Blessings of the New Year

The New Year has seen some changes and many blessings at the clinic. Judi and I returned to the US in January, where we were able to be with our family to welcome a new grandson into the world, and to say goodbye to our newborn granddaughter and my brother, who returned to the love of their Heavenly Father. It was good to be able to encourage one another in the challenges of new life, and the adjustment to being separated from those we love. We were just grateful to be able to have that time at home, and for me to be able to work to get the resources we need to continue our work here.  The trip was made possible because we were able to add Dr. Eric  Presler Odida to our staff in December. He graduated from medical school last year and just finished his internship, and because he was there, we could travel, while he took care of our patients.

We were even more grateful and indeed overwhelmed by the outpouring of love that greeted us in the New Year. Many of those who are supporting the clinic donated during the Christmas season, resulting in all of the equipment and medical supplies that we were able to bring back with us!  This included a new microscope, a wheelchair and a cot, as well as an emergency cart.

New Clinic equipment

Those were all blessings, but an even greater blessing was that we had a vehicle that could carry it all back to the clinic in Awasi. Back in August, the opportunity came for us to bid on some Toyota Landcruisers that the Kenya Red Cross no longer needed. These had been used as ambulances, and were stripped down for resale. We had bids on 3 vehicles, high, medium and low priced, and we won the bid on the middle one. We had the resources to pay for the vehicle, but it needed a lot of work for it to be suitable for us, so when we had returned form the US after Judi’ accident in November, we had sent it to the shop for refurbishing. We didn’t actually have all of the money we needed for all of the work at that time, but trusting in the Lord, we moved forward. When we arrived back this time, it was ready, and the generous donations we had received allowed us to pick it up and use it to transport everything back to the clinic.

We now have a “go anywhere” vehicle to use for transporting patients, personel, and equipment! While this was still a very substantial cost, we were blessed to be able to get it for about half of the usual cost!

God always seems to be providing at the very time that it is needed. We were powerfully reminded of this the day after we returned, when we were notified that one of the church members in a rural area was very ill. He was no able to walk, and so could not get transport to be seen at the clinic. So Dr. Odida, our nurse Lucas Otieno, and myself were able to take the Landcruiser on it’s first house call. 

 It had been raining in the area where our patient lived, and we did find ourselves stuck once, but a quick shift into 4-wheel drive extricated us, and we were able to continue on our journey. Our patient needed to be seen in the clinic for lab work, so we brought him back with us, and were able to use our new wheelchair to easily transport him around the clinic. A week before, we would not have been able to do it, but just when our brother needed it, God had provided the needed equipment, so his needs could be met! Talk about God’s perfect timing!

There is so much going on in terms of the clinic. We are going to be adding a new building which will have toilet for patients to use, a laundry/sterilisation room where we can clean linen and equipment for sterile use, and a storage area. We are also going to be drilling a well (or borehole, as it is called here), to provide the clinic with water during the dry season. We are collecting rainwater now, but it is sometimes not enough, and as we expand it will certainly not be enough.

And another big change is that Judi and I are planning to move to Awasi, to a house right across the road from the clinic. That will avoid our current 45 minute commute each day, and allow us much quicker access to the clinic as we need. We will miss the 5 flights of stairs we currently climb to get to our apartment in Kisumu, but we are willing to sacrifice that.

God is truly blessing us in this endeavour to share his love with the people here in Africa. We are certainly humbled by the opportunity we have been given to be a blessing both physically and spiritually to our patients and the community. We cannot thank each one who has been a part of this endeavour, and trust that the Lord’s promise is sure that, as we seek first His kingdom, everything that we need will be added to us!

We Are Not Alone

As we have been open and seeing patients now, I have to say what a blessing it is to have other organizations that are available to assist our patients.  We are not alone. Just to give a couple of examples:

We had a gentleman come in who had been referred by a neighbor we had seen here. He was from the slum area of Nyalenda, and had been “sick” for some time. He had been to several facilities, and had been treated for some of his symptoms, but was also trying to self treat. He did have a job, but had been unable to work, so our low consultation fee was an added incentive to come.  While he did have several issues that needed lab testing to sort out, his most immediate need was for HIV testing, as he admitted to being married but having 3 “side women”, and not knowing his own or their HIV status.  We were able to call on ICap, an NGO we have mentioned earlier to come and test him at our facility without cost, and he was found to be positive, and needed to be started on treatment.  However, he also needed more laboratory testing for his current symptoms, and was not able to afford those, or even the transport to the lab.  As we commiserated on what to do, our Medical Records Officer mentioned that in the next gate over, there was an NGO called “Love Matters Most”, who specialise in services for HIV patients.  So we went over and talked to them, and that is what they do- help HIV patients to get transport and the testing they need! What a blessing, and they were right next door.

Another patient came in with pain in her left eye after having the eye removed for an unknown type of cancer several years ago.  She had not had the resources to get any follow up, and had actually gone to Tanzania for the surgery because there was a physician’s strike in Kenya at the time. We were able to get a CT scan done through the local church oblation fund, and did not find any evidence of tumor growth, but the pain she was having was keeping her from sleeping at night, and she had almost given up on life.  I knew of an NGO called KenyaRelief in Migori, who, before Covid, was having teams of physicians from the US come over to provide surgeries at a low cost.  I called Steve James, the director from Tennessee, and found out they had a team of ophthalmologists coming in 3 weeks! He gave me the name of the leader of the team, and I contacted her with what was going on, and she agreed to see our patient. To make a long story short, she was able to give the patient a nerve block that completely took the pain away, giving her a new lease on life! They were also able to get her safety glasses to protect her remaining eye.

Our patient and the eye doctor at KenyaRelief.

It is so heartening to see the many organizations that are working together to offer services to the low resource population here.  People have asked how much of an impact could a single clinic have, and truly it is just a drop in the bucket of the need.  But working with so many others, each drop becomes part of a stream that can make a difference in the lives of so many.

Giving Thanks

Giving Thanks

I love the time between Thanksgiving and Christmas. It is always a time remembering all the blessings of the year, and then celebrating the coming of the One who makes it all possible. Followed, of course by a new beginning, where anything is possible in the new year. For us, this season has been especially wonderful, as the Mildred Smith Mission Health Center has become a reality! Yes! Just 2 years, 2 months and 2 days after being incorporated as a not-for-profit corporation, we started seeing patients at the Kisumu clinic. I have no idea how that time ranks in comparison to other people/s endeavors, but I can honestly say it is new record for me...since it is the only not-for-profit overseas clinic I have ever opened.

Since I was supposed to be chronicling our progress in this blog, I will give a recap of the journey before I get into the thank-you’s. Judi and I  came back to Kenya in August. The work on the clinic property was still in full swing, with the room with the bathroom still being finished up, the glass panes panes in the louvered windows being  fixed, the tin shelter room being made into a useable building, furniture and desks being purchased for all the rooms, and the gate being fixed. While we were in the US, the pharmacy area had been partitioned off by a metal grate, the kitchen area had been made into a lab area, the rooms had been painted, plumbing had been done to put in a water heater, and a church family had been hired to stay on the grounds for security. It was actually a blessing all around,as the family was able to build a better house after their house was flooded during a heavy rain, and we got security and grounds keeping from people we could trust.

In between times, Judi and I would travel back and forth to Nairobi to try to work on getting the clinic license and my medical license. We were staying at our friends Pam and Eric Odida’s home, and were in full Covid lockdown mode, so of course everything was more complicated, from government offices being closed, to curfews limiting travel time. We also were looking for an apartment to move into, so we could give Pam a break, and we were blessed to find an apartment about a block from the clinic at a good price. It was on the 5th floor, but we needed the exercise. As far as furnishing this apartment, our real estate agent, who found us the clinic and our apartment, also sold us her parents living room furniture. We also found a used living room table at the grocery store, and we ended up getting appliances from a variety of shops. 

