Increased results and positive development at Gundua Secondary School
From 6.00 to 7.58 in average grades. In 14th place out of 500 in the Buuri-district. Three students remitted to University on Gundua Grants. 14 students qualifying directly for University studies. Additional grants and student support established. Computers and internet up and running, new books and new housing for the teachers. Gundua Secondary is now an established school with students applying also from other villages. We have established good working relations with both government and locals to support our school. We have a great team of young and enthusiastic teachers who want to succeed. On one level the school is now quite autonomous, but there’s still a great need for support and control. For the coming year our goal is to reach 8.50 in average grades – a real challenge. At the same time we have intensified our engagement with Gundua Primary and are looking into supporting yet another primary school in the area.

Increased professionalism, structural capital and business mindset at GHC:
When GHC celebrated its first anniversary, I went on air on the national radio and promised to help the locals to increased health by offering modern, evidence-based care and education without a huge profit-gain. This was commented on by the reporters and appreciated by the community. Now it’s time to prove me right.

We have introduced stricter routines and demands on evidence to support the diagnosis. Certain lab-tests with specified results are required to make the diagnosis and to prescribe medicine, especially antibiotics. We have now have good control over different flows –patients, medicines, lab-tests, earnings, costs – and the business is now well functioning.

A new tariff has been established with adjusted prices on all services, medicines and tests, along with the requirement that everything is to be registered for total transparency. In parallel we are lowering our purchase prices by introducing more suppliers of equipment and medicine. We have also clarified the importance of charging for our services, both with the locals and with our employees. We have better routines for when and how to handle emergency calls.

We have obtained a mobile unit for transports. We have well-established relations with nearby hospitals and other clinics. We have dentists in place. We have helped 40 children to the world. We have a communications plan aiming at increasing both the educational and the market activities. We have new farms on their way to signing contracts. We have an upcoming cooperation with Rotary who, along with its Doctor’s Bank, will be a welcome addition. We have a well functioning health care centre.

Being part of developing both our schools and our health clinic here on site, to get to know the employees, work together, plan activities, discuss new investments, develop processes and routines, meet students, patients, and above all – to see the effect of our work for the people of Ex-Lewa – has been greatly rewarding.

Sara Spendrup Dyer is ready to continue this important work with a local team. There is great potential to develop Gunduas’s activity even more in Kenya.

//Johan Bååthe

To this day, Gundua’s emergency fund has collected more than SEK 30 000 from both private donors and companies. This is really fantastic. We have strived to allocate the means in the best possible way. We have supported four babies and their mothers who had to go to the hospital and couldn’t pay the hospital bills, as well as a few elderly who also could not afford to pay the hospital fee. We have also supported 15 students at Gundua Secondary with their tuition fees and 10 students at Gundua Primary with smaller sums. In all we have used almost half of the fund.

One of the students we support is Titus Muthengi. Titus started at Gundua Secondary after New Year as the second best student from Gundua Primary. He comes from poor conditions and also had the bad luck to cause a fire that burned down the simple hut he and his sister lived in. He now lives with a relative and is still a very talented student.  We will keep our eyes on Titus and follow his progress.  He might be a candidate for the Gundua-grant when he graduates?

Two of the babies we hope will get a good life are the twins who were dramatically delivered at the Gundua Health Centre a night in October. They are both well today and we hope that they will grow up healthy together with their mother and older brother.

Thanks to all of you who made it possible to help the people of Ex-Lewa. It’s a fantastic gift from you to those who really need it and it really makes a difference. We will continue to use the fund for the really needy and we will keep you posted.

I have been reading Maciej Zaremba’s articles about Swedish care in the Stockholm daily newspaper Dagens Nyheter. Well-written and interesting – and somewhat alarming. As responsible for Gundua´s health care unit here in Kenya, you get another perspective on things like care quality and productivity.

Here are some unsorted thoughts and reflections on the Kenyan care situation and how to run a health care unit in the Kenyan countryside.

