This being our second newsletter for 2015, we hope you will find the articles informative as we have covered a variety of topics.

Mid year is always a good time to take stock of your achievements. As Elective Africa our year has been wonderful so far from expanding our local teams; attending the 65th annual American Medical Students Association (AMSA) convention including the AMSA Pre-health Fest; visiting schools in Florida, Pennsylvania, Maryland and Washington DC to meeting new faces and reuniting with old faces such as a repeat attendance by one of our past medical elective student who came for the New Doctor and Resident Program. 

We participated in a CSR activity, where we painted two classrooms in one of the children homes that we support in Arusha. We have also talked about devolution of healthcare in Kenya: a very insightful article by one of our supportive doctors who mentors elective students in Migori Kenya, Dr. B. O. Owino. We cannot forget the common ailments taking the lives of our young children yet they are preventable diseases. 

We thought we share about infectious diseases especially for the medical students interested in Internal Medicine placements. One of our very popular hospitals in Kenya, Mbagathi Hospital, welcomed us to do an article on nutrition. This is a very exciting field. One would be surprised how much the population that they cater for have to learn about taking care of their health. This was enlightening even for us. To wrap the issue up, as you plan your elective away, a guide on what to pack. 

We hope you\'ll find some time in your busy day to read this newsletter. Let us know your feedback on our current articles and what else you would like to see in our future editions.

Grace W. Weru

General Manager

Elective Africa strives to grow with the communities which have oppened their doors to us to offer community and volunteer services to our clients. We are humbled by such support and we make it a personal goal to grow and empower these communities. With each client on board, Elective Africa (EA) organizes volunteer and community service activities, which help the community while also giving our clients invaluable local exposure.

For the month of June 2015, EA decided to give Fruitful Orphanage a facelift by refurbishing the orphanage. Elective Africa\'s Tanzanian Program Co-ordinator Phabian Mjarifu, the Business Development Officer Noreen Kinanja and the four students on program: Morgan from Miami University(Ohio), Dylan from Michigan State University, Jeffrey from Wheaton College all from the United States and Jen Wae from Newcastle University Malaysia set out for Fruitful orphanage in Arusha, to paint the classrooms.

Isaac Sumary, the current director, the father figure of the orphanage welcomed us and took us in to have a tour of the orphanage. We walked into their living room and found a group of children surrounding a laptop watching something, which we later learnt was a movie and the machine belonged to a volunteer student: Katrin Witte from The University of Applied Sciences in Muenster, Germany who was on her internship. One could tell that the movie was captivating from the excitement on the youthful faces glued on the screen; given that they lacked the basic comforts that we take for granted like televisions and radios.

As soon as they realized there were visitors around, some joined Isaac to show us their safe haven. The simple house has a living room, two bedrooms: one for boys and the the other one for girls, a toilet and bathroom facility outside the house and a yard for hanging clothes. We then proceeded to the classroom area a few metres away where we would spend most of the day and crown the task at hand.

There were two classrooms which had desks, pictures of the children hanging on the walls and books on makeshift shelves. We pushed them to one side while the rest of the team started mixing the paint with turpentine. The painting got underway with some children chipping in to help while the rest played outside. Dylan and Morgan were great at entertaining the kids. Dylan played cards with a small group while Morgan played hand games with others. The only toys in sight were a skipping rope and a pack of cards. While the painting continued, I went to have a chat with Isaac to find out more about Fruitful Orphanage.

According to Isaac, he established Fruitful Orphanage, on April 1^st 2014. The home is currently a refuge for thirty-six children between the ages of three to eleven who are either orphaned, former street children or under-privileged children living with HIV/Aids coming from poor homes. 

Isaac started the orphanage out of compassion to help orphans; being an orphan himself. He was orphaned at the age of sixteen and lived in the streets until a HIV organization took him in. Through the organization, he managed to get a sponsor who supported his education up to the O levels after which he took a course in tourism and hotel operations. Thereafter he worked at Africa Sun Star Resort in Ngorongoro for a year, saved up and used his savings to start the orphanage and a shop.

The facility currently rents the house and two classrooms for 200,000 Tanzanian shillings almost equivalent to USD $100 per month. The house shelters twelve permanent orphans in residence, while twenty-four others are day scholars who come from large families that cannot adequately support them especially families with widows as the primary breadwinners. The two classes available cater for the children in the following ways; one is for the younger children of between three to seven years while the other caters to the older children of eight to eleven years.