We did have a complication at the bank, where their patience was running low at the delays while they waited for me to get a work permit. They finally decided that we could not access our account unless we had a “local director”. So we had to see if we could get a letter recognizing Eric as a local director. That took 3 full days in Nairobi, with Eric pulling in all of his contacts. 

The biggest complication continued to be that I really needed a work permit. The work permit was waiting on my medical license, and the medical license was waiting on the clinic license. So the clinic was our focus. We had several people giving us advice, and rarely did the pieces of advice match. We finally got in touch with the sister of one of our church sisters, who works in the sub-county Hospital as the director of laboratory services, and she gave us the contact for the MOH of the sub-county, who has the responsibility of sending the letter to the Medical Practitioners and Dentists Board that would allow our clinic to be licensed. He told us all we needed was a licensed nurse and a letter showing we had a way of getting our medical waste disposed of properly! So with the assistance of Eric’s cousin Monica, who also had a business selling medical equipment, we were able to get the required paperwork done and got the request in to the Medical Board.

It was not in time for us to get the work permit so we had to go back to the United States because we were in Kenya on a 3 month tourist visa. In late October we went home, and stayed until mid-November.  That was really a blessing too, because we got to see family, and Judi and I both were able to work to save up a little more money to keep us working here in Kenya.

When we got back in November, the clinic license came through! I got my Medical license application in after a couple of days of trying to get the proper paperwork from the Registrars office.  I was told it was going to take about 2 weeks for the Board to act on the application, and then was told there would be a physical interview with the board that I would need to do. This was all new, as I had gotten my license last year in about 15 minutes! 

By December, I had my license to practice medicine in Kenya! I still needed to get the work permit to actually “work”, even though I am volunteering. So I was very excited to get all of the paperwork in. I was even more excited when I got the notice from the immigration office in Nairobi telling me all I had to do was pay the fee, go to Nairobi and pick up the permit!

We went to Nairobi to the Immigration Office, and was told they had actually changed their minds, and I needed to apply for another class of permit! It was, of course a more expensive one, and none of the paperwork from the original file would carry over, so I had to gather it all together again. With Covid, it also was to be applied for online, and the only way to check on progress was to look online every week until a message appears telling me what to do next.

I did get a contact in the Immigration office from our Real Estate Agent.  After talking to him, he assured me that even though it could take a while for the actual permit to come through, that if I had made the application (and paid the fee), that the immigration officers would have mercy and let me volunteer until it came through. 

So on January 4, 2021, we saw our first patient. There are many people that I am so thankful to for making this possible. I cannot possibly mention everyone, but it would be a big mistake for me not to try. So thank you to Judi, my wife, for her unfailing support, sewing curtains, bookkeeping, (more on that in future blogs) and love. Thank you, Pam and Eric Odida, for your home, your love, and tireless efforts to get the clinic going.  Thank you to Tom Okeyo for the same. Thank you to Monica Adhiambo, for all of your help, advice and  for your willingness to sponsor the clinic. Thank you to Nishma Karia, the Real Estate Agent from Lake Estate Agency who has kindly helped us in so many ways. Thank you to Avalyne Ayoto and her family for keeping the clinic safe. Thank you to Eli Okeche for the physical work at the clinic. Thank you to all of the fundis (craftsmen) who have worked on the clinic. Thank you to the staff at the clinic, Brendah and Efgo, for all of their work and support. Thank you to Edna, the sub county nurse who has helped us with immunizations and pharmacy purchases.  Thank you to Winnie at the Kenya Medical and Dental Board Council who helped with all of the paperwork and applications. Thank you to all the doctors and clinicians I quizzed about setting up, and who gave me invaluable advice. And most of all, thank you Heavenly Father for the way you have guided us through all of the obstacles and challenges so far, and for the promise of the blessings yet to come.

So as the New Year begins, we are blessed to have so much to look forward to, those things which will be done that have never been done for the kingdom before.

Coronavirus Edition

May 25, 2020

This Memorial Day finds me back in the United States, by an amazing set of circumstances.  I have been in Kenya since March 3, before the Covid-19 thing became a thing, and with the airport closed and Nairobi in quarantine, I was not sure when I might have been able to travel again!  My purpose in Kenya was two-fold: to get my work permit and to get the clinic building in order to open the clinic.  The good news is that the second goal has been realized, but we will get to that in a minute.

The first goal has been a little more elusive.  In my last blog, I wrote about my hopes to have the work permit by the time we left in December.  Optimism has always been my strong suit, but it is getting tested!  In February I finally got word that my work permit would be granted, as soon as I presented my Kenyan medical license to the Immigration Office.  I was returning in March, so I sent all of my credentialing in to the board and also sent the hard copies by First Class Mail to Eric Odidia, the local representative to be taken in to the Medical Board.  They actually arrived about 4 weeks after I did, so the hard copies were not helpful.  As it turned out, it was all for naught anyway, as they required the license for the institution I would be working at in order to license me.  This is because they do not license me to practice medicine in Kenya, they license me to practice medicine at a specific facility in Kenya.  We had been holding off on committing to purchasing land or a building until I had a work permit, but it was now obvious that I would need to have that in place before I could get my license, which of course was necessary for my work permit!

So it was back to square one to get a physical clinic.  I had two friends working with me as we looked again for a good location at a reasonable price.  It seemed as though we were just destined to be blocked in our endeavors, however. We would find plots in good locations, only to find that the price had tripled or quadrupled when it came time to sign a contract.  This was usually when I arrived on the scene to close the deal, or when I went to actually look at the land or buildings we were considering purchasing.  Several times, we found that the plot sizes on the supposed land titles did not actually the match the size of the plot we were being offered, which did not seem to be an issue with some people, as they claimed they had purchased it that way without issue.  When we insisted the plot size match the title, we were told it would be a lot of trouble with neighbors, or the Title Office, so that was enough of a red flag to wave us off.  Other times, it would turn out that the person selling the land did not have the right to sell it, as there were several other family members who also had claim to the same land.  One time, we found out that it was a wealthy Aunt in Nairobi who was selling the land, but it was the only land the family had, and if it was sold they would be thrown out in the street!  Apparently, the Aunt had been given control of the family land, and was taking all of the proceeds for herself, and leaving the family destitute!

As the weeks went by, and we dealt with Realtor after Realtor, there began to be bad feelings against the two gentlemen who were helping me with evaluating and procuring the land.  The Agents started sending them threatening texts saying that they were “going behind their backs” because land that we rejected would be sold to someone else, and they suspected that we had obtained it through a back door somehow.  One of the local guys even was beginning to be threatened because people were saying they were preventing me from buying the lands at inflated prices, and so were betraying their community!

In order to protect everyone and just get a land deal done, I eventually turned to one of the church men who owned some property in Riat, a suburb up the hill from Kisumu.  It was not necessarily in the greatest location, but I figured we at least would be able to know we had a clear title and that we could pay an honest price for the land.  He was very helpful, and we got surveyors from the land office to come and demarcate the plot exactly...except they couldn’t do it.  The surveyor was very apologetic, but took us aside to say that there apparently had been some shenanigans going on in the land office, because there were addendums to the original title, which essentially left no land for the owner!  The owner said to me,”Doug, I live in a very funny country, where you can have a piece of paper that’s says you own land there, but there is no land to be found!”  As that case was obviously going off to a long, hard fought court battle, we opted out of that also.

After going back online, we found some compounds for rent in the area we were looking for, so we went to LakeEstate Realty, to enquire.  There we met Nishma Karia, and were directed to a compound in Milimani which was renting for a tolerable sum, and consisted of two buildings and an outbuilding, a bougainvillea wall around it, located on a good road and one block from Nyalenda, one of the larger slum areas in Kisumu.  Milimani is considered to be one of the safest areas in Kisumu.  The owner was in the process of renovating, and was very open to our needs to convert the place into the clinic.  So two days later, on May 7, 2020 we signed the contract to rent the compound!    

