This is not valid: No money, no health service, honey!

The poor and helpless people in the fight against diseases on a Lake Victoria island are not alone with their health trouble any more. Medical centre opening on Rusinga Island has been the last project of Centre Narovinu Island of Hope.

Next to the school, nursery and orphanage, there has grown a clinic, which is trying to fight off inaccessibility to health care for local people. Bad access to health care on the island is both physical (real distance of hospitals or lack of public transport) and financial (health care is mainly financed by direct payments from patients). The ill are therefore brought to hospitals by their relatives in such late phase of their disease that even the maximum possible effort can not improve their health state. Centre Narovinu clinic started to operate in the spring of 2010 only with local medical staff. Thanks to the support of Medical and Social work University of St. Alžběta in Bratislava the team could be strengthened by two doctors from North Moravia, Zuzana Fajkusova and Marie Ticha.

What made you leave peaceful environment of local hospitals and set off to cure in Africa? What had you expected from Kenya?

Marie: Even during my studies I wanted to go somewhere where a doctor is needed more than in Europe. There is a huge disproportion between the number of doctors in Africa and Europe; for example, if there were the same density of doctors in Brno as in Kenya, there would be just about 50 of them there! This lack of doctors has troublesome effects in Africa, especially in the country. An African doctor was not possible to reach in Rusinga, even for more than a thousand Euros per month. For a local doctor to work out of a town the salary offer must be around two thousand Euros per month. In Nairobi, skilled doctors can make even higher money. So why to slog up to discomfort - with a low salary?

Zuzana: In comparison with Marie, Africa was not any news to me. I had experienced a three-month stay in a hospital in Ethiopia, and I also knew that the best was to have no expectations. In Africa, things are totally different and unpredictable, therefore we wanted - after my "hungry" experience in Ethiopia - be at least sure about eating. We brought forty kilos of food to Kenya, and I have to admit we did not feel sorry at all.

Do you remember your first impressions from the community centre Island of Hope and the clinic?

Zuzana: We were pleasantly surprised by the centre. Nice buildings with a neat lawn are not common in Kenya. Our clinic is definitely the most beautiful facility on the whole island. People looked nice from the beginning, but it was very difficult, sometimes impossible, to tell them apart. They all were dark skinned, short black haired and with white teeth ... to distinguish children from the orphanage took us two long months. You have to use such identifying signs like a nice smile, dimples, style of walking, etc.

Marie: At the clinic I was very nicely surprised by the laboratory. I had expected a microscope at maximum, but the number of diagnostic facilities and other equipment, which we could use, was amazing for local conditions.

What duties at the clinic did you have apart from the roles of doctors?

Marie: For several first weeks our main tasks were to observe local staff at work, to organize work at the clinic, to order medicaments, to manage the pharmacy and to subsequently reorganize the whole operation of the clinic. To initiate cooperation with local health facilities and governmental institutions, in the way to enable access to medicaments and health materials distributed for free by Kenyan government, was crucial. Primarily, this concerned antimalarics of the first choice (Coartem), special formulas for malnourished children, testing sets for HIV, etc. Despite initial bureaucratic obstacles we managed to ensure continuous supplying of our clinic by these medicaments. However, it mainly concerns future cooperation. For the time being, necessary material is paid through donations of development support SlovakAid, the same as salaries of local staff. Towards the future, the plan for the clinic is not to be dependant on financial support from Europe, which is why it is very necessary to form maximal cooperation with local offices, and to educate skilful local staff.

Zuzana: Our common work day started at about 8 a.m. Ideally, a receptionist had already started to register coming patients. Registration hours officially finished by 3 p.m., but it took a lot of work to explain patients, that it was more advantageous to visit the clinic in the morning. We lost about three months due to a communication mistake, because we found out that a day in Kenya starts at 6 a.m., which is the 0 hour. When we emphasised to patients to come at 8 o'clock, they actually understood at 2 p.m... and finally they came at 4 p.m. Daily, we treated about 30 patients. Their number depended mainly on weather - it is very difficult to reach the clinic in the rain. In a nice weather, which was usual, working hours used to prolong up to late afternoon. In the evening and at night our work shifted with local staff consisting of one clinical officer (sort of a more educated European nurse) and from one to two nurses. Similarly, we shifted also our weekend duties, so that somebody was permanently at disposal.

Did you ever have to improvise while treating your patients due to lack of medical supplies or unknowingness of local disease?

Zuzana: While treating patients we had to improvise almost always. Especially bandage which is used in our country is very expensive and not available in Africa at all. We had a lot of syringes, needles, infusion sets and protective gloves; however, their quality was incomparable with the ones used in Europe. There were enough medicaments there, and we practically had all we needed. The situation concerning medicaments is rather opposite in Kenya. In a shop you can buy any medicament without a prescription, and use it as you wish. It may result firstly in damaging a patient (pregnant woman, not suitable dosing, late coming to the doctors), and secondly, conditions for loosing sensitivity of microbes towards given medicaments are build.

