What One Person Can Do: A Video from Maseno, Kenya -- by Dr. Christiana Russ

EGR blogger Christiana Russ -- a pediatrician who splits her time between Boston and Kenya -- offers this video her brother put together to describe the work of the Mother's Union of Maseno and the deworming program that they are doing there.

It's a great story of What One Person Can Do, and the key is that when Christiana showed up in Maseno, the first thing she did was ask questions and listen. Then she looked at how she offer her gifts in partnership with the gifts of the wonderfully gifted people (in this case, the Mother's Union) who were already there. What resulted was an incredibly low-cost solution to a debilitating problem.



Dr. Christiana Russ is a pediatrician doing her residency at Boston Children's Hospital, currently working at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. She is also chair of the Executive Council Standing Commission on HIV/AIDS.

"The Bishop Masereka Medical Centre -- best practices for medical care in Uganda" -- by Dr. Christiana Russ

I have spent the past three weeks in Kasese, a town in western Uganda. I was a guest of a retired Anglican bishop Zebedee Masereka and his wife Stella. They invited me to come do some pediatric work at their health clinic – the Bishop Masereka Medical Centre, which functions under the umbrella organization called Bishop Masereka Christian Foundation.

I have a tendency to rant about the quality of health care provided in places which display a cross and are purportedly Christian. In far too many of these clinics you find poor staffing with inadequate training, insufficient supplies, too much dirt, and a level of ‘care’ that would inspire anyone but the most desperate person to stay home until knocking on death’s door scares them into seeking help. They come too late, there is little that can be done and adequate interventions at that point are very expensive. When they succumb their family and friends remember only that medical care didn’t help and cost a lot, and thus the grisly cycle continues.

At the Bishop Masereka Medical Centre (BMMC) I have seen a model of how things can be done differently. First, and perhaps most importantly, the Bishop and Stella urge their staff to treat their patients lovingly. Isn’t that, after all, how we as Christians are to be known?

The BMMC also strives to provide excellent medical care. They have hired a physician, Dr. Daniel, who recently graduated from medical school in Uganda. He pushes the staff to make decisions based on evidence. He encourages people to think of other causes of fever besides malaria. He insists on treating each patient well – so much so that when a 13 year old girl was diagnosed with TB and lost to follow up, he went into the town to find her so she could begin her treatment. The staff counselor then met with the girl’s family and community to teach them about TB. A few days later a woman came in with a ruptured ectopic pregnancy which is a surgical emergency. Dr. Daniel not only ensured that she was referred to a hospital with an operating theatre, but he also went several hours later to make sure they had done the surgery quickly and that she had stabilized. This is evidence of medical care, true care, and this is also why the number of patients at the Bishop Masereka Medical Centre is increasing rapidly.

Dr. Daniel and the Bishop are working hard to raise funds for their clinic. They hope to move out of their cramped, rented rooms and build a small hospital replete with operating theatre, full lab and radiology facilities. They are chasing down local businesspeople seeking donations and are planning to take out loans as needed. The care they provide isn’t free, but it is quality care that is worth the cost, and they have some donor funds that assist in running the clinic (such as the physician’s salary).

It is my prayer for Africa that health facilities such as the BMMC will continue to spring up in small towns like Kasese, where they are most needed. I pray additional dedicated and smart doctors, nurses, counselors and other staff will be trained well and will invest in improving the health care in these communities. When the quality of health care that is offered improves, and when it is given with love, people do come. It is astonishing and miraculous to witness the dramatic healing that can sometimes happen then.

Dr. Christiana Russ is a pediatrician doing her residency at Boston Children's Hospital, currently working at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. She is also chair of the Executive Council Standing Commission on HIV/AIDS.

"Abundance" - by Dr. Christiana Russ

These past few weeks I have been thinking a good deal about abundance. In my last blog I had written some about the culture shock of returning to the United States during the Christmas season, and the incredible and overwhelming abundance of material things that we are blessed with. Lately I have been thinking about God’s abundance instead.

We are used to working with models of scarcity. We talk a lot in development about ‘sustainability’. In the church the catch phrases such as ‘good stewardship’ might have us thinking along the same lines. I recently was talking with an HIV committee at a church group and heard the quote ‘Do what you can, with what you have, where you are.’ spoken by Theodore Roosevelt.

So that is a very good and reasonable way to approach economics – distributing scarce resources. I think the quandary faced by those of us who claim to believe in a God of abundance is that we sometimes get trapped into believing our resources are scarcer than they are.

Let me explain a bit further. I work part of each year as a pediatrician in Kenya, and one of the most frustrating problems I face is the overwhelming numbers of people who just absolutely can not afford health care for their children. The hard part is that the mission hospital is already limping along – charging minimal fees for services. Those minimal fees still amount to $10 a day for an admission plus additional fees for lab services and medications. Parents are so worried about hospital charges that they don’t bring their children in to hospital at all, or if they do bring them it is often in very late stages of illness when appropriate care is decidedly more complicated and expensive than it might have been several days prior.

