My training in Kenya
Jambo! I'm writing this post from IU house while drinking a Tusker. This week has been unbelievable. There is so much I want to document in this blog, so I apologize if it is lengthy. But you'll want to at least scroll down to see the photos!
There are 4 ward teams at the pediatric hospital at Moi University: Tumaini ('Hope' in Swahili) 1 and 2 and Upendo ('Love' in Swahili) 1 and 2. I am on Upendo 2 Team. My first day was post admission, and the experience was a bit overwhelming. The rounding team is 10-15 strong, represented by medicine, nursing, pharmacy, nutrition, social work, etc. I certainly stand out wherever I go in Eldoret. I am one of the only "Mzungus" (white person) in a town of roughly 750,000. Also I seem to be the tallest person in the hospital. The pediatric hospital recently opened and is state-of-the-art for this region; however, here I find myself in a room the size of your average living room, where there are 12 patients and their families in beds with no barriers. Single beds are often occupied by two patients and their parents. Children with malaria, HIV, tuberculosis, cancer….all in the same room.
This is the initial shock. I was expecting it, but there is no way to prepare. Most of these children should be in an intensive care unit, hooked up to monitors, receiving a myriad of medicines and personalized attention. And the barriers become clear quickly: the only CT scanner is down, the medication isn't available, the parents can't afford a test. The list goes on and on. I felt absolutely helpless.
About the medical team. I am ashamed that I assumed beforehand that my education would be superior to the education at Moi University. I thought I would be teaching my medical student counterparts about everything I've learned with the state-of-the-art learning resources I've had access to in the states. I couldn't have been more wrong. The students are brilliant. They are teaching me things I should already know or have forgotten. Granted, this is my first hospital rotation since I took Emergency Medicine six months ago. Taking light electives during interview season really made me rusty.
Medical students at Moi University take six years of medical school, with clinical rotations starting in the third year. I am most impressed with their knowledge of therapy doses. This has been one of my weaknesses, but they are very adept at recommending specific doses, which is even more difficult in pediatrics since doses are weight-based.
I am also awed by the thoroughness of their history-taking. Since many labs and imaging are not possible, every piece of information gleaned from the patient's history is valuable. I am learning to ask questions I would have never considered: Do you live in town or in the country? Is your kitchen inside or outside? What fuel source do you use? Where do you get drinking water? Do you boil or treat your water? Is your toilet inside or outside? How many rooms does your house have? Do the rooms have windows?
I am glad to have faced these initial challenges. One of the reasons I came here was to be exposed to a different culture and healthcare system. This was not supposed to be easy. Much of what I have learned does not apply here. I came because I think that all health is global health. All human lives matter. And though Kenya is distant from Indiana, the health here affects us. Perhaps some we won't fully realize the connection for a number of years. The world is becoming increasingly connected, and you only have to look at recent headlines concerning Ebola and Zika Virus to see how "those diseases over there" become a problem for our local communities.
The other reason I came was to try to help, even if in a limited way. It's good to say after a week I definitely feel like a valuable member of the team. I have taken leadership over the management of multiple patients. Team members are often very interested in learning how we treat patients in the USA even if such treatments do not exist in Kenya. I have taught fourth year students about physical exam skills. And I have been handing out those stickers and Pokemon cards that I've had stuffed in my white coat pockets along with my pulse oximeter, stethoscope, reference books, etc.
I must mention a couple other experiences last week. The Dean of the IU School of Medicine, Chair of Surgery, Chair of Medicine, and other IU faculty visited last week. On Wednesday, there was a banquet celebrating the AMPATH consortium and the partnership with Moi University. It was incredible night. There have been many key players in the success of this partnership, but none more than Dr. Mamlin (he prefers to be called Joe). He moved here from Indiana to dedicate his life to fighting the HIV epidemic in Kenya. The details are described in the book, "Walking Together, Walking Far" by Fran Quigley. I got to spend a day with Joe in the AMPATH clinic in Turbo, and small town 45 minutes away. Joe is something else. We know he's at least 80, but he still dedicates his life to serving his patients. I found myself at ground zero of the fight against HIV, sitting next to Joe behind his desk as patient after patient came through the door. I saw Joe take money out of his wallet for the patients who couldn't afford transportation to their next location. I saw him crack jokes with his patients in fluent Swahili. He translated for me while I filled out antiretroviral and opportunistic infection prophylaxis prescriptions with a big grin on my face. I saw him be one of the coolest physicians I've witnessed.
We spent last weekend at Lake Nakuru Park. It's about a three hour drive from here, and the eight of us had a great time crossing the Equator in our large safari van. The diversity of life and scenery was astounding. I can only compare it the first time diving in a coral reef (my first experience was in Grand Cayman, an undergraduate IU Study Abroad Trip). I was in a landscape I have never seen before. The lions were a highlight, of course. This country is a treasure with so much to offer, and I keep chuckling to myself when I think that I sacrificed a vacation month to be here.