In July of 2019, I went to my first health-related experience abroad as a medical student. I spent four weeks in Mombasa, Kenya, shadowing physicians from the country’s second-largest public hospital, and learning about the Kenyan culture and healthcare system. My goal through this experience was to learn and understand how a country, different than my own, manages public healthcare, to perceive how culture plays a part in healthcare, and precisely what role I can assume, as a future doctor, to better global health care. I firmly believe that a great doctor cannot be limited to their home surroundings to treat a patient holistically. They must be knowledgeable about different cultures and beliefs and the way that disease manifests in different ethnicities and backgrounds. My trip to Kenya had the sole objective of putting me on the path to becoming, what I regard as a great doctor.
Similarl to Brazil’s public healthcare sector, Kenya has four levels of public healthcare services: primary, secondary, tertiary, and urgent. During my time in Mombasa, I got to experience the functioning of the tertiary healthcare level, being that I was shadowing physicians at Coast Provincial General Hospital (CPGH). The first thing I grasped about public healthcare in developing nations such as Kenya is that underfunding is generalized in the healthcare system. This, likewise, happens with public healthcare facilities in Brazil; however, the tertiary level is usually better funded if the city is large enough or if the hospital attends to a large number of individuals, but still underfunded nonetheless. Whereas, here we had the second-largest public hospital in Kenya and there were only three nurses per shift working in an ICU with over ten beds (usually in ICUs it is necessary to have one nurse per bed) and that was the only public ICU in the whole county district, portraying that even though this hospital clearly attends to a vast group of people, it still did not receive the funds to hire more hospital staff. This understaffing issue depicts something that I took for granted for a long time about Brazil’s public system: in Kenya, there are two doctors for every 10,000 Kenyans, whereas solely in the state of Bahia (my state in Brazil) there are 13.5 doctors per 10,000 citizens. I always thought that my state was considerably medically understaffed, but after realizing that my state had almost seven times as many doctors for 10,000 people than an entire country, that put things in perspective for me.
One thing that I learned once I immersed myself in the Kenyan healthcare system that surprised me was that public healthcare is not free. This took me by surprise because I come from a country in which everything in the public health sector, ranging from surgeries to hypertension medication, is free. And I assumed that it would be the same in Kenya because 37% of its population is living below the poverty line. During my time at CPGH, I witnessed people that could not afford to pay 5 USD for a cast, that could not pay 2 USD for prenatal care, I saw people that weren’t able to be treated because they did not have the money to buy the medication needed for it. The country’s public healthcare policies do not always favor the people to which they are attending. With only 4.6% of the population having health insurance and public insurance not always being able to afford what they propose, the Kenyan people end up at a dead-end street, where the policies that should be for them, sometimes are against them. However, even with all of these hardships, I got to witness doctors, among other health professionals, do whatever they could to try and help these patients with the few resources that they had. Even though they were clearly not paid enough, they were there for the patient and would try to help in the best way that they could, because they lived and understood the disadvantages that the patients went through within the public sector.
The most compelling aspect of my whole experience was being able to understand the Kenyan labor culture as it is remarkably distinct from the Brazilian one. Brazil is the world’s second lead in c-section as many women choose to undergo this procedure rather than natural birth. Whereas in Kenya, c-sections are reserved for emergencies or high-risk pregnancies only. After experiencing the natural labor procedure, it was clear that it is a more accessible, humanized, and holistic approach to the labor process, as it praises the natural course of birth, and allows a better connection between mother and child. In my medical career, I will most certainly advocate for natural labor and its benefits. Also different from Brazil; women go through labor alone, with no family member present. This was something I considered extremely important to learn about, as I believe that, particularly because the women are undergoing the labor process alone, the health professional must form an even stronger connection with them to make them feel comfortable during the process. This is something I will take into my medical career as I work abroad.
As I lay out my commentary based on my experience, it is important to note that it is easy to be a spectator, a passenger that will not have to live through these hardships that Kenyan medical professionals and its population face daily within the healthcare system. And it is easy to assimilate everything that is wrong with the system, but not provide solutions, or care enough to empathize because it does not directly affect you. However natural that may be, it is essential to try and understand what these difficulties mean socially, economically, and culturally to a country, how it affects the growth, the education, and try to find ways, even if small ones, that a spectator can help out. Kenya is a country that has only had four presidents and not even 60 years of independence yet, it has an abundant amount of growth in its future, and it is important to magnify this growth. Kenya taught me the importance of giving back to the community. It taught me that healthcare is inherently a human right, and it should not be taken for granted. The experiences I’ve had through this program helped me understand that I want to be involved in global health and that I want to help create policies that make public healthcare systems beneficial for the people that it is designed for. The good things do not convey the potential that something has, as growth is found in hardship.