My accommodations were better than when I go on a personal vacation: always got the best food, having a chef allowed us to get to taste so many different food from the country, beautiful home, so comfortable, absolutely felt like a home away from home! There is so much support from the IMA crew, always someone there for you, they even provide you with a SIM card to make sure you have a way to communicate with them and others at anytime. Our mentor was always available through e-mail and replies so fast. No matter what was the resquest, they found a way to answer to it and made it safe for all the interns. Only positive comments really!
I went on the Safari in Nairobi: loved the fact that the IMA team had everything set for you once you had paid the required fee like the plane tickets, the rides from the airport to hotels, rides all over the city, some of the meals, etc. You had one job after that: ENJOY THE TRIP! The presence of a guide throughout the entire trip is also a plus since we had someone to help us go from place to place, communicate and teach us on so many aspects of the city and animals. Finally, the visit to the Masai Community was a great idea: I love getting to know real life stories so this was a safe and amazing opportunity.
Just recently, I graduated from my undergrade program in Health Sciences, at Ottawa University. Afterwards, I had the opportunity of working in different fields as a physical therapy assistant at a private clinic, a care giver’s assistant in a home and a substitute teacher in elementary and high school; all which led to my final career choice, Physician Assistant in Pediatric.
Next fall, I will hopefully be attending a PA program in which I will use a combination of my previous healthcare experience with the new ones acquired through my International Medical Aid internship in obstetrics and gynecology, in pediatric and in intensive care units, to excel in my future courses.
Through this essay, I will present various perspectives of my placement in Kenya using different aspects based on the healthcare delivery, the political system and the cultural variations encountered at Coast General Hospital.
My learning adventure began on week one, at the Labour Ward of the hospital. The first element that caught my attention was the lack of privacy, a major concept in Canada that was not enforced at Coast.
For instance, during their visits, pregnant women were required to make their first stop at the examination room.Every “room'” was separated from one another by a simple curtain, in most cases not entirely closed; thus, private conversation subjects between doctor/nurse/intern and patient would become a conference with everyone in the perimeter. In addition, mother’s hospital books were located at the welcome counter, giving accessibility to anyone at anytime.
At Coast General, the notion of giving birth is comparable to a transaction: for example, some show up at thehospital for the first time only when the moment comes to give birth. Nurses also expect each patient, when dilated enough to allow the baby’s exit (at seven to ten centimetres), to push quickly and efficiently; as a matter of face, it was rare for a birth to occur without an episiotomy. The most rapid delivery I have seen at Coast General Hospitalwas of a mother, who made her first hospital visit when having short contractions and all in around fifteen minutes,she had given birth to a premature baby, taken a shower and was ready to go. Aside preterm births, stillbirths andfetal deaths are very common in Kenya – hence many mothers barely flinch when announced the baby’s death.
For Canadian women, the entire pregnancy process is an experience with several steps: prenatal visits many weeks before the child’s arrival, pregnancy photoshoots, gender reveals, pregnancy workouts, etc. Some even get to choose the type of delivery they desire such as vaginal births, natural births, scheduled cesarians, scheduled inductions, etc. On the big day, in contrary to Kenyan women, Canadians enter the delivery room with their companion by their side and their families eager to meet the family’s new addition.
Unlike the American postpartum rooms, where each mother gets a clean bed, a spacious room, and fair nutritious meals portions, at Coast, rooms are overcrowded, sometimes obliging two mothers and their babies to share abed. In addition, the food provided by the hospital consists of a slice of bread and milked tea.
During my time at the Coast General, I noticed a big lack of sterile instrument use. For each birth, a nurse-midwife is entitled to a sterilized pack of equipment allowing her to proceed to the delivery with safety. Unfortunately, therewas a lot of contact between clean and sterilized surfaces: in certain cases, after wearing sterile gloves, midwives would handle various objects before inserting their hands into the mother’s vagina.
For the second and third week of my internship, I got to work alongside Doctor Siminy in pediatrics: myfavourite department. There was a lot of opportunities for learning in such short amount of time due to the diversity of the cases. Just like in Canada, each doctor has an office where patients are received: in every room there are two chairs, a table, and an examination bed. However, they are aesthetically different from our “kids friendly” rooms: walls did not have paintings of children playing at the park and room corners did not have toys and drawings for entertainment and distraction purposes.
The benefit of an outpatient department like pediatrics at Coast General Hospital is the increased probability offinding treatment in one location. Let us use a scenario to illustrate this statement: a child, born to a mother with HIV, comes in with a high fever, diarrhea, and a pulmonary infection. After the diagnostic, the physician requires the patient to consult the Comprehensive care clinic for AIDS, the Laboratory and the Radiology Department forthe fever, diarrhea, and lung infection and the pharmacy for the medicines.
For many families, “going to the hospital” involves taking a day off work, paying transportation fees, traveling forty-five minutes to two hours, etc. Thereby, having the possibility of making one stop to get all the help they need is a major upside.
From my observations, I noticed that many of the severe cases in pediatrics were direct consequences of parent’sbeliefs. For example, we had a young patient who came in one year following the incident responsible for distorting his elbow. “Why would they wait this long to bring him to a hospital?” I wondered the exact same thing.
