Until a few years ago, Kombewa District hospital could best be described as a dispensary. Typical of such facilities in most rural settings of Africa, the hospital, situated in the Nyanza Province of Western Kenya could only handle very minor medical complications of patients, who are mostly poor.

Patients seeking treatment at the facility would usually go without essential drugs while the staff, mainly a skeleton one, had challenges working with basic medical equipment like syringes, which were lacking. Patients soon abandoned the facility as it became increasingly clear that they would merely be referred to other hospitals.

Journey of hope
Kombewa District Hospital is gradually receiving a new lease of life as a result of its proximity to the Kombewa Clinical Research Centre, one of the three study sites in Kenya where the clinical trials of the malaria candidate vaccine RTS,S is currently taking place.

This journey of hope, unknown to the locals, originated quietly from the Bagamoyo Research Training Centre in Tanzania.

The third phase of the world's most clinically advanced malaria candidate vaccine, the RTS,S had finally taken off and soon it would be rolled out in Kenya, which is one of the seven participating African countries in the trials.

Little did the residents of this sleepy village in Western Kenya realize that the journey which began several miles away in Tanzania would soon improve health care provision in their community and bring with it huge gains.

Residents of this remote village today confess that things have improved not only for the once deplorable district hospital but also in the other health facilities within the Kisumu West district, which is covered by the Kombewa Clinical Research Centre, where the clinical trials for the malaria vaccine is taking place.

As a result of the ongoing trials at the Centre, the Kombewa District hospital and the outlying health facilities within the district have had their capacities strengthened in terms of the provision of medical care and are now well placed to cope with the increasing demands for health care by their patients.

According to Dr. Walter Otieno, a Principal Investigator at the Centre, which launched its malaria vaccine trials in July last year, there is the need for research scientists working in the district to have a working relationship with the existing health facilities within the study area.

An urgent need however is to tackle the deplorable conditions of most of the health facilities to create a favourable ground for the study. The researchers have identified the Kombewa facility and 21 health centres and dispensaries spread across the district as their potential collaborators in the study.

Scientists at work in Kombewa

The much needed improvements which was made possible through the assistance provided to the facility by the Malaria Clinical Trials Alliance [MCTA] to the Kombewa Clinical Research Centre has seen a renewed hope amongst the many patients who now stream back into the hospital for treatment.

Only last year the district hospital got a major face lift which saw the old roofs replaced.

The wards were also renovated and additional 60 bed capacity ward for adult males built with funds provided by the Kombewa Clinical Center which is operating under Walter Reed, an affiliate of America's CDC, alongside Kenya's Medical Research Institute, (KEMRI).

The facility also received a modern X-Ray machine worth millions of shillings and oxygen concentrator machine both donated by the MCTA , an African- led institution established to build capacity in the fight against malaria.
The Alliance which is made up of scientists within and outside Africa also provides training and technical assistance to research centres in nine African countries.

These countries are Mozambique, Senegal, Ghana, Nigeria, Tanzania, The Gambia, Gabon, Kenya and Malawi.

A reason to smile
Even though malaria still remains the main public health challenge to residents of this district with almost 60 percent of children admitted to the district hospital being due to malaria attacks, the people of Kombewa village now have a reason to smile.

In Kenya for example, digital X-Ray machines are only available in three study sites, one at the Siaya district hospital - another study site in Western Kenya and at the Kilifi site found along the coastal strip of the East African country.

The Kombewa District hospital's Medical Superintendent, Dr.Joel Ogutu can no longer hide his joy. According to him, the situation at the district hospital before they received the equipment from MCTA was pathetic. He watched helplessly as many patients were turned away from the hospital because of lack of essential instruments. His prayer was that one day things might improve for the better.

''All our patients, especially the TB cases where X-ray services were critical would be referred to the new Nyanza Provincial General hospital, the only referral facility in this region which is situated almost 20 kilometers away in Kisumu.
The patients would meet the cost of transport to and fro and a lot of time would be wasted as a result.'' said Dr.Ogutu.

