Marba Medical Camp

This past weekend, Penda Health took our services to a remote Masai community in a village called Marba.  We treated dozens of patients, we bonded as a team, and we were shown great hospitality by the people who welcomed us into their community.

The main road in Marba!

The main road in Marba!

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Our signboards!

Our signboards

Our reception area

Our reception area

Our outstanding translator and receptionist, Vicky!

Our outstanding translator and receptionist, Vicky!

 

Our lab

Our lab

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Evaluating and treating patients at Penda Health - Marba campus!

Evaluating and treating patients at Penda Health – Marba campus!

And last, but not least, our dinner:

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It’s not easy to move our team, equipment, and supplies to such a remote location, but we’re trying to see if there is a way we can make this a regular clinic in Marba at the community’s request!

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New data on our patient population!

We’ve completed another round of chart review, and we wanted to share some of the high-level statistics that we’ve gathered!  The following is data from more than 200 charts.Image

Kitengela Clinic
 
Female:    71%
Male:        29%
Adults:      80%
Children:  20%
 
Average Age: 25 years old
 
Acute Visits: 83%
Non-Acute Visits (Family planning, pre-natal care, well-baby, etc): 17%
 
Most Common Visit:    Urinary Tract Infection (13%)
2nd Most Common:    Abdominal Pain (11%)
3rd Most Common:     Family Planning (10%)
Umoja Clinic
Female:  73%
Male:      27%
Adults:     71%
Children: 29%
Average Age: 23 years old
Acute Visits: 61%
Non-Acute Visits (Family planning, ANC, well-baby, etc): 39%
Most Common Visit: Cancer Screening (breast and cervical cancer) (15%)
2nd Most Common: Abdominal Pain (8%)
3rd Most Common: Family Planning and Urinary Tract Infection (tie) (7% each)
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What have we learned from this?

  • The whole family likes to receive care at our clinics, but adult women are our largest group of patients.
  • While most people come to Penda Health because they have an acute illness or problem, about 1 in 3 people come to Penda Health when they are feeling well in order to get preventive care!
  • We see everything from injuries to skin rashes, but urinary tract infections and abdominal pain are our most common acute complaints.

It is really fun for us to review our charts to make sure we are providing the highest quality medical care, but also for us to step back and take stock of how we’re helping the community and where the gaps are.

Some goals we have for the future based on these findings are:

  • Increase the number of people who come in for preventive care!
  • Discuss our approach to abdominal pain as a group since this is a common and challenging complaint.
  • Continue to work on standardizing our approach to common conditions.

Feedback?  Would love to hear from you in the comments section!

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Announcing: Clinical Officer Training!

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Robert Korom, MD; Medical Director, Penda Health

We are very excited to announce Penda’s first Clinical Officer training sessions!  These sessions will offer continuing medical education (CME) credit for clinical officers who attend.

The following sessions are scheduled:

  • Monday, October 21st (9 am – 12 pm):  We will be discussing “Approach to Family Planning Counseling” and “Diagnosis and Management of Hypertension in the Outpatient Setting.”  Course instructors: Robert Korom, MD; Medical Director, Penda Health, and Darius Nyamai, Penda Health Clinical Officer.
  • Tuesday, October 29th (9 am – 12 pm):  We will be discussing “Diagnosis and Management of Type-2 Diabetes in the Outpatient Setting,” and “Abnormal Uterine Bleeding”  Course instructors:  Robert Korom, MD; Medical Director, Penda Health, and Stephanie Onguka, MD, Family Medicine Consultant.
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Beatrice Moraa, Penda Health Clinical Officer

Participants will receive a certificate of attendance and we’ll sign CME books.

And of course we’ll have tea!

Registration is limited to 10 participants per day.  Only the first 10 to sign up will be able to attend.  But don’t worry, we’ll be scheduling more training opportunities in the future!

To sign up, click here.

Hope to see you all there!

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Help Penda Health become a Rising Star in Global Health

Rising stars video image

Click this image to watch the video on the Grand Challenges website!

Penda Health already does a great job treating acute illnesses like malaria, typhoid, and respiratory infections.  We’ve invested a lot in creating the best health care experience our patients have ever had.

Now we want to take that one step further.  We recently applied for a competitive international grant that would allow us to focus more on screening and treatment of chronic diseases like high blood pressure and diabetes.  Although these diseases don’t yet get a lot of publicity in Kenya, they are projected to be the leading cause of death in Kenya by 2020!

