WALK THE TALK

 

2010 was a phenomenon year; first and foremost in my personal life and in my professional work as a medical doctor. I have gone through a transformation, one that changed my perspective to providing health care for the Kenyan public. I am based at a peripheral district hospital in Kenya, serving a large local catchment. I remember my first night on call, having to make decisions on delivery of babies and care of mothers. I was challenged by the huge responsibility, especially by the fact of not having a back up doctor to execute my decisions.

I remember sitting through the HIV pediatric clinic with my consultant in medical schools. I have vivid memories evoked by that first HIV positive adolescent I attended to. It was an oxymoron, a feeling of pity at looking at the ‘doomed’ child’s future and one of admiration at how much living experienced. This mixed feeling is something that I carried throughout my medical training. I still remember how angry I was when a couple brought in their HIV positive child for treatment, having had other 4 children living with the virus. I sought to understand what their motivation was and how much more cruel they could get to wish for more children.

With the advent of HAART (highly active antiretroviral therapy), having children that are HIV negative is a reality. More interventions have been addressed towards reducing mother to child transmission, and effective family planning remains a huge pillar in the preventive efforts. I must admit Family planning techniques was one of the easiest topics I studied in school. An old proverb goes “It is easier said than done”, and providing advice on effective family planning is advice I easily dispense.

Having a stable partner was the turning point for my assumptions. I could see how crazy I was in love…still am! In my relationship family planning was a challenge, and that desire to have a child; that no one should be denied of the feeling if they wish to have children. I had a large debate with myself on whether to ask my partner for a HIV test, and was relieved to do so finally. I am now a mum to an 8 year old, with a loving and caring partner; and the talk of having a little “IT” because we cannot agree if it is a girl or a boy. I experience those maternal instincts and realize how important family is.

So 2010 is the year I fell in love, and that changed it all. I am much gentler in caring for mothers. In my practice it has been about optimizing care for mothers and their HIV children as well as their unborn children. Prevention of transmission of the virus, effective contraception for HIV positive couples, and provision of a safe delivery space for mothers are all the more real in my work.

My attitude has changed. I am not 50-50 any more. I must admit it has not been easy, I occasionally do get upset with the loss to follow-up or problems with adherence but overall I am able to deliver care that ensures minimal chances of HIV transmission. For the HIV positive children I make effort to provide primary care, ensuring wellness of the child before disease sets in. This has made me more of a proactive person, testing all my patients and starting them on care. One year later it is about enjoying my work, and sharing the happy not ‘doomed’ lives of my young HIV positive patients living positively day by day!

 

if you enjoyed reading this please vote for me here....

http://icare.rnw.nl/index.php?userpick=discussion&post=63&vote=true&a...

 

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KENYA ICT BOARD GRANT

I am a big fan of research, obsessed by technology and community work, and hence when i learnt about the concept of ICT for development, i jumped into the bandwagon of joining the forum

I was glad to write an article on the Kenya ICT board grant..and you can have a read here...

 

http://www.ictworks.org/news/2010/07/16/what-kenya-ict-board-content-grants-m...

 

leave a comment on what you think

 

 

 

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DIARY OF A MEDICAL INTERN- FIRST POSTING

It is exactly  a month since I changed internship places…well maybe with a  first definition of internship- This is the compulsory working year every doctor undertakes after graduating from medical  school so as to get a permanent licence to practise in Kenya. On a  different note/definition, this is the time you are at the bottom of the food chain..the lowest being that is to be used by everyone.

I did think I would be blogging on my experience every day (only to keep me sane), but between moving to a new house(happens not to be too easy), and starting with an obstetrics rotation well time had become a rarity. I am working at a district hospital near the Nairobi capital,which is quite a change from my initial posting to the national referral hospital. I would not say the welcome was ambient, but given the one month I have been around people are welcoming and always ready to help.

My rotation in maternity/obstetrics/gynecology has been quite a difference from what I anticipated. Despite a lot of effort to enjoy the subject area, it has been one of my failures of medical school in terms of interest.However with no option left I must say I am glad to get over with the rotation(in 1 month hopefully)….

