I have three main goals for my time at the Moi Teaching and Referral Hospital in Eldoret, Kenya. First, I plan to participate in the clinical care of hospitalized pediatric patients. This is similar to my current role as a pediatric hospital medicine fellow, where I lead a team of residents (registrars) and medical students on hospital-based rounds, developing diagnoses and treatment plans for each patient. Second, I will spend time teaching the registrars and students about both common and atypical pediatric conditions and their pathophysiology. These may include reviewing topics such as pneumonia, asthma, dehydration and fluid management; and teaching on less common diagnoses such as pertussis (whooping cough), Kawasaki disease, Guillain-Barre syndrome, and more rare genetic disorders. Teaching will happen informally during rounds and also during a more formal morning report. Finally, as there are physicians from many institutions who come to work, teach and learn at this hospital, I’m excited to exchange ideas and perspectives on pediatric care with other doctors from around the world.
I hope to provide excellent clinical care for the pediatric patients at Moi Teaching and Referral Hospital; however I believe the lasting benefit will be for the medical students and residents I work with. I’m passionate about medical education, particularly because I’m the first member of my family to attend medical school, and did not have exposure to many mentors in the healthcare field. I think it is important to teach the next generation of learners. During my training, I’ve come to realize that patients often don’t fit the “textbook” criteria for symptoms or diagnoses. Medicine is far less black-and-white than it seems, and the way we manage even common pediatric conditions varies greatly depending on institution, region, and resource availability. Because of this, I think there is tremendous value in seeing different styles of practice outside one's own. I hope to engage the trainees at Moi in discussions that balance both evidence-based recommendations with what is feasible for their institution, community, and the individual patient, with the ultimate goal of providing the best possible care. Similarly, I plan to learn as much as I can from the residents, especially for pathologies that are less commonly seen in the United States.
As described above, I believe the lasting impact of my trip will be the teaching provided to the medical residents (registrars) and students as they are the future physicians in this community. I anticipate that the resident physicians can grow in competency to use narrow spectrum antibiotics to reduce risk of bacterial resistance; catch acute rheumatic fever earlier in the course and prevent progression to rheumatic heart disease; increase cancer suspicion and develop protocols for childhood cancer screening; improve pain plans for patients with malaria; develop public health talks regarding TB, hand hygiene, and cleaning water that is used in the home to reduce the risk of childhood gastroenteritis. The learnings will also carry forward through an ongoing institutional partnership with AMPATH which allows trainees from Kenya to come visit and learn at our teaching hospital in Austin, Texas.
On a personal level, I hope to develop my clinical and leadership skills through this experience which I know will influence my practice moving forward. Working in a setting where some of the care provided may be determined by limited access to technology - for example, patients who cannot afford lab tests, limited number of ventilators, limited CT and/or MRI machines - provides a unique opportunity to think about triaging and resource availability as part of medical decision making. This is something I am not accustomed to, but I hope will make me a more astute clinician, relying on other tools (e.g. physical exam, labs) to reach an accurate diagnosis.
The people most significantly impacted by my trip were the Kenyan medical students, medical officers and pediatric registrars (residents). I had the opportunity to do informal teaching on rounds and more formal, weekly lectures. These talks allowed the residents to satisfy some of their core pediatric competencies and sit for their board exams.
Additionally, I provided direct patient care on the inpatient pediatric wards caring for patients with a variety of diagnoses including renal failure secondary to malaria, TB pericarditis, rheumatic heart disease, congenital hypothyroidism, and intractable epilepsy among others.
Finally, I think perhaps the biggest impact was on myself! I am leaving Kenya with far more awareness of new pathologies including tropical disease we don't see in the U.S. and late presentations of more common conditions. Working in a resource-limited setting has taught me how to me more judicious with diagnostic testing. I now ask myself "Do we really need that x-ray? Will the flu test change our management?" when I previously would have ordered these studies automatically. I also have a new awareness of antimicrobial resistance patterns (a massive problem in Kenya) due to a combination of factors including overuse, over-the-counter availability, and counterfeit medications. I hope to continue working with the antimicrobial stewardship team in Eldoret to encourage antibiotic de-escalation and appropriate use.
