On Kenyan Time

Being the youngest “physician in training” on the trip, I found myself scared and overwhelmed…to say the least… before embarking on this journey.  Now having it almost come to an end, I thought it would be appropriate to mention a few of the incredible lessons I’ve learned from this life altering opportunity.

 Coming from a bustling State Hospital in the US where any laboratory test or consult could be obtained with a click or call, life in Kenya may seem to come to a staggering halt.  While in the mobile clinics, our texts, combined knowledge and experience from the upper level physicians, and most importantly, the history and physical exam guided our diagnosis and treatment.   So a question or two for all the budding doctors out there, “What is the appropriate regimen of treatment for Typhoid fever? For cutaneous Leishmaniasis?” Well if you’re like me, I had to look it up, and not to mention ask about a million other questions to help sort through the many differential diagnoses that exist in the tropics.  So, lesson number one would have to be, don’t be afraid to not know something, as this will invariably be the case.   And don’t be afraid to ask for help. As Dr. Hodges says, common things are still common, even though we’ve gotten to see several rare diseases that one may never see in the US.

In what seems to be the lack of rush to do anything, we’ve found ourselves engrossed in conversations about the community and the struggles they face.  You see the importance of a handshake, of asking “Habari” (how are you) and in taking time to make each patient feel welcome.  The Kenyan people are such gracious hosts.  In two separate mobile clinics, several of the community women cooked all day to provide a meal for our team in thanks for providing medical care for their community. In a country where food is precious and a nutritious meal often hard to come by, such a gesture was incredibly powerful. 

For many, we are the first “mzungus” they’ve seen, so even the smallest gestures speak volumes.  The children here are both curious and sometimes afraid, but you can always get a smile with a quick game of tag, or soccer, which they LOVE to play. The bottom line is that these children hunger for an out-pouring of love and affection.  Being in Kenya has helped me to understand the importance of the unspoken word and gesture as equally important in the care of the patient as the medicine we provide.

Finally, I’d say the lesson I’ve learned best is to be confident in myself and the rest of the medical team.  That regardless of age or experience, the greatest satisfaction has been merging the didactic knowledge learned in the first years of training with clinical experience to serve the community competently and compassionately.  One case particularly comes to mind.  A young boy about 5 years old came to clinic with a peculiar rash that had begun on the face and had descended to the arms and trunk.  The rash was fine and popular and did not appear to be in the distribution of scabies or a tinea corporis infection. The rash did not have any varying levels of healing. No other siblings were affected.  The child also complained of a stuffy, runny nose, and inflamed red eyes.  Because rashes are so prevalent here as the result of fungal and bacterial infections, and bites, at first it appeared theses may be two separate entities. Getting the whole team involved, with further questioning it was discovered that the child had been febrile the week before. On Physical Examination, findings were generally unremarkable except for the stuffy nose, papular rash that had begun on the face, then descended to the arms and trunk, and prominent posterior auricular lymphadenopathy.  In consulting with the attending and texts, we felt confident that this was a case of Rubella, a viral infection we don’t see anymore in the US because of the MMR vaccine given twice before children reach school age. We reassured the family and offered conservative management of the symptoms.  Practicing medicine is an incredible profession, and I’ve felt incredibly blessed to have this opportunity to sharpen my skills here.

-Hannah Bauer