Clinic entrance

Clinic building

This is going to be the clinic facility proper, and the second building, which consists of two rooms, will be a place where patients can be treated who need a bed.  We will have two female and two male beds, but we needed a toilet facility.  The owner said he wanted to put in a toilet anyway, so he is building the toilets and tying them into the sewer system for us, free of charge!

Additional rooms and restrooms.

Gate to the clinic compound!

Finding our location was a blessing in many ways.  Two days before we signed the contract, the US Embassy contacted me to let me know that there was going to be a flight out of Nairobi on May 14.  The airport had been closed since the end of March, so I had thought my planned return to the US on May 12 would be impossible.  My wife Judi had also planned to come over to assist in the clinic set-up, but her April flights had all been cancelled, and she was unable to come.  With the Covid scare now coming full force, I had gone to the local hospital to offer my services if they were needed, but there actually have been very few cases outside the Nairobi and Mombasa, so they did not need help at the time.  The rest of the licensing had to be done online anyway, with the Government offices being shut down, so it seemed like a good time to return, work in the US to refill our personal coffers, and await the lifting of restrictions.  Now with the clinic location determined, and licensing just depending on finishing the renovations, everything seemed to be finally coming together.

Then we went to the bank, and found another problem when we tried to take out money to pay for the rent and security deposit.  When we registered the company, we had made Eric Odida the Local Representative, so that he could sign checks and do the banking until I got my work permit and would be able to use bank funds.  However, the Kenyan government changed the rules on us, and said that only a Local Director could do banking transactions!  This was because there had been so much trouble with local representatives conning companies and stealing money from foreign companies!  While I appreciated the sentiment, it would have been good if someone had told us us this earlier, because now we could not access the funds in the bank until Eric was made a local director or I got my work permit!  Fortunately, we also had an account for the company in the US to handle dollar transactions, so we were able to close the deal for the rental of the clinic compound, but we are going to have to be working on getting Eric’s status changed to Local Director remotely as soon as possible. And hopefully and prayerfully, we will find the funds to complete the renovations we need to do so the clinic can be licensed, so I can be licensed to work there, so I can get my work permit and start the work we have been pursuing for so long.  

And so despite the Covid-19 virus, the difficulties in doing simple things like purchasing land or using a bank account in an underdeveloped country, and the challenges of getting back into the country, we continue to trust that God will do this in His time...we just hope and pray His time is soon!

Clinic waiting room

Clinic waiting room

The Work Permit

So the last hurdle that I am aware of at this time, is actually getting a work permit so I can stay in country and work for free, and of course send a copy to the KRA to verify my identity (see Obtaining a PIN above).  Again the process is online, or at least it starts there.  There are several classes of work permits, but the Class I permit for “Approved religious or charitable activities” was billed as the easiest to get and the cheapest, assuming you have a church or an approved nonprofit organization for which you are working...,and I do! It is also cheaper to get the medical license if you are working under a Class I permit. 

The process goes something like this.  You fill out the online application, along with all of the supporting information and documents, which are scanned into the document, along with your photograph.  Then you make a physical printout of the entire application.  Then you pay the fee for the application, over your phone, using the M’pesa payment system, and make sure you have the receipt printed out also.  You then go to the Foreign Nationals Immigration Office at Nyayo House in Nairobi and stand in the line until you can turn all of the materials in to the clerk, who reviews them, points out any deficiencies and has you go get the extra needed materials.  This can be a long ordeal, as in our case where it took from 9:00 am to 4:30 pm, and 6 different visits to the window.  Fortunately, they let me cut into the line each time I came back, which was a real blessing, because the line only grows as the day goes on.  I actually became somewhat of a fan favorite, as the people in line were cheering for me each time I came back, and giving me encouragement.  The deficiencies included: 

~I not only needed the receipt from the M’pesa payment, but I also needed to have a photocopy of the SMS the phone company sent me saying what was paid and to what company.  This necessitated going to the Safaricom office in Nairobi, and having them track down the SMS message in their system (not an easy thing, apparently) and give me a copy.  Note to self- don’t delete seemingly redundant the and useless SMS messages from your phone!

~2 passport photos, exactly matching the one submitted and printed out online?!

~A tax compliance certificate from The KRA stating that you are compliant with all taxes, even though the company just registered with the KRA 2 weeks before and no taxes are due.

~etcetera, etcetera.

The last thing they wanted was a copy of my passport page with my current tourist visa on it.  As I left the window for the 5th time, and told Judi I was on my way back to the cyberCafe, (which was 2 blocks away, and whose security people knew us so well that we no longer had to have our backpacks examined when we went in), she said she would wait this one out.  She must have looked discouraged, because a man next to her asked what was going on, and she told him it was our 5th time to the window.  He said it would be nice if they would just tell you all the deficiencies at once, and Judi agreed. He then asked what I needed, and she told him it was a photocopy of my passport. He told her to call me back in.  He then took me down the hall to an office, where he got a photocopy for me! What a blessing! The office was going to close at 5:00, and I was not looking forward to another 4 block round-trip!

Back at the window, the people in line groaned when the clerk told me I had everything, except I was required to have a printed copy of the checklist off of the website!  That would be the checklist that did not list all of the extras I had spent the day getting!  They called out the clerk, and told him to have mercy on me, so he relented and I got the coveted stamp of acceptance on the large pile of paperwork.  My inline friends said that was a good thing, and when I asked the clerk how long it would take to process, he told me to “ask them” as he went on to the next client.  They told me it would take about 10-14 days, and that I could look for online updates on the Foreign National Service website.

That seemed to be a perfect timeline, since Judi and I were leaving the next morning to go back to the US for our oldest granddaughter Sydney’s baptism, and I was going to stay for 2 weeks!

It was kind of funny when the clerk reviewed my application. One of the important things that has to be answered by the group you are going to work for is, “What proof do you have that you have tried and failed to find Kenyans who can fill your position” and “What are you doing to train Kenyans to fill your position”.  I had answered honestly, and when she read the answer she said rhetorically, “You mean you couldn’t find any Kenyan physicians who wanted to work for free, and don’t think you can train anyone to work for free?”.  I assured her I thought it was unlikely, and she agreed.

After my return to Kenya, I went to Nigeria for a church men’s retreat, and so it was about 4 weeks, and I had not heard or seen anything on my email, so I went back to the FNS office to inquire about the application.  I really just wanted some reassurance that there was not a glaring omission in my paperwork.  The ladies there laughed when I told them the date of the application, and said it was “just 2 weeks ago, and it was too soon.”.  I pointed out that it was actually 4 weeks, but they said it was still too soon, that for a new application, it would take 2 months, and that my confusion was from the fact that reapplications usually took about 2 weeks.  They also were unable to actually check my application because the computer system was down, which goes along way toward explaining why you do everything online, and then print it all out physically!

Two weeks later, I found myself in Nairobi, so I dropped by again,and they were able to check my application, and assured me it was making its way through all of the required departments on schedule.  I told them I was flying out on the 24th of December, and they said I should check back at that time, and it might be ready.

That would certainly be a great Christmas present!

Location, Location, Location

With all of the other things that are going on, one underlying issue all along has been where the clinic will be located.  Our mission is to bring high quality preventative  and acute care to low resource segments of the population.  The idea being to have the clinic in a high population density area of low income people so that they can walk to the clinic and we can have easy contact with them.  That translates into a slum area, as opposed to a rural area, where the people are just as poor but we would not the numbers or the access we need.  We also need to have electricity, water, sewer, and access to fiber internet, as we want to use a cloud based Medical Record system, that will be accessible to us, our patients, and other healthcare providers seeing the patients.  One of the frustrations of the doctors at Jaromogi Oginga Odinga Teaching and Referral Hospital when I was working there was that they often had patients come in with no idea of their diagnoses or medications, or even a history of how long complaints had been present.  But everyone has a cell phone, so with a patient portal, their records can be available to any doctor they see.  It also means that our records are not susceptible to fire, flood, equipment thefts or other unfortunate events.  Of course we will also need backup systems for each, but a back up is a lot less expensive than a full system.

