Start small, start now, learn quickly

Over the past week, I have been trying unsuccessfully to describe concisely what this summer has meant to me. What was I supposed to have accomplished while being here? What did I actually accomplish? When discussing health disparities, is personal accomplishment the correct metric?

Perhaps I should start with what a Slemenda Scholar is. The program is named after Charlie Slemenda, an IUSM epidemiologist with an intense interest in global health who passed away suddenly from a heart attack at a very young age. Funded completely by the IU Center for Global Health, it sends 2-3 medical students who have just finished their first year of medical school to Eldoret, Kenya, to experience everything that AMPATH is, and see what role global health might play in their future careers. It is without a doubt an investment in us, the Scholars, and our development. While there has never been an ounce of pressure on us to return or commit to a career with AMPATH, the Slemenda legacy is strong-the majority of Slemendas return during 4th year, residency, and eventually, long-term, to serve as team leaders for 2-4 years or live permanently in Eldoret as practicing clinicians. The current medicine team leader, a Slemenda, is married to another Slemenda, who has also served as a team leader before! What is truly amazing is that the partnership between IU and Moi University is so strong, and that IU is so committed to the work being done here, that IU departments, from their own budgets, fund their faculty members to come here and practice for 2-3 years at a time. It makes me proud to attend a school that believes so clearly in improving healthcare everywhere and supporting long-term efforts to do so.

After movie night last Thursday at the children's hospital, Faisal, a triple board resident (pediatrics, adult psychiatry, and child psychiatry) from IU, mentioned that he wanted to check on one of his patients, and I joined him. His patient was a three-year-old boy suffering from cerebral malaria, throwing up blood and bleeding from different parts of his body. Faisal worried that he was going into shock and tried to take the child's blood pressure, but there was no working blood pressure machine or cuff at the hospital. To get a sense of the child's BP, Faisal used his pulse oximeter to check the heart rate and then pressed on the child's foot to check his capillary refill. The heart rate was high, but the pulse oximeter also showed that the child's O2 saturation was 70% because due to the nurses' strike, his nasal cannula prongs were not being checked for proper fit. He recommended strongly that the child be moved to the ICU, but no beds were available. The next day, the child went into respiratory and renal failure and ultimately passed away.

So many stories like this one have stuck with me since being here for the same reason it stuck with Faisal-patients like these may have made a full recovery in a more developed country, without as many resource-limitations and barriers to care.  It seems sometimes that the days are equal parts hope and frustration, and that no difference is being made. The clinicians that work here must learn how to treat each patient like the first one of the day and develop incredible resilience to continue working in less than ideal situations. So many times, I have wondered how they continue to have such a positive attitude. My view is biased-I have spent such a limited amount of time here and I see only the short-term. The truth is that so much progress has been made, progress that can only be made when people commit to a community for a long period of time, and that is the macroscopic view that people saw and continue to see in these developing communities. The title for this blog post was inspired by Joe Mamlin, of course, quoted from a meeting with clinicians at a rural health facility.

What I have taken away from these encounters and conversations with physicians is that even though there is so much to be done, there is so much hope, and that is what draws people here, and what makes me want to come back. Progress anywhere is not instantaneous, but if we start small, start now, and learn quickly, over time, it will be made.


This sign is on on [sic] the side of a very plain road on the way to Nakuru County, but pulling over and taking a picture with it is a must before leaving Kenya

This sign is on on [sic] the side of a very plain road on the way to Nakuru County, but pulling over and taking a picture with it is a must before leaving Kenya