Prior to beginning my internship in Mombasa at Coast General Provincial Hospital, I had completed approximately 200 hours of medical volunteering in hospitals around Los Angeles, California. I had never been exposed to serious illnesses or diseases with pneumonia arguably being the most serious condition I have ever encountered. Most of the patients I had seen and interacted with simply had some sort of upper respiratory tract infection or were simply stricken with diabetes or obesity. Looking back, I could not have imagined all that I would be able to view and learn while rotating through the different departments at CPGH. During the internship, I was happily placed into the Pre-PA Program where I hoped to gather knowledge and shadowing experience from Clinical Officers which are the equivalents of PAs in Kenya.
As for the unique and remarkably memorable cases I had the privilege of viewing firsthand, there was certainly no shortage of them. My very first case was of a two-year-old boy who was suffering from Ricketts. I had only heard of the condition from textbooks and learned from my attending pediatrician that this was common among young children in Kenya. Dr. Siminyu passionately questioned, “I bet you’ve never seen that in America and I highly doubt you’ll ever see it even after you become a PA.” To be frank, he is probably correct. As my first case this was especially memorable simply since the condition is just so common in Africa and learning that just easily made it unbelievable to me.
However, the case of Rickets is certainly not a case that will stick with me for the rest of my life as the one I am about to describe. My experience in being in areas of intense odors and smells is certainly above average in my opinion for a young college student. I have taken a class with cadavers and have grown accustomed to the smell of formaldehyde. In addition, I also visited the morgue on a few occasions at CPGH and witnessed some autopsies right behind the medical examiner. Nevertheless, none of this experience could have prepared me for the sight or smell I would experience with this patient. The patient was a middle-aged man who was suffering from a rare form of Tuberculosis called Pott’s Disease. This form of Tb usually affects the lower area of the spine and can easily spread to other areas of the body. In this patient, Dr. Hassan had to forcefully remove pus and other fluid from the patient’s inner right thigh. A rather significant and potent iliopsoas abscess had been festering for a period of three days now. The disease had unfortunately spread to this area of the body and had caused significant infection of the muscle and tissues associated in that region. The procedure itself was simple; squeeze out all the fluid. I have never smelled a worse stench in my life than the pus that was streaming from that man’s inner thigh. Dr. Hassan simply made a small incision and just pushed on the area surrounding the hole and an endless faucet of rather odorful fluid came out. Most memorably, I have never seen a doctor or attending nurses gag from a smell before. The odor was so strong people in the waiting area of the Emergency Ward were complaining of the smell. Importantly, Dr. Hassan stopped the procedure because the man was thriving and screaming in too much pain. He mentioned to me however that he truly stopped the procedure because there was simply too much fluid coming out; that this simple procedure had transformed into a surgical one that would have to be continued in the Main Theatre. This by far was the most unique and memorable case I ever encountered during my time at CPGH.
In addition, I should mention that I had the most interactable and personal relationship I have ever had with a patient before throughout all my clinical volunteering hours. I had the pleasure of caring for and getting to know a middle-aged man for two weeks during my departmental rotations. The first week I met him was in the Radiology department where I was shadowing radiographers, radiologists, and sonographers through various procedures. My radiologist happened to be on her lunch break at the time and I thought this would be a great and humbling opportunity for me to meet and just talk to some of the patient s waiting. This man happened to speak English perfectly to the point where he was understanding my American slang and jokes. He happened to also be born in California as I was and moved to Kenya when he got married as his wife was from Nairobi. I can not express how much we had in common throughout our initial conversations; we were simply compatible. He told me how he graduated from the U.S. and met his wife on an internship and how life just took him to Nairobi and Mombasa. We shared several hearty laughs and heated discussions about our favorite American sport teams and even had heated arguments on what Steven Spielberg movie was the best. In the moment, I could not believe how someone on the other side of the world and twice my age could be so relative and share so much in common with me. As he was a fantastically friendly and intelligent person, he was unfortunately in a hospital.
