On day one of a week long visit to HIV and TB programs in Kenya, we visited the Mbagathi District Hospital hosted by U.S. infectious diseases physician Dr. Jennifer Cohn. The district hospital, with a patchwork of funding from a variety of donor governments including the U.S., provides a broad range of services for the largely poor population of the Kibera slums in Nairobi – one of the largest informal settlements in Africa.
With funding cobbled together from the U.S. Agency for International Development, the hospital offers comprehensive HIV and maternal health services. The U.S. Department of Defense operates an influenza surveillance program and the London-based Wellcome Trust conducts a study of malnutrition in children. The U.S. Centers for Disease Control and Prevention provides support for laboratory services and each of these funding streams has resulted in improved facilities and capabilities. Nevertheless, the HIV clinic is serving some 10,000 adult and pediatric patients—twice as many as they are equipped for – and new mothers and their infants sit practically on top of one another for lack of space as they wait to be discharged. With eight beds and four tiny rooms, the maternity service averages about 300 births per month.
Seven hundred patients show up at Mbagathi daily, and 50 to 70 percent of those who present for care are HIV-infected. The hospital relies on cost-sharing from patients. Although HIV services and TB sputum microscopy and drugs are free, chest X-rays and medications beyond the core TB and HIV drugs, including a few for opportunistic infections, are ordered by prescription. Frequently these prescriptions go unfilled because patients simply cannot afford them.
The HIV clinic receives referrals from every department of the hospital with patients presenting with late-stage disease and serious opportunistic infections. The median CD4 count for new HIV patients is 110. Most of the 1,500 children being seen by the HIV clinic are orphans. We met with an inspiring nurse turned pediatric psycho-social counselor who works skillfully and compassionately to address the trauma in these children’s lives and to prepare them to live with HIV infection.
The hospital staff are welcoming and profoundly committed, from the somewhat bedraggled Ob-Gyn who spoke with us between deliveries, to the head of medicine who patiently walked us through the various health clinics that serve as a lifeline for the poorest people in Nairobi. All are concerned about the unrelenting demand for services and all are worried that donors will retreat when so much work remains. But there was also great hope, as even the chief of medicine was aware of the recent exciting breakthroughs in HIV research—including the promise of HPTN 052.