Please click here to watch the 2 minute video explaining what we hope to do.  And please vote “thumbs up” on our video to help us achieve our vision of making Kenyans healthier!

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Safecare Conference

 

 

 

Safecare Logo

Last weekend, representatives of Penda Health attended a prestigious international conference held by Safecare in Mombasa, Kenya.  Safecare is an international organization that accredits health care facilities all over the world.  The purpose of these accrediting bodies is to have a way for the general public to know if a clinic or hospital is high quality.

Nick Safecare Pic

Our co-founder, Nicholas Sowden, gave a fantastic speech to the Safecare community and influential players in the Kenyan Ministry of Health which outlined the important role that Safecare plays in our facilities.  One of the things we’ve learned after operating health centres for nearly 2 years is that many of the things we do to ensure high quality care are invisible to our patients.  For example, patients may not always know that we dispose of our medical waste properly, or that our equipment is cleaned and sterilized in the appropriate way. Even though we think these things are really important to our patients, it sounds silly to advertise, “We dispose of our medical waste properly!”

Safecare gives us a way to advertise our high quality care to our patients, and may one day allow patients to compare clinics and hospitals based on these standards.  We were evaluated by Safecare several months ago, and we are pleased to report that we earned the highest quality rating of any hospital in East Africa on a first time assessment.  This allows us to now advertise that a 3rd party has scrutinized our clinics and our processes and gave us a strong stamp of approval!

How will this system help provide Kenyans with better health care?  We envision that one day, all clinics will have to post their Safecare quality ratings.  This will give the average person walking past the many clinics on a busy street a way to judge the quality and safety of the clinics they are choosing from, rather than basing their decision on who has the biggest sign.

Nick Dancing at Safecare Pic

Of course, after all this heavy discussion of health care quality and safety, we had to let off a little steam as well…

Thanks for the great conference Safecare and Pharmaccess!  See you next year!

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Advice from Penda’s Office Manager on How to Communicate about Assignments

Penda’s amazingly organized Office Manager, Yvonne Akinyi, recently shared with us her wisdom about how to effectively manage and communicate about projects at work. She has summarized her advice in a guest post to give some insight into the way she and the Penda team balance the many moving parts of our growing chain of medical centres. 

Yvonne Akinyi, Penda’s incredible Office Manager

Assignments are a part of everyday work. Some are in our usual schedule and others are not. Without proper planning and communication a lot can go wrong. It is therefore important to have a set of guides on how to go about handling these tasks.

  1. Have a list: This will help in organizing all your work in one place and in knowing what is done and what is still pending.
  2. Understand the assignment: When receiving an assignment from someone, it is important to know three things:
    • Priority – how important is this assignment? Can other work be done later?
    • Timing – is there a fixed deadline or due date?
    • Why you are doing the task – This is important so that you don’t make tea when they actually wanted coffee! Communication is important here. Ask questions to clarify whatever needs to get done.
  3. Confirm that the assignment is on your list: Send an email, make a quick phone call, or tell people that “I’m working on it.” Always include a date of when you expect to be finished. Check that you included any new assignments. When you have a lot going on, forgetting is easy.
  4. Communicate: Always remember to communicate when you finish an assignment or when it is going to be late. Give the person a new date for when you expect to complete it. If you don’t tell them, then they will think you just forgot!
  5. Under promise and over deliver: Never say you will finish an assignment today when it will actually take you three days to do so. Instead, if the assignment will take you two days, say you will get it done in three or four days, then deliver on the second day. WOW!!!
  6. Take tough assignments strategically: Sometimes you find that you are given another task while you are still trying to get some top priority ones done. Instead of turning the assignment straight down, do this:
    • Understand the task – maybe it is really important, and they need your help.
    • Check on your other tasks – If these tasks’ due dates are not soon, you can take it. If the due dates are soon, say No like this;
    • Explain what you are saying yes to, then say no – If you say no to this assignment it’s because you are saying yes to another.
    • Offer another solution – “I can ask someone from reception to help you out, or maybe we can do this tomorrow.”
    • Most importantly, communicate with all parties you are doing assignments for.
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Penda’s First Medical Centre is Now Profitable!

