A case study of the Tenwek hospital community health programme in Kenya.

Tenwek mission hospital, situated in the west-central highlands of Kenya, initiated a community health programme in 1984. This paper describes the major features of the programme and assesses the impact on a number of health and family planning practices after 3 years of implementation. Comparison of the results in the programme areas with the baseline survey and with control areas show significant changes in several indicators. It is concluded that Tenwek hospital demonstrated the impact a hospital can have on health of communities by effectively moving into community-based health care.

Tuberculosis risk among migrant farm workers on the Delmarva peninsula.

A survey was conducted to ascertain the risk of tuberculosis (TB) among migrant farm workers on the Delmarva peninsula. Relevant histories were obtained from 842 migrants; a total of 709 skin tests were completed, and 239 sputum specimens were examined for acid-fast bacilli (AFB) and culture. No cases of infectious tuberculosis were ascertained by history or AFB examination. One sputum culture was positive for M. tuberculosis and 13 were positive for various species of nontuberculous mycobacteria. Thirty-seven per cent of migrants tested had significant skin test reactions of 10 mm or more. Reaction rates for men were 41 per cent and for women 25 per cent. Age specific rates ranged from 14 per cent in children aged 5-14 to 54 per cent for ages 45-54. Rates for the principal national/ethnic groups were Haitians 55 per cent, Mexicans 36 per cent, US Blacks 29 per cent and US-born Latinos 20 per cent. Based on these results and other information currently available, it is recommended that current Centers for Disease Control (CDC) recommendations for TB prophylaxis continue to be applied for migrant workers, but that mass screening by skin testing in camp populations not be emphasized. Other recommendations focus on: case finding of active disease, improving continuity and follow-up, increasing coordination among involved agencies, and actively supporting improved economic and living conditions for migrant farm workers.

Primary health care and Protestant medical missionaries in Kenya.

PIP: In spite of a long relationship between medical missions and primary health care, relatively few medical missions and missionaries have actively embraced and implemented primary health care programs. This study reports on the present activity level of Protestant medical missionaries in primary health care (PHC). From September through December 1983, the 79 member organizations and facilities of the Protestant Church Medical Association in Kenya were provided with questionnaires to be answered by expatriate medical mission staff. A total of 61 individuals returned questionnaires. Background characteristics of the respondents and self-determined estimates of the % of time spent on various activities are presented. The major site where work was done was reported to be the hospital for 64% of respondents, while the remainder reported working mainly outside the hospital setting. Doctors were significantly more likely to be hospital-based than nurses. PHC activities account for a mean of only 13% of the work week and hospital-based activities, 62%. One might expect that missionaries of longer experience would be more aware of local needs and become more involved in PHC, but this survey does not lend support to such a hypothesis. Such evidence of little involvement in PHC ought to be a major challenge to medical missionaries. It is argued that medical personnel within the church are in a unique position to develop and promote PHC.^ieng