This year, I decided to challenge myself and push my clinical knowledge to its boundaries by working in an unfamiliar country with a different health-care experience than my country Qatar. I wanted to go somewhere that possessed little technological resources. Although some people may aim for more well-developed locations, I believe that learning starts from the patient’s bedside, by seeing, feeling, and listening. In my opinion, the lack of resources, tools, or laboratory and radiological tests challenge the doctors to use and rely on their own brains and to think in creative ways—something I do not often see in my country due to its wide availability of advanced technology, which can quickly give a definitive diagnosis. Because the future is difficult to predict, I decided to pursue this experience to prepare myself for all difficult circumstances. Fortunately, I found this program offered by the International Medical Aid at the Coast Provincial General Hospital.
On the first of July, I arrived in Nairobi, the capital of Kenya. It was a difficult day. At the airport, I struggled to get my bags to another building, where I had to go check in my bags for my next flight to Mombasa. My bags weighed a total of 60 kg, and they fell from the trolley twice. At that time, I was already sweating heavily from the pressure of making it to my other flight on time. During those moments, I remembered my father’s advice to exercise in preparation for this trip, as things here are not as developed and comfortable as in Qatar. This was my first lesson from this trip; I needed to get stronger and healthier to be able to serve people as a health-care provider.
When I first arrived at the CPGH, I noticed that the building looked old and that the roads were full of mud and unclean water. This was the total opposite to the hospitals back home, which are actually much cleaner and newer than five-star hotels. Nevertheless, I told myself not to judge the hospital from the outer appearance of its building but rather the people serving in it, as well as the availability of essential clinical tools. When I entered the hospital, I noticed that many departments had a sign on their doors stating the foundation or persons who have donated for the development of the department. I felt happy when I saw the names of countries, presidents, spiritual leaders, and others.
During my time there, I saw many clinical signs I have read and studied about but never seen anywhere outside of our clinical books. Having this opportunity allowed me to see and examine things I have never seen in my country; it gave me an alternative way of learning that I never would have received in my country. I learned by touching, smelling, hearing, seeing and, most importantly, feeling. This way of learning is a more effective way of encoding these lessons into my memories because they are not pictures in a book. These were real people in front of me, and I could clearly see their suffering and pain. They say that feelings and emotions make our memories stronger. Back home, our population is made up of only 2,000,000 people, making it difficult to observe the clinical signs I encountered here. For example, I have studied ascites (fluid accumulation in the abdominal cavity) considerably, including how to confirm it; however, I never had the chance to see a case with my own eyes. I was able to see one here and even do the clinical exam to confirm it. As another example, prior to this experience, I never saw a woman in labor. Here, not only did I see many, but I was also able to apply my knowledge of the Apgar score, which assesses the need of the newborn for resuscitation and needs to be done as soon as the baby is born. Another case I will never forget is a woman with crepitus (crackling) in her chest. This woman had CPR 2 days prior and, due to the fracture of her rib, had air escaping under the skin of her chest, making it feel like crackles. All these cases I have so far mentioned were witnessed within 1 week. I saw many more that I will never forget.
One encounter I will never forget happened to me and another medical student at the hospital. Back home, our university offered all students a subscription to a well-known, trusted medical resource called Up-to-date. I remember how professors urged students to use and take advantage of its benefits. I also remember students complaining about how annoying and pushy the professors were in regard to this resource. Here in Kenya, I saw people dreaming of getting access to this resource. Many were jealous of my access, particularly because I am only a third- year medical student whereas they were already medical doctors. As an act of goodwill, I decided to offer a last-year medical student a subscription. She was surprised and even cried for a couple of minutes. This reminded me to be thankful. It is important to use our resources as much as possible, as many in the world wish for it.
I have been obsessed with basic life support for a long time. Back home, however, I was unable to obtain any experience related to it. I only practiced and had several courses on models. I never thought I would be able to resuscitate a real person until a very late stage of my life. I always wondered how I would act and whether I was strong enough. Would I be well prepared for such situations? In an unexpected situation, one of the doctors in the women’s ward asked me to perform CPR on a dying woman. I was shocked but immediately shook it off because there was no time to waste. So, I started performing CPR exactly the way I was taught. I did not think that it would be so similar to the model I had practiced on, but surprisingly, it was. After 3 minutes, I felt exhausted and could not do it anymore. I felt guilty because, while anyone would feel exhausted after a while, I felt I could have done better if I was more fit and if I regularly performed physical exercise. I asked one of the nurses to come and take my place. As soon as she came to replace me, the doctor asked us to stop the resuscitation process. At this moment, I felt very upset and confused. I talked to myself, saying, “Where is the AED? This isn’t the way it’s supposed to be! Only 3 minutes?! Seriously? Giving up this soon?!” I then talked to the doctors to express my frustration, but I felt that they were used to it. I felt very distraught at the idea that I might one day feel just like them, used to seeing people die in front of me and able to give up so easily. Thankfully, it is not the same case at home; doctors try for a much longer time and use as many available resources as possible to bring the patient back.
In summary, I learned many lessons from this trip that I would never have learned from the health-care system back home. I became more thankful of what I have, and I saw many clinical cases that made me apply my clinical knowledge to determine patients’ diagnoses. I talked to many nice, kind patients and learned their sides of the story. Finally, I learned that I should work more on myself and never underestimate a patient’s life. They say that people change over time, but I believe that there are certain values that should never change.