I asked him what images or tests he was getting done at Radiology and even at the lab as he had several referrals for blood and platelet tests as well. He explained to me that physicians were not certain as to what was causing his symptoms of exhaustion and severe headaches. I responded that hopefully none of his symptoms meant anything too serious and happily helped him into the X-Ray room and told the radiographer just how incredible of a person he was. His tests commenced and I happily wished him a great afternoon. However, later that evening, as I was viewing several chest X-Rays and angiograms along with Dr. Valerie, we happened to come upon his chest X-Ray, spinal X-Ray, and angiogram. Dr. Valerie quickly turned upset as she viewed his angiogram and even me with little experience in reading radiological tests noticed there was certainly some sort of mass located in his brain.
I honestly hoped I would not see the man again as I could not face him and let on to him that he was fine. Incredibly, he found himself again back in Radiology with more tests being conducted on his lower extremities. I made little contact with him, but on his way out he called to me and told me he had a question. He asked, “Just because I have cancer doesn’t mean we can’t still be friends, right?” I awkwardly smiled and let him know that we were absolutely still friends. He continued onto me that it was an operable mass and that his outlook on the surgery would be positive. The doctors noted to him that he may experience some weakness in his limbs on his right side after the surgery due to the mass being located on the left side of his brain. Altogether, he should make it out alive and continue living his life with his daughter and wife. He also mentioned to me that the tests being conducted today were just as a precaution and to assure that there were no abnormalities located around his body. Most importantly, he stated his surgery would be taking place next week and I happened to be rotating into surgery the following week. I made it clear to him that I would be there for his surgery and to talk about how the Dodgers were going to lose in the World Series again this upcoming season. He laughed at my comment and graciously invited me over to dinner later that week so I could meet his family.
The dinner was easily the best dinner I had in Kenya. His wife made an assortment of Kenyan foods and we basically just talked about life and all that comes with it for 5 hours. However, the most memorable thought from that night I can recall was his wife reassuring me that he would be fine throughout the surgery and that all would be well. Friday morning came around and the surgery was a few hours prior to commencing. I was with him for about an hour during pre-operation in the surgical ward and we talked about a plethora of things. However, approximately 20 minutes before we carted him into the theatre, he sharply motioned to me to come over as he had something to tell me. “Okay, I need to get a little serious before I head in.
You are the only person among this hospital staff that I truly trust, and I know we’ve known each other for a few weeks, but I have a task for you. If I go on the table, I need you to tell my family how it happened as best as you can. My wife also trusts you and I think my daughter trusts you, but she does think you’re weird since you’re not African. And lastly, make sure they put everything back where it should be will ya’?” I laughed at his explanation but as he got carted in and went under, I could not help thinking that what he told me was outright frightening in my mind. He had to make it through this.
The surgery went perfectly through the first three hours with all the now removed glioblastoma resting on the nurse’s equipment tray. However, just as Dr. Okonga removed the last bits of tumor and told his assistant surgeon to begin the suturing process, the unthinkable began occurring. His heart rate and respiration plummeted and Dr. Okonga ran right back into the theatre and from there chaos ensued. I could not understand what the staff were communicating to one another as everything was now being said in Swahili; all I could make out was that this perfect surgery was heading in the wrong direction. Additional oxygen and compressions began 30 minutes after his decline in respiration and heart rate, and in a span of an additional 10 more minutes he lay cold on the metal table. My friend was no longer with me. I let the surgeons and nurses break down what just happened for some time and patiently waited outside the theatre for Dr. Okonga. He came out about 20 minutes later and all he could explain to me that there was a complication as he removed the last bit of tumor from his brain. His body utterly and completely went into shock as it occurred and they made several attempts of trying to raise his heart and respiration rate back to normal, but to no avail. Dr. Okonga relayed, “These things happen in medicine unfortunately and there was nothing else we could have done.” And just like that, he walked away back to the surgical ward to report and file my friend’s untimely death. Now I had to prepare for a guilty walk to a home that seemed strange to me now and an explanation for which I had none.
I left that home feeling disheartened and outright helpless, but also hopeful. I relayed the explanation to his wife just as Dr. Okonga told me. She was in tears, but she also wanted to assure to me that it was all a part of God’s plan. We happened to all be Catholic which may have been a huge reason in all of us gelling together so well. I cannot even remember how many apologies I gave her that evening and she kept repeating that none of it was my fault. My lasting memories of the conversation I had with her that night was her sternly telling me to keep following my path in becoming a PA and to do my best and to try and make sure something like this never occurs again within another family. I left that sanctuary of a home with my friend’s Dodgers jersey as his wife mentioned to me that he would have wanted me to have it. I have that Steve Garvey jersey already framed in my bedroom as a reminder of him and how he impacted my life. I highly doubt I will ever have a personal interaction with a patient in the same way I had a relationship with this man throughout my life or medical career. I simply hope that I can devote my life’s effort to making peoples’ health better and more friendly just as my friend and his family wished. If there was any doubt in becoming a PA or other health professional, the thought was eradicated the moment I met this person.