Now the district hospital offers all the X-ray services to all its patients and earns thousands of shillings in revenue from the charges it levies.

According to him, the digital machine has greatly enhanced efficiency at the facility. Pictures produced by the machine can be sent electronically anywhere in the world and results obtained as soon as possible.

In this small village also sits a modern laboratory right in the middle of a rural setting. Each day, mothers and their young ones below two years enrolled in the RTS,S vaccine study stream into the Kombewa trial site to take part in perhaps the biggest study ever at the 11 sites in the seven African countries.

The Kombewa Clinical Research Centre does not lock out other needy patients from communities it works with from accessing help at its facilities.

That was the case late last year when the seven year old Sabastian Onyango from one of the villages covered in the study was down with what later turned out to be Meningitis.

Even though the young boy was not in the study, his younger brother Philip was. Their mother, Millicent Onyango, could not raise money for his medication but approached the center for help and that request was granted on humanitarian grounds.

'He was airlifted to Nairobi, and eventually to Uganda where he was later operated on and treated.
“Today he is doing very well and I plan to have him enroll in class one next year. The cost for his treatment ran into millions of shillings which I could not afford but the centre helped me,'' the mother said.

Even vehicles used by the researchers at the centre have on many occasions helped to rush accident victims to various hospitals in the district and particularly to Kisumu where the provincial general hospital is located.

The move has not only enhanced the working relations between the centre and the community within which it operates but has also greatly benefited the district hospital which operates just one ambulance for all the emergency cases brought to its door step.

The Principal Investigator said because of the trials at the centre, modern machines have also been available which currently is shared between the centre and the other hospitals in the area and helps to diagnose a number of childhood diseases.

Some of them include the blood culture machine, culture for meningitis, urine culture and stool cultures which were not there before the study began.

The machines most of which were provided by the MCTA have increased diagnostic accuracy and helps to determine the drugs sensitivity.

The investigator said before, most of these diseases were treated based on clinical signs and symptoms.

Apart from the provision of the modern equipment, the research centre has also seconded at least one of its staff in all the health facilities within the area where the trials are being carried out to boost the strength of the facilities in terms of personnel.

At the district hospital for example, there is always a pediatrician on call. The centre has four pediatricians who besides taking part in the trials also see patients who seek help at the facility with different complications.

‘'This centre has four pediatricians and because of this, the community here benefits in a big way since they not only see ailing participants on the trial but also assist in any complication which might arise at the nearby district hospital and as a result standard of health care is greatly enhanced.' 'said Dr.Otieno.

The many job opportunities provided by the centre is yet another positive aspect that has benefited the residents of this district, thanks to the ongoing research work.

Currently about 80 people are earning their income directly from the project while even a bigger percentage of the locals, mainly farmers supply their produce to the research centre.

Kombewa trading centre has also sprung up in the process and today it has a vibrant economy within the district with several housing projects springing up.

The trial at Kombewa which has now opened up Kombewa village and its environs completely began following the success of phase two studies in Kenya and Mozambique, where RTS,S was shown to have reduced clinical reports of malaria by 53 percent.

The vaccine candidate which many scientists have billed as a possible magic bullet also had a promising safety and tolerability profile when used alongside standard infant vaccines.

The Kombewa study site is located in an area where malaria is endemic. The area's Provincial Director of Public Health, Dr. Jackson Kioko, said 40 percent of children below five, here have malaria parasite in their blood.

Besides causing acute illness, malaria

Infections have resulted in missed school and work days. The disease has also lowered productivity among the farming groups in the region leading to food insufficiency.

RTS,S which is being tried in the area was developed and manufactured by GSK Biological of Belgium and PATH Malaria Vaccine Initiative.
In Kenya, KEMRI/CDC is enrolling about 1,800 children at its Siaya site while the Kombewa center KEMRI/Walter Reed progammes will enroll 1,600.

The entire study across Africa will enroll a total of 16,000 children of the 11 sites in the seven participating African countries. Researchers hope that if licensed and subsequently approved the vaccine would be an important addition to the current tools available to fight malaria.