My global health lesson: Start small, start now, learn quickly
Roshni Dhoot Jan 12, 2018
As a rising second year IU School of Medicine student, I had the privilege to spend last summer in Eldoret, Kenya, with the Slemenda Scholars program. Over eight weeks, I learned so much about AMPATH Kenya – IU’s world-renowned medical partnership in Kenya.
The Slemenda Scholars program is named after Charlie Slemenda, an IU School of Medicine epidemiologist with an intense interest in global health who passed away suddenly from a heart attack at a very young age. Funded completely by the IU Center for Global Health, it sends 2-3 medical students who have just finished their first year of medical school to Eldoret, Kenya, to experience everything that AMPATH is, and experience the role global health might play in their future careers. It is without a doubt an investment in us, the Scholars, and our development. While there has never been an ounce of pressure on us to return or commit to a career with AMPATH, the Slemenda legacy is strong. Many former Slemenda scholars have returned to work in Kenya for 2-4 years or live permanently in Eldoret as practicing clinicians. And some have even married other Slemendas!
What is truly amazing about AMPATH is that the partnership between IU and Moi University is so strong. The IU School of Medicine is so committed to the work being done here that many departments fund their faculty members to come to Kenya and practice for 2-3 years at a time. It makes me proud to attend a school that believes so clearly in improving healthcare everywhere and supports long-term efforts to do so.
During my experience in Kenya, one of the nights I remember most was when I joined an IU medical resident doing a rotation at Moi Teaching and Referral Hospital to check on one of his pediatric patients. The patient was a three-year-old boy suffering from cerebral malaria, throwing up blood and bleeding from different parts of his body. The resident was worried that he was going into shock and tried to take the child’s blood pressure, but there was no working blood pressure machine or even cuff at the hospital. To get a sense of the child’s blood pressure, the resident used his pulse oximeter to check the heart rate and then pressed on the child’s foot to check his capillary refill. The heart rate was high, but the pulse oximeter also showed that the child’s O2 saturation was 70%. I was amazed by his ingenuity in caring for the child despite lacking basic equipment. Because of the ongoing nurses’ strike, his nasal cannula was not being checked for proper function. The resident strongly recommended that the child be moved to the ICU, but no beds were available. The next day, the child went into respiratory and renal failure and ultimately passed away.
So many stories like this one have stuck with me—because patients like these may have made a full recovery in a more developed country, without as many resource-limitations and barriers to care. It seems sometimes that the days are equal parts hope and frustration, and that no difference is being made. The clinicians that work here must learn how to treat each patient like the first one of the day and develop incredible resilience to continue working in less than ideal situations. So many times, I have wondered how they continue to have such a positive attitude. My view is biased—I spent such a limited amount of time in Kenya and I saw only the short-term.
The truth is that so much progress has been made, progress that can only be made when people commit to a community for a long period of time, and that is the macroscopic view that people saw and continue to see in these developing communities.
What I took away from these encounters and conversations with physicians is that even though there is so much to be done, there is so much hope, and that is what draws people here, and what makes me want to come back. Progress anywhere is not instantaneous, but if we start small, start now, and learn quickly, over time, it will be made.
Blog title inspired by Dr. Joe Mamlin, Professor Emeritus of Medicine and AMPATH co-founder, overheard while inspiring clinicians at a rural health facility