WHY PALLIATIVE/HIVAIDS CARE
The effects of HIV/AIDS can not be under estimated. Years down after a lot of advocacy didn’t seem to bring desired behaviour changes towards prevention and control HIV/AIDS. With this background our approach shifted to care and support for the infected and the affected. Touching AIDS practically has born fruits. This focused on active involvement of the community who are crucial partners in winning the battle.
MAUA PRACTICAL APPROACH
- Starting at the top. Active engagement and involvement of top church leaders to solicit their support. They hold the key to opening avenues to reach the community members.
- Give Initiative time to grow. Work closely with the community which will lead to sustainability. Vertical approach of implementation results in poor support and failure of the initiative.
- Build the programme together. This encourages the community to feel that they are actively involved and valued. This results in not only moral but material support.
- Convince through Success. When community members see restored lifes of their brothers and sisters, stigma goes down and more come forward for testing.
PACKAGE OF SERVICES OFFERED
- Voluntary Counseling and Testing (VCT) Services
- Preventing Mother-to-Child Transmission of HIV (PMTCT) services for pregnant mothers
- Follow up supportive counseling services
- Pain and Symptom control
- Home visits to the very sick
- STI treatment and management
- Orphan care support
- Guardians support groups
- Widows empowerment support through Micro finance loans
- People Living With HIV/AIDS (PLWHA) support groups
- Sex Commercial workers support groups
- Kitchen Garden initiative to address nutritional component of care
- Teens with HIV support groups
- Enrollment of patients into National Hospital Insurance Fund which caters for hospitalization bills.
- Over 970 patients on ART Treatment
- Over 1300 patients are receiving supportive care
- 800 patients enrolled into NHIF scheme a big financial relief in payment of hospital admission bills.
- We have four very active community satellite clinics where services are offered weekly
- Replication of community based palliative care concept to other areas-6 more communities are waiting facilitation to start services
- Formation of Active PLWHA Support groups important in psychological support and treatment adherence.
- Stigma and discrimination is reducing towards those infected and affected.
- Donors confidence and financial support of services
- Maua has become a center of excellence in palliative care services.
- Many institutions are coming to learn our model.
- Presentation of our model of care to national and international forums and meetings
- Successful community caring programmes work where communities are actively involved and engaged.
- Resources for caring and supporting sick community members exist in the community.
- Active mobilization is all that is required Integration of services is the way to success.
- HIV/AIDS treatment support programme requires a team of active and dedicated men and women.
We Have What It Takes To Turn The World Over With Care
The first Methodist missionaries came to Kenya in 1862. A mission was opened at Meru in 1912. In the annual report of 1918 Rev. J. B. Griffin, General Superintendent of the East African District of the Methodist Church bemoaned the meagerness of the healing ministry of the Methodist Mission. He reminded the home missions committee that East Africa stations had never had a doctor appointed to them. He pointed out that missionaries were seriously aware of their limitations and they looked forward to having a doctor among them. The British Methodist Church approved building a 50-bed hospital in 1928, after obtaining a government grant of UK ?500. In 1928, Dr. H.W. Brassington was sent to open the first Methodist Hospital in Kenya at Kiegoi.
Apparently at about the same time Sam Berresford gave UK ?3,000 towards building and equipping a hospital at Maua after the building project at Kiegoi was abandoned because of poor soil quality. Another version for the reason for changing the site was that those who wanted the hospital at Maua sabotaged the project at Kiegoi by undoing at night what construction was accomplished during the day. Still another version is told that the undoing was by those in Kiegoi who did not want the hospital there. Sam Berresford’s son, Thomas had hoped to be a medical missionary but he died at the age of 22 and the money that had been set aside for his medical education was used for the construction of the Berresford Memorial Hospital at Maua.
The hospital opened on the 15th of July 1930 with two 25-bed wards one for women and one for men. There was an examination room and dispensary, two store-rooms and a kitchen. The hospital was staffed by Dr. Brassington, and nurses Tate and Brassington (wife of Dr. Brassington). Dr. Brassington’s sister who was a nurse joined them about 6 months later. In the first half year 1,580 patients were seen, 24 of whom were inpatients. Yaws accounted for 40% of the illnesses with the rest consisting of malaria, dysentery, bronchitis, scabies, worms, constipation, a hyena bite and septic knee. Dr. Brassington wrote that “these visits mean at least 1,580 people have been brought in touch with practical Christianity”. In addition to two nurses Dr. Brassington had the help of five Kenyan "dressers".
