“Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete.” – Paul Kalanithi, When Breath Becomes Air
As I sit down to write my the first installment of my “blog” (journal, essay, exposition, short novel…) detailing my two months here in Kenya, I realize I am having a very hard time conceptualizing the passage of time. A small part of me feels as though I’ve lived here for months on end, while most of me feels as though these first four weeks have gone by in the blink of an eye. This experience is already irrevocably changing me and my perspective on the world, and I am eager to see the person I will be at the end of it all. I’m going to take this first opportunity to detail what I saw, experienced, and did over just my first two weeks in this community built from the AMPATH mission, and I will detail what I’ve done in my down time and more specific reflections in a later post.
After about 24 hours of travel, including an overnight stay in Nairobi, I arrived in Eldoret to be warmly welcomed into the IU House family, beginning with an introduction to the new compound rescue puppy named Brody. Our first two days were spent rounding on the internal medicine wards with the medicine team leader Dr. Matthew Turissini.
Moi Teaching and Referral Hospital is one of only two level-six tertiary care centers in Kenya, the other being in Nairobi. Our experience on the wards was, to say the least, an eye-opening way of being introduced to the public healthcare system here in Kenya. My only basis for expectations stemmed from spending the summer of 2016 rounding with various specialty teams at Riley Hospital for Children in Indianapolis, and I can say with certainty that experience did not prepare me for my first day in the hospital here. On walking into the wards, my first observation was that there are as many as two patients per twin sized hospital bed, organized in “cubes,” separated into male and female wards. The beds are numbered within the cubes, but patients often leave their beds and wander around the hallways, which seemed to be a source of frustration for the medical team as it often made it difficult to find them to perform routine vitals or discuss their care during rounds. On the provider side, from an outside perspective it was sometimes difficult to tell which student or physician intern was in charge of each patient, as the rounding teams were upwards of 30 people in size, and very few of these individuals had actually had contact or taken part in the care of the patient.
While the system is one that is far from what I was accustomed to, despite the initial shock and instinctive comparison to medical care at home, I learned to quickly adjust to how the system works and flows. It has its shortcomings and kinks, but as does our system at home. We have discussed how it is easy to judge a care system based on its apparent “low hanging fruit” problems, but it is more important to look past these snap judgements and potential “quick fixes” to look into the depths of what is working and what isn’t. While we have not spent the majority of our time in the clinical setting, it was really beneficial to be able to experience it in order to gain a deeper understanding of how healthcare functions here.
The next initiative we visited was the Tumaini Innovation Center, a school and housing project for 20 boys, ages 11-19, who were rescued from a life on the streets of Eldoret and given a home, food, and an academic future. The word “tumaini” in Kiswahili means hope, and in visiting the center you find that hope is a tangible, palpable thing here. It is impossible to visit Tumaini or meet an individual affiliated with the center without hearing or seeing their war cry of “jenga vijana,” or “build youth” – a philosophy that seems to emanate from every fiber of the facility and every pore of the staff and volunteers invested in the lives of these young boys. A lot of the boys were addicted to glue, involved in crime, or just simply vulnerable and failing to thrive without consistent food and education before being welcomed into the Tumaini family. Beginning as a drop-in center, Tumaini has had the opportunity to expand to include boarding and academic facilities, and is opening a new vocational school soon. They are also currently fundraising in hopes of widening their capacity and potentially opening a parallel girls’ facility. We visited Tumaini with a group of undergraduate engineering students from Purdue University who spent a month visiting the center daily to teach engineering classes to the boys and help install solar panels on the roof of the center. A second group of engineering students from Purdue are still working at Tumaini to design and build an agricultural vehicle to help prevent harvest and profit loss in transiting crops from farm to market. At the end of our second week here, the Purdue students invited the boys over for dinner, and they were given a true “American” feast (ie. hamburgers, hot dogs, macaroni and cheese, watermelon, etc.) and they demonstrated their dance team performance for us after presenting on all that they had learned in their engineering classes over the previous few weeks. I have never seen so many hot dogs consumed by such small human beings in such a short amount of time in my life, and it is a sight I will likely never forget!