Our current economic models don’t offer really great solutions to this dilemma. Insurance would perhaps give people a safety net that would bring them in sooner for care, but the national health insurance in Kenya is too expensive for most poor rural families. The only conclusion I can come to is that at least right now, while the general populace in rural western Kenya is so impoverished (we all hope that will change some day), an external source of funds needs to exist to subsidize or pay for health care. The economists among us might disagree but that was the solution I kept bumping up against.

And that idea would stick like a big lump in the back of my throat. My prayers filled with phrases such as, ‘God – I don’t have that kind of money. God – I don’t KNOW anyone with that kind of money. God -- I know I can find money for the 30 or so kids who come to the hospital each month for care now but once this plan works and more children are brought in for care, I’ll be entirely up a creek.’

God fortunately is pretty clear with me in these situations. I sent out an email asking for money for a de-worming program for our kids in Maseno. The response resulted in about five times as much money as I had hoped to raise. I wrote my initial blog describing my frustration at the lack of funds for healthcare. There were additional generous responses with funds sent to Maseno Hospital. Friends from home also offered money to be used as a sort of discretionary fund. Gradually I began to get the idea – our God is a God of abundance. He says, ‘Ask and you shall receive.’

This doesn’t mean don’t be careful with money. I do believe in good stewardship and stretching your every donated Kenyan schilling as far as it will go. But I also am learning that sometimes you have to dream a little bit bigger than you might otherwise be comfortable with. Sometimes you have to have a little faith that God is backing you up and has sent you to this work and will not abandon you.

So I continue to seek that balance between realism and sustainability and faith in God’s wonderful abundance. How else can we move towards God’s Kingdom come? Please keep Kenya in your prayers.

Dr. Christiana Russ is a pediatrician on faculty at Boston Children's Hospital. She spends half the year at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. Christiana is chair of the Executive Council Standing Commission on HIV/AIDS.

Baby Jean (or Why Fee For Service Medical Care Doesn't Work in Poor Communities).

by Dr. Christiana Russ

I work as a pediatrician at Maseno Hospital, an Anglican Mission Hospital in Maseno, Kenya. It sits high up on a hill over the university, and consists of several cream colored buildings with bright blue trim and red roofs. We have a pediatric ward, a male ward, a female ward, maternity, an operating theater, and an outpatient clinic. There is also the Comprehensive Care Center for HIV/AIDS where antiretrovirals are distributed. We have a decent pharmacy and lab, x-ray services and even an ultrasound machine.

Maseno Hospital originally was designed to have approximately 160 beds. During my tenure here, our maximum inpatient census has been approximately 25 patients. This isn't because the communities around Maseno are healthy and well – in fact HIV infection rates are estimated to be approximately 15% for men and over 20% for women aged 15-35. Of all the children born here, approximately 125 out of 1000 won't reach their first birthday and over 200 out of 1000 won't reach their 5th birthday. These numbers used to be much lower, but the HIV pandemic has devastated the young adult population taking away employers and employees and thus further impoverishing the region. HIV has also been taking away mamas and papas, leaving children behind hopefully with extended family, sometimes only older siblings to care for them. The children who die, die mostly of the same diseases that have always killed children who grow up with not enough food and unsanitary conditions. Malaria followed by pneumonia and diarrhea are the primary culprits, all of which are treatable conditions. These children do not receive care for these conditions in this particular area of the world because their families cannot pay for it.

The example of this failed system of care that sits heaviest in my heart is baby Jean – a one month old baby girl seen at Maseno Hospital outpatient clinic one Monday with fevers up to 39 ºC (102 ºF). A lab test revealed elevated white blood cell count; she was fighting an infection. Any small infant with a fever needs to be taken seriously. They often have only subtle signs of bacterial infection and can develop sepsis and die with extraordinary speed if not treated. Baby Jean's mother, however, did not have the deposit for her to be admitted to the hospital so despite the clinical officer's advice that she be admitted, she went home. She was brought back two days later in the evening with difficulty breathing, and was admitted on IV antibiotics and IV fluids.

The following morning she was dead.

This story makes me SO ANGRY. It is an affront to us as human beings that in this day and age it is still possible for a child to not receive appropriate medical care, especially when her mother sought it out. It is an affront to the Anglican church – the entire communion – that we have a cross hanging on the front gate of this hospital and that we don't fund it well enough to take adequate care of those who enter here, even the small children. It is even more damning for us that other organizations are able to find the funds to provide free or highly subsidized care, and we are still operating in a hopelessly un-Christian fee-for-service system. When people don't get basic health care because they can't pay for it, it's a travesty. It's disgusting. It wounds us all.

I am sick at heart today for the children who die due to lack of care, who die within a few miles of institutions such as this hospital which have the capacity to care for them but somehow don't. I am sick at heart for the mothers and fathers, grandparents, and siblings who bury their little ones and know this is not the way it is meant to be. This is not God's plan.

Dr. Christiana Russ is a pediatrician on faculty at Boston Children's Hospital. She is currently working (and spends half the year) at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. Christiana is chair of the Executive Council Standing Commission on HIV/AIDS.

Tomorrow: Josephine Mujawiyera