As I look back at my stay in Kenya this summer, I am struck by the incredible knowledge and experience I was able to obtain from my peers and mentors in the hospital. From seeing a natural birth for the first time to seeing neurosurgery on a 7-year-old boy, I realize the wealth of information I was exposed to. I am so grateful for the opportunities I was given to learn more about healthcare in such a different environment. During my internship, I learned how to be empathetic, sure of myself, and how to remain calm in high-stress situations. When comparing what I saw at Coast General Hospital versus what I have experienced in hospitals here in the United States, the biggest differences that jumped out were the state of medical issues presented, and the resources available to treat said issues.
The easiest way to sum up the difference between the care I saw in Kenya and the United States is that in Kenya, the majority of treatment is reactive while in the U.S. the majority of care is preventative. In other words, illnesses were very advanced by the time a patient decided to seek help limiting doctors to do damage control for these people. An example of this is a middle-aged man who came into the emergency room for “foot pain”. When Dr. Ahmed removed his sock, it revealed a big toe that was almost completely black necrotic tissue. Looking at his patient booklet, I saw that the man was a diabetic and Dr. Ahmed explained to me that he clearly had not been taking his medication, causing this breakdown of tissue. There was little that could be done except for cutting away as much dead tissue as possible. Had this been any other toe, the entire toe would have been removed completely but since the big toe is essential for walking, Dr. Ahmed explained that it had to be preserved as well as possible. This case demonstrates the state of care I observed at Coast General because had this man came into the hospital a few weeks earlier, a doctor could have seen the beginnings of tissue breakdown and implored him to take his medication before the damage progressed. I believe this problem of patients waiting too long to get care can be attributed to two main factors: Accessibility and Urgency.
Healthcare is simply not easily accessed by a large percentage of the population due to the proximity of hospitals, the cost of care, and the ability to leave home and family. There was a patient who came to the hospital with a cist the size of an apple protruding from his mandible. The doctor estimated that this had been growing for at least 10 years. When asked why he had never come for treatment before, the patient replied that he lives a whole day of travel away from the hospital and had nowhere to stay in Mombasa until now. The low concentration of good hospitals in rural areas is clearly a factor in the delay of patient care and this is an issue that is rarely seen in the United States. Here, every major city has multiple hospitals, and most smaller towns also have an assortment of healthcare options. Another patient I saw was a single mother who was having trouble breathing due to a large supra- clavicle abscess that was slowly closing her airway. With three young children, she was unable to receive earlier treatment because she had to wait for a family member to come take care of her kids. It is sobering to recognize that with such a serious ailment, factors like this causing a few days of delay can be the difference between life and death. In the U.S. most patients are fortunate enough to have easy access to reliable healthcare which allows disease to be caught early and remain treatable.
Urgency is the other factor I identified as a root cause of the disparity in healthcare between Kenya and the United States. It became clear to me that most patients at Coast General didn’t realize that their injuries and illnesses could very quickly become life threatening when left untreated and were caught by surprise and forced to rush to the hospital. This speaks to a general lack of knowledge regarding medical issues throughout the population that causes many to believe they are not in danger or in need of help. In addition, going to the hospital is not a priority until it is a pressing matter due to finances because basic necessities such as food will always trump that. By the time a medical issue has reached the point where going to the hospital is the patient’s greatest need, it is often too late. When looking at a patient in the United States, choosing between their food for the day or going to the hospital is not often a decision that has to be made. Because of this, an American can go to the hospital at will as soon as they realize something is wrong. Having this luxury makes the difference in catching medical emergencies before they happen.
In addition to having reactive care versus preventative care, the availability of resources was also a very evident difference between Kenyan and U.S. healthcare. I watched in the minor theater as one of the Nurses struggled to suture and dress a wound because the surgical gloves were only available in one size and were too big for her hands. This is exceptionally hazardous for both her and the patient as she could have easily punctured a glove while handling the needle, or misguided the needle due to reduced dexterity. Looking back on my time spent in hospitals in the U.S., I had never seen a limit in resources, especially one that was detrimental to a care provider. This lack of resources was also apparent in the newborn unit (NBU) where two or three infants would be sharing a bed designed for one baby. It is very easy to imagine American parents outraged at the sight of their newborn sharing a bed because such lack of resources is unheard of in U.S. hospitals.
When I signed up for this program, I thought I had my entire career planned out and was ready to start checking boxes along the road ahead. I wanted to go to dental school and was considering orthodontics or oral surgery as possible specialties. It was only through spending consecutive weeks in the dental unit at Coast General that I began to realize I could use my skills in a much better way in a different setting. This realization first dawned on me during morning rounds with the oral surgeon as he visited a patient in the emergency ward. As we walked into the triage room, I noticed commotion at one of the beds and saw a nurse beginning CPR on a patient. My heart jumped as I realized this was real, I had been trained and re-certified multiple times in in CPR but had never seen it happening in real life. Without thinking, I threw on a pair of gloves and began to rotate in doing chest compressions. Dr. Aarif kept encouraging us to continue as we desperately hoped for any activity from the heart. Finally, it was called off and I stood there in shock realizing what had just happened, my instincts threw me right into the heat of it, and I was totally confident in my own abilities. That experience in the Emergency Room made me want to go back, and I did so with frequent night shifts because I had discovered a love for high-pressure situations and knowing you were the first person to make an impact. I now see that my abilities to stay calm under pressure and have thick skin make me very well-suited for a career in Emergency Medicine and am genuinely excited for what lies ahead.
This trip to Kenya taught me so much about healthcare delivery and how I can fit into such a system. I learned so much about what it means to care for patients, and how important the relationship is between a healthcare provider and a patient. I also was able to see the devastating effect that a lack of resources has on a hospital, and how a general lack of urgency regarding wellness can magnify illness. Spending time back home has helped outline the stark differences between Kenya and the U.S. and it has given me a new-found appreciation for all that I have.