Mfangano Kageno Clinic

We set out for a 2 day clinic excursion on the island of Mfangano. I had spent most of my previous trip in 2006 on this beautiful island and it was a great return. The chief, Michael, of Mfangano North, welcomed us as we arrived. He was there in the full uniform of a chief of the islands. The clinic was cleaned and ready to see patients and yes, the sun was shining. What a beautiful day to help with the initiation of such a wonderful facility, Kageno Mfangano.

The clinic structure was complete, however, it resembles much of the clinic I remember on Rusinga from 2006. The cement walls are barren with a fresh coat of paint. The windows were in place and the grounds down to the beach were cleared so patients could pass freely too and from the clinic facility. The building does not yet have examining tables, electricity to run a proper lab, or permanent physicians or nurses to stay and run the facility.

The chief of the community announced the opening and there was such a great response. We saw over 150 patients the first day and over 50 patients the second day. Mfangano is an isolated island, and Nyakwiri beach community where the clinic is located is an even more isolated point of the island. It takes a lot just to get there, but it is much closer for many of the people who were forced to make the journey to Senna health facility some 16 KM away if need be. Many people could not make that journey and were left to succumb to illness because they were too poor to afford the 100 shilling (about 1 dollar and 20 cents) each way cost for the boat trip (the island is very mountainous and difficult to pass in certain parts, thus boating around is the best and easiest means of transportation). Thus, a facility in this location is a much needed addition to such a wonderful community.

Present at the clinic were myself, Anjali, Lillian a clinical officer (similar to a PA in the US), Grace our lab tech from Rusinga island, Nancy from Senna Health facility on Mfangano who was administering vaccinations to children and also running our limited pharmacy, and Bernard a trained VCT (volunteer counseling and testing HIV). Many people of the community helped translate and overall I would call the clinic a great success. However, when we left, we left behind a empty clinic for the time being.

We saw patients ranging in age from about 6 months to 99yrs old. Ailments common in the US were prostate issues, pneumonia, HIV, and eczema. We also saw many rarer infectious tropical diseases such as Malaria, Entamoeba Histolytica, Ascaris (roundworm), and a likely measles case. We think there may have even been a case of mumps, but being trained in the US I could not tell a case of mumps if it slapped me in the face, which it likely did on many occasions.

The pharmacy was helpful, however, we were only able to procure enough meds that we could carry. Kageno Rusinga has a well stocked pharmacy but it is funded only for the island of Rusinga and taking meds from Rusinga and bringing them to Mfangano only meant that the people of Rusinga would go without medications. It was a very difficult concept for me to grasp, but we did have to refer many to dispensaries around the island to fill various prescriptions. We did have enough treatment for Malaria, the mainstay being Cortem (artemether/lumefantrin) and Fansidar (names which I just learned here and dosages as well). We had Flagyl for parasites, and a few tabs of doxycycline for the rampant Chlamydia problem we found. I also ended up treating a lot of pneumonia with the cipro we were able to bring with from America (yes I know it is not the best respiratory fluroquinolone, but we really had no other resources).

We referred many to the district hospital on the mainland in Mbita town. This was difficult knowing most would not make it. We worked closely with the VCT counselor Bernard who was testing people for HIV and also counseling them. Overall he tested 24 people and he tells me 5 tested positive for HIV. The Nyakwiri beach community has a HIV prevalence rate of greater that 30% we are told and it is likely due to the practices of the fishermen.

Overall, the experience was one I will never forget. We were so graciously welcomed and honored. I learned so much and I cannot thank the community enough. We had the opportunity to walk down the fishing banda following clinic (the place where the catch of the day is brought prior to its loading for transport to the mainland) and speak with many patients we had just treated in the clinic. Many people would likely be hospitalized in Milwaukee, however, here they are going about their business and getting ready to go out for the nightly fishing expedition to catch OMENA the local delicacy (something that resembles minnows and dries on the beaches during the day).

The clinic structure is present, but sustaining it will be a difficult task. More fundraising is needed in order to have a full time nurse or clinical officer there to see patients daily. A functioning lab is a necessary requirement here, as we learned after many days of working in the islands. The rooms are well structured, but without exam tables. Also, a proper women’s exam room with equipment is a necessity in this community as pregnancy related issues are very common. Otoscopes and tongue depressors would be basic necessities we were lacking as many kids come in with upper respiratory infections and ear infections. Also, a functioning VCT center with a full time VCT employee present is a need that cannot go understated. Also, a person trained at administering and training patients on ARV therapy is a must as this community is so isolated.

Overall, I thank this community for welcoming us with open arms. We thank Michael, the chief for showing us such great hospitality. We thank Kageno for providing transportation  to and from the island safely and for allowing us this great opportunity. We have many great memories of this experience and I look forward to the chance of sharing them with all who care to know. We are forever grateful…          Ero Kamano Ahyina Mfangano and Kageno.