The Lwala Village Development Committee (LVDC) has been in place since 2005 to organize the construction and operation of the clinic.  The 21 members were picked by their clans as representatives, and did a great job of liasing with the community and providing leadership to the project.

As the clinic began operating, and the size and complexity of the project increased, the needs for community oversight and leadership have changed.  To keep pace with these changes, the LCA board, executive director, founders, and LVDC executive committee redesigned a smaller, more skills-based LVDC to meet these needs.  The new committee will meet monthly to evaluate financial and operational reports from the clinic manager and accountant, and to provide assistance as needed to the clinic staff.

The new committee is comprised of 11 members, including representation from men, women, youth, people living with AIDS, the Church, and each of the 7 clans in the area.  It includes people with management experience, financial expertise, and other critical skills.  The new committee met for an orientation meeting last week, which included discussion of expectations and a detailed examination of the updated committee bylaws.

Our hope is that this updated committee will be able to more effectively provide leadership, assist the staff, and ensure financial accountability.  Welcome to the new members!

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The clinic opened on April 2nd, 2007, and our one year anniversary did not go unnoticed! We organized a big celebration for the staff, the land donors, the Lwala VIllage Development Committee (LVDC), and the community. In fact it was a very big celebration, we even slaughtered a cow!

It was a great opportunity to celebrate, and we also took the opportunity to honor the original LVDC. This committee, which was elected to represent each of the clans in the area to the project, has worked hard for 3 years to make the clinic a reality. Each member received a clock and a certificate for their work.

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We’re happy to announce the employment of a new clinical officer at the Lwala Community Health Center, John Badia. John is from Kisumu, and completed his training there, first at Kenya Medical Training College (KMTC), and then through an internship at Nyanza Provincial Hospital. Afterwards he worked at the Patient Support Center, a special clinic for people with HIV/AIDS run by the CDC and PEPFAR in Kisumu.

A clinical officer (CO) has a level of training roughly equivalent to that of a physician’s assistant. In Africa they train COs because nearly all of the doctors they train leave for greener pastures. COs are trained in symptomatic management, which means they’re trained to identify clusters of symptoms and apply decision making guidelines based on those symptoms. They do not have the extensive scientific background that physicians do, but in resource limited settings a CO can be a cost effective way of getting a lot of people treated for basic diseases. The standardization of treatments assures that the most common diseases are treated effectively, even if some of the more rare diseases are missed. In Kenya only the big city hospitals have doctors, and even there they’re in short supply. In the smaller towns and rural centers, COs are the highest level of clinical staff.

In Lwala John will lead our clinical staff of 3 nurses, a nurse’s aid, a pharmacist and a lab technician.

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There has been a developing interest lately in the issue of sanitary pads for girls in Africa. The interest stems from the fact that many girls drop out of primary school when they get their period, because there are no toilet facilities at school and they don’t have access to sanitary pads. This is certainly true in Lwala. But in digging deeper we found the picture to be still darker; boys are offering to buy the girls pads in exchange for sex.

This is one manifestation of a widespread problem that public health types blithely call “transactional sex.” In settings of extreme poverty and gender inequality, sex is one of the few forms of capital available to women. But the stakes are high. For the girls, and for the boys as well, the risk of getting HIV and other STIs is huge. Though we don’t know the prevalence of HIV in Lwala for sure, we estimate it may be as high as 30% based on the data we have from Lwala and the surrounding areas. And youth ages 14-24 are often at significantly higher risk than other age groups. And of course for the girls, there’s the unintended risk of ending the problem of menstruation, however temporarily, by getting pregnant.

We wanted to address this issue of injustice at Lwala Primary School. However, we don’t feel that the wholesale importation of pads and tampons from American firms, which is in vogue right now, is either sustainable or environmentally friendly. So we partnered with a new non-profit in the states called Goods4Girls, which provides reusable fabric sanitary pads for girls in settings of poverty. In fact, we’re their very first implementing partner! Thanks to the coordination of Caitlin Reiner, the LCA education committee chair, and Deanna Duke, the founder of Goods4Girls, I was able to carry over a suitcase full of reusable pads sewn by women in the U.S.

On Thursday we took advantage of the opportunity afforded by the pads to do a sex ed and hygiene training day at Lwala Primary. We began with a lively participatory discussion with all the children from 4th through 8th grade, led by the clinic’s lab technician Michael Ondiek, with help from our new CO John Badia and other clinic staff members, about puberty and changing bodies, HIV/AIDS, and other STIs. Milton Ochieng’ gave out biscuits to kids who answered or asked questions, which made thing really lively. After about 2 hours of this (kids in Lwala have very long attention spans!) we split up into boys and girls. The boys wrote down their questions and put them into a special “anonymous question hat.” Then John and the other male clinic staff members and the male teachers led them in dialogue, role play, and even a little slam poetry. You could hear the laugter a mile away! At the end, since they didn’t receive any pads, they received two soccer balls donated by Eleuthero of Portland, Maine.

The girls gathered together with the female teachers and nurses Rose Adhiambo and Vine Adoyo to learn more about menstruation and how to use and wash the pads. There was some good laughter there too. 47 girls received kits, each of which included 4 or 5 pads and a carrying case. The girls who haven’t yet started menstruating each received a pencil, which made them very happy. We left 21 kits at the school for the teachers to give to girls as they come of age.

