My thoughts are increasingly focused on two months from now, when I leave Kenya after spending a year here. There is so much left to do!
Hire a nurse for the expansion of treatment of HIV at Ochuna, and wherever else we need them.
Make sure all the nurses are licensed in Kenya. Some were hired a year ago and have not yet gotten their Kenya license—I think it is because it costs them money to do so, and no one has put much pressure on them thus far.
Meet with the Kenya Ministry of Health and get them to agree that we can treat all HIV positive clients on site with anti-retroviral drugs (ARVs), TB prevention, and prophylaxis of opportunistic infection. (Currently our mandate from MOH only includes treating pregnant mothers who come to us for antenatal care and are then found to be positive, their children and partners found to be positive at our site.)
Hire a “mentor mother” who will be in the well child clinic so that all our duties to the mother won’t be forgotten as we take care of the babies: moms need Vitamin A, sometimes tetanus or Rhogam, post-natal assessments at defined times after delivery, support in the areas of nutrition and breastfeeding.
Make sure somebody feels comfortable assessing the patients with high viral loads (the virus is HIV, and approximately 12.5% of our clients are infected), making sure they get counseled and re-tested if they are adhering to treatment, and switching them to another regimen if needed.
Familiarize the nurses and clinical officers with the system that exists for clinical consultations for complicated HIV cases. This is something I just became aware of in 2018, quite by chance, and I have not yet succeeded in actually getting an answer from them. I have learned how to contact them, how to submit a clinical summary, and several contact phone numbers and e-mails for the county and the national levels. We will undoubtedly need more assistance on cases beyond the two I have submitted so far.
Finish my contributions to re-writing the clinical guidelines for Kenya—a huge project which the folks back in the states are helping me with, thank goodness.
Keep my trees and flowers alive for another two months, and with any luck, figure out who will take care of them when I am gone. I hope the new Agriculture In-Charge will take them on, but she has quite a full plate with the shamba of vegetables for the children’s home, and the “public” parts of the grounds. My plants are mostly in the expat portion of the compound. I now have a small papaya tree, and lots of papaya seedlings, an avocado tree, a loquat tree, some passion fruit vines, multiple philodendrons, two mango trees (volunteers) and several shade trees, the names of which no one knows the English translations for.
The other really exciting thing is that I am having my first friends come visit me! We are going on safari to the Masaai Mara, and I am so excited.