Sponsors are constantly sought to support further the education of the children beyond this point since the orphanage is not in a position to accord them opportunities beyond the basic education they can offer. Volunteer placements organizations such as Elective Africa support the orphanage by identifying needs, mobilizing resources, placing volunteers to teach and support the orphanage while creating awareness about such facilities.

The orphanage has been lucky enough to get sponsors to help it buy its own land. The current vision of the orphanage is to get more sponsors to sponsor the children\'s education, build its own accommodation and classes to accommodate more students and sustain the children it supports access basic necessities: shelter, food and clothing, get access to clean water and house staff at the centre.

By the time Isaac was done giving me the orphanage’s history, Elective Africa\'s program participants with the help of Phabian were done painting and were creating aesthetics for the walls. Jeffrey and Jen Wae were using leaf fronds to create motifs and getting the children to imprint their hands on the walls. The children were so excited by this. Meanwhile, other children were enjoying piggyback rides from Morgan. 

We were finally done at sundown when we congregated to take photos. We said our farewells and left for Arusha. It was a humbling and enriching experience to share a day with Fruitful Orphanage.

As Elective Africa we are thankful to the program participants who have been great at: mobilizing resources, teaching and motivating the children, creating awareness and the various donations to hospitals. 

To find out more about our donations and points of need in the various facilities we operate in contact us via info@electiveafrica.com.

Devolution is an approach that has been used in both developing and developed countries to improve access to various facilities, improve service delivery, bend the cost curve, increase accountability and improve responsiveness. Kenya has not been left out in this approach. It began her healthcare devolution journey in 2010 after an immense vote by citizens for a new form of governance for change and accountability.

Migori County has a high population with a fertility rate of 4.2% according to Multiple Indicator Cluster Survey (MICS), life expectancy of 42 years and a large proportion being below 24 years of age. It has high poverty levels with 43%  accoding to Kenya Demographic and Health Survey (KDHS 2009) of the population living below the poverty line; this has direct implications on nutritional status and access to healthcare. Moreover, there is a high burden of communicable diseases such as malaria, diarrhea and HIV with rising cases of non-communicable diseases. Despite health facilities being within 5Kms from most households, existing infrastructural gaps affect the access to these amenities. Further, severe gaps across all cadres of health workforce, limited specialized care and inadequate essential health products and technologies affect the provision of quality services.

Since the advent of devolving health services in Kenya, a lot of changes have taken place ranging from infrastructural improvement- almost all dispensaries, sub-county hospitals, referral and level 4 facilities have been face lifted. For instance in the case of Migori County, there are more theatres constructed to ease congestion at the Migori County Referral facility. 10 ambulances have been availed to all the sub-county health facilities to facilitate referrals and respond to emergencies. This has indeed improved service delivery in our health care system.

It is worth noting how the County Health Management Team (CHMT) is working round the clock to ensure adequate training of health personnel to bridge the gaps in the Human Resource for Health (HRM) by establishing and operationalizing the Kenya Medical Training College –Migori with funds from the County Government that has seen students undertaking nursing courses.

Recently, the County Government employed a large number of health professionals ranging from Medical Doctors, Clinical Officers, Nurses and Lab technicians. This has indeed bridged the gaps in Doctors to Patient ratios thereby improving service delivery and minimizing burdens related to overworking. This will not only be of added value to patients and healthcare givers but also to Elective students both locally and from overseas such as those we have trained from Elective Africa\'s programs as they will have a number of qualified personnel from whom to learn, shadow and get proper guidance in the various areas of interest. 

Devolution of health functions at the Migori County has culminated to a strengthened Community Health Strategy- more Community Units initiated, capacity build and Community Health Volunteers recruited and trained on level 1 service provision. This has indeed improved approaches towards preventive care. This has contributed to reduced queues at the hospitals as opposed to situations before Devolution. Medical Elective students therefore, will be able to work alongside trained and qualified Community Health Volunteers to be able to learn and participate in the provision of health care services at Level 1 in a rural set up.

I would want to state that Devolution is indeed a blessing to us in the health sector and despite the challenges of proper working conditions, housing and better terms of engagement; we hope that with time, things will change for the better.