My experience from working at CPGH was certainly memorable, but the second I stepped into the hospital I already noticed the significant differences in the delivery of healthcare compared to the United States. As discussed in one of our lectures, “Among the Public Health Services Sector, most facilities tend to be under-resourced in terms of equipment and clinical staff as well as share lower standards of care when compared to the private sector” (IMA 2019). There were numerous differences I noticed as I began my internship at CPGH compared to hospitals in the United States. For example, every note, record, chart, or evidence of a patient was in paper with no information digitized at all. The use of physical copies of information and data caused notorious confusion among health care practitioners at moments since some data would often go missing or be misplaced. Arguably the greatest misfortune without a computerized central system was how archived patient information would be deleted or otherwise misplaced, meaning if a returning patient came into CPGH, they would have to be processed all over again.
Other differences I readily viewed firsthand was the lack of sanitation, cleanliness, and otherwise disorder of CPGH. Each of the physicians and nurses are fully capable of handling and caring for patients but with the environment they work in, the job becomes challenging and, in many cases, quite difficult. With upmost resources challenging to acquire, “The health insurance scheme does not contribute a significant amount of funding to public hospitals in Kenya and is largely unaffordable for a majority of Kenyan citizens especially in the informal or poor sector” (IMA 2019). Without out delving too much into the steps Kenya needs to become a more advanced and industrialized country, the country needs to solve the poverty issue. Most lifestyles and other ways of life will fall into order once poverty is mostly eradicated in Kenya. The overall wellbeing and security of the healthcare system will improve greatly if poverty were cut down to improve the lives of most Kenyans.
If the overall welfare and status of Kenya improves some of the direct issues regarding Kenya’s healthcare can be readily improved. For example, “Many of the current challenges facing healthcare in Kenya include inconsistent resource allocations, ethnic discrimination, long and frequent medical personnel strikes, resignation, and poor working conditions” (IMA 2019). I happened to work during one of the many healthcare strikes they hold at CPGH every year during my internship. The period was unsettling especially for interns since we had no doctor or nurse to whom we could shadow. More importantly, there were hundreds of people who had no option to seek and acquire the care they needed. The strike apparently was due to the medical professionals going unpaid for months at a time. Their response was completely understandable, but obviously a problem exists between the government and its medical practitioners. The issues regarding the stability of healthcare in Kenya all begin at the top of the Kenyan government and unless there is a significant change of view in determining what is best for the country, the healthcare system will continue to suffer dearly.
This internship with International Medical Aid has been a productive, engaging, and humble experience. Any and all my expectations and goals I had prior to travelling to Kenya were satisfied in the first week in Mombasa. I do not believe I could ever share an experience as fulfilling and knowledgeable in the United States nor would I see 90% of the associated diseases and conditions I met while interning at CPGH. All the physicians, nurses, and clinical officers at CPGH provided me with invaluable knowledge that I will go on and use as I train to become a PA. They taught me techniques and ways of looking at medical problems that I do not believe I would be able to find in a medical textbook. They were simply lessoning I could not learn in a traditional classroom setting. Through this experience with IMA, I have learned how to readily listen to a patient and to complete challenging tasks with limited and otherwise underwhelming resources. I believe that my passion for wanting to help and care for people increased insurmountably through this internship and my motivation for becoming a PA is more confirmed in my mind. Every health care professional I met at CPGH did their job and did not complain about being out of examination gloves or faulty MRI’s or chest X-Rays. They all contained a passion for providing people with care that I have not seen personally in the United States.
Perhaps it was the conditions in which they worked in or just how much harder they had to work to be in the positions they are now in, but they all seemed to have this “fire” to solve the problem. I hope I can adapt and acquire this “fire” and integrate it into my own medical training and career. Nonetheless, I believe I will never have an experience as fulfilling and enriching as this internship that I had the pleasure of working through with International Medical Aid.