Big news! In July, Penda’s first Medical Centre hit cashflow positive. That means we’ve hit a long-time goal of ours: Delivering very high quality primary healthcare to Kenyans in a profitable fashion.

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The team in Kitengela finally did it. They earned a profit of 22,000 ksh in July. Nice work.

High Quality Care

Last year, Penda Health was evaluated by Safecare, Africa’s leading medical quality auditor, and earned the highest medical quality score in East Africa of any first time audit. Read more about Safecare here.

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Treating all types of Kenyans

99% of our patients at Penda have no health insurance. The median price for a visit at Penda is only $5 (including consultation, lab investigations, medicines and any preventative healthcare services). This compares to $35 average visit price at private sector chains (the only other quality option), $10 at “mom and pop” clinics and around $4 at “free” government clinics.

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Profitable

The Medical Centre earned 22,000 KSH in profit in July. This includes only revenue earned at the Medical Centre and includes all expenses needed to run it (all staff, rent, operations expenses, drugs, etc. etc.). It can now continue running indefinitely without any type of outside financial support.

Congratulations to the Kitengela Team

Schola, Stanley, Josephine, Hellen, Abu, Frida, Ann, Adams, Maureen and Calvin (and of course Yvonne, Cyrus, Beatrice, Kasmaba, Chege and many others) put in so much hard work and dedication to make this achievement happen. They are a truly fantastic team of people.

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What’s Next?

The Kitengela team is expecting to expand the Medical Centre soon, increase its patient numbers, quality, service offering (including ultrasound) and continue growing. Its profit and future profits will go to repay the social shareholders who invested their capital to start the clinic and then to expand and open new Medical Centres.

The wider Penda Health team is opening its 2nd Medical Centre this week, which we hope will hit cashflow positive within 6 months. The 3rd Medical Centre should open in 2013 and we hope to grow to 100 Medical Centres by 2020.

Here’s what happened this month:

Patient Volumes Keep Going Up

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As you can see, we’ve pretty consistently grown our patient volumes ever since we opened. We now average more than 30 patients a day. This makes us the 2nd busiest outpatient clinic in all of Kitengela after the government clinic.

We’re doing lots of community outreach these days

Of this, 187 of the patients were seen outside the clinic in our partnerships efforts that lead to 66,000 ksh in revenue for the month. They held 3 events this month:

  • Bouncy castle, vitamins and health education at a local school
  • Family Planning and cancer screenings at a local flower factory
  • Outreach to a nearby community in partnership with Tunza (PSI)

Preventative Healthcare Continues to Rise

We saw All-time percentages of patients accessing family planning, antenatal care, cancer screenings, well-baby visits and other preventative healthcare. We don’t know exactly what is driving these, besides that our team is working hard to make sure our members get the care they need.

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Improving our Patient-Provider Interaction is paying off!

6 months ago we realized that we needed to pivot and rethink interactions in our exam rooms.

Today the PPI program is now at full-scale implementation. We’ve trained all our providers and are now using a rubric to evaluate communication in the exam room. We also continue to polish the interaction trainings we have developed. Currently we are working with University of Nairobi medical students to create Swahili- and Kenya-specific communication resources, with an eye on filming a set of training videos to accompany Penda’s patient-provider interaction curriculum.

The results: Our patients seem more satisfied and leaving feeling more confident in their care. We’ve also seen a huge shift in the happiness of our providers, who feel more capable of making our patients happy. This has been a ground breaking-success for us.

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Antibiotic Resistance Patterns Reinforce our UTI Guideline

One of the most common illnesses we see at Penda Health is urinary tract infections in young and middle aged women. These infections are common in women around the world and can usually be treated with a short course of antibiotics as an outpatient.

In countries throughout the world, and Kenya is no exception, there is increasing antibiotic resistance in the common bacteria that cause UTI’s. In fact, strong oral antibiotics like ciprofloxacin are only about 60-70% effective anymore in UTI cases!

Penda appropriately uses nitrofurantoin as first-line UTI treatment

After reviewing the medical literature and local guidelines, we decided that an antibiotic called nitrofurantoin should be our first-line recommended treatment for outpatient UTI at Penda.

The challenge we are having is that our patients have a perception that nitrofurantoin is a “weak” antibiotic, and they request “strong” antibiotics like injections of ceftriaxone (an IV antibiotic that we usually only use in the hospital setting).