One of the first things that happened when I started was that all employees wanted a 200% salary increase. I thought it was at spelling error, they must mean 20%.  But, no.  Here in Kenya it’s quite allright to ask for as much as 200 %. Everybody does it, for instance, the doctors demanded and got a 300 % raise the other year. This drives inflation, needless to say. The logic is: everybody knows that the country’s highest officials and institutions not only have much higher wages than ordinary employees, they also try to benefit from tax incomes and other things – “and if they can,we can…”. People also know that agreed increases are not always carried through and that the monthly pay sometimes doesn’t come at all. So you go on strike and demand high increases. After a lot of discussions with the Gundua employees we finally landed on a more relevant level of between 15-25 %.

There is thus often strikes, especially among the state employed nurses with the consequence that the state owned hospitals run into great problems since it’s the nurses who do the lion part of the work. This became very evident a recent night. We had a patient who had been severely beaten in the head with a panga, a type of machete. As she had no money she wanted to be sent to the state owned hospital in the town of Meru, 40 km away. As we went, she became steadily worse. When we arrived the hospital was closed. This was the only state owned hospital within 100 km, and it was shut down because of striking nurses. We were forced to turn around and ended up in a private missionary hospital with our very ill patient. They took care of her immediately. A so called Clinical Officer, the level under a regular doctor, shaved our patient’s head, confirmed that there were three deep stabs, one of which had crashed her skull, cleaned the wounds and sew it all together. No questions asked. “Should we X-ray”, I asked discretely. “No, the machine only works on weekdays, she will have to wait to tomorrow”. And the next day, after x-ray, she was released.

In Kenya, it’s a big difference between care and care. My own personal opinion is that Swedish emergency care is very good, probably world-class. It may happen in Kenya also, but never where I have been involved. Our talented nurses at Gundua can handle a lot, both emergency and less acute cases. But certain things they can’t do. Delivery complications, bad poisoning cases, cuts and really ill patients we are forced to transport to the neighbouring hospitals with more resources than we have. And in some cases this feels like we are leaving them to an even worse fate. It works slowly, a sense of urgency is often lacking, lots of bureaucracy, poor equipment, low hygiene, missing competence. A woman is moaning with half her arm almost torn a part, but nobody seems to notice, in the state hospital. A baby dies a day after we left her for more qualified care. After-care is often about releasing patients as fast as possible, which seems to be the same as in Sweden.  Beds are missing and the patients can’t pay for the expenses, so away with them quickly…

Health care is not for free in Kenya and therefore highly segregated. In Nairobi there are large, modern university hospitals for the privileged. At the local state hospitals, care and medicine are subsidized but still not for free. Oftentimes these hospitals are running low on medicine-stock and the medical resources vary from hospital to hospital.

The patients from our area are very poor. They complain that a medical exam at Gundua costs 50 Ksh (3.50 SEK) and that the medicine (that we sell practically at cost) is too expensive. They often choose, instead, to visit the local state health clinic where the cost is 30 Ksh, and where they always hand out medicine for free, often malaria-medicine, despite the fact that malaria is not prevalent in this area. This is a dilemma. We want to help as many as possible to better health and a decent life. But care has a cost, even here. Often we subsidize patients who are lacking all means, sometimes we have helped pay patients’ medical bills to get them out of the hospital to which we transported them in emergency situations. One solution is NHIF, National Hospital Insurance Fond, an insurance that covers the most basic care.  But the locals don’t understand the logic of paying in advance for something that might happen, and even if they do understand, they can seldom afford to pay.

Over all the lack of knowledge and insight in health-related matters is worrying. The importance of eating right, washing and keeping clean, handling food correctly, clean teeth and basic hygiene, etc. are not well known. We conduct different information and coaching activities within different areas, such as personal care and hygiene, nutrition, family planning, mother and child care, HIV, emergency care etc. to get the individual to take more of a personal responsibility for their own and their family’s good health.

