GEMx Blog

Learning about the Healthcare System in Kenya

September 20, 2018

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Frank Mayindi, a GEMx Medical Student from Makerere University College of Health Sciences [MEPI] taking an elective program at Kenyatta University

Frank Mayindi is my name, from Uganda, a Muganda by tribe, 24-year-old male currently pursuing a bachelor’s degree in medicine and surgery at Makerere University Uganda-Kampala College of Health Sciences currently in my fourth year of study, with a very strong passion for surgery, aspiring to be a neurosurgeon in future.

FRANK MAYINDI(1) EBELE GIFT ISAAC(2) MRS DOROTHY .W(3) AND KIKOYO JOACHIM(4) from the left side at the safari park in Kenya.

I undertook an elective placement at Kenyatta University Nairobi, Kenya through the period of 2^nd June to 1^stJuly under the Global Education in Medicine Exchange (GEMx) and I take this opportunity to extend my heartfelt gratitude to everyone that made this possible. ( Makerere University international office, Kenyatta University, and the GEMx co-ordinators).

My stay in Kenya was full of many experiences. While at Kenyatta University I rotated in the Department Of Surgery at the Kiambu level 5 hospital.

For the time I was in the hospital, I participated in ward rounds (major and grand), clerkship, and examination of patients, follow up of care of patients and bedside teachings. These activities enhanced my clinical skills especially in surgery and also served as a stepping stone to pursue my career in surgery.

I also attended CME’S (Continuous Medical Education sessions) and Morbidity and Mortality reports in which I got updated about some of the current medical practices and different approaches to patient care. I also appreciated the key leading causes of mortality and morbidity in the hospital’s catchment area.

Photo with the rest of the GEMx members at the postmodern library in Kenyatta University

Through my interaction with fellow students, I learned a lot about the Kenyan culture in terms of language, culture, and entertainment. I cannot withstand the temptation to mention about the wedding I attended at one of my friend’s place and the fact that most of the weddings were held on Saturdays and all vehicles attending a burial had to bear a red cloth tied to side mirrors or any available place as a mark.

I managed to attend a community outreach held at Brydges Home Center in Kajiado County, it was a place away from Nairobi and I managed to have an experience of Kenya outside the main capital city. While at the outreach I stationed in the pharmacy department where I managed to dispense different medications to the different patients, it gave the opportunity to interact with the pharmacy students and also learn briefly about the common drugs used in Kenya.

Group Photo was taken at the community outreach

Through my stay in Kenya, I realized that it was a cold country compared to my home country, however, I managed to maneuver through the weather through the use of jumpers and very thick sweaters. However, there were no unexpected outcomes through my stay in Kenya.

I was warmly welcomed by the student community especially the students I was to rotate with, at a moment I didn’t feel I was in a different country, they played a major role in my stay in Kenya. They taught me a lot of Kiswahili and Kikuyu, allowed me to join them in their co-curricular activities like football matches plus tennis and also I participated in their discussions as early as the 4^th day of my stay. Still, through the guidance of my fellow students I managed to visit the national hospital of Kenya-Kenyatta National Hospital-and this broadened my picture of the health care system in Kenya. All in all my interaction with the students was far-reaching and up to now I still maintain communication with them and there was no moment I felt unsafe and not welcomed by them. Through interaction with the lecturers, I managed to meet with surgeons practicing in Kenya and the chairman of the department of surgery at the hospital, these greatly natured me in the field and encouraged me to pursue my career further.

The picture was taken at one of the clinical teaching sessions in Kiambu

To any student out there planning to partake a GEMx elective in a country away from home, I strongly encourage you not to hesitate to pursue such an elective. Learn about the language of the host country especially the basic words for basic community survival and also while in the host country make as many contacts as possible to further grow your carriers and to enhance your international relations and let every day that you spend for your elective count.