As Dr. Siminy explained, after an incident requiring medical help, many parents will first turn to religion. If that doesnot work, they will try traditional medicine through consumption of mixtures of ginger, lemon and medicinal plants,witchcraft, etc. As a last resort, they will lean to modern medical care, and when they do, more damage would have already been done.
On my second week at the pediatric ward, we had an interesting case of a mother who brought in anunconscious baby for a late vaccination. She had carried that newborn, all the way from home, covered with a traditional sheet. Once in the vaccination quarter, mothers were required to sit in a row, allowing nurses to work effectively. Nurses would ask mothers to make the child’s arm available for the shot, going from one baby to the other. As the nurse was about to vaccinate our patient’s baby, unlike her usual habits, she first asked for the blanket to be lifted, revealing a lifeless child.
From my standpoint, the most chocking part of this case was not the baby’s condition but the healthcare professional’s reaction to the nurse’s implication: many congratulated her for checking the infant’s status before the procedure, an initiative that seemed crucial to me. Later, I was explained that mothers have tried prosecutinghospitals for administering medications potentially responsible for a deceased infant, hoping to get a compensation from the organization.
Finally, I spent my last week at Coast at the Intensive Care Unit (ICU). The recently renovated department ofthe institution exuded features of Canadians ICU’s. However, as observed in the whole hospital, there was a lack of resources in this unit as well: it accommodated only nine beds for adults and kids, two beds for babies, one electrocardiogram, and one defibrillator. In addition, the availability of some materials, such as bed nets, were at the families’ discretion, therefore, not provided by the hospital.
As it was my first time working in an intensive treatment unit, I had few expectations, especially given that this was the unit sheltering patients with the most critical cases. Coast’s ICU’s death rate was surprisingly high: onlytwo out of nine patients had a chance of survival. In my opinion, I found that Coast General’s ICU mostly contributed in slowing patient’s deaths. Also, on many occasions, working in the ICU was emotionally challenging: one day the patient could be doing great and stable and the next day, his health could be worse than when he arrived. While I had great hope for patients with an improving condition, seeing them die before my eyes was difficult.
The common factor of in these deaths seemed to be poverty and lack of resources (provision of health professionals). Here is an example to support my affirmation: Early in the week, we had a patient who suffered from a postpartum bleeding causing a bilateral acute subdural hemorrhage. As she underwent her first burr holesurgery for the right side, she had a cardiopulmonary arrest. That is when they implied a myocardial infraction (M.I.). For several days, doctors studied her case, suspecting that the anesthesia, trauma, and her personal history of myocardial infraction made her code. Due to the shortage of surgical nurses and the seriousness of the situation, physicians concluded that it would be best for the patient to get her left side burr hole surgery in a private facility.
Healthcare workers of Mombasa public hospitals are currently, on and off, on an ongoing strike: several have not had their salaries for months. According to the World Bank Data, in Kenya, the doctor to patient ratio per 1000 people is 1:5000 in comparison to 1:385 for the same population in the United States.1
The patient’s family refused to send their relative to a private facility due to the lack of funds and the high cost of treatment in a non-public establishment. Public health service sector provides the most accessible and affordable care for populations in Kenya. […] These facilities are mostly under-resourced in terms of equipment and clinicalstaff.2 Unlike hospitals in Quebec, Kenyan relatives had to purchase the medications prescribed by the physicianin order for it to be administered to the patient during the intensive care, pay for the patient’s daily cost of bed use and pay for the anesthetic needed during surgery.
Ultimately, as the medical team took the decision of performing the surgery at Coast General Hospital, with employees and residents available at the time, the patient died before she could go to the operating room.
In Quebec, these types of situation are unlikely to happen due to the common use of health insurance, covering most of our health expenses. In opposition, building a market for health insurance in Kenya has been an uphill task. Only 25% of Kenyans are covered under a private, public, and community-based insurance schemes. […] Both consumers and health care providers have poor knowledge and perceptions of health insurance. […] Low cost, innovative insurance products are uncommon in Kenya.3
If I had to use one sentence to describe what I have learned from my internship with IMA, I would say that I have learned that: “It’s not how much you have that counts, it’s how much you can do with what you have.” Coast General Hospital partakes in the improvement of many lives with just a few resources. Could we imagine how much more they could do if they had as many resources as Canadians do? They would do miracles.
And this quote could be applied in many aspects of life: Kenyans are one of the most loving and welcoming people I have ever met, and, truly, they are the proof that you do not need to be a billionaire to be happy.
Working at Coast General Hospital officialized my decision of wanting to become a Physician Assistant. Once I graduate, I plan on doing humanitarian work at hospitals in my home country, Ethiopia, and hopefully make a difference in many lives.
Moreover, inspired by our Wednesday’s IMA community outreach, I will also use my background in teaching to raise awareness on many subjects that are currently taboo in the African communities such as periods, sex, rape, mental health, etc.
And on this note, I will add “Assante” Kenya and “Assante” IMA for all you have thought me.