My Medical Officer (MO) and good friend Abdalla shared his philosophy with me after witnessing my heart twinge with pain alongside the 14-year-old girl sprawled across the ER table. His ideal has ingrained inside me and transcends all injustices I see— at CPGH, in child detainment alongside our southern border, in racial and gender inequity in the workplace, in the homeless shelter across the street from the Starbucks I frequent. But in that dusty corner of the CPGH ER, I understood the difference between witnessing injustice as a passive bystander and taking control of said injustice to learn from and better the debilitated victims. For most of my IMA peers, this call of responsibility transcended into a pursuit towards medical school. Me, I diverged.
I entered IMA with an open soul and an undecided scholarship beneath the healthcare inequity umbrella. With an inclination to study infectious disease and global health inequity, I requested to learn in the CCC (comprehensive care unit) unit for the entirety of my stay, all while taking afternoon shifts in the ER, maternity ward, and NBU to enrich my studies. I soon came to the unsettling realization that hands-on patient care would not be my field of pursuit—I wanted something more, to upscale my actions, to treat populations rather than individuals, to be bigger, to do better.
My call to action stemmed from observations of systematic injustice entrenched upon CPGH and accepted by the masses. A lack of a ventilator in the NBU ended the life of a newborn baby. Unwashed materials between patient rotations in the ER left many susceptible to infection. A lack of nutritional supplements in the CCC denied an HIV patient from increasing her BMI to a healthy level. These small pieces of the CPGH puzzle not only identify the many broken links in the chain of action, but also how widespread the issues are. Each fault can ideally be eradicated via simple intervention, more donations, or even more attentiveness. While all true, each imperfection relates back to the large injustices done onto the facility by lack of governmental upkeep, monetary corruption, and a disadvantageous starting place. Trained and qualified healthcare workers cannot care for their patients to the best of their abilities given the state of hospital resources. I visualized this injustice firsthand in the maternity ward. A woman in labor had no access to a Cesarean section due to a lack of available theaters; as such, she succumbed to a natural birth for forty hours. In another example, a cancer patient in need of radiation was referred to a hospital in Nairobi, which was the only facility in Kenya to offer such services. This patient could not afford a ticket to Nairobi nor the time to wait months for the next available appointment; as such, this patient’s health was sacrificed due to a lack of resources not only in CPGH, but also in all of Kenya.
Besides health crises that stemmed from within the hospital, I also recognized the population denied access to CPGH facilities as a whole. One consultation meeting is 200 Ksh. Over half of the Kenyan population amasses 180 Ksh per day; to ask a majority of the population to give over a day’s amount of work (and maybe more to cover transportation fees) over to a consultation that lacks the resources to properly treat serious inhibitions is preposterous. That money could instead be used for food, drink, shelter, and any other daily life accommodations. The public health system is broken if it cannot serve who it is meant to serve.
Hyperaware of all the issues observed around me, I decided to educate myself on the topic as well as I could. Bridging my two passions of infectious disease and healing public health disparities, I circulated my self-education around the CCC.
I spent my hours at the CCC conducting personal research regarding the current state of the public health system in Kenya, the general sentiment towards NGO donors and public aid, the meager state of sustaining supplies, and what needs to be done to improve patient outcomes as a whole. I conducted 21 interviews amongst the MO’s, nurses, and interns stationed around the CCC to try and understand the state of public health from all health worker perspectives. Each interviewee spoke upon the lack of governmental support for the CCC, the lack of resources and staff for day-to-day life, and the overall belief that the CCC can run smoother, faster, and more carefully. Alongside these sentiments, every interviewee relayed their belief that the CCC has improved in resources and daily mechanics throughout the years and will continue to improve given the dynamic nature of the facility.
The CCC serves one of the most vulnerable patient populations in the world (patients living with HIV), and requires up-to-date facilities and resources in order to do so well. It is largely unaffected by governmental influence due to NGOs that cover the majority of the funding. However, the funding covers just enough to keep the center afloat on a day-to-day basis.
I also discovered improvements made to the CCC throughout the past ten years; the center digitalized its patient database, relocated its pharmacy inside the center to reduce stigmatization, and hosts daily health talks as a form of social intervention and education. These interventions have improved patient outcomes and adherence records, thus reflecting the benefits of constantly updating the center and innovative thought.
Compared to a western facility, the CCC is in need of more technology, more MO’s, and more mental health resources. However, because this list of demands is considered superfluous to donors, patients are then denied access to a more updated system, a more competent staff, and mental health services to guide them through a life of HIV.
My interpersonal relations within the CCC were the most impactful CPGH moments outside of my research. I woke up each morning excited to see my friends and learn from them why they decided to pursue a career in infectious disease. Nurse Rosie’s eyes glimmered whenever she talked about the gratification that came to serving those who truly needed it. Nurse Rebecca treats each patient with the same love and care that my family graces me with. Dr. Matonda treats a man living with leprosy to lunch every week because he sees him not only as his patient, but also as his brother. This well-rounded treatment gives patients the physical and emotional support required to maintain a high compliance percentage. I am honored to have witnessed and integrated myself into the CCC’s culture of respect, dignity, and grace.
I hold the hope instilled within the CCC, the compassion in Nurse Rebecca’s will, and the pursuit of justice within every healthcare worker in the CPGH with me every day. I will not let these sentiments fade away after my physical time in Mombasa. Rather, I will use my efforts and attained knowledge to be proactive about some issues noticed at CPGH. I am working with two other CPGH interns and professors from my school to create an online platform that connects Western doctors to doctors in Mombasa. The platform will offer a source of support and mentorship, and will be an optimal resource for those at CPGH to convey the resources they need to a power that may be able to help them acquire it.
From my time with IMA, I learned that I am meant to participate in the healthcare sector on a larger magnitude than everyday patient care. I want be the change for unjust policy, and I want to be the link between Western and LMIC communication. Through these implementations, I hope to positively influence a larger magnitude of vulnerable populations suffering from unjust healthcare systems.
IMA taught me that change comes slow, but change is necessary. And while change has been happening throughout the decades, it is not happening at a fast-enough rate. I want to be the catalyst in this reaction, and, thanks to IMA, I believe that I can.