Kenya Heart and Sole Afya Njema Project
By Eileen Stuart-Shor, RN/NP, PhD, Pre-Admission Testing
When most people think about Africa, they think of malnutrition and infectious diseases like TB, HIV, and malaria; and indeed, those conditions remain a concern for the continent. But Africa is also in the midst of an epidemiological transition with non-communicable diseases, including cardiovascular-metabolic disease.
Recent estimates place the prevalence of hypertension at an astonishing 30 to 40 percent in Sub-Saharan Africa. This double burden of infections and non-communicable diseases has a profound impact on individuals, families and the region in terms of health care costs, suffering and lost productivity.
The Institute of Medicine and World Health Organization has called on the world’s clinicians and researchers to exercise leadership and advocacy for chronic diseases, to build evidence-based and locally relevant solutions and to promote solutions through collaboration.
The Kenya Heart and Sole Afya Njema project (KHAS), a partnership between UMass Boston College of Nursing and Health Sciences, the University of Nairobi School of Nursing, Kijabe and Tumutumu Hospital Schools of Nursing and the Ministry of Health, has been working towards this goal for several years.
KHAS partners U.S. and Kenyan colleagues to improve cardiovascular and metabolic health through the development of a feasible, sustainable and culturally relevant cardiovascular/metabolic risk reduction program that emphasizes local leadership, community engagement and self-management.
This June, six nurses from BIDMC – Christine Bertoni, RN, TSICU; Romelyn Higgins, RN, MICU; Tiffany Phelan, RN, Farr 5; Joyce Larson, RN/NP, Pre-Admission Testing; Eileen Stuart-Shor, RN/NP, PhD, Pre-Admission Testing; and Joelle Chateauneuf, RN, Joseph Smith Community Health Center – traveled to Central Province Kenya as part of the KHAS team.
The first few days were a blur of visiting Kenyatta (the largest government hospital) and spending time in the communities of Thageini and Kigumu to become acclimated to the Kenyan health care system, local customs and conventions. We visited with families in their homes and learned about how people live, eat, earn their livelihood and get around. Since we were going to be screening and treating cardiovascular-metabolic disease, we needed to understand the local context for risk factors.
At first, it was hard to see beyond the constraints; few material resources, inadequate facilities, high patient-nurse ratios in the hospital (sometimes 30 to 1), lack of clean water and electricity and limited access to health care, transportation and affordable food. But gradually, the assets began to shine through; the incredibly beautiful mountains and lush green, unconditional welcome into homes and clinics and the perseverance we saw in the face of adversity.
Over the next two weeks, we traveled many miles and worked closely with our Kenyan partners in six community health centers: Thageini , Kaiyaba, Nyanduma, Kigumo, Kambui and Onga Rongai. U.S. students and clinicians were paired one to one with Kenyan students/clinicians, and the clinics were set up in a way that leveraged local community participation.
When we arrived, there were often hundreds of people waiting to be seen. Sometimes we had to turn people away and sometimes we sometimes we had to finish the day after dark using flashlights and headlamps.
As we set up at the clinics, Kenyan students used African storytelling as a way to address the waiting crowd with a play about CV-metabolic disease and how to prevent these conditions. This was extremely popular and effective.
The screening team used the World Health Organization’s World Health Survey, standard medical history questions, and measured biometrics such as anthropometrics, blood pressure and fasting glucose. Based on this information, every person got a personalized feedback sheet (in Swahili or Kikuyu) on their risk factors and ways to stay healthy.
Based on their non-laboratory based global risk score, patients were triaged to be seen by the nurse practitioners and physicians in the treatment area, where we were also training Kenyan nurses to treat/refer by protocol (hypertension, diabetes, angina, CHF). We screened over 1,400 individuals and approximately 80 percent of the population was triaged to an advanced practice clinician. As one BIDMC NP said, “I’ve never worked so hard in my entire life!”
At the end of the clinics, more than 100 students, faculty, clinicians and policy makers (Ministry of Health, Kenya Nursing Council, Kenya National Nurses Association) gathered in Nairobi for a debriefing conference to talk about ways of increasing capacity for nursing at the community level. Each year, we see a bit more success in the sustainability and ability to increase KHAS.
As an example, last year the Kaiyaba clinicians and faculty from Tumutumu started a peer-led CV-diabetes support group. In addition to meeting monthly, they started a community garden of indigenous heart healthy greens and established a monthly outreach for screening and education at local churches.
When we arrive home to the U.S. after KHAS trips, the work is not done. We remain in contact with the Kenyan partners throughout the year as they continue to establish resources like the Open Access Africa website – a site we helped create to make it easier for clinicians and academics to access scholarly articles.
Kenya Heart and Sole has deep roots at BIDMC. The Heart and Sole CVD risk reduction model emanated from the CV risk reduction program developed in the Divisions of Behavioral Medicine and Cardiology. When BIDMC established the Roxbury Heart Center in 1997, the program extended into this high risk minority neighborhood and to this day, the Roxbury Heart and Sole program continues weekly in the Roxbury neighborhood.
The contributions – time, sacrifice, expertise, good humor and medical diplomacy – made this year by my fellow nurses enriched the trip in so many ways, and were critical to the success of the trip.
How to sum up the experience?
Long days, short nights, arduous travel over bumpy mud-slick roads, large crowds, private moments, chaos, peace, smiles, small miracles, large tragedies, material constraints, pain, joy, good will, wonderful colleagues, mysterious cross-cultural misunderstandings and more. It was such a panoply of emotions that ran the full gamut, but it all contributed to an experience that will stay with us for a lifetime.
Our KHAS work is focused on population health solutions, but populations are made up of individuals. The Kenyans we worked with and cared for were touched by what we did; our lives were transformed by what we experienced. We returned to the U.S. enriched, energized and humbled by the journey.
To learn more about the KHAS project and to read Kenyan and U.S. student and clinician reflections, please visit here.