Medicine has always been my passion, however the road to get into medical school is a tough and competitive one. My purpose for volunteering abroad was to learn, encourage, and remind myself the reason why I decided to take this road. Being a pre- med student in Canada can sometimes get discouraging since we get absolutely no clinical experience or courses related to medicine, besides basic science. Even volunteering opportunities at hospitals are narrow and not really hands-on. Having said so, I will be forever grateful for the opportunities that International Medical Aid offered me and the inspiration and courage they seeded in me to pursue my dream with more determination than ever. The reason why I have chosen medicine is to help others to the best of my abilities. I was born and raised in Honduras, also a developing country, and ever since I participated in brigades there, I was motivated to dedicate my life to serving those in need. World Health has always been an interest of mine, so I was thrilled to get to know Kenya and have the opportunity to immerse in a healthcare setting that I was not accustomed to. This internship not only challenged me but also gave me significant insight and preparation to work under difficult circumstances and scarce resources.
I was fortunate to work with incredibly knowledgeable doctors who were patient enough to answer all my questions. There were several scenarios that I will carry with me throughout my career. During my week in Radiology, we saw numerous relatively young patients (20-45 years old) with traumas and diseases that were never treated properly and had only grown worse over time, up to a point were a full recovery was nearly impossible. For instance, a 3 year old boy was referred to Coast General Provincial Hospital. He had lupus, but he was not treated properly nor diagnosed with lupus on time. He had recurrent fevers and was only treated with ibuprofen for the fever specifically. Unfortunately, when a patient has lupus, they are more vulnerable to get infections since the disease weakens the immune system. As a consequence, the patient developed cerebritis (bacteria entered the brain through his sinuses) and this caused hydrocephalus. Dr. Valerie explained that the CT scan already showed irreversible brain damage that would most likely result in dementia. The only plan of treatment was now a shunt to release the pressure caused by the excess fluid.
This case was a quintessential example on the importance of having the equipment necessary to properly diagnose a patient and giving adequate treatment as early as possible. In Canada, cases like this would rarely happen since detailed lab examinations are made to rule out any other diseases, patient follow-up is reachable, and treatment technologies are exceedingly advanced. In this situation, the patient’s mother did not have the healthcare knowledge nor the economic freedom to visit a doctor as often as desired. The National Insurance Hospital Fund offers two types of memberships, the one more accessible to the majority of the population costs $5 per month. Taking into consideration that most Kenyans live by making $1-2 per day, insurance is helpful but still unaffordable for those living below the poverty line, which is a vast majority. I was able to see this as we visited the Maasai village and its surrounding areas. As we drove from Maasai Mara back to Nairobi, the closest health centre from the villages was in Narok, which was 2 hours away driving.
During my week in Internal Medicine wards, I was able to have a better understanding of the hospital’s dynamic. Usually consultants, interns, and some nurses gather and discuss the cases after they finish their morning rotations. The discussions gave me a better understanding of the weakness that exists in Kenya’s health infrastructure. Nurses expressed their frustration when they received patients from the Emergency department with no X-rays or lab examinations done prior to admitting them to the wards. Consultants also talked about how hard it is to get specialists to visit patients. For example, there was a patient with a skin condition and consultants in Internal Medicine were unsure if it was scleroderma or other disease. They had been waiting for the dermatologist for 5 days to tell them what treatment would be best to follow. Dr. Bebora, a medical officer, also addressed the lack of blood supply available for patients. During my rotation, there were three patients with severe anemia that had been waiting to get a blood transfusion for days. She explained there were several more patients who needed blood, but not enough donors. I decided to donate myself, so she took me to the blood blank. The clinic was “hidden” behind the hospital and there were no signs that would help me get to it if I was not accompanied by Dr. Bebora. I was surprised that the only test done was to make sure my hemoglobin and my blood pressure were fine. The form I filled was not too detailed and asked about medical history. I then handed in my form and the clinician told me my hemoglobin was fine and that I was all set to donate. Personally, I am aware about my medical history, vaccinations, medications, etc. but I can see how this can be a setback for those who want to donate but have no file or knowledge of theirs. Additionally, if information is hidden or the donor is not aware of a condition, complications during the transfusion increase. With the Canadian Blood Bank, the procedure is more detailed. After the form is filled, the clinic staff makes sure you understood every question and goes through the questionnaire with you. A brochure is also provided so that the patient understands the procedure and an aftercare guide is also given. This provides a pleasant and reliable experience, which encourages donors to keep donating and create awareness.
