The Present Condition of Medicine and Society in Kenya

Transcription

1 The Present Condition of Medicine and Society in Kenya Rie Kakuta, Yasuhiro Morita, Hanae Kamikura, Yoshihisa Fujimoto Shiga University of Medical Science

2 Acknowledgement We would like to express our sincere gratitude to all the staff of NUITM-KEMRI project; Ms. Shiho Honda, Mr. Takenaka, Dr. Muhoho in Nairobi office, all DSS staff in Suba field station, and great support of Professor Shimada, Professor Kaneko, Professor Minakawa, Professor Ichinose. Rie Kakuta, Yasuhiro Morita, Hanae Kamikura, Yoshihisa Fujimoto Shiga University of Medical Science Program date Schedule Tue Arrival in Nairobi Wed Nagasaki University Nairobi Research Station JICA Thu Kibera tour Fri Getrule Children's Hospital Sat Free Sun Free Mon Kenyatta National Hospital VCT CCC Tue Kenyatta National Hospital Wed Move to Mbita Thu Hospital induction Fri Hospital induction Sat Fieldwork for malaria Sun Move to Nairobi Mon Safari Tue Safari Wed Safari Move to Nairobi Thu Departure for Japan

3 NUITM-KEMRI project office in Nairobi Rie Kakuta Nairobi Research Station, Nagasaki University Institute of Tropical Medicine [NRITM] was established in KEMRI near the Kenyatta National Hospital in NUITM has three bases of tropical studies in Kenya, Nairobi, Suba and Kuwale. We visited NUITM-KEMRI project office in Nairobi and Suba. For this project, the researchers of Nagasaki University can study tropical medicine in local areas for long-term continuation. In Kenya, there are some serious infection diseases, malaria, tuberculosis and HIV/AIDS. Infection diseases are the problem not only in the tropics such as Kenya, but also in advanced nations. The whole world is menaced by infection diseases, HIV, BSE, SARS, and so on. In 1982, JICA had built the microbiology institute in KEMRI. Now, Nagasaki University rebuilt and uses the part of this institute (CMR) and studies tropical medicine, such as parasitemia (schistosomiasis, malaria), virus disease (yellow fever, West Nile virus). There are three sections in the institute, molecule laboratory, biochemical laboratory and pathogen laboratory. For more safety study, not to infect disease in laboratory, the BSL3 laboratory (P3) is seated. Most of the machinery and compartment in this P3 are made in Japan. The P3 laboratory is used for physical containment negative pressure. In this room, researchers use serious viruses, West Nile virus, yellow fever virus, unknown virus and multidrug resistance tuberculosis. The air-conditioning units are controlled by computer. This P3 has three filters to remove dust from air. The air of Nairobi is more dusty than Japan, and so the second filter is changed for a new one shortly. Blackout sometimes occurs in Kenya, and so that institute has self-generators. For these backup systems, researchers can experiment safely. The laboratory in NUITM employs bachelor who graduated bioscience or biochemical, and trains them as researchers. There were many researchers from different universities.

4 Impression I thought the P3 laboratory stood comparison with that in Japan. Dr. Ichinose, the professor of Nagasaki University, said it was hard work to build the institute. Before the start of the project in Kenya, there were some problems, but the project team staff got over that. I felt their passion to Kenya project very much. Many professors said that continuing the research in Kenya is very important. It is beneficial to Kenyans to continue a serious commitment to research and make good use of the study s result, but never to do brief research. For example, it is not enough only to reduce the number of mosquito in short term. Some cases make the field condition worse. I learned that researchers must predict the influence of the field. (Kenya Medical Research Institute Centre for Microbiology Research) (The P3 laboratory and Dr. Ichinose)

5 The differences of medical system between Kenya and Japan Yasuhiro Morita We studied about the differences of medical system between Kenya and Japan. Kenya government has a special system of counseling and treatment for HIV, because there are many HIV patients, and many people die from HIV/AIDS. There are VCT(Voluntary Counseling and Testing ) centers and CCC(Comprehensive Care Center) in Kenya. If you go to Nairobi, you can not come back to Japan without seeing VCT center. The number of VCT centers is about 1000 in Kenya. People can undergo counseling and testing for HIV/AIDS for free in VCT centers. The counselor can give the patients relief and fuel his motivation to cure HIV. Patients who are positive on HIV test should go to CCC. They can undergo care for HIV. CCC consists of several parts. They are given below. 1. Reception 2. Sample collection room 3. Exploration room 4. Triage nurse room 5. Social worker office 6. Nutritionist office 7. Physiotherapist room 8. Date room

6 Kenya has the special system of counseling and treatment for HIV. In Kenya, not only doctors but also counselors and even physiologists can treat patients. They can treat patients comprehensively. I think this system is very wonderful way to support HIV patients. We Japanese have to study this point from Kenya. In Japan, only doctors treat a HIV patient. It was only in Japan among developed countries that the number of HIV positive patients (new diagnosed) is increasing now. We have to stop this phenomenon. We should make a point of giving HIV patients relief. On the other hand, we could realize how medical system in Japan is great. We visited 4 hospitals in Kenya. They are given below. 1. Kenyatta National Hospital 3. Gertrude s children hospital 2. Hospital in slum 4. District hospital Only Gertrude s children hospital has very beautiful buildings and facilities. Because it is a private hospital. However the others have very dirty buildings and old facilities. Only rich people such as policemen, politicians and foreigners living in Kenya. can go to private hospital in Kenya. General people in Kenya cannot go to private hospitals. So they go to public hospital. There are so many patients in public hospital. So medical stuffs are always deficient in Kenya. However in Japan, we can go to any hospital and can get all every treatment because of the insurance system. We Japanese have to maintain this great insurance system.

