PCI is excited to be continuing our partnership with AMPATH and supporting their innovative work on primary healthcare. A key area of focus in this next phase will be the development of an ‘Operational Guidance’ manual: a practical guide to systems and infrastructure needed for setting up and running primary healthcare services. This will ensure that what has been learnt – and the positive impact on patient care – can be replicated elsewhere.
PCI team member, Dr David Mazza, recently met up with some of the clinical team and patients that make up the innovative Family Medicine clinic at the rural Milo Health Centre, which this new toolkit is being based on.
“On the eighteen km journey along a rutted dirt road from Webuye County Hospital in Bungoma County, Kenya, to Milo Health Centre, we pass many farmers preparing their small plots for planting when the rains come. Children wave as they walk to school. The only other vehicle on the track is an occasional motorbike. As we travel, Dr Akiruga, from the faculty of the Moi University Family Medicine training programme explains why he set up the innovative Family Medicine Clinic at Milo Health Centre.
“People in the rural community living with hypertension and diabetes could not afford the cost of transport for repeated clinic visits at Webuye Hospital. Nor could they spare the time away from their farms. By establishing a family medicine clinic at Milo Health centre, those most in need can access holistic Family Medicine and benefit from continuity of care.”
Local health worker teams leading the way
When we arrive at Milo Health Centre, Dr Akiruga and the attending Family Medicine Registrar, Dr Hussein, greet the patients who are already waiting for the clinic with handshakes and warm words. The clinic is also linked to a microfinance group where group care is provided monthly. There is clearly good rapport between patients and clinicians. Robert Sirengo, a Clinical Officer well known in the local community is also on hand and runs a chronic disease clinic in parallel with the Family Medicine doctors.
Clinical Officers undergo a two-year training programme and function as independent practitioners. Robert grew up near to Milo. His understanding of the community and use of the local language as well as his dynamic personality and determination to provide high quality health care have resulted in him becoming well respected in the community and a key part of the healthcare team.
As the clinic gets underway, Dr Akiruga and Dr Hussein benefit from Robert’s local knowledge about patients, and Robert learns from the clinical experience of the Family Medicine doctors. There is an impressive atmosphere of mutual respect and support. As we sit observing the consultations taking place, it is clear that the patients are also benefiting from the team approach. A patient attending the clinic with diabetes appears to have poor control. Instead of simply increasing the dose of medication he is on, the doctor asks Robert to talk to the patient. Because of the strength of their relationship, the patient can explain to Robert that he has not been collecting his medication regularly. The importance of compliance is then discussed. In other settings, a patient in a similar situation would have ended up with a prescription for yet more medication which they would have been unlikely to afford.
Seeing the impact
There is early evidence that the Milo Family Medicine clinic, by bringing Family Medicine into a poor, rural community, is providing a service which patients with hypertension and diabetes are keen to use. Retention in care, always a challenge in this kind of setting, is much higher than at the clinic in Webuye Hospital, and blood pressure and blood sugar control is improving.
As part of our Healthcare Innovation Programme, PCI is very pleased to be supporting AMPATH as it seeks to learn from the successes of the Milo Health Centre Family Medicine clinic by creating the Operational Guidance manual. Once developed, this manual will be used to help establish a similarly effective clinic at Webuye Hospital. There is also great interest in this project in the wider Family Medicine community in Kenya with the potential for other Family Medicine training programmes learning from the experience at Milo Health Centre.”