On the rotation..my approach was to set up learning objectives.i kinda like not to get overwhelmed and hence planning my work this way helps. I must admit that this center has a lot to offer in terms of learning..i have gained experience that cannot be fit within the one month. Moreso it has been an opportunity to reaffirm to myself that I am still interested in medicine, and that I still get that undescribable feeling when caring for patients..

My biggest challenge has been getting too personal with the mothers. I have delivered very many, but there is the occasional mishap and that has put me down. I attempt to rationalise my feelings to probably the ever nagging thought of having a family of my own soon. Back to work though……Well her name we will say patient X, a primigravida(1st pregnancy) came in labour. Unfortunately she did not progress well and when I reviewed her and prescribed for an emergency ceaserian section she started crying. It is an unfortunate nature of rudeness in the labour ward(I am catching on this bad habit) but I did promise the patient that we would do all we could. Well in the next 30 or so minutes the baby was dead, and the mother had a ceaserian wound to heal….and that was the first time I lost a baby(medically called a fresh still birth). Well with a  spoiled mood I still believe I did everything I could for her but well I am learning you cannot be god …even if everyone around you expects you to be…..!!

On my last miscellaneous rambling is patient Z, who has had 2 pregnancies but with no living child. She explained that her last pregnancy the baby died at 37 weeks and so she wanted me to check on her status. What comes to mind is diabetes in pregnancy, I took the initiative to do a  random blood sugar that was at 10 mmol/dl…not diabetes in itself but a point of impaired glucose tolerance. I was not able to perform an oral glucose tolerance test. Anyway the patient did get discharged but came a day later with an intrauterine fetal demise. I was so moved and no amount of comforting would make her feel better, as explained in her words that ” doctor..the whole village will keep saying I am the woman that only delivers dead babies……” During a thanksgiving mass after my graduation, the only words I seem to remember from the sermon are “You will show how greatful you are to God through the love that you will show your patients” I am a little confused as to what this exactly means, but  I did promise myself to help my patient and friend, patient Z to safely get a live baby as soon as we could.

Well despite writing more on the negative side, there have been great moments, numerous babies that I saved because of timely intervention. I am excited that I am performing the ceaserian sections on my own, I am comfortable managing the floor.. despite the fact that I have managed to do little reading this rotation. Apart from work I guess I miss hanging out and doing techy stuff with myself, but I got a probook hp laptop and that should count for something i think.

In the next month I plan to work more on my surgical skills, performing explorative laparatomies for ectopic pregnancies, tubal ligations  and more ceaserian sections. On areas of health care improvement would mainly be in the area of PMTCT, it makes the AMPATH center look like it exists in a developed country. Seeing patients not on HAART, Ceaserian sections as the mode of choice for delivering HIV positive women and single dose regimens is a pity because of the low success rates for these interventions.

July has been quite a cold month here, but I am hoping to meet new friends to add cheer…..i have one in mind though that I would probably want for more than friends(naughty wink)!!!

Till my next psoting then its au revoir/ kwaheri/ bye bye…..

 

 

 

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FURAHI DAY a.k.a NEWS-VENDING FRIDAY

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I woke up as usual today, had to fetch some water and clean utensils
before leaving for work. It has been a busy day for me, I totally
forgot about the CNHR midterm evaluation report, I had tons of work to
print and scan and email and I was kept busy all day. I am working on
a borrowed desktop so it’s taking me some time to customize my needs
and softwares (means I have not done any useful coding over the last
week or so).
I have missed 3 days of my French class but I was glad I did not miss
anything much. I wa excited to spend time with a friend today….passed
by the Debonairs Pizza place for the Friday offer, then to Jazz bar
then home.

Well that will be my highlight of the day, plus having spent an hour
my day as a newspaper vendor. I did enjoy winking back at the drivers
and all people that passed by (and I am good at winking..the hello
type) and the small talk that I made…on politics, ; including
answering a question whether the police salaries have been raised. I
was humbled anyway and rained on for a while!

Well I have 2 hours to midnight and I must send in an application for
the AMFAR fellowship in HIV/AIDS. This goes to plan B….but for the
weekend I will be revising for my interview.!!! Happy May Day and
Labor day!!!!