7 Mbita Hanae Kamikura We went to Mbita. Mbita is one of the poorest areas in the northern part of Suba District, in western Kenya. Luo people mainly live there. Their lives depend on farming and fishing in Lake Victoria. Malaria and HIV/AIDS are common diseases in this area. Professor Kaneko cooperates with the local stuff in carrying on DSS program. DSS stands for Demographic Surveillance System, gathering data about registered people. View of Mbita. Fishers. Controlling malaria vector project Professor Minakawa plans to exterminate malaria by killing mosquito larvae using BTi. BTi is a kind of larvicide made by Bacillus thuringiensis var. israensis. The toxin is effective against only anopheles mosquitoes and it is resolved by ultraviolet rays. He formed the vector team. They monitor the residents infection and attack rate based on the data acquired by continuing DSS for one year. They also investigate the number of mosquitoes and identify its species in Luo house and breeding habitats at a two-week interval. They found that environmental changes influence the prevalence of malaria. Reduction of the water level of the lake increased the number of the habitats for Anopheles funestus. There are three types of malaria vector in Mbita, Anopheles gambiae, A. arabiensis and A. funestus. A. gambiae and A. arabiensis, which grow in sunny small pools, are common. A. funestus has a smaller body than that of A. gambiae, and their larvae live in large vegetated pools. The nests of mosquitoes exist everywhere, such as pools on the lakeshore, hippos footprints, moats to keep hippos from fields, uncovered waterway to irrigate a land. If we want to fight against malaria, we must decrease basins for breeding habitats.

8 We went to Takawiri Island for field work. There we found only few anopheline mosquitoes because it was transition period during rainy season and dry season. Dr. Minakawa told us that 60 percent or more of children have malaria parasites though the percentage of anopheles mosquitoes which have it are only one percent. View of mosquito controlling project in the future The vector team plans three programs to make Mbita a malaria-free area. The first plan is collecting sample of bloods to examine the possession rate of malaria parasites in collaboration with ICIPE(International Centre for Insect Physiology and Ecology). The second is making the plasmodium gene database to find some gene mutations causing severe cerebral and refractory malaria. At the last, they will cooperate with Sumitomo Chemical Co., Ltd, distributing mosquito nets to children in order to measure effectiveness of it. We could not see the scene of the local fishermen using them which were distributed free of charge for fishing and drying fish. Habitat for A. funestus. Impression I thought about a good way to support developing countries during my stay in Kenya. Though the contributor seems to send only articles, such as machines or prefab house, there is no person who is able to use them; thus, it is useless. If there are neither facilities nor enough money that can utilize it, contributions will become mere ornaments. They are self-complacency of supporting organization. First of all, the infrastructure maintenance such as roads, water supply, and electric power transmission to make full use of the contributions is needed.

9 Now after the riot in Kenya Yoshihisa Fujimoto Some tribe raised a riot against the wrong presidential election on December 27, At them the riot police fired gun, and the number of the dead amounts to more than 1500 mutually. When we arrived at Jomo Kenyatta International Airport and watched people in Nairobi city, we didn't feel an uneasy atmosphere that recently there were a riot. Everyone wears a suit neatly and walks merrily on the dirt road. The guide and plainclothes police officer showed us personally Kibera Slum on August 28. We could see plots of land that remain idle, half-built houses and work of construction in part of the slum which is crawling with people and shanty. We heard these are the grounds and houses of the Kikuyu that were broken and burned on the riot. Many of the Kikuyu have been evacuated from the slum, and they can't come back for fear though the riot was settled. Therefore they lend relatives their grounds and houses. Even if their houses are burned and they are evacuated, the titles to their grounds remain in their hands. (The riot police and the mob ran counter to each other on this rails) Thanks to the professors in Nagasaki University Nairobi Research Station, we could look around almost all of Kenya. For example, we could look at the present condition of Mbita which is far from Nairobi and near from Lake Victoria. In Nairobi there are so many people and cars that we feel tense, but in Mbita there aren t so many people and cars that we feel calm. There were many ships that sailors had to row themselves

10 in Lake Victoria. They fished famous Nile Perch. We went to market in Mbita, but we couldn t see it. We heard Nile Perch is exported at good price, so it isn t sold to the citizenry. By the way, when we went to Mbita, our driver who is the Kikuyu disliked going to Luo s house. I explained about it in follows. The Kikuyu was sent into exile from the periphery of Lake Victoria where the Luo live, because of the riot after the presidential election. That is why our driver was frightened to go there. We Japanese will not understand tribal struggle. We can understand only that it may have deep-rooted hatred. It was difficult for us to find the sign of the riot. People in Kenya look calm at our aspect, but they remember the riot clearly, and still have fear of other tribes. (The sun setting over Lake Victoria.) (The ship for fieldwork) (Extract from newspaper in Kenya)

11 JICA JICA(Japan International Cooperation Agency) started to send volunteers in Kenya from The role of JICA is sending volunteers in Japan to various countries. First, I explain JICA. The sum total of the volunteers in Kenya is about The number of the volunteers working now is 55. The limit of working successively is 2 years. JICA has many voluntary activities, for example, the measures against HIV, the environment, the protection of animals, the rehabilitation of juvenile delinquents. We heard about HIV mainly. In Japan people have the knowledge of their own diseases as much as doctors have, because almost all of them have computers. However, in Kenya the citizenry don't have money and the knowledge of preventive medicine and their own diseases that are taken as a matter of course in Japan. So they have no idea where they should go when they get sick. They don't know how they should do when they catch HIV. That is why they will die at home without necessary examination and treatment. People in Kenya need more of the influential people who have various skills and knowledge than those who work together. We have to study hard many things. (There is JICA Kenya Office in this building.)