The following day, we had the opportunity to visit with the Sally Test Centre child life team at Shoe4Africa – the pediatric hospital on the campus of Moi Teaching and Referral Hospital. While child life programs are extremely prevalent in pediatric hospitals in the United States, Sally Test is the only established child life program in sub-Saharan Africa (as far as is currently known), making it a very, very special initiative. The Sally Test Centre has both a separate building on the campus of the hospital where more stable inpatient children can go and play games, read books, color, do puzzles, etc., as well as playrooms on the individual floors of the hospital for the patients who may not be as mobile or stable. There are child life specialists on each of the wards as well who are trained to help prepare and support children through medical experiences, as well as help counsel them as needed. I spent the morning playing games and reading books to primarily oncology and burn patients in the external building. One of my favorite things about little kids is that there are many more ways to communicate with them than just verbal language, so for the majority of the time spent there I didn’t need any Kiswahili to English (or vice versa) translation, so I didn’t feel as though I was burdening anyone with my ignorance of the language. In the afternoon, the child life team had special guests from a secondary school in Hong Kong who had raised money to build them a new classroom, so we got to witness a true Kenyan celebration! There was quite a bit of singing and dancing, as well as juice, tea, and cookies (per usual). It was incredible to see how happy not only the children were, but also their mothers and family members. They were able to let loose and relax for a little while and join in on the celebration, ultimately participating in a “dance-off” against each other. It was a very good reminder that not only is the mental health and happiness of the patient crucial for good health outcomes, but the same applies for close family members and caregivers as well.
Our next adventure was spending the day with a community-based model founded by AMPATH called Chama cha Mamatoto. Chama cha Mamatoto is a model of peer support groups (chamas) led by community health workers that bring together women in pregnancy and early motherhood, combining health education, social counseling, relationship building and a savings and loans program in order to improve health outcomes and financial stability. There are close to 20 of these groups scattered around the rural villages of Western Kenya, all of which have separate groups for pregnant women and mothers of babies / toddlers. Our journey to one of these villages was an adventurous one as we traveled into the highlands outside of Turbo sub-county. While a beautiful drive, it was a treacherous one thanks to the rainy season – though we only got stuck once! I was impressed by the immediate help we received from men who lived on the farmland around where we slid into the ditch – it was as though they had a 6th sense for recognizing our crisis was happening. As we drove through the villages, being the one in the window seat I was greeted by many young children with a chorus of “MZUNGUS!” – a word roughly translated to “foreigner” (well…more accurately “white person…”) that I’ve grown very accustomed to, especially from kids we drive or walk past. On arrival to the community center, we were greeted with a beautiful welcoming song and dance and draped with tinsel flowers, surrounded by many hugs and kisses. The women of this chama were incredibly warm and loving, and they seamlessly extended these traits to us on our arrival. We were shown around the facility, which was much more extensive than I ever expected. It was complete with a birthing room and a short-term maternity ward, as well as several meeting and gathering spaces, and is staffed at all times by a clinician and nurse in case a woman arrives in labor. We were then run through a typical chama meeting, which included going over a health topic, a social topic, and the collection and distribution of communal money used for loans to help improve personal finance. These groups have seen quite a bit of success in both improving maternal/fetal health outcomes as well as the financial stability of the members and ability to provide for their new children. In all, I was incredibly moved by the strength of the bond among these women and the sense of community they have built through their shared experiences and the trials and tribulations of pregnancy and early motherhood. I look forward to hopefully visiting more of these chamas and learning more about the program and its future while I am here.
The last component of AMPATH we visited in these first two weeks was the HIV Resistance Clinic – an outpatient clinic held every Friday for patients who are not responding to first line HIV antiretroviral drug regimens. This lack of response by the disease is due to one of two things: actual viral resistance to the drug (hence the clinic name), or lack of compliance in taking their medication (the more common of the two). My time spent in the clinic was a rollercoaster of emotions as we seemed to alternate between patients who were doing well on their second or third line therapy, patients who were still not compliant (and not willing to be compliant), and those still not doing well on their medications. One patient in particular that truly gutted me was a 6 year old little boy whose viral loads were still rising exponentially, despite being on the most advanced line of treatment. The physician could do little but send off a sample of the virus to test it for resistance, and encourage the family to continue to be compliant with his medications. Prior to coming here, I had heard quite a bit about the successes of antiretroviral treatment and how it has immeasurably changed the lives of HIV patients here in Kenya, but I did not expect to find myself face-to-face with one of its failures, especially in the form of a very young child.
The quote I included from Paul Kalanithi at the start of this post seems to do the best job summarizing what I have experienced so far while immersing myself in the AMPATH mission. We’ve spent a great deal of time in my first few weeks discussing and emphasizing the bilateral exchange aspect of this organization, and how it facilitates the flow of ideas and personnel and knowledge. AMPATH would not be successful, or really have started at all, without human relationships and the exchange of knowledge and passion that permeates these relationships. My first few weeks here have been a never ending cycle of questions and answers and still more questions, and I have had the opportunity to learn from so many individuals, and reciprocally share what I know back with them – whether medically related or not. I have left each experience with a fuller mind, but also seemingly bottomless curiosity and desire to develop deeper connections in order to exchange more ideas. Above all, it has become abundantly clear to me throughout my short time here that little can be accomplished alone, but what can be accomplished in consortium and partnership with open minds and open hearts seems to be nearly limitless.
The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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