Local Physicians and Donors Empower Organic Health Response
On a crisp spring morning, anglers wade into the Roaring Fork River. The squawks of blue jays and sparrows overlay a peaceful soundscape until the rumble of an emergency helicopter emerges, shaking the valley walls as it descends to the community hospital.
Four thousand miles away in Kenya, the sights, but not the sounds, are familiar. From the shores of Mfangano Island, Lake Victoria’s blue waters spread southwest, bordered on one edge by distant, misty mainland mountains and on the other by a far-off Tanzanian horizon. Men and boys in brightly-painted fishing boats paddle out in search of a day’s catch. Behind them, Mfangano Island’s hillsides rise abruptly from rocky shores where maize patches, tin-roofed homes and towering trees create a tapestry of countryside colors.
But no helicopter will be breaking the morning silence here. For as much as these two communities, the Roaring Fork Valley and Mfangano Island, share in water and mountain landscape, they diverge in emergency health response.
The 26,000 people of Mfangano Island (pronounced Mm-fan-gahn-o) live in beach-side fishing communities. They lack consistent electricity, a reliable road or a “9-1-1” number. Their island is home to the world’s deadliest snake, the Black Mamba, and to parasites with extraterrestrial names like Plasmodium Falciparum and Schistomsoma Hematobium. It’s a place where rocky dirt roads rival any single track on the Western Slope and where the prevalence of HIV/AIDS is estimated at over 30 percent! It’s a place where 9-1-1 sure would be a good number to have.
A chance encounter at a bus stop led Glenwood Springs High School graduate Chas Salmen to complete his research for an Oxford masters degree in Medical Anthropology on Mfangano Island. That, in turn, laid the groundwork for an extraordinary partnership that has brought dramatic changes to emergency health services on Mfangano Island.
Thanks to loads of goodwill and support from Roaring Fork Valley residents and businesses, a partnership called Organic Health Response (OHR) was formed here, and over the past seven years, OHR and a community center known as the “Ekialo Kiona Center” have grown to include more than 3,500 members. They have supported many community-led initiatives that address local environmental, social, economic and medical challenges. OHR’s initial project was to build a solar-powered community center that provides free HIV testing and counseling, as well as free WiFi Internet access.
One of OHR’s latest projects is the new Ekialo Kiona (EK) Emergency Boat. Built from planks of “blue gum” wood bent into shape with wood-fired steam, the boat was fashioned in the traditional Suba style, using glue and thin metal strips but without power tools. While the bright colors of the Emergency Boat symbolize a local-global partnership, the boat is far more than a symbol, having served dozens of sick and injured patients.
One recent morning, Emergency Boat Captain Walter Opiyo was awakened by his cell phone. Frantic, the nurse at Mfangano Island’s only health facility made an urgent request: “Bring the emergency boat as quick as you can!”
Within minutes, Opiyo was lugging the 40 horse-power motor to the boat by wheelbarrow and pushing the boat towards an unknown trauma at Sena Beach. Behind the scenes, Peres Okinyi, a “health coordinator,” dispatched Lucy Kwala, an Ekialo Kiona “health navigator,” who rushed to meet the patient at the clinic.
As a health team assisted a stoic 72 year-old woman – we will call her “Elizabeth” – over the rocks, through waist-deep water and to the blue emergency boat, the details and urgency of her trauma began to emerge. Recently widowed, Elizabeth was tending maize when a neighbor attacked her with a machete. It was a boundary dispute – a shocking and rare act of violence among the peaceful Lake Victoria villages. Using her left arm to protect her face, Elizabeth suffered a deep laceration that severed muscle, tendons and blood vessels in her forearm. As the blood soaked through an emergency cardboard splint and gauze wrap, Opiyo and Kwala realized that Elizabeth needed more care than the meager island clinic could provide.
Calling ahead with one hand and holding a bag of IV saline with the other, Lucy Kwala arranged for Elizabeth’s care at the Mbita District Hospital, 90 minutes away on the mainland. There, a physician took an X-ray and diagnosed Elizabeth with an open fracture of the radius and ulna with vascular injury, and the urgent need for a surgical washout.
In pain but safe, Elizabeth had reached life-saving care.
Three days, one operation, and several grams of antibiotics later, Elizabeth returned to her humble Mfangano Island home. She had been a victim of violence, but also the beneficiary of a coordinated emergency care effort known as “Health Navigation.” An innovative approach for rural, under-resourced populations, it’s the latest program initiated by Organic Health Response.
Across Lake Victoria, maternal and child health is a major challenge, and one where local residents also benefit from Health Navigation. OHR has found that simply bringing pregnant women to a skilled birth attendant during delivery can prevent maternal-child transmission of HIV and address obstetric emergencies.
EK Emergency Boat Captain Walter Opiyo wrote about a recent delivery involving a 15 year-old girl:
“Guys, we had a case from Ugina Health Center, Mfangano South, where the nurse called on Wednesday around noon with a delivery case complication. The mother gave birth safely at 11 a.m., but unfortunately the newborn baby died. Thereafter, the placenta was stuck inside, never came out at all! The family arrived with the patient at around 6 p.m. while bleeding and very weak. The ward nurse tried to remove the placenta until the next day, but the placenta came out just in parts.
The medical office called me to activate the E-boat for transfer to Mbita District Hospital to remove the placenta because the mother bleeded too much and needed a blood transfusion. The weather was rough with big waves, but under careful drive and control I made it safely…the patient was feeling more pain and restless, still bleeding too.
Finally, at the hospital, she was given out some medications and a blood transfusion…and the placenta come out safely. Bravo! She was discharged yesterday and is back home, recovered well and strong (can walk and eat). The family, plus the staffs in Homa Bay County Hospital, Sena Health Center and Ugina Health Center are very happy with the Health Navigation Team at EK Center for the good work performed on care coordinations to this mother on protocol and logistics to save her life.”
On Mfangano Island, the low-cost, low-tech innovation of Health Navigation reduces unnecessary delays in decision-making, transportation and receiving necessary services, and that can have a dramatic impact for hundreds of expectant mothers.
From birth and child health crises to adult accidents, Health Navigation is having a major impact on emergency care on Mfangano Island. And the support of Roaring Fork Valley residents show what an impact our local villages can have on villagers half a world away.