Our initial plan was to start out by renting a building, and progressing to owning our own facility some time in the future. As we looked at possible sights, several factors worked against us.   First, when people with buildings, such as schools that were not doing well, heard that we were thinking of placing a clinic there, they thought it was a great idea.  So great in fact, ithat they decided to cut out the middle man and just set up their own clinic!  Others said they were so glad that we were interested, because now they could put their children through college and retire on the huge amount of rent they would be collecting from us!  We also had considered seeing if some of the rent could be reduced by doing renovations, but that also proved to be unpopular.  Then there were warnings from local business people that contracts really don’t have the same meaning here that they have in America.  In other words, even if we got a decent rental rate, and did the renovations, there would be nothing stopping the landlord from arbitrarily raising the rent, or vacating us.  Of course you could take it to court, and in 2-3 years the case would be heard, but there would be no guarantee that the judge had not been bought off by the landlord.  So our attention turned to land ownership and building, rather than renovating.

You might think that land in a slum would be very low cost. You would be wrong.  Several dynamics are in play, but the largest one seem to be political.  Area chiefs are appointed by the government based on the tribe of the majority landowners of the area.  So even though the temporary mud houses on the land might not bring in much rent, the clout of owning the land and the people on it is very valuable politically. Another factor is the mzungu factor- pale skin still says “money for free” very loudly, so if I would go to see land, the price would immediately increase by 3-5 times, up to $35,000 for less than 1/6 acre!  Another factor is that the area is being set up to be growing economically with a new port being established to connect to the Chinese railway system that Is being built from Mombasa. This has brought Asian and Somali investors, who are willing to pay top dollar for investment purposes.  Which all goes to say, land is not cheap.

Obunga is the name of probably the poorest area in the Kisumu region.  We had a guy willing to sell, and it looked like a good location- directly across the street from a public school, and beside an orphan feeding center.  But on closer examination, there were issues. There was no sewer line. The area where the sewer would run, would be along a road that was seen on the map, but was covered in real life with makeshift housing.  The school across the street was using outhouses for toilets. The other issue was the internet.  I talked to the Safaricom people about the possibility of getting the fiber network in the neighborhood. It is already across the road in Tom Mboya estate, and across the road in Kondele, but they didn’t feel there would be enough customers to justify the expansion across the road.  I suggested to the manager  that there might be some PR value to supporting a clinic in the poorest neighborhood, but so far they have been unimpressed. So our search expanded to Nyamisaria,  Nyalenda, Manyatta, and Kondele, areas where the fiber at least runs through if not to!  We also have gone a little further out to Rabuor, to a little more rural area that still has some population density and is on the main road where the fiber runs.

The other problem with buying land is figuring out exactly what land is being sold, and who exactly owns it.  The plot maps often show access roads where temporary housing developments now sit, and houses straddle what is supposed to be a boundary.  The issues of land title are also legion. There are the transfer titles, where the land has been transferred to a group of siblings and one of them wants to sell, but has to get things changed over.  Even legal land titles can be an issue in a place where the proper amount of money can generate a perfectly legal title for someone else’s land! And it may change hands legally several times before the competing titles are brought to light.  So as of now, we are still looking for the right land, and praying that God will help us through the morass!

Obtaining a PIN

Happy Anniversary!

It has been exactly one year since the Mildred Smith mission health center was registered in the United States as a nonprofit organization. Whenever you are working in Africa, it is always a given that things are going to move more slowly than you expect. That being said, it has been a lot slower than I hoped, if not slower than I expected!

But progress is being made. After getting the registration back in August, the next step was to get a personal identification number (PIN) from the Kenya Revenue Authority. This is a number, somewhat like the Social Security number in the United States, which identifies an individual or a business to the government. That was billed as being a relatively simple procedure, which could be done online.  Eric Odida, the local representative for the company, made the application with the help of friends at the KRA, so we would be assured that it was done correctly. After two or three weeks, we had not heard anything from them online, so I went in to the KRA office in Nairobi to investigate. There I was told that the application had been rejected, and that the reason was that I had to be the one to apply for the PIN for the company since I was the Foreign Director.  I was also told that they had sent an email telling me about the rejection, but when I questioned that, it was found that the email had not been sent.

One of the reasons why we had Eric make the application, was because it was required that the applicant actually have a personal PIN, which I did not have.  So I went online to apply for my PIN, which required that I enter the PIN of the company that I was working for, which of course we did not have.  Checking in at the Kisumu KRA revealed that this was a situation beyond their capability to resolve, so my wife Judi and I went back to Nairobi again to see what could be done.  We were given the name of a person at the Nairobi office, but when I went to enquire about seeing her, they entrance desk people insisted I go to “window 8” where I would be assisted.  When I explained my situation to that gentleman, I was directed to window 13, where I was told that nothing could be done, but there was a gentleman at the Kenya Investment Authority who would be able to clear up all of my paperwork issues and if I got a note from him, they could give me an individual PIN.  It was a Friday afternoon, and when we got to the KIA, our gentleman was not available, but a lady said she could assist us.  It soon became evident that she could not, as she really had no experience with a case like ours, but she did give us some paperwork on NGO (Nongovernmental Organization) registration.  As we were leaving the office, we got a call from the gentleman we were looking for, and he said he could assist us us on Monday morning.

Monday morning at 8:00 we met with him, and another gentleman in his office. He assured us that by virtue of us being a nonprofit organization and having over $100,000 dollars to invest, we did qualify for their help, but only as an NGO.  If we were registered as an NGO, then he could give us the authorization to get a PIN.  They then referred us to the NGO Board, where we were told that we didn’t need to speak to anyone until we had filled out the online paperwork, starting with a name search to verify that the name was not being used by anyone else.  When I told them it was being used because we were already registered, we were told the first step then would be unregister the clinic, and then start the registration process.  This all sounded vaguely familiar, like, what we had just done to get registered in the first place.  This was confirmed when we were told that after the name was cleared, our application would be sent to NIS for vetting, and it would take 6 months!  I explained that I had just been vetted, and would hope that the original vetting would be enough, but was told since this was a new company, the process would have to be repeated.

Needless to say, we were a little discouraged at the prospect of starting all over again, particularly with no assurance of a successful outcome.  We seemed to be out of options, but the power of networking saved the day. In Kenya, people survive because of the network of people around them, whether it is family (which includes your “cousins” who are not related to you, but are from the same village), schoolmates, business associates, etc.  Without these contacts, you really do not have a chance in such an otherwise dysfunctional system. Eric Odida reached out to his former boss, Jack Ranguma, the former governor of Kisumu county.  As well as being the former governor, Jack Ranguma had previously been the first indigenous Tax Commissioner in Kenya, and had written a lot of the tax code for the country.  He did not know of any reason why there should be an issue getting the PIN, so he asked us to accompany him to the KRA to see what could be done.

Jack Ranguma is still held in high regard at the KRA, and everyone knew him, either from when he was there or from his large portrait in the board room.  We were taken to the Deputy Commissioner’s office, and after the situation was explained, he called in Wanja, the Assistant Manager of the Domestic Taxes Department to see what the real issue was.  She explained that the real issue was that they needed to have some way of verifying that I was who I said I was, and that I was in the country legally.  There is no communication between the various government departments, like Immigration or the Attorney General’s office, so the fact that I had a visa and had been vetted by the National Intelligence Service, could not be used officially by the KRA to certify who I was, so they had decided internally that the criteria they would use would be if someone had a work permit, they could verify that they were who their passport said they were.  It was simply a bureaucratic workaround, because no one wanted to be responsible for making a mistake!