The school principal, Madam Damaris, was delighted. She deals with so many challenges in getting the girls through school safely, and this is one huge challenge met. In fact several of the teachers told us that even they learned some new things! One of them told Milton, “Even when you think you know it all, there are new things to learn.” Already the teachers are talking about inviting the clinic staff back for another sex ed day, and the clinic staff are encouraging the teachers to form a school health club.

Thank you Goods4Girls!

Erokamano Gige Nyiri!

I’ll let the girls thank you themselves, in English and in DhoLuo. Just click on the links to see the videos. In DhoLuo, “thank you goods for girls” is “erokamano gige nyiri.” On behalf of the LCA and Lwala Primary School, I’d like to express my appreciation to Goods4Girls, Deanna, Caitlin, and all those who donated pads to Goods4Girls. This will make a great difference in the life and education of the girls of Lwala. THANK YOU!

We’ve already heard from several people interested in getting involved. One way you can help is by sewing pads for Goods4Girls to distribute in other communities. Information about that is available at their website. Another way you can help is by donating to the LCA’s microfinance fund. We’re hoping to start a sewing business in Lwala so that women can make reusable pads right here in the village and sell them to other schools and villages, and maybe even some of the international NGOs providing disposable pads. All we need is a small building, a few treadle sewing machines, and some materials to get started. Thanks!

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Kids hopping out of the back

In front of the clinic

Polishing the windows

Milton and I arrived in Nairobi on Thursday evening. Unbeknownst to us, until we saw one another leaving the plane, we were on the same flight from Heathrow. We spent Friday in Nairobi, taking care of a few meetings, and then caught the 6am shuttle from Nairobi to Kisii, the second nearest town to Lwala, though about the nearest hardly deserves the name. After an hour or so in the shade, Moi, Betha, and Michael picked us up in the new clinic ambulance! It’s an old but very rugged Toyota Landcruiser, which we will modify to fit a stretcher in the back. For Lwala, we weren’t looking for a fancy ambulance with life support equipment. We just needed a vehicle that could negotiate the “road” in all weather. This should do the trick. Having capable transportation means we can get people to Tabaka hospital, about 25km away, in an emergency. In the past we would call vehicles from town to come provide transport, but in rain or darkness they would refuse to come, which tells you something about the road. Now that we have reliable transportation, we’re more confident about establishing maternity services at the clinic. The ambulance has already taken several emergent cases to Tabaka. “It’s already saved lives!” Milton says. On behalf of the LCA, let me give a huge thank you to Martina Fuchs and Ian Swan at the Real Medicine Foundation for donating the funds for the new clinic ambulance!

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The installation of running water at the clinic is underway! The clinic was built with running water in mind, so all the piping has been in place. All we needed was a sufficient source of water and a pump to get the water into an elevated tank to provide pressure. However, getting a good source has been a major challenge!
Blood:Water Mission generously donated the funds for us to drill a well at the clinic. Unfortunately, the first hole we drilled was dry. The second hole has sufficient yield for household use, but not enough to install a submersible pump as we had hoped. That well, which is about 200 meters downhill from the clinic, is used by the neighboring families. We also use it at the clinic, particularly during the dry seasons, when we have women carry the water bucket by bucket up the hill to fill the tank. This is a very labor-intensive solution, so when it’s raining we rely on a short section of gutter to fill the same tank.

After further consultation with Blood:Water Mission and several site visits to other clinics and hospitals in the region, we decided to install a large rainwater catchment system with enough capacity to tide us over during the dry seasons. We will gutter the entire clinic, install a below ground storage tank, and install an elevated tank. Water will flow from the gutters into the below ground tank, then will be pumped to the elevated tank using a small pump run on our existing solar power system, and then flow from the elevated tank into the clinic. You can see things are well underway!

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Undoubtedly you’ve heard about the violence in Kenya following the presidential elections. The violence did affect the clinic, though perhaps not in the way you’d imagine. Lwala was peaceful, and for precisely that reason many patients who would otherwise have gone elsewhere walked great distances to get healthcare in Lwala. (more…)

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The first public showing of the Sons of Lwala documentary is coming right up! The Tennessee Performing Arts Center will host a preview of the documentary on Thursday, March 27th at 7:30 pm in Nashville, Tennessee. It promises to be quite an event, with honored guests Senator Bill Frist and Milton and Fred Ochieng’. The band multi-platinum Grammy winning band Jars of Clay wrote some original music for the documentary, and they will play live at the preview event. (more…)

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In Hanover, NH on March 1st, the students of Dartmouth Medical School honored Lwala with the second annual Dance for a Dream. The event, held at Collis Commonground, included performances by a host of student dance troupes, including the Gumboots, Sheba, and of course the Dartmouth Medical School dance troupe! In between acts, Milton and Fred Ochieng’ gave a presentation about the Lwala health center. They included a long ranging story that began years ago with the death of a laboring woman in a wheelbarrow on the way to the hospital, and ended this past December with the safe delivery of her granddaughter at the clinic, in spite of a breach presentation. (more…)

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