Robert Orynich

robertSchool of Medicine UCSF

Suba, July – August 2014

The first initiative of the Sustainable East Africa Research on Community Health (SEARCH) Collaboration is a community cluster randomized trial in 32 communities in Uganda and Kenya to test the hypothesis that when HIV treatment is started early, health is preserved, children stay in school, adults stay in the workforce, and over the long term, health care costs are lower at community-level. It was my responsibility to design the protocol used to abstract patient visit and caseload data for SEARCH; pilot this protocol at three clinics in Migori County, Kenya; and assess the changes in costs at the pilot clinics, all in six weeks.

After introducing myself and my project to my new colleagues, we worked together to identify the three pilot sites: Tom Mboya Health Centre, Sibuoche Dispensary, and Nyatoto Health Centre. I then cataloged the content and structure of potential data sources at these clinics, identified my target data sources and wrote a data abstraction protocol.

In the process of carrying out the data abstraction at my first site however, I began noticing errors in the daily activity logs and monthly summary reports, especially regarding the documentation of unanticipated, unscheduled patient visits. Therefore, I revised the protocol to change the sampling methodology from extracting data from a randomly chosen days to randomly chosen patient folders. The patient folders were confirmed to be higher-quality data sources by both my observations and the clinic staff’s wisdom.

After successfully completing the data collection using the new protocol at the three pilot sites, my colleagues and I disseminated our findings by presenting our results to 50 FACES and Ministry of Health staff members.

Through my work in Kenya, I learned how important it is to remain agile to change plans when new insights arise and how to communicate with our large and diverse international team of Kenyan, Ugandan, and American researchers. Reviewing the detailed documentation of patient transfers, deaths, and losses to follow-up also gave me an appreciation of the mobility of patients as a potential barrier to care.

On a more personal note, my conversations with staff and local people led to a rich exploration of the nuances of Kenyan cultures. Particularly enlightening were the conversations with clinic staff and community health workers on how factors such as the definition of masculinity and the common grieving practices in Kenya contributed to the stigma of HIV. Lastly, the triple-digit hours I spent reading through medical records of HIV-positive patients also humanized my sense of the scale of the global AIDS epidemic today and deepened my understanding of health as a human right.

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