Wanja was then directed to take us to her office, while Jack Ranguma waited in the Deputy Commissioner’s office, and find a way to resolve our problem.  She called in Jacinta, the lady who actually pushes the button to give the PIN. Jacinta proceeded to explain again why it was impossible, and so she and Wanja stepped out for a few moments.  Eric told me that the discussion was probably along the lines of, “These people are here with the former Commissioner, and we are to tell them how we are going to do it, not why it can’t be done”.  I don’t know what the real conversation was, but on their return, the decision had been made that I could hand write a letter stating that I would turn in a copy of my work permit when I got it, and in the meantime, they would use that as if it was a work permit and grant me my PIN!  So Jacinta pushed the button, and voila, my PIN appeared!  Thank you Jack Ranguma and all of the folks at the KRA for the invaluable assistance!

With my PIN in hand, I went online to apply for the PIN for the clinic. Everyone said it should only take a few days to come through. So when 2 weeks had passed, and there was no notification from the KRA, I decided to call Wanja to see if she could check and see what was going on- if I needed some more documentation or whatever.  She said she would, and 2 hours later, the Mildred Smith Mission Health Center had it’s very own PIN!

Opening a Bank Account

Back in January, I had talked to a manager at Barclays Bank about opening an account so the funds we needed would be readily available.  He told me then that it was necessary to have a PIN for the clinic, as well as an individual PIN to open an account and have me be a signatory.  He also had offered to give us a free, no fee, account as part of their partnering to improve the community.  With our recently acquired PINs, I wanted to get the account opened as soon as possible so we could begin obtaining land or rental for the clinic, and to start getting equipment.  Eric Odida suggested I look into an account at the Credit Bank, because the manager there was part of his network, and would be able to offer us a personalized service the bigger bank could not.  Sure enough, the Kisumu Branch manager, David Ondier, was able to match the Barclays offer, and get our account set up.  After we signed all of the paperwork, he asked for my stamp. I told him I did not have one and was not sure what he was talking about. Well, it turns out that in order for a business signature to be officially recognized, it has to be stamped with an official stamp.  So where could I get this stamp?  Why just down the street at a stationery shop.  So we went down the street and found the place. They said the stamp would cost 1,600 Kenya Shillings, or about 16 US Dollars.  He asked what I wanted on the stamp, and told me to return in 3 hours and it would be ready.  I was a little surprised that they did not need any identification from me, or any paperwork documenting that the company actually existed or was registered or had a PIN, but apparently that was not required.  So three hours later, I had my stamp which then made my signature legal.  How it managed to do that, I have no idea, but the account was now in place.

The first order of business was to make a trial deposit, to make sure all the numbers were in order.  The funds for the clinic are being collected through African Restoration Ministries in Independence, MO., and the treasurer, Brian Mundy, was able to get the trial run done, and the bulk of the funds transferred without problem.  Well sort of. I got a message from the bank manager saying that the funds had been transferred, and would be available as soon as “due diligence” had been done.  Because of the issues of money laundering and corruption going on in the country, it is required that the sender gives a letter verifying the funds have been properly sent.  I’m not exactly sure how a letter is better than the routing information showing the banks and accounts that the money came through, but we work with the system we have.  ARM sent the letter, and we now have a fully functioning bank account!

I’m Back!

It has been 6 months since I added to this blog, but things are moving again. When last we met, I had been told by the Registrar’s office that it would be 3-6 months to get the CID (Criminal Investigations Division of the Kenya National Police) vetting done, so the clinic could be registered. Everything else, as far as entering into contracts, setting up bank accounts, equipment purchases, etc. all depended on that. So we waited. I was able to make good use of the time, however, in getting experience that will help me in the clinic when it does get established. My wife Judi and I took an Emergency Ultrasound introductory course in Chicago (shout out to “3rd Rock Ultrasound”-great course), but it was obvious I would need to have a lot more experience before I could use ultrasound meaningfully in Kenya. I had purchased a Butterfly IQ handheld US unit, and practiced with it during the course. For those who don’t know, this is a revolutionary piece of equipment! It is a $2,000 handheld unit that plugs into an iPhone or iPad, and gives results comparable to an $80,000 or more machine that requires multiple probes that cost 10-20 thousand dollars apiece.  But the equipment is only as good as the person holding it, and after 4 days of intense training, I had a good idea of what I was supposed to see, but not a very good idea of how to actually obtain those images.

I contacted several hospitals in the Kansas City area when we got back, and got a positive response from the Research Medical Center ultrasound staff, who agreed to let me come and hang out with the Ultrasound Techs, and with patients permission, use my Butterfly IQ to try to replicate the studies they just had with the real machines. The techs could also critique my technique and offer suggestions as they had time. 

I certainly gained a new respect for the knowledge of anatomy and the amazing abilities of the techs to get the information they do from the studies they perform. So for 6 weeks I was blessed to have that experience, and to be able to dramatically improve my ultrasound skill.  On the weekends, I was working at Appleton City, MO in the Emergency Room, and was able to use my new skills in “real life” too.  In fact, a few days ago, I got an email from Butterfly IQ, telling me I was one of their top users of the Butterfly in the United States, and wanted to get my thoughts on improvements they could make with their product.

I also got to attend the Inmed International Medicine conference in Kansas City, and made some valuable contacts there with other providers and groups that will be helpful in the coming months, and to work on getting the web-based Electronic Health Record we will be using lined up.

But back to Kenya.  After 3 months without any word, Eric Odida, my good friend and local director for the clinic, went to check in at the CID office to see how the vetting was going on.  They told him they do not do the vetting, that it is done by the National Intelligence Service (NIS).  So he went to the NIS, who looked up the reference number and said that the file had not been forwarded to them yet.  Then it was back to the Registrars office, where he was told the requests are forwarded in batches, not sent individually, When he pointed out that it had been 3 months since the application had been accepted, they explained that sometimes applications got overlooked when they were doing the batches, a common problem in such circumstances.  Eric asked if someone could give special attention to our application, and was told that was not a good idea, because it would appear as if someone had taken a bribe and was pushing it, so it could go badly for the application.  He then suggested he would like to speak to a supervisor about it, and was informed that was not a good idea, because the clerks would not want to handle the application, because they knew special notice was being taken, and would be afraid to be associated with it.

Since the logic of that was unassailable, it was back to waiting. As the sixth month rolled around, I received an email with the last page of the application with the notation “KG Approved” written at the bottom.  Eric, who was in the United States at that time, informed me that meant “Kenyan Government Approved”, so I was very excited.  The email told me I should copy the page they sent me and paste it in the application online in place of the original last page. I was not sure what that meant or why that would possibly be necessary, since that had both documents in their possession, so I went back online to the government “e-Citizen” site, the portal to immigration and business registration and all things governmental.  When I got on, I found that I could not get to the 4th page, where the documents were, because an error was now showing on the 2nd page, which was where all of the addresses were listed.  The page had gone through without any problems 6 months earlier, but now brought up only an error message, which prevented any further progress.

So I tried to call the Registrars office in Nairobi.  I did finally get someone, but they could not understand my English, or there was a bad connection, so they told me to e-mail them.  I had already tried leaving a query on the site, but did email directly to the office, and never did get an answer.  Eric also tried to call, and actually talked to a supervisor, who was in a meeting, but promised to return his call.  Follow up calls never found anyone available to answer questions, and back on the e-Citizen website, a message appeared telling me to send them an alternate email address.  I did that, and never got a return email, but the message changed and I was directed to come to Sheria House, the registrars office in Nairobi.  Eric and I both were returning to Kenya in mid-August for a church Women’s Retreat, so we decided it would just have to wait until then.

I will admit, I was getting a little concerned about whether this clinic was actually going to be something that would actually happen, and decided to make it a matter of fasting and prayer.  I am not trying to make any statement of ecclesiastical principle here, but I have found that when I have been faced with life-altering decisions in the past, that if I fast and pray for 3 days, God has always seemed to give me direction.

