School of Medicine
When I go to Kenya this year, I will be working alongside my fellow residents, nursing staff, and attending doctors from our children’s emergency department. This will be a fantastic opportunity to gain more clinical exposure with international health in different settings, from local clinics within the city of Nairobi to rural dispensaries many hours from the nearest hospital. By caring for children who likely have not had routine care, I hope to have an impact on their health and futures, which I try to accomplish with all of my patients.
I will see and learn about different pathologies and disease presentations in children that I will not see often in the United States due to our early interventions and access to care. This includes but is not limited to various infectious processes, nutritional deficiencies, and genetic and metabolic disorders. Additionally, I also anticipate becoming acquainted with local culture as it relates to views on health, illness, and attitudes towards medical interventions and healthcare providers. It will also help me become familiar with the medical system in Kenya from a physician’s perspective, as obtaining diagnostic tests and images and providing medical treatments in places with limited resources are often very challenging.
Overall, this rotation will help me achieve many of my personal goals, which is to gain experience providing medical care in resource-poor settings, gain a fund of knowledge from first-hand exposure, and help further my plans to incorporate global health into my career as a pediatric emergency physician.
Johns Hopkins Department of Pediatrics
Karen Schnelder, RSM, MD
After more than 24 hours of travel from Baltimore to Nairobi, we were exhausted. The six of us—pediatric residents in our third year of training—had one day of rest before we packed ourselves into an ambulance and left Nairobi for Samburu to begin our volunteer experience. Samburu was a desert region to the north; we would cross the Equator in our 4-wheel drive ambulance with our luggage and medical supplies strapped tightly to the roof of the vehicle. The asphalt roads ended after about 6-7 hours and we drove an additional 3-4 hours on dusty dirt and rocky roads. We stayed in a town called Barsaloi and for the next 2 weeks we spent each day driving to different towns in the area with our medical supplies in the ambulance.
We worked with nursing staff from the regional Catholic dispensary to test and treat for malaria, provide vaccinations to children, and provide prenatal vitamins to pregnant women. We learned that we were not the only mobile clinic to pass through the area as we saw some children who had their vaccinations in the weeks prior from government nurses and other medical staff. However, we were the only physicians to visit these areas yearly. We saw at least 100 patients daily and were able to treat simple illnesses such as upper respiratory infections, rashes, and gastroenteritis with the supplies we brought with us.
Left: We had large suitcases full of our medical supplies and took turns with seeing patients and preparing their medicines in our “pharmacy.” Right: Some of our clinics were held in elementary schools, some from the back of our ambulance, and one in the local health dispensary in Barseloi.
The people who lived there were, easily enough, called the Samburu tribe, and they spoke the Samburu language. They were closely related to the famous Masaai tribe in southern Kenya and Tanzania, with their red and colorful checkered clothing and beaded jewelry. They were polygamous and they lived in a menyatta—simple huts made of mud and branches that housed one family of one mother and her children. Running water was limited, and their diets mostly consisted of meat as they herded goat, sheep, and cattle.
Dietary limitations and lifestyle definitely played a role in many of the complaints we saw: Women complaining of muscle aches, clearly related to carrying their children, water, and food for miles. Headache complaints when water was limited and uninterrupted sleep was difficult when sleeping in a hut with several other people and minimal padding for a bed. One of my concerns was seeing skin infections and knowing how difficult it would be to keep these wounds clean without running water. Another valid concern was how families would store and safely keep the medicines we gave them when they lived in such crowded huts. We did our best to help them by giving them clean towels to help with dressing changes and made sure that medicines were clearly labelled and packaged, but this was also difficult given poor literacy.
These concerns were not a huge surprise to me, but one thing that unexpectedly surprised me was that most of the adults only spoke the Samburu language, not Swahili. During medical school, I stayed in a Masaai village in rural Tanzania and learned enough Swahili to have short conversations; I was under the impression that all Kenyan children would also learn Swahili (and at least some English) during their schooling. I learned that while this was true for most of the country, the school system in Samburu was still integrating itself into the region and it was understandably very difficult to travel to this area. We had translators to help us however the breakdown in communication was evident for more complicated patient problems.
As our time in Samburu came to an end and we traveled back to Nairobi and then a town called Mutomo to the east. We spent the remainder of the trip screening hundreds of children for heart murmurs, hernias, and other medical conditions requiring imaging and further interventions. We also helped with surgeries for inguinal hernia repair and repair of undescended testicles with pediatric nurses and a pediatric surgeon from California. Being able to perform a relatively simple procedure to help these children was an immediately rewarding experience that was a contrast from our mobile clinic in a more primary care setting. However, while the families in Nairobi and Mutomo did speak Swahili and some English, many people still did not have running water, electricity, or clean homes to protect against infection.
The experience overall made me more confident of my goal of incorporating global health into my practice. I have always known that pediatricians in general have a huge impact on the life trajectory of their patients, and seeing how much we were able to help those with no resources made for a worthwhile experience that has further strengthened my desire to practice medicine in the resource-poor settings. As a future Pediatric Emergency Medicine fellow, I plan to focus my research and scholarly activities into projects related to addressing these disparities in healthcare, hopefully setting the foundation for a career in global health.
We spent a lot of time driving in our ambulance in Samburu with our medical supplies strapped to the roof of the ambulance. Our drives were long and bumpy on dirt roads.