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International Child Health Section: Articles
Chogoria, Kenya, November 19 - December 14, 2007
Submitted by Serina Patel
I recently spent a month in Chogoria, Kenya as part of an international paediatric elective. During my time in Kenya, I worked at the Presbyterian Church of East Africa (PCEA) Chogoria Hospital.
PCEA Chogoria Hospital is a 312-bed rural general hospital financed by patient’s fees and donations. It is located in Meru South District which is approximately a three hour drive from Nairobi. It has medical, surgical, paediatric and maternity wards and an outpatient department with dental and eye units. Specialists include a surgeon, obstetrician and gynaecologist. A paediatrician and internist visit the hospital every one to two weeks. The hospital is staffed with eight house officers, equivalent to interns, who rotate through the various departments. There are two medical officers, with training equivalent to a second postgraduate year and several clinical officers, similar to nurse practitioners and a large number of nurses. The hospital is equipped with a large and active community health department, an anti-retroviral clinic for HIV patients and a palliative care unit.
When I arrived, I was exhausted from the lengthy travel from icy St. John’s, Newfoundland. However, during the car journey from Nairobi to Chogoria I was awakened by the beautiful scenery and, of course, the bumpy roads. We drove through hills and valleys covered with lush vegetation until we arrived near the base of Mount Kenya at the end of a dirt road. I was excited for the adventures to come and for what would be one of the most rewarding experiences of my medical career. And, this would all take place against the most breathtaking backdrop.
I spent the month working with a Kenyan intern and was involved in all aspects of paediatric and neonatal care, including inpatients and a busy outpatient department. Occasionally there was a medical student so I was able to do some teaching. It was overwhelming to be the only paediatric-trained individual at the hospital, but I quickly realized that I had a lot of support. As mentioned, the paediatrician visited twice during my stay. In addition, the interns were very knowledgeable in common paediatric illnesses seen in Chogoria. We were able to learn from each other and exchange knowledge that improved the quality of care of our patients. The most common cases I saw included severe dehydration, malnutrition and its subsequent effects, such as rickets, respiratory illnesses, and infectious diseases such as malaria, tuberculosis and HIV. Sadly, I had a few cases of post-traumatic stress in young children as well as cases of child abandonment.
I was impressed that despite the limitations and lack of resources that existed at this hospital, including mechanical ventilation, medical instruments such as otoscopes and thermometers, medications and subspecialist physicians, Chogoria Hospital provided some of the best medical care in the region. In fact, the medical care exceeded that of many government hospitals. The interns and medical officers are responsible for the hospital and have only one year of postgraduate training. I was amazed by their knowledge, skill and confidence at this level. It is not surprising that the hospital functions so well when the physicians are dedicated to the well being of the patients and are always striving to learn the most up-to-date medicine, despite lack of access to libraries, Internet and journals.
During my elective, I faced many of the challenges I had anticipated. I had to adapt to a new environment and new healthcare practices. I was able to seek guidance and support from my Kenyan colleagues on many occasions. There was certainly a language barrier with my patients, however, I overcame that aspect quickly. I picked up some common phrases in Kiswahili, but I mostly relied on English speaking nurses and simple human connection through universal gestures and expressions.
The most significant challenge was in realizing the major gaps in training of support staff and nurses that would not be acceptable by North American standards. I realized this during the resuscitation of one of my sickest patients. There was a deficiency in basic life saving skills, such as initiation of CPR and bag mask ventilation. It saddened me to know that many of my sickest patients could have had better outcomes had they been in Canada. However, I took this opportunity to raise awareness among the other physicians about the importance of such skills and of teamwork in acute situations. We decided that resuscitation rounds should occur monthly to learn new skills and keep them fresh. And through the gracious donations from Newfoundland, I was able to supply the library with a number of PALS books and Broselow tapes. I hope that on my next visit I may have the opportunity to teach some of these skills in a more formal way.
I learned many things, including more general paediatrics experience and a better understanding of tropical medicine — an area in which little instruction is provided in our training. As well, I had the opportunity to interact with other trainees in a different country. Professionally, the experience taught me how to overcome such barriers. I had to rely on basic skills in history taking, a good physical examination and minimal investigations to come up with a rational diagnosis and management plan. As a paediatrician, this will help my career because I will think more carefully when ordering tests and investigations.
I am an advocate for children, both in my community and the global community as well. Learning about issues that face children around the world is important for any paediatrician. It is our duty to promote awareness and support these issues. In an era of globalisation, I will surely encounter patients from developing nations, and by having some knowledge about their circumstances, whether economic, social, emotional or political, I will be better able to attend to the needs of my patients.
I have great memories of all those I met - the physicians, nurses, and most of all my patients. The Kenyan people are kind hearted, warm and welcoming. They made me feel safe in a new place and made it easy to adapt to the cultural differences that exist both in the practice of medicine and everyday life. They were appreciative of my time and my friendship. The children, though initially unsure of my strange face, would awkwardly stand at attention when I walked by. However they quickly became friendly, showing their affectionate manner and contagious smiles. Meeting the local people and taking part in their daily activities, was culturally enriching. We shared experiences and memories that will be lifelong.
I am grateful to have spent time in this most magnificent and stunning country, and hope to visit again soon. Having stimulated my own desire for international health endeavours, I hope that I may encourage others to seek similar opportunities.
My thoughts are with my Kenyan colleagues as they face with much political unrest in their country. I can only hope that peace comes to Kenya quickly and that they may overcome the challenges that face them today.
Posted: March 2008
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