This time was no different.  After the 3rd day of fasting, I woke up around 4:00 am and felt directed to email a friend with some advice and counsel. After I did that, I was given the thought that I should go back to the e-Citizen site, and replace all of the numbers in the addresses on the page with spelled out words (i.e. three instead of 3).  I did that, and it worked!  I was able to replace the last document in the application, and when I rechecked the e-Citizen site later in the morning, the registration had been completed! So on August 2, 2019 the Mildred Smith Mission Health Center became a legally registered company in Kenya.  

I have no idea whether changing the numbers had anything to do with it, but by God’s grace it was accomplished.

Setting Up, part 3

I’m met an 11-year-old girl today who, barring a miracle, will be dead in the next 24 to 48 hours. She’s a beautiful young lady who came to the casualty (emergency room) where I was working, vomiting, hallucinating, and very agitated. After medication she calmed down and called for “Doctor Mzungu”. I went over to her gurney, and she wanted to “give me a high five”. I did the “go low, too slow” routine, and she was delighted.

She was bitten by a rabid dog a few weeks ago, and was treated with some antibiotics. A week later, she was called back and appropriately started on Rabies shots, but only had one and never returned for the other shots. Even at home we don’t have effective treatments for rabies once it is in the central nervous system, and here we have even less. The poverty of resources and of understanding her condition led the family not to avail themselves of the treatments, and now there is nothing humanly possible to save their daughter. Through my tears and the memory of her smile, I am reminded why I am here.

What if we had a clinic located in her neighborhood, where the goal was not to make money, but to educate as well as treat the patient in the context of her family situation? What if, through our computer software system we were sending cell phone reminders to her parents to return, and being prompted to call them to find out what was going on if they missed a visit? What if we could set up a system where we could incentivize parents to follow through on preventive care, not just for vaccinations, but to receive education and encouragement in a family medical environment? That’s the dream! What if? Then this vivacious little girl would have a whole life ahead of her.

So it is worth it, even though there can be frustrations. I ended my last blog by stating the last registration hurdle had been overcome. Well, that was not quite the case. It was ready for review, and that review was not good. The instructions clearly said to submit the documentation either in JPEG or PDF format, so several of the items were just photographed and submitted. My application kept getting returned because they were wanting me to resubmit several items, so I kept recopying everything and sending it back in, only to have it rejected again, after a 4-7 day review. Judi was kept busy at home sending documents that I thought I needed, but it was of never enough. Last Sunday, in the rejected column, I got a message from someone in the bureaucracy, saying cryptically, “Come to Sheria house.” That is the Office of the Attorney General located in Nairobi. So I caught the 9 pm bus, arrived in Nairobi at 4am with plenty of time to walk the 5 blocks from the EasyCoach bus station to Sheria house by 8:30 am when it opened. There I was informed that all the documentation had to be in PDF format ONLY, and that was why it had not been accepted. I could not figure out how to change a picture into a PDF file on my phone or iPad, so I had to resort to Cybercafe in the building across the street. Tina was very helpful in getting files on my email sent to her, changing them and sending them back in PDF form, so I could sign them, and return them to her, so she could send them to me as a PDF file again. (Note: I could not just print them from my email on a cybercafe, because my email insists on protecting me by sending a message to my phone, which I am currently using a Kenyan SIM card in, so the message is inaccessible-I love security!) With everything on my phone in place, I returned, and in review, found that I had not placed the Lot number on the address in the right order, and since I had already submitted the form again, it would have to be rejected and opened for corrections again.

Rather than wait 4 days for that to happen, the lady at the help desk took me directly to the person who was handling my case, who was very helpful in assuring everything was in order - which it was not! Apparently, it had not been communicated to me well that I needed to have the American business license and the constitution notarized- and not just notarized, but notarized in the country of origin.

So, back to my ever helpful wife Judi, who fortunately had the next day off, and was able to get a notary to sign that she had seen the documents, since of course there were no signatures to be notarized. And so, after quite along time, it seemed as though the process of registration was about to be complete. Then everything else could fall into place: beta PIN from the government, get the bank accounts open, secure the site for the clinic, and get started on the equipment and personnel. Again, the personnel at Sheria house were very helpful and were really trying to do their work efficiently. The barriers to getting things done here are not lazy, uncaring or incompetent people, it is the systems they are forced to work under, with shortages of literally everything, including electricity. It is not so amazing that things sometimes go slow. What is truly amazing is that so much actually does get done eventually!

Anyway, as I sighed a breath of relief at seeing the end in sight, she said, “Now, we will send your application to CID (the national intelligence service) who will vet you, and then you will be ready to go”. Naively, I asked if that would be done in the next 2 weeks I had remaining in Kenya, and was informed it would be more like 3 to 6 months! And that I could expect a call on the phone, my Kenyan phone, which of course is not active when I remove my SIM card at home, so I guess I will be carrying 2 phones for a while. Too bad Apple doesn’t have dual SIM cards in their phones!

One afternoon I found myself talking with Aggrey Anditi, a friend and local businessman at his Abala Centre, outside of Korowe. His suggestion was to just give it to a lawyer, and have them do it. He even offered me his lawyer, but unless there is something else missing here, it should be done. Literally everyone says to avoid the lawyers here, and no one seems to trust any lawyers except their own. But if this doesn’t go through, the next try will be with lawyers!

Setting Up, Part 2

I intended to blog once a week, and wondered if I would have material to blog about that often...I is now week three since I returned to Kenya, and I have not had time to blog! Obviously a lot has been going on, but I will try to catch you up.

I returned to Nairobi in mid-January, and spent my initial time in meeting with people who know what they are talking about with businesses, building clinics, running clinics, and medicine in general in Kenya. I can’t stress enough how important having contacts with people is in this environment, and how much of a joy it is to have them offer their help.

I started with a meeting with Richard Kerich, a long-time acquaintance with whom I had a “black milk” encounter several years ago. It’s a great story and a Kalenjin thing, but I won’t go into that here. He used to be the head of the National Health Insurance Fund (NIHF), the Kenyan government insurance program, so he was very helpful in helping me understand the insurance landscape and where a Mission medical clinic would fit in. It turns out it will fit quite well. Kisumu, where the clinic is planned, is part of a pilot government program to give everyone a health card, instead of having them buy the insurance, and seeing if there can be a cost saving by having people get preventative and acute primary care before illnesses progress to where they need to be hospitalized- the essence of Family Practice and the goal of our clinic!

He also now runs a consultant inn business that helps establish medical clinics, so he gave me a lot information about personnel pay scales, as well as a step-by-step plan for identifying a location, partitioning the building, equipping the facility, staffing the facility according to government requirements, and applying for all of the licenses.

These include, in step-wise fashion:

1. County Government License to operate

2. Public Health License

3. Medical license for the facility ( rides on my medical license)

4. Laboratory license

5. Pharmacy license

6. Radiology license, if desiring to have on-site radiology services.

Richard then gave me the contact of Noor Majid, the man they use for getting facilities set up, and had his assistant send me a complete prospectus of a project they had recently been involved with setting up 10 clinics in Nairobi. That allowed me to get a very accurate estimate of what we would need to get the running for the first 6-12 months, using real figures. Richard was incredibly helpful, and took a large part of very busy day to introduce me to healthcare in Kenya.

The next meeting was with Dr. Tamer Mikhail and his wife Dr. Sherry Eskander. They are both working at the Coptic Hospital in Nairobi, a Mission hospital system that is well known for quality medical care. I was given Dr. Eskander’s contact by Karim Hanna, whom I met through the Global Medicine interest group of the American Academy of Family Practice. They were very helpful in sharing with me about the mission hospital experience in general, and with specifics of the Kisumu region in particular. They were kind enough to offer contacts with whom I could set up a possible clinical experience while I am here. I was looking to work at Jaromogi Oginga Odinga Referral and Teaching Hospital, but had not confirmation from them yet, so it was comforting to know there might be options if that did not work out! Again, they gave me the better part of their morning, and were very kind. They will definitely be a good resource.

