - all very poor. In Kenya, the life expectancy is only 56 years. It was higher, said Stewart-Freedman, when it earned statehood in 1963, but then the AIDS epidemic struck. Now 6.7 percent of the population are HIV carriers or have full-blown AIDS (compared to 0.1% in Israel). About 150,000 Kenyans die of AIDS each year (compared to 100 in Israel).
The country hopes to reduce child mortality by two thirds in accordance with the UN declaration on that subject in 2000, improve maternal health and combat AIDS and malaria. "But many Kenyans use water from polluted Lake Victoria and don't sterilize it," said Stewart-Freedman. "In Israel, there is one doctor per 500 inhabitants; in Kenya it's one per 12,500. Most of those are concentrated in the larger cities, so the majority of the population have almost no ready access to a physician. If someone has tuberculosis, AIDS or malaria, the likelihood of getting medical care is low." MANY ROADS outside Nairobi the capital are not paved, although some Israeli contractors are currently working on paving projects there. Unpaved roads wash away during the rainy season, so it's hard for sick people to get to hospitals and doctors. Livestock often have the right of way, said Brendon-Stewart, who was driven around the country with Zimmerman.
"So digital teaching and technology would be the best way to get medicine to the public," he continued. Even though only 0.7% of Kenyans have a land-line phone, 30% have cellular phones, and many have third-generation models. Meanwhile, just 8% use the Internet.
TEREM's first and main branch, in Jerusalem's Romema quarter, is able to use advanced computer communications with its peripheral branches in Arnona, Modi'in and Beit Shemesh, where doctors who are not orthopedists can consult with orthopedists in the main branch. X-rays can be sent instantaneously from one branch to another. Such technology could be used in Kenya, said Stewart-Freedman. E-protocols and "computer wizards" can be used by trained laymen to fill out computerized questionnaires on cellphones to describe symptoms and suggest treatments. If it cannot be dealt with by the layman, he or she can consult by cellphone or computer with a physician far away. Antibiotics could be given even without seeing a doctor if the protocols are followed. Even though this is not an ideal way of practicing medicine, it is preferable to the existing situation in Kenya, said Stewart-Freedman.
Zimmerman said the Kenyan health system includes government, private and church-based facilities. The local dispensary is the grass-roots level of medical care, rising to higher-level clinics and district and provincial hospitals and tertiary or referral hospitals. "Hospital staffers told us about problems of documentation. Often, nothing about a patient has been written down. At one 400-bed hospital they visited, the director was only 16 months out of medical school and his deputy had graduated only eight months before." The Ahero subdistrict hospital had many malaria patients with mosquito nets hanging over their beds. "They had handwritten records of antenatal care and vaccinations," Zimmerman recalled. At the Nyanza Provincial Hospital, there were clinical officers who were just high-school graduates but gave care while consulting with doctors in complicated cases.
Those patients physically able to reach hospital often go there even though they have only a minor problem. "The hospitals are thus inundated," added Stewart-Freedman. "They can learn from us - automated protocols could revolutionize medical care there. But we can also learn from them - the Kenyans are very good at waiting in line," the TEREM doctor said with a smile. As gifts to senior staffers of medical facilities, Zimmerman and Stewart-Freedman brought framed copies of the physicians' oath reputedly written by Maimmonides. "They have humble attitudes to healing," said Stewart-Freedman.
"I am very grateful for what you did for us," the Kenyan ambassador said. "Kenyans are a very friendly people and love Israelis. When they know you are Israeli, they want to welcome you." The twoTerem physicians "really do have a good understanding of our healthcare system," the ambassador noted. "My government takes seriously its responsibility to provide a high quality of life for all its citizens. It aims to become a middle-income country by 2030." The health sector comprises 8% of total government spending, but as Kenya's population is young and growing, this puts a strain on the government, she said. "We have some very good doctors, but many of them have emigrated to other countries." Malaria is the most common disease, followed by pneumonia and AIDS, said the ambassador. Most hospital beds are filled with AIDS victims, so those with other problems have nowhere to go. "Many people are small-scale farmers living thousands of miles from major cities. Few sick people have someone to host them, so they spend nights in the hospital corridors." Yet the ambassador said: "We believe we are on right track. Private health care is encouraged. Nairobi hospitals take in patients from all over Africa and other places. There are private clinics, some belonging to faith-based organizations, but their fees are exorbitant. There is a shortage of medical supplies, and this can disrupt operation schedules. But my government recognizes the importance of health in reducing poverty and promoting development." The government of Kenya has even created two separate ministries, one for providing and supervising medical services and a new second ministry of public health and sanitation. "It is perhaps too much for a single ministry to handle," suggested Kyoumbi.
"We know we are not doing so well, but we can learn a lot from our friends. We have a special tripartite project with money from the government of Kenya, a Galilee college in Israel and USAID that has trained 100 doctors and medical managers," said the ambassador. "It has been very successful, with some training done in Israel. It has been going on for a year, and we are signing more protocols to expand it. We believe that what Israel has is God-given, and if we can get a bit of it, we will be blessed." One of the first countries to send medicines and supplies to assist injured in Kenya when there was a political fracas earlier this year was Israel. "We have not forgotten. We've had terrorists come at us to test our relationship, but they didn't weaken it. Israel rose to offer expertise and support. We are very grateful." The ambassador, dressed in floor-length traditional robes, concluded: "Thank you for the sacrifices you make for the good of humanity. He who has health has hope, and he who has hope has everything."
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