According to a description of the early days of the hospital by Mr. Henry M’Murugu who was one of the first dressers (local Kenyan who were taught to change dressing and render patient care), and who later became a clinical officer, money was not in common use in 1934 and food could not be bought. Payment for outpatient treatment was by food, which in turn was fed to the inpatients. Eggs were often brought because most people did not like eggs. About this time the government and hospital began to insist on payment with money for payment of taxes and hospital fees. There were no toilets, patients used a bucket, which was later emptied, and the contents buried. The admission fee was 15 cents but increased to 20 cents the next year. Annual hospital income was Ksh. 1,000/=. Mr. M’Murugu started as a trainee in 1937 and served the hospital till his retirement in 1984. He was a pillar of local society.
The hospital made slow but steady progress. Dr and Mrs. H.W. Gerrard came to the hospital in 1936. Dr. Gerrard was both a minister and a doctor. There was much progress during the tenure of the Gerrards. The chapel, which today is the centerpiece of the hospital campus, was begun in 1938 and completed in 1940. Mrs. Gerrard planted the beautiful jacaranda trees that line the avenue as people enter M.M.H. The Gerrard family donated most of the funds for construction of the chapel, and the chapel was dedicated to the memory of Dr. Gerrard’s mother and father, Mr. and Mrs. T.L. Gerrard. The dedication plaque remains in the chapel to this day.
In 1940 there were over 1,000 inpatients and 31,141 outpatients who had been treated at the Berresford Memorial Hospital at Maua. In addition to the main hospital at Maua there was medical work in dispensaries situated at strategic geographic locations.
Dr. Stanley Bell and his wife Margaret succeeded the Gerrards and served from 1940 to 1950. There was much progress under the leadership of the Bells. A training programme was begun and the nursing school established in 1942. Children’s and maternity wards were added and in 1947 a TB ward was opened. The first Caesarean section was performed at the hospital in 1942.
Much of the history of the hospital from 1950 to the present is rather sketchy and readers of this account are encouraged to make additions and corrections.
In 1951 Dr. Donald Morley Gambier (Don) left the UK in 1951 with his wife Gwyneth to work at the mission hospital in Maua, Kenya. They returned to Bristol, UK in 1953. It is thought that Dr. Ware succeeded Dr Bell as Medical Superintendent in the early fifties. He was succeeded by Dr. Paul Wakelin who made a major contribution by instituting a clean water supply that helped reduce the incidence of water borne diseases. Dr. Bates served from 1957 – 1961. During his tenure village visits were began to train village women to be midwives. Sister Muriel Chalkley began as a midwife tutor in the 50s. She clearly remembers going out into the villages to encourage women to come to the hospital to deliver their babies.
Training of nurses began in 1942 with the training of “Dressers”. Dressers were Kenyans who had no professional training but who were trained on the job to change dressing and render patient care.
Dressers were upgraded to “graded nurses”. Subsequently the Enrolled Nurses and Enrolled Midwives programmes were begun. In 1977 the Enrolled Community Health Nurse programme was started, and in 1996 the Registered Community Health programme began. The school trains both female and male nurses and the school has maintained a high pass rate on the Nursing Council examination – 100% in most years. Graduates of the Nursing programme have served in all parts of Kenya and the school is proud of the contributions its graduates have made to the health of the nation. There have been a number of Principal Tutors in the School of Nursing; including Margaret Bailey, Louise Hall, Florence Mubichi. Florence Mubichi started as an Enrolled Nurse and gradually acquired more qualifications, becoming the first Kenyan Principal Tutor in Maua.
The Kenyan Methodist Church became autonomous in 1964 and at that time the name of the hospital was changed from Berresford Memorial Hospital to Maua Methodist Hospital.
In 1966 additions to the hospital expanded the bed capacity of the wards.
In 1973, Sr. Meg Bailey came to Maua after having been the only trained nurse at Ngao from 1968 to 1973. Meg was the matron at the hospital until 1975 when she went to the UK to do Health Visitor training. She returned in 1976 and started the curriculum development for Enrolled Community Health Nurse Training at Maua with Louise Hall. The Community Health Department was formed in 1977, with Sr. Meg Bailey as the Coordinator of Community Health.
She was also the Principal Tutor. Meg was assisted in setting up the Community Health Department by Mattie Tolley who joined the school of Nursing to work in the community with P.H.C. and to teach in the school of nursing. Mattie left in 1986. The community nursing and health development project involved training of community health workers and traditional birth attendants as well as nurse training. There were 80 nursing students, 3,000 deliveries in a year and in 1988 community based distribution agents for oral contraceptives were trained. Meg left Maua in 1990 to start the Methodist Church Health Project where she worked until 1999 when she left Kenya.
Sr. Janet Mwalimu was the first Kenyan to be appointed as Matron in 1977, and served till her retirement in 2003.
The 50th anniversary of the hospital was celebrated in 1980. It was noted that much had changed from the hospital’s opening in 1930 from 20 deliveries a year to almost 3000; from begging mothers to deliver in hospital to two in a bed; from one full time doctor to three, from one registered nurse to seven; from 50 beds to 130. Though much progress had been made communicable disease were still rampant especially tuberculosis, venereal disease, worms, gastroenteritis, malaria and measles which claimed the lives of many children. It was a time when there came a realization that in addition to treating diseases a much greater effort needed to be made toward prevention.
