Kenya - my other home

by Emmanuel Ndayisaba

EN-with-group-at-hospital2The last time I left Kenya was December 2010, when my family was being resettled in Adelaide as refugees. We had been living there for 14 years. All this time, we lacked the most basic human rights, we could not pursue higher education or get a working permit. Above all, we were never going to become Kenyan citizens. So, when I left, I was not expecting to miss it or desire to ever go back. Returning after 6 years of living a wonderful life in Australia, which was now my home, was daring. 

As I entered university the desire to return to assist in Kenya began. Public health lectures, helped me see where each idea could be put in practice back where I grew up. The worst realisation was knowing that these diseases were treatable but due to a lack of resources and qualified personnel could not be addressed efficiently or appropriately.  I kept feeling a burning desire to return and understand the healthcare system, to be able to give back. I decided that If I was to go back, it would be after acquiring enough knowledge to be able to lend a hand to those already doing the amazing job of keeping my people alive: doctors and nurses. When I was finishing my second year of post graduate medical school, I knew I could now take proper medical histories and examinations, as well as perform small procedures. I knew I could be useful in a health care team. I decided it was about time I went back.

Organising the trip was a bit difficult. Kenyan hospitals may have websites and internet, but they rarely read or reply to their emails. I wrote to many of the hospitals that I knew, and got no response. Like anything in Kenya, it is usually about who you know. So, I contacted a friend of a friend, whose brother knew someone who worked in a catholic mission hospital somewhere in the middle of the Rift Valley. The connection was so fast, and my application was approved to have a 4 weeks’ elective placement with a colleague. The planning was scary, as during all this I kept doubting whether I was ready to go back to Kenya, the place where I lived for 14 years but never felt at home. 

Time passed, and November was here. We flew from Sydney to Nairobi. Knowing the needs of the hospitals in Kenya, we collected medical supplies from Air Borne Aid, a student-led organisation that provides medical supplies. We each took around 20kg. Being Australian medical students provides us privileges that make it easier to do elective placements overseas. One of them was free insurance and travel insurance cover by MIPS.

When we arrived, Kaplong Mission hospital was another 4 hours’ drive from Nairobi, the capital city. It is a nice rural town, very green and with a lot of milk! The hospital administration was happy to have us. They asked us which area of medicine we want to work with but it was a difficult choice, as they all seemed good for us to learn. The hospital has 150 beds, including two medical and surgical wards, a paediatrics and a maternity ward. They also have an outpatient clinic that has several departments including, child and maternal health, TB and HIV clinics, as well as an ENT clinic. The outpatient clinic also provides dental and physiotherapy services. Around the time of our arrival, doctors all over the country went on a strike in all public hospitals. This left our mission hospital as the only health service provider in the region. We were receiving more than five times the number of patients they usually receive each day. 

On our first day, we learnt how to settle in and what we could help with. The first lesson we learnt was that there was only one doctor every day, and they were covering all areas of the hospital. Everything else was done by enrolled nurses, who were trained at the hospital’s nursing college. We also learnt that the people we had been mistaking for doctors were ‘clinical officers (CO)’ - a role created by the Kenyan healthcare system to respond to the shortage of doctors. Young people are trained for three years on how to diagnose and treat the most common diseases of a particular region. They see patients in the outpatient’s clinic and when they decide to admit them, the doctor will see them during ward rounds the next day. These guys knew their medications off the top of their heads, including dosages, contraindications and what was affordable or not. We then realised that the hospital administration was expecting us to work with the CO in seeing patients, admitting them and then liaising with the doctor when they come the next day. When the doctor was around, they expected us to help them in the theatres to manage the wards.

EN-equipment-and-sutureOn our first day, we started seeing patients in the clinic, while waiting for maternity to call us to learn how to deliver babies. We were initially shocked by the amount of people waiting to be seen by the CO. The line was long and people had been waiting for hours. We realised how they were being seen, without a long medical history, mostly without an exam. It became clear to us that, if a full history and examination was to be undertaken, only a quarter of the people would be seen. This was a new concept to us, especially when most investigations cannot be performed in the hospital. The main investigation was a complete blood count. We offered to create a new role whereby, if a patient seems very weak, we would see them, take a proper history and examination, and decide whether they needed admission or not.  Language was a major barrier and often an interpreter was required. I speak Swahili, but most older people in this region only spoke Kalenjine, a local language. We sometimes had to allocate one bed to two very sick patients because neither of them could be discharged. Within two days, we were already used to the fast pace, and our approach of taking a history and examination was gaining popularity among patients. We performed simple procedures such as suturing wounds, draining boils, dressing diabetic wounds and resuscitating patients who overdosed on organophosphate poison. 

