Banda Health and Kijabe respond to COVID-19

By Carmen Pauls Orthner | Kenya in East Africa

Banda Go's first clinic in 2018. Photo by Tim Coleman.

An SIM-initiated IT project is helping small, independent medical clinics prepare to care for COVID-19 patients in city slums and rural areas of Kenya.

In response to several initial cases in mid-March, Kenya’s national government acted swiftly to contain the virus, and two weeks later, imposed a nationwide dusk-to-dawn curfew, which is being enforced by police and appears to be slowing virus spread.

Dr Steve Letchford, a medical doctor serving with SIM, fears the close quarters of the already-overcrowded slums of cities like Nairobi and Mombasa may not only dramatically increase the number of COVID-19 cases, but lead to severe economic problems as well.

“If COVID-19 community spread hits these very poor neighbourhoods… it could be brutal health-wise or economically,” Letchford said. “They have no margin, [even] when things are going well.”

As Letchford explained, “social distancing” and other COVID-19 prevention methods are nearly impossible in the slums. There is usually one wage earner, working at a factory or selling basic goods, who then supports a whole family – two to eight people, sleeping together in a room barely bigger than three meters, corner to corner.

Water is a luxury that has to be paid for, and brought in daily, so washing hands is difficult. And in order for anyone to eat, the wage earner has to go out every day, which is why the curfew is for nighttime only. Just two weeks after the curfew was instituted, American news channel CNN aired footage of a near-riot in Nairobi’s Kibera slum over a shortage of food aid packages.

In these disadvantaged areas, most people rely for their medical care not on government facilities, but on hundreds of tiny, independently operated clinics, many of them run by Kenyan Christians. Twenty of these clinics are supported with management software developed by Letchford and the IT team in SIM’s Banda Health project.

When COVID-19 hits the slums, “these clinics are going to be up first, but they are working with very tight resources. The reality is that when you are really poor, your clinic is really [financially] poor also,” Letchford said. “But your local clinic can be your best chance of getting care quickly. SIM’s Banda Health goal is reaching these frontline healthcare providers and empowering them with the IT tools they need to transform healthcare for the most vulnerable patients. If we wait for these patients to get to the mission hospitals of the world, it’s often too late.”

“The whole reason to reach and help the guys on the front lines is because that’s who’s there,” Letchford added. "They are the first stop for these patients. As we build relationships with these providers, we are constantly asking, how do we help them to sustainably improve the care they provide these most vulnerable patients?”

"As we build relationships with these providers, we are constantly asking, how do we help them to sustainably improve the care they provide these most vulnerable patients?"

As people start getting sick and scared during a COVID-19 outbreak, Letchford predicts that the number of incoming patients could easily triple. The clinics’ supplies of water, soap, and personal protective equipment are limited. If a clinic’s medical staff – none of whom are doctors – get sick, the clinic has to shut down, which means removing a community’s vital source for diagnosis, treatment, and medication.

Banda’s business software makes day-to-day operations – such as invoicing and recording treatment or drug payments, or keeping track of their stocks of pharmaceutical drugs – easier for the clinics. This in turn makes them better prepared to handle a crisis, such as a COVID-19 outbreak, Letchford said.

“They have more time to take care of their patients because they’re not spending all their time trying to keep track of the pieces of paper and then make sense of them,” he said. “And a good financial system means they have the money… to buy soap, or if they want to buy some masks for their staff, or gloves.”

During a health crisis like the COVID-19 outbreak, though, what the clinics need most is a source for good information – someone who can help them distill the information they are getting online down to what is most accurate and useful. That is where Banda Health comes in.

Although the clinics subscribe to the Banda software to help with daily business management, “an unexpected value-add for them is just knowing that they’re part of a network, even though they’re all their own private clinic owners – just knowing that someone out there cares about how they’re doing even as health care providers,” Letchford said. “Our goal is not software – our goal is building relationships with frontline healthcare providers and helping them provide good healthcare.”

"Our goal is not software – our goal is building relationships with frontline healthcare providers and helping them provide good healthcare."

As a consulting physician at Kijabe Hospital (a ministry of the Africa Inland Church in Kenya), Letchford has been a front-row observer as the hospital has mobilised its outbreak team and prepared the hospital to serve as a primary care centre for COVID-19 patients. Deeply impressed by the quality, speed and level of detail that has gone into Kijabe’s response, he is leveraging that thinking and preparation to help the Banda-supported clinics get ready to deal with COVID-19.

“When this thing hits, and the next 30 people walk in, what are the four things you need to check on everybody? And what’s your plan? There are drugs we’re still going to be giving. You need to be sure you have A, B, and C. And how are you going to help your people learn to know what to do? … It’s about helping them know, what do they do as these people roll in, rather than just shooting from the hip,” Letchford said. “So at least they feel like they have a plan, and [know] how are they going to protect themselves.”

As he considers how the Banda-supported clinics will respond to COVID-19, Letchford’s greatest comfort comes from knowing who is running these clinics, and why. Many of these providers are believers with a gospel-driven desire to care for people living in desperate situations. One of these clinics is run by a woman named Mary, who started her clinic in the time when there were no drugs in Africa to treat HIV/AIDS. Back then, Letchford said, “there was nothing you could do except sit with people as they died and help start taking care of their families.”

“Mary argues with God all the time. It’s like, ‘God, really? What am I supposed to do with this? These people? This is a disaster.’ But what does she do? Whatever God tells her. That’s what she does,” Letchford said. “What’s she going to do with coronavirus if it gets bad? I don’t know, but it’s Mary. She will take God’s hand and do what she has to. … That’s why they’re there.”  

While the Banda-supported clinics may wrestle with the day-to-day realities of supporting their communities through this crisis, there is one critical thing that they can offer their patients: themselves. “It is bringing hope that someone, at least, is in there with you,” Letchford said. “And not because they can give you something to cure you, but because someone cares.”

“Like in the days of a plague in days gone by, the church … steps into this (situation) without hope of a cure,” Letchford said. “These believers are there, ready to get as many people through it as they can.”

Support healthcare facilities through SIM

SIM’s COVID response project is helping AIC Kijabe Hospital, Banda Health and many more gospel-driven ministries as they navigate the bring hope to many during the COVID-19 crisis. Can you help? Read about the relief project around the world or donate using the location closest to you and the project number 99753.

Pray for:

• Those struggling during COVID-19 to find comfort in Christ.

• God to provide healthcare workers and the clinics they serve with enough protective equipment and resources.

• Kijabe Hospital to continue treating patients with expert care and gospel-driven love.

• Banda Health to support clinics effectively and make their eternal purpose known.

Visit Banda Health's website to learn more and support its ongoing ministry. Visit Kijabe Hospital's website to learn about their continued work.