Dr. B. O. Owino-Migori Hospital

According to the World Health Organization (W.H.O), pneumonia is a leading infectious cause of death in chilldren worldwide accounting for 15% of all deaths of children under five years old. It is estimated that 93,500 deaths amongst this group in 2013 may be attributed to pneumonia. This stunning figure however represents a 44% reduction over the previous years figures according to the United Nations Children Fund\'s (UNICEF) report (2000-2012). With the current progress in healthcare systems globally, many more lives could be saved. Given these statistics, we sought the opinion of Faith Ombati an experienced pediatrician. 

1. What is pneumonia? It is an infectious disease that could be bacterial or viral which causes an inflammation of the lungs and hence filling the alveoli with liquid or pus.

1. Why are so many children still dying of a disease for which there are vaccines and effective treatment? In toddlers it is very difficult to identify this problem even by doctors especially general practitioners. Thus, it develops very fast and is hard to control due to late medical attention. Also, some people do not have access to vaccines while in some it is pure negligence or lack of awareness. People should be trained in the use of these vaccines. Parents should be sensitized and made aware of the signs of pneumonia and not delay visiting the hospital. Some medical rules are also not followed. For instance, a pediatric doctor should first examine a child before any procedures are carried out which unfortunately does not always happen mainly due to limited qualified personnel. Another factor that has caused these infant deaths is relapse of pneumonia already existent within the body. How does this happen? In some cases, some kids already have pneumonia so the vaccine might intrude and increase the problem. The child’s body in some cases is not able to act as a battlefield for the jab and the bacteria. This however happens a lot in rural areas especially in developing countries. Vaccines are only given to healthy kids or healthy persons. 

1. Tell us about pneumonia control initiatives that have had a great impact in Africa. In clinics, there have been vaccinations on child clinic days and Public Service Announcements (PSA’s) stuck on the walls. Paeditricians have continuously advised on kids being injected before the cold season when pneumonia is most prevalent. The immunization charts have been found to be useful such illiterate mothers have been able to keep up with the vaccines schedules.

1. Why do mothers fail to pick up on the early signs of pneumonia and seek help when their children show signs of respiratory disease? Pneumonia has very many signs that overlap with signs of other diseases such as common cold. For instance fever, crying and loss of appetite. This makes it very hard to point them out. Mothers are not to be blamed and they should also not be hard on themselves when they fail to recognize some symptoms fast enough.
2. What habits make children prone to pneumonia? Exposure to cold is the common reason. Kids hate wearing warm clothes because they are uncomfortable. They are so energetic and generate much heat. Other habits include walking barefoot and the bacteria are everywhere with us. The kids’ immunity to fight certain attacks is low thus it is easy for them to be brought down.

1. Is there a particular season where there are more cases than others or this runs through out the year? Normally during the cold season the cases are more. However for the costal region it is different the warm weather is normally mistaken and no harm is seen, kids are in water all the time, air conditioners are always on and people tend to find comfort in the breeze and the blowing wind. Children have poor thermo regulation and for adults sometimes overexposure just overwhelms the body’s general balance and this exposes one to pneumonia. Also, it should be noted, those with HIV are easily put down with pneumonia any time due to the weakened immune system. It is one of the opportunistic diseases of AIDS.

1. What are its causes? Cold, exposure to viral/bacterial infection, poor ventilation due to poverty, poor feeding and general hygiene.

1. What are the signs? These are more dependent on age. In children you will observe.

• A fast respiratory rate which is more than 50 per minute (fast breathing)
• Poor appetite
• Vomiting
• Severe dehydration (In this case is when most women rush kids to hospital)
• High fever 38 degrees celcious and more
• Lethargic (Dull)
• When breathing the nasal alae moves
• When breathing in by kids, the lungs move inwards instead the normal moving outwards
• Grunting when breathing or through out
• For adults you will observe a cough and chest pains

These symptoms can be hard to recognize by a mother who is not trained. First sign to seek help is when a child refuses to eat and that is usually missed.