There is also a risk for waste and there is a bit of cheating. This happens everywhere of course, even in Sweden. When I started to analyse the accounts at the Clinic, they didn’t add up. We bought medicine for quite a lot of money, and we dispensed a lot as well, but our income was very moderate. Something was wrong. After some meetings and more analysis it was clear that the revenues did not match the deliveries. Friends, mothers, siblings and others are probably included in the group who had been given medicine for free. We have managed to change this however. We now have a more thorough control and follow-up of medicine, revenues, lab-tests, inventory, etc., and this has had a positive effect. Our revenues are up 50 %.

Prescription of medicine and especially antibiotics is a challenge. In the western world there is a lot of discussion about resistance to antibiotics, probably even here in Kenya at government level, but not so much locally. There are several reasons why it’s more common to prescribe antibiotics here. The nurses are taught to think “better safe than sorry”. They often use mass-prescriptions; everything at the same time, since you never know if the patient will return. There is a cost for the trip as well as for the medical appointment. The environment is a real breeding ground for infections. Often dirty, hot and humid or cold and humid, a lack of clean water and small possibilities for cleaning wounds as well as general knowledge of how to treat a wound. So antibiotics get to be the general cure. There is also an anticipation that medicine is necessary to get well. Like malaria pills that are prescribed all the time for different illnesses putting pressure on the nurses to prescribe medicine that might not be needed at all.

At Gundua we are striving to use lab-tests to support the diagnosis and the recommended treatments. We have tougher requirements than other clinics to prescribe certain medicine. It’s not always appreciated by the locals, but it as a given for us.

To run a health clinic in Kenya comes with a certain setup of challenges. What is possible and natural in Sweden is not always possible here. We need to combine flexibility with structure and control. However, it’s fantastic to realize how much can be achieved with relative moderate means and practical efforts. This last year we have seen over 6000 patients, delivered almost 40 children, conducted a series of information/educational meetings and have contributed to better health conditions for the people in Ex-Lewa. This is something to be really proud about.

This week it was exactly one year since Gundua Health Centre opened and received its first patients.It’s amazing how time flies. The one-year old will be duly celebrated of course. We invited everyone we wanted to meet; representatives from the District Health Government, people from the neighbouring large farms who we would like to offer retainer contracts, the Swedish Ambassador (who unfortunately was busy elsewhere), the new Buuri MP Kinoti Gatobu, contacts and friends at other hospitals and clinics, media as well as the most influential people from the different villages around Ex-Lewa. We decided to run the clinic as usual, seeing patients and celebrating at the same time. After several discussions,it was agreed that our MP would arrive on Friday the 5th around 10 AM. His presence would make it easier for us to get others to come, everyone is so eager to meet this new promising minister. We put up our balloons, poured reflexes and condoms in large baskets, put up our new sign and proceeded to wait for our prominent guest. Four media companies were on site – tv, radio and two newspapers– MP Kinoti had participated in a radio interview the previous evening and talked about his visit to Gundua. Time passed, no MP. Two journalists started to interview me about Gundua Health Centre, so we got that out of the way. Finally, however, he arrived with a large group of people and everything could get started. The first thing we did was to walk around the centre and show him the facilities. Everyone was impressed by the high standard and how nice the clinic looks, especially our modern lab and the delivery room. We then had a ceremony led by Chief Helen, great as always. Students from Gundua Secondary together with the Gundua Parent Dancers presented us with a fantastic show and we were all invited to dance with them. I gave a speech about our vision for the Gundua Health Centre – to create better health opportunities for children, teenagers and inhabitants in Ex-Lewa by increasing awareness about basic personal hygiene and by providing modern and affordable healthcare to the needy. The following morning I could hear myself speak on the national news summary on the radio, and the reporter saying how grateful and happy the people of Ex-Lewa are for the health clinic. We could not have gotten better advertising.

The owner of one of the big rose farms, who we hadn’t previously met, arrived and was duly impressed. We immediately agreed to work together, which is exactly what the clinic needs. The MP as well as the representative for the District Health Governmentpraised our health clinic and we finished off with a good discussion with the MP about both the clinic and especially our school. We would like to put some pressure to ensure that the teachers we are paying for should instead become the responsibility of the Kenyan government. The rain naturally poured in time for food, but it did not matter and we are all looking forward to an exciting second year for Gundua Health Centre.