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Wednes(day) 27th april 2010..I am a member ..and its YES to the constitution!

I woke up today morning in a mood of being a responsible citizen

i just found out the voter registration site is like 200 meters away and took a morning walk before heading to work.

On my view of the  constitution it is a pity that abortion is not legal and my two cents being....we are not legalising abortion because many women are doing it!! We are legalising it so that should a woman decide to have an abortion that they have access to safe and quality services.

Well gotta show off my thumb mark and the card it self!!!


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MOBILE APPLICATIONS LAB FOCUS GROUP DISCUSSION

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DATE: 27TH APRIL 2010

ORGANISER: WORLD BANK

CO-ORGANISERS: NOKIA RESEARCH LAB, GOVERNMENT OF FINLAND AND INFODEV

VENUE: I –HUB

BRIEF INTRODUCTION BY WORLD BANK REPRESENTATIVE…In a Nutshell!!!

The concept of a mobile applications lab is one for Africa that borrows from the business model in South Africa that utilizes a triple helix approach to bring entrepreneurs into the market. This is important because the growth of mobile phone use in Kenya and Africa at large has been enormous and is here to stay….

The World Bank is interested in this project because

1.       Africa would be the first to be served from the resulting applications therefore Africa would be the pioneer rather than a follower; and this has been shown to have better impact as is the case for the mobile money transfer service.

2.       This has the potential to create wealth= creating development

3.       There are areas like agriculture where the World Bank is involved and would like to encourage social innovation.

Of course there is always the example of the success of mpesa…

SPEECH FROM KINGORI of NRC

Nokia is driven to support innovation,…and has market penetration of 60% and in some places its 90% and this is such an opportunity. There are no funds from Nokia but the already developed curriculum/training with MIT and Nokia certifications are resources they would like to see at the lab

SPEECH FROM ANDREW L (KENYA ICT BOARD)

Kenya has just launched an incubator project to be held at the Sameer park on Mombasa road and this could be an area where one mobile applications lab could be hosted.

We need to address the issue of who is our target audience….at the moment looks like it will be students hence the lab should be accessible and affordable!. Thus the CBD of Nairobi is also an alternative host.

If you live outside Nairobi, now worries, the aim of starting out in Nairobi is because it makes sense to do so. But the plan is to move to other places.

Of importance to the government is the content of applications that we develop. The aim should be to set standards of practice with applications that can be replicated elsewhere.

He encouraged a need for more” i-hubs”…with a need for a road map on an appropriate plan.

NICK FROM EMOBILIS ( A MOBILE TRANING CENTRE IN WESTLANDS)

With over 1 year in the market, Emobilis was started as a private company that sort to address challenges to the gap that existed in mobile training. They have an incubation program for successful applications for the students, and their competitive advantage is that they already have established curriculum offered for 3 months.

There were 3 main areas of discussion

The first 2 topics sort of merged together in the discussion and hence I will put the main points as such.

 

1st topic: HOW CAN THE MOBILE APPLICATIONS LAB ENCOURAGE INNOVATION?

Subthemes

1.      What is a mobile application lab and how would it respond to Africa’s needs?

2.      How would the lab serve to encourage innovation and business startups

3.      Could the lab serve as a business incubator

4.      What types of services and functions should the lab provide?

Topic 2: Which application will most likely succeed?

SubThemes:

1.      What are existing initiatives to encourage innovation in this field?

2.      What are the critical areas for capacity building?

Responses

Jessica of I-hub suggested use of mobile boot camps and competitions that focus on a certain theme…the last competition held this year focused on using mobile technology to foster local content.

A different view is to focus on developing applications and after which we move to the next level…which is incubation ; and this can be looked at as a ‘super application’

It was identified that we need to define Africa’s needs….which mainly at present focus on access to information and services. After this we can respond to these needs.

There is need for a social definition of Africa..I-phones succeeded because they added value to those that utilized them..In Africa issues about education, health, social welfare and housing are crucial and form most of the social context. In a recent discussion on twitter on ICT4D: south to south collaboration between the west and east Africa, developers from Nigeria felt what was needed most was an application to deal with traffic. Mobile pay services for airport taxi would be great instead of waiting in a queue for the same.