1. Why does pneumonia receive less media attention in our country than health problems that have a similar disease burden? By that I believe you are talking of diseases such as Polio, Tb, Cancer, Heart problems and HIV. The exposure is still low I agree. Despite the high numbers of deaths, people still do not consider pneumonia a major disease. The Paediatric Association and practitioners need to be more vigilant with the media. Pediatricians are also very few and more should be trained to cater for the populations in respective countries.
2. What would you advice young mothers with regards to pneumonia? I would advice alertness. Making money is key but always spend time with your child this way you will also be involved in the development of your child. Also always ask any bugging questions you have while visiting a doctor. I have witnessed many mums being very shy just ask away it will really help you understand the issue at hand. In the villages, mothers idolize doctors a lot but this should not be cultivated both with the doctors and the patients.

Paula Gateru a certified nutritionist from The University of Nairobi. She has a lot of passion in nutrition, still practices it though she ventured in a private business. She volunteers a lot and takes part in a number of medical camps within Nairobi and Kenya. She did her internship at Mbagathi Hospital one of the hospitals Elective Africa work with in placing students for various elective programs.

1. What experience fascinates you in the nutrition profession? It’s amazing the way most people are ignorant about their nutrition needs. Most people either eat to fill up their stomachs or to satisfy a craving. Very little emphasis is put on the nutritional needs.
2. What made you decide to pursue a career in this field? When I was young, I never liked medicine, so I always wanted a way out of treating some common diseases the natural way, instead of using prescription drugs. I have always believed that if people ate well we would avoid the many diseases we have now, especially terminal diseases.
3. What interests you most about health and nutrition especially in the Kenyan context? It amazes me most that if we decided to eat in a proper manner and lead an active life, our hospital beds would not be that full. The local/indigenous foods like managu, terere (traditional vegetables) and so on are actually the best and most of them have medicinal value. We have very nutritious foods at our disposal.
4. Through our previous communication you mentioned that you have interned in Mbagathi Hospital, which we also work closely with. Kindly tell us more about the nutrition department. Though small, the nutrition department at Mbagathi Hospital is very efficient. Most of the work done there is consultative.
5. How was your day like at the hospital? I will talk about the paediatric ward because I spent 75% of my attachment there. I would report at 8 a.m. and start by looking at the admission list to identify any new admissions. I then proceeded to prepare the first dose of therapeutic milk for the malnourished children and serving the children. Afterwards, I joined the doctors for the ward rounds and take the anthropometric measurements and make a follow up on the children’s progress. The afternoons were spent preparing the second dose of therapeutic milk and serve the children again while bonding with them and counselling their mothers on their nutritional needs. That was a typical day at the paediatric ward.   
6. How was it interacting with the patients? My interaction with the patients was awesome! I got to talk to young and old mothers and counsel them. I also played with the children; they are so adorable (She says with a grin).
7. What nutrition condition did you get to interact with a lot? Many kids suffered from marasmus, diarrhoea and chronic underweight.
8. What is so challenging working as a nutritionist and especially within this hospital? I found working in a hospital fun but also challenging because you get attached to the patients so much and feel a great loss when one happens to pass on. I had a very bad experience with one of the patients we lost.
9. How did you encounter the challenge and what would you advice our program participants in the various departments towards such difficulties. After the loss, I was devastated. I had to go through counselling to get over the loss. To avoid such, I would advice people to try not to get attached to the patients. Carry out your duty professionally, but do not get emotionally attached. It is hard but one has to try.
10. A while back this year, we had the former US president Bill Clinton and his daughter visit Kenya seeing the work of the Clinton Health Access Initiative (CHAI) educating families about the use of Zinc/ORS in treating diarrhoea. What is ORS? Oral Rehydrating Solution is a solution given to patients to restore electrolytes in the body and treat dehydration caused by diarrhoea. It is a mixture of salt and sugar.
11. How does it prevent diarrhoea? How efficient is it? It does not prevent diarrhoea; it restores electrolytes and treats dehydration. OR therapy has helped lower mortality rate, due to dehydration by diarrhoea, by 93%.
12. Where as we have seen there are sachets sold over the counter there is a way one can “Do It yourself” (DIY) at home. How can the solution be made at home? What are the ingredients, portions? For adults and children? The directions are indicated on the sachets. Basically it is the contents of one sachet dissolved in a cup of clean water. Children under two are given quarter to half a cup after every loose stool, older children are given half to a full cup after every loose stool. Infants are given a teaspoon every two-three minutes.
13. What similarity is there between Zinc and ORS? Zinc serves as a simple, inexpensive and critical tool for treating diarrheal episodes among children in the developing world. Zinc becomes depleted in the body during diarrhea, but recent studies suggest that replenishing zinc with a 10 to 14 day course of treatment can reduce the duration and severity of diarrheal episodes and may also prevent future episodes for up to three months.
14. Do you have any advice for students interested in studying nutrition? Go for it. There are endless opportunities of employment.
15. What skill do you consider to be essential to work in this industry? You have to be empathetic and patient because you are dealing with people.
16. How has nutrition awareness changed since you got involved in this field? When I was starting, it was a new field and many were not aware of the benefits of good nutrition. Right now more people are becoming conscious of what they eat and how it affects their bodies. So I could say that people are more aware.
17. Do you see a change in the public perceptions of nutrition in Kenya? I believe the more people are aware the more change we will see. People are now going back to the roots.
18. To wrap this interview on a fun note, what is your favourite healthy snack? A “goooood” piece of pineapple.