Our philosophy at Penda is to be both patient-centered and provide high-quality, evidence-based care. Antibiotic treatment is one area where those two values occasionally come into conflict with each other. As much as we try to explain in simple terms, using analogies, and taking our time, some patients still feel very strongly that they need ceftriaxone for their UTI.

Explaining antibiotic resistance to patients is challenging but essential

Explaining antibiotic resistance to patients is challenging but essential

This past Saturday, I learned some new information at the 2nd annual Infectious Disease symposium at MP Shah Hospital:

According to a study done at Aga Khan University in Nairobi, there is greater resistance to ceftriaxone than to nitrofurantoin in outpatient UTI’s in our community! This means that the injectable antibiotic is not just unnecessarily broad-spectrum, it is actually less effective than our first line treatment! This study not only confirms that our guideline is appropriate, but it reinforces the idea that appropriate use of antibiotics in the outpatient setting is critically important.

We are working hard to incorporate this into our repertoire of techniques to effectively communicate with patients about their treatment options. It is truly concerning that antibiotic resistance rates are as high as they are in Nairobi. Perhaps one of the greatest public health benefits Penda can bring to our community is appropriate antimicrobial stewardship.

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Addressing the Changing Disease Burden in Africa

recent World Bank paper is getting a lot of press in public health circles.  The report is called “The challenge of Non-Communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa,” and is a really in-depth look at the changing epidemiology in Sub-Saharan Africa.  In addition to assessing the health challenge posed by traffic injuries, it shows that while infectious diseases like HIV, TB, and malaria are still huge issues in the region, the economic growth and urbanization that is occurring is creating new health problems like high blood pressure, diabetes, and heart disease.

The report emphasizes the need for “horizontal programs” that address overall patient health, as opposed to “vertical programs” which focus on a single disease like HIV or diabetes.  We agree!  (See this New England Journal article that explains how important this is).

At Penda, we’ve been doubling down on investment in the horizontal approach to public health.  We believe in comprehensive, patient-centered primary care — not just treating HIV or providing pre-natal care, but developing relationships with our local community, understanding our patients, and building trust for the long-run.

Kudos to the World Bank for highlighting such an important issue!

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Medical Centre #2 Update: Preparing to Open!

The walls are up, the tiles are set, and the medical equipment is on its way!

Looking down the hallway in Medical Centre #2

Looking down the hallway in Medical Centre #2

It has been incredible to see the floor plans we sketched out in chalk in May transform into a bright, spacious healthcare facility. Penda Medical Centre #2, in Umoja, is spectacular. With three large exam rooms, two procedure rooms, and expanded lab, pharmacy, office, and reception spaces, we are excited about the potential to accommodate larger patient volumes and introduce new services.

The flow of the space has also been refined from Medical Centre #1’s design. The lab is located conveniently next to the washrooms so that patients can directly and discretely give samples to the lab tech. The drug-storage room is designed to make dispensing drugs easier and more efficient for providers. A medical equipment closet located between the two procedure rooms will allow Penda to share expensive resources between two rooms, streamlining procedures. These design features have been a great opportunity to apply what we have learned about how to blend patient comfort with staff convenience to improve care.

Always mindful of patient experience in the reception area, Penda has redesigned our seating to be more comfortable and extensive. To keep patients entertained and happy during their (short) wait, the reception area will boast a children’s play area, a flat screen television, and a large window overlooking Umoja.

Reception area and office door

Part of the reception area and the door to the office

The secret to acquiring all these stellar features while not going over budget? Having Penda’s prudent, multi-talented accountant, Antony, helping oversee construction and equipment purchasing. Chege and Kasamba, our operations officers, have been instrumental in pushing construction forward and ensuring that everything is done according to Penda’s high standards. Driving through Umoja with them, it seems as if they are managing a custom project at about every third shop.

Umoja health camp

Future Penda members at our Umoja health camp

While construction has been on-going, Beatrice and her growing Medical Centre #2 staff have done an incredible job building up anticipation in the community. We have had a number of very popular events at the clinic site in the past two months. This included a three-day health camp that saw over 500 patients! We predict this will translate into many new Penda members. Medical Centre #2 will open as soon as the paint dries and the official facility inspection and licensing are complete, likely by the first week of August. Watch for an announcement of the official date soon!

 

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