Tusonge Mbele Pamoja

There's a Swahili proverb that says "tembea uone"; essentially it means "walk and you will see", encouraging the listener to embrace new experiences as an opportunity to learn and to grow. Every time I anticipate another day-and-a-half of travel to reach East Africa, this phrase comes to mind. Each experience, each opportunity to return, is its own adventure with new things to see and an infinite number of things to learn.

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My name is Grant Callen and I am a rising second-year at Indiana University School of Medicine (IUSM) on the Bloomington campus. Over the past several years I have been extremely fortunate to spend a good deal of time in East Africa. Before my first year of medical school I chose to take a gap year in Tanzania while living with a host family and working in a rural HIV clinic. Finding your passion so early on in a career is truly a blessing, and I am so grateful for the chance to live out that dream in Kenya this summer.

Working at AMPATH as a Slemenda Scholar is pretty much the pinnacle of summer experiences, as far as I'm concerned. You're a baby doctor - as I like to refer to medical students, a research assistant, a world traveler, and a college freshman all at once! I say this because not only are you a practicing clinician (as loosely defined as possible) on rounds, but you are also: advancing the academic body of work that AMPATH puts out via an independent project; experiencing the intricacies of Kenyan culture alongside the natural wonders of East Africa; and living in a dormitory-style hostel with your fellow Moi University medical students.

I chose to wait to write my first blog post until we (Helen, Roshni, and myself) had been here for three weeks. Why? Because we have yet to do the same thing twice! Every single day is a new and different adventure - pediatric rounds one day, psych in-patient assessment the next, and traveling out to Sonoko for a community dialogue day following that. The goal of these first few weeks has been to expose us to as many parts of AMPATH/MTRH as possible while helping us to understand how it all fits together. Before I get too far ahead of myself though, check out these pictures - they're each worth a thousand words, right??

 

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The AMPATH Centre is the hub for HIV treatment, research laboratories, and TB services; as a part of MTRH, AMPATH has a catchment population of over 4 million people in Western Kenya

 

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Shoe 4 Africa is the first free-standing Children's Hospital in the whole of Central and East Africa, as well as only the second in all of sub-Saharan Africa (the first is in Cape Town, SA)

 

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Chandaria - as we call it for short - hosts palliative care, chemotherapy, HTN/Diabetes, and many more referral services - as well as the AMPATH research labs and consortium offices. 

 

Maybe now you can imagine yourself in our shoes! So you've just finished your first year of medical school, you have never truly been on a ward as a baby doctor - with your white coat on and stethoscope around your neck, nor have you ever really been expected to know more than the classic symptoms and buzz words for a single diagnosis. And now? Now you're being called "Dokta" by actual doctors; now patients' family members seek your advice while attendings grill you on liver enzyme levels; and now you're faced with patients two-to-a-bed suffering from diseases you were told not to worry about because "we don't really see this anymore…".

And that's day one - a Saturday that we volunteered to work. Since that first day I have learned more about the practice of medicine, the inherent inequalities of for-profit healthcare systems, and the barriers to quality care that affect generations of a single family and populations as a whole. Instead of trying to detail all of the ways this experience has impacted me, I want to share a single story.

This past week I found myself on the men's acute ward during rounds - a rotation that I wasn't even meant to be on (oops). I had chosen to follow two Purdue PharmD candidates - Shannon and Arthur - through their routine as they were essentially pharmacists and nurses for most of their time here. As the attending physician moved from patient-to-patient, I quickly noted that we had skipped one. The patient, a 17-year-old boy, was "discharge-in" - meaning there was nothing to discuss about his care. He was diagnosed as aphasic, paraplegic following meningitis at age 10. His story got me thinking of how the healthcare system had failed this child, causing me to focus on him for longer than most. As I watched him sitting there, admittedly ignoring the ongoing brief of another patient, he began to seize. So I called Shannon over to ask about his anti-epileptics, of which there were none; in turn, Shannon shared this observation with our attending and he was placed on a Carbamazepine regimen to prevent further convulsions

In that one moment everything changed for this patient. When I came back several days later it seemed nothing short of a miracle had taken place. As the attending passed the patient this time he asked "Habari bwana?" to which the boy slowly, but clearly answered "Mzuri.". My jaw must have been on the floor because the attending reached over, patted my back, and asked: "are you as surprised as I am?". Now I can't claim to know what happened or how (my pharmacology knowledge doesn't come close to explaining this situation) but what I do know is this: sometimes just being there makes all the difference. I absolutely do not credit myself with what happened - literally anyone could have observed his seizure and asked about the medications - but I was there. And now that patient is back home with his family, speaking to them for the first time in years.

In these first three weeks there have been many occasions when I have felt uncertain about my place here. As medical students we don't do ill-prepared and unsure very well, but that's exactly what we are at this stage of our training. Meanwhile, we are surrounded by some of the greatest minds in global health, all trying to mentor us while doing their part to "save the world". So sometimes it feels like you've been dropped in the middle of the ocean without a life vest. But if you get up every day, take your cold, hostel shower, and show up to work - sometimes you'll be in the right place at the right time. And for some patient, that will be enough.


Posted at 06:54

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