We found the link!
Jambo! Today was our second clinic day and it was very busy to say the
least. It was technically our earliest start as the entire Mashavu
team left Hotel Ivory by 6:45AM. Things didn’t go exactly as according
to plans, but we ended up gathering everyone together and leaving
Ivory by 7:00AM to arrive at CYEC by 7:30AM. We spent the first hour
setting up for the clinic: we decided to setup 2 fully functioning
kiosks, have a kiosk response station, interview and focus groups, and
a doctor clinic. This mashavu clinic was different from the first one
in several ways. First, the patients that came were all university
students from a local college in Nyeri. All of the students were over
18 years of age and spoke fluent English so we did not have to worry
about having translators available at any of the stations. Besides the
demographics, the operations of the clinic was also different: instead
of having pre-mashavu interviews, we received verbal consent from the
patients and then had them come into the clinic to get their vitals
first. After receiving their vitals from the first station, they could
go to the second station where a second kiosk operator could obtain
their contact, social, and medical history. Interviews and focus groups were held afterwards to get a sense of what the students thought about Mashavu in their community. Most importantly, though,
we found the link!
Each person was assigned a specific role for the clinic. Brianna and
Bello were in charge of welcoming the patients and getting
consent/recruitment at the start of Mashavu. Julie and Steve were in
charge of kiosk 1 and Rene assisted them with acquiring the medical
history after the patients received their vitals. Similarly, Rachel
and Pat were in charge of kiosk 2 and they were assisted by Tara S.
After going through the actual clinic, most patients would go to the
interviews section which was led by Carey and Alice C. Some patients,
however, were selected to attend the focus groups which were run by
Brianna and Alice. After going to interviews and focus groups, the
patients would then go the kiosk response station which was led by
Tom. Finally, Ross and Carol were on hand if any of the patients
required additional attention.
Here is a breakdown of a typical Mashavu encounter that a patient
would have experienced today. We transported all of the patients from
the university to CYEC through a couple matatus. When the patient
arrived, Brianna and Bello greeted them and acquired informed consent.
Our education team consisting of Shengian, Alice L, and anyone else who
had some free time. Once the kiosk operators were ready, Samir and/or
Tara Y would escort the patient from the line to the clinic. Upon
entering the clinic, the patient would be greeted by our CYEC helpers.
They would first take the patient to the vitals station where the
patient first got his or her height measured. The patients would then
come back to the vitals station where the following off the shelf
devices were used: weighing scale, blood pressure cuff, thermometer,
and a shared pulse oximeter. Additionally, the two kiosks had the
Bio-E’s blood pressure cuff and pulse oximeter. The weighing scale and
the stethoscope were not operational in time for the clinic. One of the Bio-E
thermometers also ended up failing in the morning so it was removed
from the list of devices.
Once the patients received all of their vitals, they would receive a
slip of paper with their vitals and then would go to the second part
of the kiosk where their medical and social history was entered. The
slip of paper was vital because it had the biomedical device
measurements that the second kiosk operator would use to enter into
the Mashavu program. Afterward, the patients would provide their
contact information to the operator, get their picture taken, and
finally go through the social and medical history. Once all this
information was captured, the data was saved locally on the kiosk
computer and then sent over the internet to the doctors (first part of
the link complete!).
After leaving the kiosk, the patient went to a post-Mashavu interview
with either Alice Cheng or Carey. In place of a post-Mashavu
interview, groups of students were invited to participate in a focus
group with Brianna and Alice Lee to give feedback on the Mashavu
experience. During these interview and focus groups, we provided the
students with some biscuits and juice! While the patient was in the
interview or focus group, the doctors were reviewing the medical
information that was electronically sent to them. The doctors logged
into the Mashavu website and selected their respective kiosk. From
there, they could see new patients that were going through the Mashavu
clinic and could select specific patient files. All of the medical and
vital information that was collected at the kiosk was available for
them to review remotely. Once reviewing that information, they could
comment on the case on the website and that information was directly
transferred to the kiosk response station electronically (second part
of the link complete!) When patients finished the interview or focus
group, they would go to the kiosk response station where Tom would
tell the patients that comments given by the doctors. Tom received the
responses of the doctors via email directly on the Mashavu program.
Most patients that we saw today were healthy, but there were a select
few who the doctors requested to see for a more thorough checkup.
Over the course of the day, 35 people were Mashavued. The clinic
officially opened at 9:00AM but the students from the university
actually arrived at the CYEC at about 10:30 (that’s Kenyan time for
you!). We finished seeing all the patients by about 1:30PM and were
back to the Ivory by 3:00PM. The student-made biomedical devices worked well. One of the thermometers had a broken circuit, but was quickly fixed later in the evening by replacing it with a different circuit. Although the adult scale was not used, the blood pressure device, pulse oximeter and even spirometer were all used. Because all three of the commercial mercury thermometers were broken the previous day, patients had to use oral thermometers under their arm in place of the mercury thermometers. For the next clinic on Saturday, we will be sure to have enough mercury thermometers, even factoring in breakages!
After returning to Ivory Hotel, the students lounged around. Some did laundry, while others grabbed a bite to eat at the restaurant (along with Tuskers, the local beer). A local woman selling tongas, traditional African clothing, came by. Students ordered flip flops, custom tailored dresses and shirts and large scarves with bold patterns.
At 8:00 PM, we had another meeting to recap the day, sans our fearless leader, “Dr. Khanjan” (in the words of Bello). However, Dr. Butler proved valiant in leading the Mashavu team throughout the past 24+ hours while Khanjan, Jeff K and Roma were in Nairobi. They will be returning late this evening.
Tomorrow we go on SAFARI!!!
Today’s lovely post written by Samir Patel (mostly) and Alice Cheng!
