By Dr. Kate Scannell, Syndicated Columnist
First published in print: 10/19/2014
She jabbed her walking stick into the dirt path ahead, then she pulled her body forward. Her legs, paralyzed since childhood by polio, dragged behind. Over and over, she repeated this maneuver until, finally, she had arranged the corn she hoped to sell in front of her hut. A single mother, she needed the money to send her five children to school and buy their uniforms.
That is how community health workers found this woman during their outreach rounds through rural Kenya. Due to lack of mobility, she'd been isolated from health care and confined to a small area around her home. "It took her an average of 10 minutes for every 10 feet she could move along a path," said Gail Wagner, a Bay Area physician who founded the Tiba Foundation, which funded the outreach effort. “Can you imagine that?” she asked.
Of course, it is painfully hard to do. What does one do as a witness to such unimaginable hardship?
"Well," Wagner said, "I'll tell you what we did. We arranged for her to get a hand-pedaled tricycle-wheelchair. She subsequently took out a microloan, bought onions and tomatoes, and leased a spot in the local market. She has since built a thriving vegetable stand, paid off her loan, and her children are happily attending school in pristine uniforms. She is always smiling."
It's heart-wrenching that such a seemingly minor intervention could make such a huge difference in someone's life. Improved mobility, greater access to health care, enhanced financial security and better-educated children -- all riding on three small wheels. Clearly, a paradigm of holistic, patient-centered -- and extremely cost-efficient -- health care.
This woman's story is but one of many that Wagner recounts to explain why she continues to work to improve health care for an impoverished African community nearly 10,000 miles away from Kaiser Hayward, where she works as an oncologist. "But it's actually easy to understand," she said, "once you've seen how access to good clinical care can improve peoples' lives on so many levels."
Wagner additionally points out how, in rural Kenya, the effect of relatively few health care dollars can be huge for a community and its members. Major life-saving surgery, for example, is often performed for about $50. Or, $100 can purchase a sturdy road bike that allows a community health worker to reach isolated patients in remote regions. It can pay a week's salary for a clinical officer who provides medical care to medically underserved areas that lack doctors.
For years, I had wanted to interview Wagner, having heard about her foundation's admirable work in Kenya and hoping to help spread the news. But it seemed acutely relevant in the current climate of heightened anxiety regarding Africa in general.
It felt timely to be reminded -- and heartened -- about real health care successes on the ground that are born from engagement and compassion, rather than distancing and fear.
And considering some major missteps in our global response to the Ebola crisis, it's instructive to be reminded that respect for community values is more than an ethical aspiration -- it's a nuts-and-bolts requirement for implementing any effective health care strategy.
Wagner learned this lesson well. Beginning in 2002 with a handful of antibiotics and a big vision, she partnered with Daniel Ogola, a local community organizer, hoping to establish a health care infrastructure in rural Ukwala, one of the most medically underserved areas in all of Kenya. "We thought, at first, that we should begin with a clean water system," Wagner said. "But when we spoke with members of the community, they made it clear that their priority was a medical clinic. And we listened."
So, "starting small," Wagner founded the nonprofit Tiba Foundation, which funded development of an outpatient clinic in Ukwala. "Tiba" -- an African word meaning "treatment" -- took root in that community and vigorously spread. Within a mere 12 years, it had funded a second clinic and additionally supported 27 government-run health clinics through which tens of thousands of people pass each year. It began recruiting medical volunteers, now dispatching more than 100 health care professionals annually to western Kenya and neighboring locales.
Wagner and Ogola subsequently founded the Matibabu Foundation, a Kenyan nongovernmental organization that is supported in part by U.S.-based Tiba. Together, the sister foundations celebrated the opening in 2012 of the Matibabu Foundation Hospital, the region's first community inpatient hospital for women and children. Moreover, as a visit to Tiba's website reveals (www.tibafoundation.org), they've recently launched several initiatives to keep young girls healthy and in school.
Meanwhile, the story gets even better. Last month, a new school of nursing opened in Ukwala, offering a 3 ˝-year training program approved by the Nursing Council of Kenya. An initiative of the Matibabu Foundation, the Mary Ann van Dam School of Nursing opened its doors to 40 students drawn largely from local communities. And, as Wagner noted, if you understood the social, academic, and economic challenges that most of those students had to endure to qualify for the school – well, your heart would simply break.
Wagner's stories powerfully illuminate how compassionate medical care can afford individuals and their communities a healthier chance to prosper in life. They underscore the importance of providing health care that both respects and reflects community. They demonstrate the firm link between a community's health and its economic development.
And on a deeper level, the stories remind us that big journeys often start from small beginnings, at great distances that shorten with each step taken, each forward stake of a walking stick along a common path.
Kate Scannell is a Bay Area physician and the author, most recently, of the novel "Flood Stage."
Copyright, 2014, Kate Scannell
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