In the meantime, the maternity wards were kept busy from the many births. It was touch deciding which one to do: Do I stop doing what I can do well, and learn how to deliver babies? Or I should do both? I decided that I was going to attend the maternity wards at night, and see patients in the outpatient clinic during the day. I ended up dividing my day into an 8am to 3pm shifts in the clinic and a 3Ppm to 10pm shift in the maternity ward. Sometimes these hours were broken due to emergencies and other procedures. The time spent in maternity was very interesting. All the work was covered by the enrolled nurses who only involved the one and only doctor if there was an emergency. They were very kind to me, they took me in and taught me how to deliver babies. After observing one birth, they made me assist in two more, then the fourth was mine. I was on my own, assisted and guided by two nursing students. I cannot describe the amazing feeling of seeing the baby cry and the mother relieved and knowing that I had just done it. From that moment on, they welcomed me as part of their team, and I would have patients to follow through the entire labour. I never stopped asking them questions, sometimes they would laugh at me and sometime with me. They were the best teachers ever. EN-delivers-first-baby

We stayed for the entire summer holiday, and the place became a second home. We socialised with the staff, the community and everyone we met. The mothers in the maternity wards named a few kids after us. One of them was a beautiful baby boy that we had to resuscitate after a long obstructed labour. 

During this time, I was flooded with emotions of all kinds. Mostly happiness, as this is what the people here are good at offering, but sometimes with sadness as well. The  saddest moments came when we weren’t able to help patients, either because they couldn’t afford to have some tests done, or were unable to travel to Nairobi to see a specialist. I found that a lot of these stories resonated with my own. They took me back to those times when I was one of them, a poor refugee in Kenya. I could remember when some of us were sick, but our parents could not afford treatments, I could see it from another angle now. I could see how important and lucky it is to have something like Medicare in Australia. 

Spending time here taught us a lot as medical students. We were there to learn, and we  learned a lot.. It was amazing to see how much change one could induce from simple things. One of them was saving a young man’s life. He had sustained an injury in a motorbike accident. As a hospital without an emergency system in place, we had to transfer him to another hospital. But with the public hospitals on strike, we would have to go to the nearby town for another bigger mission hospital. The young man had severely injured his head and had developed a seizure and was bleeding everywhere. He needed airway protection and when we mentioned it, everyone looked at each other not knowing what we meant. To our surprise, they did not have equipment for that. But luckily, we had brought some with us. We had to intubate him and transport him on oxygen. He survived to the next hospital, just because we had brought those tubes with us. Sometimes we take a few things for granted. Whether it is the tools that we only use once and throw away, those we stop using because they have expired etc all these could save lives if we learnt how to redistribute them.

Being back in Kenya ended up being one of the best experiences of my life. I finally saw where I could help to give back to a place that raised me. I may never feel like I belong there, but I know I DO. I learnt that a mediation between places like Kenya and places like Australia is needed. We have bright doctors and medical students that might be wishing to experience practicing medicine in places like Kenya. 

I would encourage anyone who is interested to go ahead and do it. The secret lies in doing it with an open mind, without criticising what they do and how they do it, but learning why, and finding out what they can teach you and what you give back. I have decided to make this a recurrent trip. I know that our medical students in Australia can learn and benefit from this. But I also want to do this in a way that benefits the community over there. Whether it is by taking some of the most basic and needed equipment, or by lending them a hand, I want to be part of this change that I want to see.

Emmanuel will be keynote speaker at NSWMSC Leadership in Medicine Symposium (LIMS). If you are interested in accompanying Emmanuel on another visit to Kenya, email info@mips.com.au with all your relevant details and we will pass it on to him.

MIPS offers indemnity cover for your elective as well as any travel you choose to do as part of that trip. Visit mips.com.au/elective to let us know where you will go for your elective.