Student Reflection: Maddy Vonderohe
My first trip to Eldoret fell in the summer between my first and second years of medical school when I was selected as a “Slemenda Scholar,” a position that granted me an internship of sorts with the AMPATH consortium. My fellow Slemendas and I were set up to not only learn about and work within the healthcare system at Moi University Teaching and Referral Hospital (MTRH), but also with other AMAPTH initiatives focused on economic stability and population health. Before leaving for Kenya I had never studied abroad nor even been away from Indiana for more than a few weeks at a time, let alone moved across the globe and immersed myself in a culture I knew very little about. I had no idea what to expect, what to think, or what to try to prepare myself for, so I tried to enter the experience with as much of an open mind as I could muster. I was ready to be a sponge, to observe and absorb everything I could in my time abroad. I knew I had an interest in global and public health, and I was ready and eager to put experience behind those interests.
However, I admit, albeit shamefully, I went in to the experience with a lot of the same misconceptions about life in a low-middle income country that are shared amongst the general American population. That is to say the very misconceptions that are broadcast widely by modern media and consumed broadly by my elders and peers alike. I assumed an inherent superiority of American health systems as a whole; I figured the majority of the population of Kenya to be impoverished and believed the body of knowledge and overall quality of life to be lesser. I expected to enjoy what I was doing, to enjoy learning, but to still leave with some air of relative dominance. That is where I could not have been more wrong. As Hans Rosling writes in his book entitled Factfulness: Ten Reasons Why We’re Wrong About the World – and Why Things Are Better Than You Think –
“Human beings have a strong dramatic instinct toward binary thinking, a basic urge to divide things into two distinct groups, with nothing but an empty gap in between. We love to dichotomize. Good versus bad. Heroes versus villains. My country versus the rest. Dividing the world into two distinct sides is simple and intuitive, and also dramatic because it implies conflict, and we do it without thinking, all the time.”
In this first trip, I had hundreds of moments every single day that challenged and broke my previous binary schools of thought. I was forced to acknowledge my own privilege, question my own values, and scrutinize how the media chooses to portray systems and cultures foreign to our own. While the Kenyan system is one that is resource-poor, it is not inferior in knowledge, it is not inferior in joy, it is not inferior in quality of life. We are raised in this country with the idea that we are entitled to an air of superiority because of where we are from, but that is entirely inaccurate. That first trip emphasized to me that while we may be privileged in our resources and our economic abundance, the geographic location printed on our birth certificate does not automatically bestow supremacy.
I think as a whole that first summer I struggled most coming to terms with the fact that at that point in my education and career I provided very little to AMPATH and the Kenyan healthcare system. It was difficult to reconcile my desire to be there and to learn with the guilt I felt taking resources and time away from an already resource-poor system. This struggle was particularly heightened by discussions about AMPATH’s foundation on the concept of bilateral exchange – it is much more difficult for Kenyan students to come to America and observe our healthcare system and population health initiatives in a parallel way. I slowly realized, though, that my purpose there for that summer was not to provide anything. It was to observe and absorb and bring back to America with me the aforementioned introspection and to ultimately do something productive with it as I grow in my career.
In the months between my visits, I did what I could to not only share what I had learned about the Kenyan medical system and economy and AMPATH’s role in bolstering both of those systems, but also how I felt and what it was like to live there in that culture. At the forefront of each of my stories about Eldoret is that I have never in my life received a warmer welcome than when I arrived there. The Kenyan culture is one of open arms, of strength in community and family ties, of treasuring the privilege of human connection. It is a slower lifestyle, one that values time spent with one another over workflow efficiency and production. They were eager to share their lives and their homes with me, and I never felt like a stranger. Every individual I met made me a better, warmer, more open version of myself. This openness allowed me to truly immerse myself in my life there, allowing me to leave American life at home waiting for me when I returned. I never found myself homesick or lonely, as every individual I met was a fast friend. Each and every Kenyan I met was a proud citizen of their country, eager to share their perspective and destigmatize themselves as a “lesser” or “developing” country in the binary eyes of the high-income world.
The decision to return to Eldoret, not even a year after leaving, was a simple one. The minute I departed from Nairobi I knew I would be back as soon as I could. I had no doubts that I would return to learn and live life for another month in the place that had made me a better version of myself, as well as a better citizen of the world. Making the initial decision, I did not put a second thought into the gravity of doing a clinical rotation here as a naïve third-year student, and even less thought into the fact that the clinical rotation would be my first one on any sort of inpatient ward. The closer I got to my departure date, however, I began to question my motivation and my own arrogance. The same guilt I felt toward the end of my first experience came creeping back. Why did I choose to send myself and my entirely novice clinical skills to what I knew was an already resource-poor teaching hospital? Why did I choose to place the weight of my inexperience on a medical school and hospital system already inundated by Kenyan students at the same stage in their education?
Even after spending my month on the wards as a member of the pediatric team, I’m not sure I can entirely justify my decision. I can, however, say that I have absolutely no regrets in returning when I did, as soon as I did. I was taught how to triage concerns, beginning with the most serious problem that can be most adequately handled by what is available, then moving forward into more creative thinking to tackle the rest. I was taught how to focus on the priorities of the patient or their caregiver, even if our priorities do not always culturally align. I quickly realized that there were ways I could minimize my burden and find ways to sustainably, positively impact the system. I put energy into learning Swahili, becoming more independent in performing tasks, and finding discrepancies in both my own knowledge and those of the local medical students so that we could teach and learn from each other. I ultimately accepted my role there as complex and layered, one that was not always entirely satisfying. But I quickly determined that one day I will be able to pay the experience forward, coming back and providing care when my training is more complete, hopefully adding more to the system than I have taken away. For now, my next visit is to come in my fourth year of school, when I will return to Kenya for the third time for another two month clinical rotation. At this time I will have another year of experience under my belt, and I will be able to contribute more productively to the care teams, continue to learn from those more knowledgeable than myself, and pass on some knowledge of my own.
I truly believe that to be the best physician to a patient, no matter where you practice, you have to develop the skills to meet people where they are, to think creatively, and to never limit yourself to learning from just your immediate surroundings. In my own experience, there has been no better place to learn to do just that than Eldoret. As Rosling writes:
“In order for this planet to have peace…there’s one thing we can’t do without, and that’s international collaboration, based on a shared and fact-based understanding of the world. The current lack of knowledge about the world is therefore the most concerning problem of all.”
Living in Kenya has been fundamental in shaping me into the physician I will become, as well as the global citizen I strive to be today. It has taught me how to practice compassionate medicine, providing me with the knowledge to disable my binary thinking, to know how to see a different culture as never inferior to my own. It is the first place that has truly and effortlessly become a second home to me. I carry the relationships I have built and the knowledge I have gained there with me every single day, and will for the rest of my life.