Another problem Dr. Bebora addressed was the strikes by the personnel. Staff from the diabetic clinic and nutritionists were on strike, demanding a better pay for their work. As a result, interns and officers from Internal Medicine were asked to rotate throughout the week to cover for them at the clinics. According to the World Health Organization, the doctor to patient ratio in Kenya is 1:5000. This is an incredible amount of work and pressure on doctors and nurses who are not making enough money for their work. Inevitably, they go on strikes, resign, or move to the private sector.
There were several cases that stuck with me during this week. I saw a girl my age who at first glance I believed was around 6-7 months pregnant. Dr. Fatma explained it was a progressive abdominal extension and that the patient had AIDS. Patients with AIDS are more likely to form masses, and they were waiting to do an ultrasound to confirm it was a tumor. There was another case were I first believed the patient was a psychiatric patient due to the signs he presented. He was screaming incoherencies, had urinary incontinence, and an altered level of consciousness. I was astounded to learn this was a case of severe malaria and could not believe a 12-year-old child was going through such a complicated case. Dr. Varvani went through all the symptoms that severe malaria presents, its causes, and its treatments. I even had the chance to look at the parasite from the patient’s blood sample and the lab technician guided me through the life cycle of one of the most common parasites that causes malaria.
These two cases are an example of what I’m calling “eye opening”, I felt ignorant with the assumptions that I made and how little I knew about the extent of these diseases, but at the same time these cases ignited my passion for medicine and how much I want to help especially in countries that are carrying heavier burdens than others. During this week, I also saw two cases of attempted suicide through poisoning. I find it appalling how a corrupt government turns a blind eye on a major health issue. Apparently, there is no funding towards mental health in Kenya from the government. According to WHO, over 2 million Kenyans are living with mental health problems, and those are only the reported cases. I believe health should always be seen in a holistic perspective, always including mental health.
My week in surgery was mesmerizing. As I mentioned before, during Pre-med there is no chance at all to see surgeries, so I felt very fortunate to be present in those procedures. I even did a night shift in Surgery. However, it did not go as expected. I was only able to see one surgery since there was no water available the whole night. This inconvenience heavily affected the one surgery that I got to see. It was a 22-year-old man whose surgery was delayed from 3:00pm to 10:00pm. He was induced for acute testicular torsion but the delayed caused necrosis of the testicle, it now had to be removed and the patient was now infertile. It was tragic to see how a very simple procedure grew in complexity due to not having water and I cannot imagine how the other scheduled patients were affected too. I spent the rest of the night talking to one of the anesthesiologists, who kindly showed me all the medications they used, the machines in the operating rooms, and how they clean everything. It was nice to see that the Surgical department actually had good equipment, a better sterile environment than the rest of the departments, and according to the anesthesiologist, medications were always available.
This internship gave me much more than I could have ever asked for. It not only reminded me of why I wanted to study Medicine, but it inspired me tremendously to pursue my career in Global Health. I learned how important it is to educate and create better awareness in order to avoid or mitigate harms. It can help people start practicing preventive health behaviors that would reduce the risk of developing diseases. It can also help detect an illness when it is easier to treat with fewer complications. I believe education is also the key out of poverty and corrupt systems, and what I aspire is to be able to invest in a country that has given me so much. I cannot fully express in words how Kenya has inspired me. Its people and its amazing culture have motivated me to become the best I can be with the hope of being able to give back once I become a doctor.
IMA made this experience very pleasant. I felt secure all the time and very well informed by my mentors on what to do and also what to avoid doing. The environment at the residence was more than I could ask for, everybody was very welcoming and making sure I was enjoying this experience. I also loved how Naomi, Benson, Joshua, and Brian were always helping get my Swahili words right! The food was delicious and accommodations were comfortable. My mentors at the hospital were incredibly helpful and patient. Even though it was very hectic, there was always someone who could guide me or help me understand everything that was going on. The only thing I would have changed is that I didn’t get to attend clinics since there were not enough interns during my time there. It was a little bit sad to see that a clinic was done just a week after I left. Overall, I will be forever grateful with IMA for making this experience as productive and comfortable as it could be.