A GEMBA and a Coke please

What is it like to be a patient (or as they say in Bungoma, a client) of the County health service?

A normal day on the road
A normal day on the road

A question posed to me a short while ago and one I think I can now attempt to answer.

Well, first of all you have to get yourself to your nearest facility. In the remote areas of mountainous Mount Elgon area this can be a challenge in itself.

Most of the the roads in Bungoma have no tarmac and have been carved out by earthmoving equipment. These dirt roads can quickly become potholed and rutted as the water of the heavy rains carves rivulets across their surface. The red soil of Kenya also becomes muddy and slippery after the rains. And it is hilly in Mount Elgon!

I arrived during this rainy season, and the heavy downpours come almost every evening after dark without fail. It has also been cool (26 – 27°C during the day) and so I’ve been pleasantly surprised at how comfortable it has been.

But the rains cause issues. The roads become impassable to all but motorbikes and 4×4’s.We visited Koshok Dispensary in Mount Elgon and this turned out to be the most inaccessible so far.

Eventually even Martin, our skilled driver, had to give up and we had to walk the last 3K up the hill to the facility.

The Road From Koshok
The Road From Koshok

Imagine having to get there when you are full term and your waters break.

Then when you get to the facility, the smallest of which are called dispensaries, you find it is only manned by one solitary nurse. Victor, seen here beside a Save The Children/GSK donated rainwater butt, was in sole charge of Lunakwe the day we visited.

Victor at Lunakwe
Victor at Lunakwe









Finally, you wait your turn to see the nurse, receive your diagnosis but are then told the dispensary is out of stock of the medicine you require. Unfortunately, it is apparent from the series of GEMBA’s we have concluded, that this is not unusual. The facilities have few resources and have devoted little time or attention to monitoring and managing their stocks.

Koshok Pharmacy Store – No shelves or cupboards available.


Bizarrely it seems, you can always get a Coke!  As we descended from Koshok we met a young entrepreneur carrying his full crate of sodas uphill, presumably to sell to the waiting clients. We duly relieved him of a few bottles, and he went on his way, but it seems some supply chains are robust and well.

Like the Pony Express, Coke always gets through
Like the Pony Express, Coke always gets through



  1. I like it Jim, keep them coming. It’s a question I always ask of the GSK Supply Chain team – how can someone get an ice cold bottle of coke anywhere in the world, but they have to walk for miles to get a simple tablet.

  2. That is sad. Simple issues but have huge impact on patients. I am sure u ll be of great value to help them overcome that.

  3. Thank you for sharing. This is so sad and yet the people are so resilant. I viewed our birthing centers that GSK funds in the Philippines this week. There are very similar issues but thankfully progress is being made.

  4. Jim, Keep up the great work the blogs are a real in site to the challenges faced by our patients. Also the learning experience you are involved in. Best Regards Duncan

  5. Great update Jim, keep them going. Also, remember to do a ‘selfie’ at some point, we want to see you in some of the pics, alhough I am sure you are looking well.

  6. Hello Jim, Good to see your all the updates and I feel very much connected with all these places and even the people. You took me one year back and this is so amazing………. I hope you are also enjoying your time there. Stay safe and enjoy the exciting journey in Kenya with SC.
    Kindly pass my regards to SC Bungoma team.

  7. …Jambo Jim, that road from Kashok -wow!! Not even a Kawasaki Hayabusa not Ducati ‘Street-Figher’ can access that road. It would be one of those “generic”/second brand motor-bikes. There’s a lesson there from the Young Man with a crate of Coke-It pleases us that Africa Vision 2020 will address these medicine access challenges. You are a foot-print experiencing it first hand, when you return home believe me the change spirit will be enormous.

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