A while ago we celebrated the great results generated by the last year students at Gundua Secondary. During the three years that the school has graduated form 4-students, we have gone from 4.9 the fist year, to 6.0 last year and to 7.59 this year in average grades, corresponding to B-. 13 students of 41 are directly qualified for University education with subsidized dues. Another 25 have qualified for higher education. This year we had no students with D+ or worse. Gundua Secondary is now the third best day school in all of Meru-county, and on 14th place of totally 500 schools in the area. There are many reasons for this success. One is the great infrastructure we now have in place. Good school buildings, equipment, benches, canteen, teacher’s quarters etc. form a stable platform. Competent and engaged teachers are an absolute must. We have a great team in place who support each other and who like working together. A pedagogic approach combining the more traditional learning with modern thoughts about individual learning has contributed to the success. An openness and familiarity between teachers and students have had a positive influence. The introduction of the Gundua Grant with last years’ Grant Fellow now attending University has inspired the students to work even harder. So it is a positive spiral. Next year we will have even more textbooks and computers thanks to generous donations and this will hopefully generate even better results. The headmaster, teachers and students have set the target to reach 8.5 next year, and this is absolutely within reach.

The celebration started a bit hesitantly. We had invited the young (26 years) newly appointed MP, Kinoti Gatobu, from the Buuri district, who had promised to arrive at 10. By 12.30 I had given up, but everyone else was happy and positive so we started the ceremony without him. Students and teachers gathered in the canteen to sing, dance and perform theatre. The MP finally arrived close to 1.30 PM to great cheers form the audience. The celebration intensified. The MP himself joined the dance and the cheers increased even more.
There were several speeches and then the MP helped me to hand out this year’s Gundua Grants to our three best students; Walter Ogeti, Duncan Aritho and James Nduati. All three of themwill get the opportunity to continue their studies at University level with the support from the Gundua Foundation. The MP then gave a speech about the importance of focusing on studies to get a better life. He himself is a perfect example; from very poor conditions he became Kenya’s best student during all of his school time and he is now the youngest member of the parliament that Kenya ever had.

After the celebration we had some food and tea together with the MP. He was very interested in Gundua and we decided to meet soon again to discuss a wider cooperation between the government and the Gundua Foundation. All in all it was a very rewarding day. We wish to congratulate our Grant Fellows Walter, Duncan and James and wish them best of luck with their future studies!

Last weekend we had new visitors from one of our main sponsors, Apotek Hjärtat. It is always such a treat. Annika Svedberg, pharmaceutical and quality manager, arrived together with the pharmacists Daniel and Maria sponsored by Apotek Hjärtat’s own Gundua Health Centre project. Travelling with them, were Billy, a consultant to Apotek Hjärtat, and Fredrik, a free-lance filmproducer. One of the objectives of the trip was specifically to tell the story about Apotek Hjärtat’s engagement in Gundua using the film media. The film will be used both internally and as follow-up to the customer activity recently undertaken by Apotek Hjärtat for the benefit of Gundua.

We had chosen two families with small children willing to participate in the film in order to show the environment we are working in as well as how exposed young children under five really are. The mortality rate for children under five is high in Kenya and Apotek Hjärtat wants to work to improve their opportunities for a better life together with the Gundua Foundation.

The recent customer activity that Apotek Hjärtat conducted to benefit the Gundua Foundation, raised the equivalent of SEK 130 000. A fantastic effort and I would like to take this opportunity to thank both Apotek Hjärtat and its customers! This gift will make a real difference among the children here, giving them access to vaccine and medicine at a reduced rate.

The three pharmacists were obviously very interested and curious to learn more about the Gundua Health Centre’s pharmacy. Our own pharmacist, Jackie, was bombarded with questions about the operation and we had a positive exchange of ideas and experiences. Maria, who is a certified HLR-instructor, held a much appreciated heart/lungsaving course for the employees of Gundua Health Centre and invited guests.