Possible areas of application development include….

·         Insurance (‘chamas’) including pyramid schemes(the latter was on a light note)

·         Micropayments for example paying for an item that costs 40 shillings

·         M-government- this is hindered by the scarcity of information by the government that is in digital form.

·         E-learning…however the manager for ICT board noted that most users refereed to limitations of the mobile phone a channel of learning. Nokia refuted this, with an example of how the Nokia N95 is used under the Nokia education delivery program in Tanzania to support education in rural schools.

The phone has a TV screen projector which is what is utilized to show content.
The teacher makes a syllabus schedule and content is available on the phone.
Due to problems with electricity, Vodafone allows the content to be uploaded when there is power
This program has served over 1200 schools and extends to even motivate the students to be successful doctors and lawyers.

·         Saving system

·         Develop a mobile ecosystem

·         Mobile marketing/advertising

·         Debt collection….especially when you have 3 or 4 bills that you pay monthly

·         security

The issue can also be looked in 2 views. With the boom of mobile phones use, one can develop applications to address a social problem or let the market drive the applications to be developed (as there is no need to box that in). The issue then will be to undertake a comparative benefit analysis of when mobile use is better that internet use.

In an area like agriculture, language barrier is a big hindrance to use of mobile phone applications. University of Nairobi has worked on intelligence solutions and the lab should aim at utilizing these to allow for language translations.

The project should target the high costs of transactions in Africa and aim to lower these.

Issues of the regulatory framework should be tackled for success of projects.

The applications must be low bandwidth and utilize low airtime costs.

There is need for research to provide evidence to policy makers.

In the just concluded Nokia competition where most awards went to South Africa, lessons learnt include that most developers have good programming skills but no business expertise. The reason why South Africa won was mainly the applications were made by a group of developers that formed companies…..rather than individuals as was the case in Kenya.

Anyone can be an innovator…..the purpose of the lab is to lower the barrier of entry into incubation…thereby stimulate innovation from people of all walks of life.

The focus should be on developing applications for the local market for example…..if there are 1 million people in Kibera and you make an application used by 10% of the population ie 100 000 people. If you make 1 shilling a day then you make Kshs 100 000 per day and 3 million in a month… all the while doing social good and generating income. Rather than develop applications for android or i-phones….developers should focus on low revenue- high volume groups of persons.

Topic 3: What form should the mobile lab take?

Subthemes

1.      Should it be local or networked….

it should be networked.

2.      Should it be physical or virtual- Physical is better so as to earn revenue. An overlap may exist when one wants to connect virtually to another developer in another part of the world.

3.      What services can be provided to ensure that the lab is self sustaining? The lab should provide more than just web applications. The business angle must however not outdo the social angle which can include outreach services to schools and universities and pro bono services.

4.      Which partners should we work with

5.      What will be the measures of success- should be tangible….for example pick a sector like farmers and assess impact we create. Also check how many applications were developed from the lab and their use.

6.      What business models are likely to work? Food for thought and long story for another day.

The lab should create incentives and aim at creating peer networks with corporate and the government.

 

FOOD FOR THOUGHT

How is it different form the NRC and is it better to focus on it as a center of excellence?

NRC is a sub contracting lab that will generate money for the university all the while encouraging innovation.

Is there a possibility of involving it in university curriculum with transfer of points

Is it better to adopt an open source approach

Role of counterfeit phones and impact on the Lab activities..

 

 


 

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TOP 10 PLACES TO VISIT IN KENYA

I am preparing for my one week visit to Sweden early June. I just got my tickets, now for the visa which is still a hustle
What i have learnt is that for the visa requirements...get everything on the list of required items else you will keep failing and retrying.
Well on the travel bug i came across this list of places to visit in kenya.

Check them out and decide on what works for you.

My vote will go to the Maasai Mara on this one......

http://www.the-top-tens.com/lists/best-places-go-kenya.asp

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OPENMRS MENTAL HEALTH MODULE

Click here to download:
mental casts.doc (2.32 MB)
(download)

My work on OpenMRS in mental Health

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GOOGLE SUMMER OF CODE APPLICATION

Click here to download:
gsoc.pdf (582 KB)
(download)

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