You have landed a great travel opportunity and you are eager to set off to your new destination. A dream is just about to come true now that all the paperwork, funding your travel and applications are behind you. The only thing that stands between you and this new great adventure is packing the items you will need for the next couple of weeks. Sounds simple right? The truth is it is quite a task. Knowing what to pack is a big differentiator of how well you will settle in your new home miles away from home and how comfortable you will be.

As a leading healthcare electives organizer, you will have received a guideline from our operations team on what to carry with you. Our support on how well we help you prepare for this adventure starts from the day you reserve your spot with us. 

The list of what to pack we derive from the general amenities within your chosen location and what the environment provides which varies from one location to another. You are encouraged to ask questions when our Program Coordinators call you in the course of your preparation and ahead of time, so that you know what to expect and to plan accordingly. Within our detailed pre-departure guide is a list of items that you will need which will help you stay organized and not forget anything. It is important not to wait until the last day to pack. 

You will be informed before hand what kind of weather to expect at your destination. The best option is carrying clothes that can easily be shed or put on according to the temperature changes and forecasts are not always reliable. I cannot help but smile as I write this. There are those who can really pack light whereas there are those who simply cannot. I guess you know where I fall in these two categories. It is tempting to pack up everything you own or think you will need but you need to prioritize, what is most important and what you can’t live without for 4-8 weeks. Take stock of what you use on a daily or weekly basis and determine items that can serve more than one purpose. For your wardrobe, size it down by using clothing items that can serve multiple purposes. For instance, do you have a short denim skirt that can be worn during hot weather and still pass for a cold day when paired with leggings and boots? Just the bare minimum will be sufficient. If there are supplies you might need that can be obtained anywhere, plan to buy these locally from the big supermarkets in our destinations, such as shower gel. 

Comfort is very important even away from home. Being in a different country interacting with new culture will compel you to talk to those close to your heart. You will have housemates but some personal connection with those you love is necessary. We advice all our clients to carry their smart phones and laptops as all Elective Africa residences have free connection to internet. Do not get carried away with traveling light. Carry those little things that will make you feel still at home. Create your little haven. Some comforting items include your favorite quilt and photos. 

In terms of packing, think of your list in the following categories: 

1. Essentials: Passport, visa (this can be easily obtained at point of entry in Kenya and Tanzania), return ticket, travel and indemnity insurance, vaccinations, Malaria prophylaxes

2.Finances such as ATM cards, credit cards, cash to carry

3. Clothes: Daily wear, sneakers, sandals, shorts, pajamas, swimming gear (for coast Kenya placement is recommended), inner wear e.t.c

4. Clothes accessories such as hat and sunglasses 

5. Toiletries: Shower gel, lotion, sunscreen, towel (we provide beddings in all locations), insect repellent

6. Electronics and gadgets e.g. laptop, iPad, Power adapter, Hairdryers and shavers, spot light

7. Hospital rotation items: Stethoscope, trousers for men, skirts/dresses to or below the knee and trousers for women for hospital wear; scrubs and white lab coat, comfortable shoes such as clogs, 

8. Others: Fast aid kit with all your to go quick medication such as painkillers and antihistamines, notebook, address and list of important contacts.

As you set off for your healthcare elective overseas, we hope this guide will be beneficial to you. Wishing you all an amazing eye-opening trip to Africa.

Want to chat with the editor? Email eodera@electiveafrica.com