Sr. Mattie Tolley from USA was a leader in emphasizing the importance of community health and preventive medicine. She served from 1977 – 1986 during which time community nurse training and the community health department were developed. Subsequently efforts at preventive health were greatly expanded.
The TBA programme was begun to improve the care of mothers who for various reasons could not come to the hospital for prenatal care or delivery.
Dr Adrian Goede and his wife Judith worked in Zaire before coming to Maua in 1981. He was an adult generalist and she helped to develop the TB/Leprosy programme. After returning to Holland they continued to support the hospital personally as well as through Sonnevanck, which continues to assist the hospital. Sonnevanck was a major contributor to the new maternity and surgical complex, which opened in 1998. They were responsible for the building of a new Isolation ward in 2006/7.
Dr. John Harbottle from UK was Medical Superintendent from 1986-1994. He played a significant role in the work of the indigent patient fund, TB relief fund, and the development of the Mission Essential Drugs and Supplies (MEDS) organisation which is a consortium that provides drugs and supplies to mission hospitals at very favorable rates. During his tenure the X-ray department
A new administration and outpatient building was opened in 1991. This included an eye and dental unit. The Eye unit was built in memory of Dollie Leonah Patrick Scott of Louisiana USA who was the major fund-raiser
Dr. Mark Frey was instrumental in establishing the dental clinic in 1991. Funds for establishing the clinic were provided by the Methodist Church of Pasadena California who supported the efforts of Dr Frey in opening the clinic. Work in the dental clinic grew rapidly.
With the prevalence of AIDS on the increase a clinic was started in 1995. The Palliative clinic has drawn national attention and today is one of a select number of clinics where treatment is partially subsidized by the Kenyan government.
Dr. Claire Smithson came to the hospital in 1989. She has most capably performed a variety of responsibilities. She is the Medical Officer in the very effective HIV/AIDS and Palliative programme, and provided critical leadership after the tragic road accident that took the lives of Dietmar and Birgit Ziegler in October 2003.
The X Ray unit was initially built through donations from Canada following a Road traffic accident in which an anaesthetist’s friend was injured and could not be X-rayed.
Dr. Samuel Mwenda succeeded Dr. Harbottle as Medical Superintendent. Dr. Mwenda oversaw the provision of the additional equipment and instruments necessary for the new complex to be fully utilized. Donors from many areas of the developed world helped with generous contributions. Dr. Samuel Mwenda’s major contribution to M.M.H. was in developing a very strong management team. He also emphasized the need for staff development.
The hospital underwent major renovation with the opening of the multimillion modern maternity and surgical complex and reorganization of the inpatient and outpatient facilities in 1998. The Presiding Bishop of the Methodist Church in Kenya, Prof Zablon Nthamburi, officially inaugurated the new complex on 22nd March 1998. Funding for the new complex was aided by major contributions by EZE of Germany, Sonnevanck of Netherlands, the World Church Office of Britain and individual donors.
Opening of the new complex facilitated an increase on surgical procedures of more than 100% from the previous year. The new labour and delivery wards were dedicated to Sr. Muriel Chalkley who was dedicated to the project and remained so even after her retirement.
A trauma room was created in the outpatient department to provide room for emergency care. A diabetes and hypertension clinic was introduced in the later part of 1999.
MMH SACCO was started in July 1994 with the objective of encouraging hospital staff who are members to save wisely and borrow to invest in responsible investments.
Dr. Dietmar Ziegler joined the staff in 1998 and succeeded Dr. Mwenda as Medical Superintendent in 2000. Dr. Ziegler was instrumental in overcoming the many challenges of operating in the new surgical theatre and expanding the surgical services offered by the hospital. He made an outstanding effort to improve the collection of debts to the hospital and to operate the hospital on a sound fiscal basis. The untimely tragic death of Dr. Ziegler and his wife was an immeasurable loss to the hospital.
Over the years many volunteer work teams from developed countries have come to Maua to undertake projects that improved the effectiveness and safety of the hospital. Just to mention a few, the hospital enjoys the availability of a dependable water supply due to the efforts of a work team that brought water 1/8 mile from a mountain stream to a large holding tank on the hospital grounds. Another team some years later provided M.M.H. with two bore holes. A boundary fence was constructed by a work team to provide security for the hospital grounds. The sewage system was created by the combined efforts of several work teams. Another team installed fire hydrants. Numerous other work teams have contributed work on other projects that have enhanced the safety, appearance and capabilities of the hospital.
In 2003 the Hospital Board decided that the leadership of the hospital should no longer be a doctor.
The post of Chief Executive Officer was created so that the doctors could concentrate on medical services.