At the same time Annika was out filming the families and children. Everything went well and gave a good insight of the extent of the poverty and miserable living surrounding the children. We had time to visit a nearby state dispensary to get a feeling for the difference in standard and quality between the Gundua Health Centre and the local alternatives.

Before returning, we made a trip to a local school to hand out soap and water from Apotek Hjärtat and to show the children how to wash their hands. A simple, but very important, activity to reduce the risk of some of the most common illnesses among children, such as worms, diarrhoea, amoebae and even dysentery.

After an intensive weekend the whole team returned to Sweden. Proud, happy and enthusiastic that Apotek Hjärtat’s engagement in Gundua generates concrete results. Thanks again Annika, Daniel, Maria, Billy and Fredrik – it was great having you here!

At the same time, no one really wants fights and riots, as these severely hurt the credibility of the country. Kenya is the leading country in Eastern Africa and a motor for the development in the area, and it’s important to show the world that it is possible to keep law and order.

The 2013 election is the most important event in the area this year, according to several observers. Eight candidates are left, but the real choice stands between Uhuru Kenyatta, son of Kenya’s founding father Jomo Kenyatta, and Raila Odinga. Kenyatta is by the way accused of crime against human rights and is awaiting ICC. Odinga, who lost the last election with the smallest margin, has been expected to win up to now, when new polls point in Kenyatta’s favour. 50 % of the votes are required to win and today both candidates have around 45 % each. If one candidate does not reach 50% of the votes, there will be a re-election at the beginning of April.

Returning from Nairobi Sunday night, we got a glimpse of the forces that can erupt. In the usually calm and peaceful city Karatina,our car came to a total stop during an hour, when thousands of election workers welled into the city from all corners. There was a sudden aggression when a drunk man stood in front of our car. He jammed his fist on the hood and screamed at our driver, and then jammed the hood again, hard and repeatedly. Our taxi-driver responded calmly but the man screamed and hit the car again. Our driver got mad, stood on the gas pedal and drove off, and the man was forced to throw himself to the side. Let’s keep our fingers crossed that no real riots will take place.

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The idea, of course, is that if people have basic knowledge of emergency situations and care, more lives can be saved. We agreed to run the pilot between February 13-15.

The event took place last week. First, parts of our staff were offered a qualified course in emergency care for medically educated people. Next we held a course for the local inhabitants in Ex-Lewa. We had booked the school canteen and brought food and drinks and made sure at least 50 persons would turn up, in two instalments.

Since we know by now, that people never show up on time, we slyly announced the session would start at 8.AM, knowing that this would mean a probable start around 10 AM. Nicky, Lucy, Katherine, Stephen and the others from England arrived at 9. At 10, three people had arrived. We waited for a while, and then, around 10.30 people started coming. So we started at 11 and decided to just have one round of education. In the beginning people were a bit reserved, but then became very engaged. With laughter and enthusiasm we were able to teach about 60 people how to take care of acute illnesses with very simple means – how to stop bleeding, lift allergic reactions, sliver bone fractures, clean breathing canals, and more. There was a lot of practice and afterwards everyone agreed that it had been a very good day.

Nicky and her team then packed up and left for England again. A heartfelt thank you, Nicky!!

Tomorrow, Friday, the chairman and CEO of Intellecta, will both arrive for a few days’ visit. We’re looking forward to showing them all good things we are doing here.

During February Apoteket Hjärtat is running a special campaign for all their Club Heart-members making it possible to donate their points to the Gundua Heatlth Centre. The points are then converted to cover the costs for vaccinations of children in Ex-Lewa.

Apoteket Hjärtat is the main sponsor of the Gundua Health Centre. During a three-year period Apoteket Hjärtat is committed to sponsoring the establishment and the management of the Health Centre. Read more about Apotektet Hjärtat’s involvement in Gundua Foundation.  More information about this particular campaign can be found at http://www.apotekhjartat.se/gundua/.