The next meeting was with Mr. Majid. He is married to an American lawyer who is working on women’s prison issues, and her father is doctor who volunteers at a Mission hospital here in Kenya, so the family has a heart for Mission work. He also works for a company called Bliss, which has set up a hundred or more clinics in Kenya. He does the building  preparation so it meets the standards for government inspection, and manages the logistics of the practices. He was very helpful in terms of specifics on costs on building preparation, and how the NGO and government programs for vaccines, HIV and TB work with clinics, costs of IT, and the nitty- gritty of practice management, like waste disposal. As everyone I have met has, he said he would be glad to volunteer his time to look over our building once we have it, and give us specifics on required specifications, etc. He will definitely be a huge asset, and he volunteered his wife’s legal skills, if needed, but I guess that would be something she might have some input on, if the need arises.

After exhausting my contacts in Nairobi, I traveled across to Kisumu. I next met with Maurice and Jane Owuor. Jane is the daughter of Jane and Austin Odicoh, good friends who are church leaders in Bonde. Maurice and Jane are running a successful clinic and hospital practice in Ahero, just East of Kisumu, called the Ahero Medical Clinic. Jane was actually sick with malaria, and was receiving IV medication in her own facility!

  Maurice gave me the tour, and had me accompany the Clinical Officers on rounds. It is an outpatient and inpatient facility. I was not licensed to practice medicine yet, but I did answer questions about management in cases where they thought I could be of help. Maurice then sat down with me to talk about the way their facility works.

I might explain first the hierarchy associated with medical practice in Kenya. Consultant Doctors are the top tier, but very scarce in Kenya. Those who be doctors who have completed a residency. A doctor that has been through medical school and completed a year of internship is called a Medical Officer. Clinical Officers are similar to a Physicians Assistant Nurses are the next tier, and can operate very independently, like the Nurse Practitioners in America.

Maurice is a Medical Officer, and Jane is the manager of the clinic. He has 4 Clinical Officers (COs) working under him. They see patients in the clinic, and refer any hard cases to him for evaluation and treatment. He also reviews all of the charts. He rounds with the COs, and is called to see patients as needed. They have a laboratory, run by a Lab Technician, and a Pharmacy, run by a Pharmacy Tech. The lab, the pharmacy and the techs all have to registered with the government. They do not have radiology yet, so if they need an x-Ray or ultrasound, they refer them to a bigger hospital, or one of the private radiology service providers (who of course vary in competence depending on their price) that dot the landscape, The medicine is basic, often involving empiric treatment for things, because diagnostic testing is too expensive or unavailable. They do give much needed care locally, and even are given step down referrals from the bigger hospitals in Kisumu at times.

Maurice and lab tech at Ahero Medical Center

I did also find out that the testing and treatment for HIV is free of charge and is largely done by government and NGO technicians who are in the clinics, so when a patient needs testing they are referred to the in-house technician that the clinic gives space to operate in the clinic. TB is also referred out for treatment, which is free, and vaccinations are given in the clinic, but are provided by the government also. That means we don’t have to reinvent the wheel in terms a lot of these programs. It is good to see so many of these initiatives making a real impact in the lives of the people here. The vaccination schedule is different than what I am familiar with, but most of the same vaccinations are given, with the exception of BCG(tuberculosis vaccine).

Maurice also shared with me their growth from a rented building to start with, growing to where they were able to invest 4,000,000 Kenyan Shillings, or $40,000, to buy land and build the clinic, after 4 years. That was seven years ago, and now they have expanded to an inpatient facility with male, female, maternity and pediatrics wards. They put the capital they had into the building, and then borrowed money for the equipment, so they could use the equipment to generate the revenue. Our goal is to not go into debt at all, but it certainly put the importance of having the physical structure as the focus at first. He shared a list of essential drugs that we can dispense as a “dispensary”, if we do not have a pharmacy technician at first.

Maurice was very helpful in describing the payment systems, what the average payment from the NHIF was per patient, and the names of groups that help Mission clinics with medications and equipment. I am convinced that Maurice and Jane will be invaluable resources as the time goes on. And Jane seemed to fully recover from her malaria.

Back in Kisumu, Eric Odida set up a meeting with Dr. Luci Ojuwong, the past Secretary of Health for Kisumu. He was able to give us the information on what would be required for our licenses, and then decided we should just meet with the current Secretary, Dr. Dickens Onyongo. He gave him a call, and found he was having a seminar in the very hotel we were meeting in, so Dr. Onyongo left the seminar and came down to meet us. He seemed very supportive of the project, and was sure there would be no problem with licensing when we got ready to do so. He gave a rundown on the regulations we need to be aware of, and what authorizations we would need if we decided to build instead of rent.

Dr. Onyongo

While I was gathering all of this information, I was also waiting for my letter from JOORTH so that I could get my license. I got that from the hospital on a Thursday, and on Friday returned to Nairobi (only a 7-1/2 to 8 hour bus ride) to the Medical Board office. Winnie Owino was there this time, and confirmed that my file had indeed been lost last time, but I had electronic copies of everything, and with those copies and the letter, she went away for about 15 minutes and came back with my Medical license! It was a breath of fresh air to have someone working so efficiently. I will need to get my license modified when I start in the clinic, but she assured me I could just come back and she would get it all done.

I went ahead and stayed in Nairobi so I could meet with the congregation in Nakuru on Sunday. They meet in Tabitha Omedo’s home, and it was good to see everyone there again, and to meet some new people too.

It turns out, in order to of get registered, you have to have a local (ie Kenyan) Director, which Eric kindly stepped in as, and to get the business lisenced, you have to have $100,000 in a bank account. Brian Mundy, the ARM treasurer, sent me a message that there is now $100,500.00 in the MSMHC account! We have surely been blessed with the right amount at the right time!

With my license now firmly in hand, and several copies made “just in case”, I returned to Kisumu to finish the last step of the registration process. I went back to Barclays to speak with Ronald Mokaya about my progress. He sat down with me to walk me through the registration, answering questions as we went. He then sent me the actual statute about registration, so I wouldn’t get tripped up again, which was extremely helpful also.

The last hurdle was paying for the application. It required me to use M’pesa, but it kept getting rejected, saying that the business didn’t match my payment. I finally figured out that I needed to pay 7,540 shillings instead 754 shillings, which meant a trip to the M’pesa shop, but soon enough that hurdle was overcome, and so now we are waiting on the governmental review.

Setting Up, Part 1

The French have a saying, “Rien n’est simple”, or “Nothing is simple”, and it seems to very true when working in Africa. It is not that it is necessarily intentionally so, it just is. There is a lot of leg work to do before you actually open a clinic, and even when you know what you are doing, it can be daunting. And when you don’t? Well let me tell you.

I came to Kenya last December, with the intention of starting the process of registering the clinic and getting my medical license to practice medicine in Kenya. I was actually here with Andrew Smith and Aaron Sindt, two young men whom I accompanied to a youth retreat in Nyamasaria, just outside of Kisumu. The youth retreat was a wonderful event, with 150 people in attendance.

But that’s another story. I had gotten the Mildred Smith Mission Health Center (MSMHC) registered in Missouri as an LLC under African Restoration Ministries in Missouri, on the advice of both Kenyan and US lawyers, who assured me that registering and operating the clinic would be much simpler and less prone to corrupt practices if it was a foreign LLC doing business in Kenya, rather than a Kenyan business. The afternoon the retreat ended, I decided to see about opening a Kenyan bank account for the MSMHC in Kisumu. Local recommendations sent me to the Barclays Bank in Kisumu. When I told them that I was enquiring about opening a business account, I was escorted to the upper floor, and given papers to fill out. I told them I was really just enquiring about the cost of the account and the checking, etc., and they said they would get me a sheet that would have all of the options and costs. Instead, they brought the director, Ronald Mokaya. When I explained about the planned clinic, he told me that the home office of his bank liked to partner with programs that helped in the community, so they would set up 2 bank accounts, one for US dollars, and one in Kenyan shillings, so that we could transfer dollars to shillings only when the exchange rate was good, and added that both would be free with free checking! He even stayed late to give me the information on what I needed from the Kenyan government to be able to open the accounts.