Marie: Furthermore, sometimes you are wrongly advised while buying medicaments in a pharmacy, which can lead to troublesome consequences for the ill person. Neither us were all-powerful. The clinic operated only as ambulance at the beginning, and we were the first contact doctors. Usually, people suffered from headache, fever, diarrhoea, or something... mostly, it was because of malaria, typhus, amoeba ... sometimes stories of our patients were more interesting: "I have felt pain in right hypochondrium for fifteen years ...", "I have been coughing for five years..". And then, God knows. These extraordinary cases luckily appeared in the first wave of new coming patients. Then they ceased.

Doctors in Europe complain that people are not afraid of getting infected by HIV any more. For many Europeans, this has been a refrain. Is it similar on Rusinga Island?

Zuzana: Several years ago, AIDS was still a big taboo. It was considered shameful to go for testing, to admit positivity. Even now, locals approach AIDS somehow inconsistently. On one hand this theme seems to appear on daily basis. Everywhere, you can see billboards with condom advertisement, and there are many places to have a free check-up. However, their capacity is far from being fully used by public. Why? Many still do not admit that AIDS issue could concern them personally. On the other hand we have seen many cases of young people, actually children, who got infected through sexual contact. The number of newly infected people is still growing. To start with education about AIDS is definitely important already at primary school children, including lower classes. When kids reach eleven, prevention may come too late. Personally, I consider lectures and discussions at schools the most effective. Only through this way a new generation can be educated, who will approach the issue of AIDS actively and responsibly. For reducing AIDS spread it is also essential to search for newly infected cases and give them throughout treatment. We organized so called "HIV camp", where medical staff tested children and parents in the school complex. Several positive children were detected, who might have now higher chances to spend their childhood as children.

Marie: It is really very hard to fight against AIDS in a place, where men offer paid sex to class-five girls, and where girls get married and become mothers in the age of thirteen, without even trying to finish their primary education. Furthermore, sex functions as a means of payment in local fishermen's community. However, we cannot stop fighting, because the chance to change all this is still here.

Are there any kinds of specific diseases in Rusinga? It is no secret that Victoria Lake water is permanently contaminated.

Zuzana: On the island of Rusinga and in the whole Nyanza province there is the greatest occurrence of HIV in the whole Kenya; according to WHO, it reaches up to 24%, which means that almost every fourth person is infected. Concerning other diseases, Lake Victoria coast is characterized by year-long occurrence of malaria, which belongs to the most frequent reasons of death in Kenya. Quite frequent, but mostly not recognized, are infections by schistosomani - parasites living in the lake. Rate of infection is high, but imperfect diagnostics does not enable to identify all cases and treat them. Also occurrence of tuberculosis is high on the island, especially in combination with AIDS. The same as in the whole Kenya, intestinal diseases caused by amoebas and other parasites are frequent on the island.

Marie: Fortunately, local people, for whom the lake is the only source of water, have learnt to use water purifying tablets or boiled water. Even here, enlightenment has worked and the situation is improving.

What is the main difference between understanding health care at ours and in Kenya? What in this context seems the facility of Island of Hope like?

Zuzana: The biggest difference between the Czechs and Kenyans might be the view on health-care as a whole, and its role in the society. In Kenya, quite commercial view on people's health is common: you have money = you have the right to be treated = you have the right to live and vice versa. Finally we found common way concerning even registration fee at the clinic. A socially favourable system was introduced, when patients pay a certain sum while coming to the clinic (equal to about 30 - 40 Czech Crowns) and they are given the highest care and treatment. Because of the fact that in Kenya public insurance is unaffordable for majority of people, patients in state facilities always pay for any treatment, giving medicament, health material and medicine one by one, which may result in a very high sum after a few days of hospitalisation. Because patients do not know in advance how much the treatment will finally cost and if they can afford it, they often decide not to go to hospital at all.

Marie: Operation of this centre is based on cooperation - the Whites - the Blacks. All what has been built came up from Africans. They know best what they lack and need. Europeans only helped them to fulfil their dream. I can see the main difference in our trying to implement "European" factors here. Children learn to be punctual at school, to take responsibility for themselves, their lives, they learn to decide in the right way, to cook, to tidy up. They learn to succeed in the real life. In the health centre the following principle is valid: Help people without regarding whether they have money for it or not.

MUDr. Marie Ticha: Was born in Opava in 1983. She studied Faculty of Medicine of the Palacky University in Olomouc. Currently she has worked at the department of hematooncology in Brno for three years.

MUDr. Zuzana Fajkusova: Was born in Krnov in 1985. She studied Faculty of Medicine of the Palacky University in Olomouc. Currently she works as a doctor at the department of infectious diseases in Silesian hospital in Opava.