I planned to have two days in Nairobi before our departure, and even bought tickets to travel, when I was informed the next day was Jamhuri Day, Kenyan Independence Day, which is a national holiday, so everything would be closed.

We were leaving for home the next night from Nairobi, so while Andrew and Aaron went to visit another place for missionary work, I was going to stay in Nairobi to look into getting my medical license and getting the clinic registered with the government, so I could open the bank account.

I decided to try using Uber, so they dropped me off on Mombasa Road, and I opened the Uber App on my phone. The traffic was very heavy, as it always is on a weekday morning going into downtown Nairobi, and the first Uber driver was on the wrong side of the road, stuck in traffic, and eventually gave up on me. The next 4 drivers who tried to get to me were either thwarted by traffic, or my English not being sufficient to understand my explanations of where I was, or they just didn’t contact me at all after picking up my ride request! Driver number 6 finally found me, and part of the mystery was solved when he asked me about my phone number. Even though I was using a Kenyan SIM card in my iPhone, my Uber account was linked to my American phone, so when the drivers picked me up, they were given a US phone number to call. That was too expensive for most, so they just rejected the ride or didn’t show up. Lesson learned. After that, whenever I connected with an Uber driver, I would immediately text them my Kenyan phone number, and it worked perfectly the rest of the day.

I first went to the Medical Practice and Dental Board office and met Winnie, who was very helpful in explaining which of the applications was the one I needed to fill out. When it came time for the fee, they did not take credit cards, so I had to go to an ATM to get the required cash. The office is just down the street from Hurlingham, which was where our house was when we lived in Nairobi in 2007. Besides a big new KFC restaurant, not much else had changed, so I kind of knew my way around the place, and found the ATM and the photo studio where I could get the required passport style pictures.

The last thing I needed was a letter stating where I would be working. While I was in Kisumu, I had spoken with some medical students from Uzima University School of Medicine, and asked them where I should go to get the best experience in treating the local population. They told me I should go to Jaromogi Oginga Odinga Referral and Teaching Hospital (JOORTH) the district hospital for Kisumu county. They’d directed me to Dr. H. P. Awour, who put me in contact with Dr. Ndinya, the Chief of Medicine at JOORTH. I as able to meet him at the hospital, and give him my C.V. and copies of license and diploma. I had not known about the letter earlier, so I called him to see if he could email a copy to me and the medical board. He said he would try.

Winnie told me she could collect everything else and award me the license in 24 hours of receiving the letter, but that was the best we could do. It was actually a very quick and efficient process, once you knew what to do.

My next stop was the immigration office in downtown Nairobi. There I found a hundred or so people spilling out of the standing room only office, and a single worker whose only answer to any enquiring (not just mine) was to say ”Take a number”. As I was clueless as to which queue I should take a number for, and was pretty sure my number would not be reached anytime that day, I decided to consult a law office about registering the business.

I took an Uber to the office, and found Charlene, who was exceptionally patient and helpful in explaining that the registering was actually something that was done online. She directed me to the e-Citizen site for business, explained the process, gave me her contacts in case I had any issues, and refused to take any payment for her time.

The first step in registering a business in Kenya is to have them do a search to make sure the name is not already in use. I did all of the work online, but when it came time to make the payment, it was required that you use M’pesa, the Safaricom phone payment system. I had a Safaricom SIM card, but had not activated M’pesa,

Another Uber ride got me to the Safaricom office in the Westlands shopping center, where I was able to activate M’pesa and pay the fee.

I have to say I was impressed and humbled by the willingness of so many to help me out, and each of them expressed their thanks for the project, and their desire to do just what small thing they could to help it along. That spirit of Harambe, or working together, is really what is bringing the dream of the Mildred Smith Mission Health Center into reality.

Welcome to the adventure!

Hello! I would like to introduce myself and this latest venture in my life to those who may not know me. My name is Doug Smith.  I am a Doctor of Medicine, a Fellow in the American Academy of Family Practice, and have a Diploma in International Medicine and Public Health. By way of introduction, I will give a little of my history. I was born in Hawaii, where my parents were serving as missionaries, and spent a lot of my late childhood in Canada. I spent a year of undergraduate work at Tel-Aviv University in Israel, and did a year of post-graduate work in Nutrition and International Development at the University of Missouri, Columbia before entering medical school at St. Louis University. I completed my residency in Family Medicine in 1990, and then spent 3 years on Active Duty in the US Navy, 2 of which were on Adak Island in the Aleutian Islands of Alaska. I also had the opportunity to spend the years 1999-2001 working in rural practices in Australia. My wife Judi and I have four children.

I became interested in working in Africa in 1997 when I had the opportunity to go on a church mission to Kenya, and have been involved in both church and medical missions to Africa, Central America, the Philippines, India and Nepal many times since then. Kenya has always kind of been my base as far as church activities have gone, and my family was able to live in Nairobi for 3 months in 2007.

While in Kenya, I was inspired by the work of the late Dr. Abisai Amolo Kola, a cardiologist and dermatologist in Nairobi, who would take trips back to his village area to help those in need of medical attention, and have looked for the possibility of returning to actually work in Kenya on a long-term basis. That opportunity came this last summer when, working through African Restoration Ministries, some start-up funding for developing and opening a clinic in Kisumu Kenya was offered.

That was the genesis of the Mildred Smith Mission Health Center. In discussions with members of the Church of Jesus Christ, Restoration Ministries, Kenya, (the sponsoring local institution in Kenya), the request was made that the center be named for Mildred Smith, a woman whose faith and example has inspired many people around the world, and who used her knowledge as a food and nutrition specialist to also improve their physical health. She continued to share with her sisters in Kenya well into her 80’s, before her death in 2007. It is certainly fitting that a center devoted to education, prevention and wholeness would carry her name and work forward. She was also my mother.

I have been asked by several people what exactly I want to see accomplished by setting up this Center. That is a fair question. There are many good medical services being provided in Kenya by government, private and mission institutions which are already established. Certainly supporting any of them would be helpful. However, as a Family Physician, I do still see a need for care focused on the unique needs of the family, including an emphasis on nutrition counseling, education, and prevention, especially among the poor, who so often do not have the resources to seek care for anything except life-threatening emergencies. I also see a need for wholistic care, including dentists, behavior health specialists and social workers to be involved. Family Practice as a specialty is just emerging in Kenya, and establishing a modern center where those principles can be demonstrated, and even taught, will be a real contribution to the community.

How will it all come together? Can all of those services be offered in a cost-effective manner in a low resource community? I really do not know, but I am excited about the opportunity to try. We have been assured that with God, all things are possible, and so we are prayerfully moving forward. It will certainly need to be a group effort, and will not be based on my knowledge or experoience alone. I have reached out to many people in planning the early stages so far, but one of my purposes in starting this web site and blog is to have an opportunity to get comments and suggestions from YOU. I would love to hear your thoughts and get your input on what we are doing. I also have been asked many times by colleagues and friends if they could come to help out on a mission trip. It is my hope that with this center, the answer will be yes. We hope to make opportunities for people of various backgrounds to come and serve, and to make it as hassle free as possible. And donations are also accepted, if that is your desire. I will use this blog to highlight needs as they arise.

The reason for this blog is also to chronicle the journey, so that others can see how the process goes. I could not find a lot of information about how to go about starting a center from scratch. This may turn out to be a roadmap if someone else is looking to see what to do, or it may be a cautionary tale of what not to do, but either way I hope it is useful as I chronicle the successes, failures, joys, disappointments and blessings of our adventure. Welcome aboard!