GEMx Exchange to UKZN

May 9, 2018

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Nancy Binsari and Tendwa George, 5^th year medical students from Kenyatta University who’ve completed an exchange at University of KwaZulu Natal (UKZN).

Tendwa and Nancy ready to go on their exchange

Introduction:

This elective is an opportunity to find out more about yourself and what you want to do in the future. The elective allows you to explore a particular area of medicine or something different, such as research or teaching.

The two of us were selected to participate in the elective term through the GEMx program. Our home school, Kenyatta University was enrolled into this program through the regional platform in Africa for the first time in 2017. Being the pilot group, we were privileged to get a chance to participate in our elective at our host school UKZN (University of KwaZulu Natal) at Wentworth Hospital. Two of our other colleagues also participated in the GEMx program, and were sent to Makerere University in Kampala, Uganda to the cardiology centre.

We had 4 weeks of rotation in the department of Family Medicine in Wentworth hospital, one of the hospitals for UKZN clinical rotations. Family medicine, formerly “Family Practice” is a specialty devoted to providing comprehensive health care for patients. Family medicine is a three-dimensional specialty, incorporating knowledge, skill and process.

Dr. Mergan Naidoo, the head of department of family medicine at UKZN was our contact person and took us through the orientation at the hospital as well as our clinical rotations in our various sections. With the aid of a well-put logbook, Dr. Mergan Naidoo took us through our objectives for the clinical rotations and also guided us on a quality improvement project that we undertook during our stay at the hospital.

4 people standing and smiling at the Department of Family Medicine

Tendwa, Nancy, Dr. Naidoo and Kenneth at the Department of Family Medicine

Week 1: Out Patient Department (OPD)

Our first week was in the outpatient department (OPD) which is divided into the chronic and acute sections. In the acute section, we clerked patients and presented to the senior doctor in charge, Dr. Oyebola who guided us and corrected us accordingly. We had an opportunity to familiarize ourselves with the South African guidelines on management of common conditions of patients in the OPD. We were able to experience a variety of conditions and were tasked to identify or at least make out the differential diagnosis of the presenting complaints.

Of the patients seen, a majority suffered respiratory diseases with TB and community acquired pneumonia leading. We also noted that the country had a large burden of HIV and it was therefore not a surprise that it was in the background in most of the TB infections. We were provided with masks to prevent acquisition of TB in patients. Other conditions we encountered in the OPD were hemorrhoids, gastroenteritis just to mention a few.

Week 2: Accident and Emergency

Nancy and Tendwa standing in front of Accident/Emergency Department

Nancy and Tendwa outside the accident and emergency department.

The second week of our elective term was at the Accident and Emergency department. This was under the supervision of many doctors. Our task here was again to see patients and clerks, suggest investigations and come up with a management plan. We would then present this to the doctor on call as well as the intern doctor for approval of our approach and advice on what we missed out on. This turned out as a very good way of learning as sometimes they pointed out that we have the theoretical knowledge but need to put more practice into applying it to the patient and seeing them as a whole. We were trained to act like investigators and see beyond what the patient is saying. It was quite interesting because no matter how busy the floor got, the doctor’s would never rush us both in clerkship and in presenting to them. We got really good insight on what it means to be part of a health team and experienced what role we had as doctors.

Week 3: Acute Admission Ward

During our third week we rotated in the acute admissions ward. This is where all acutely ill patients admitted from Accident and Emergency department are transferred for high care and monitoring till they are stable enough to be discharged or transferred to other medical facility or surgical wards. It is during this rotation that we familiarized ourselves with the protocols and guidelines of South Africa for the management of acutely ill patients during the acute phase.

Week 4: HIV Clinic

We spent our final week in Wentworth hospital was spent in the HIV clinic. Here, we learnt under the supervision of Dr. Ryan, we saw newly diagnosed patients as well as follow ups and got to experience first-hand the countries’ way of combating the high levels of HIV infection in the area.

A thorough examination of the patient was also well covered to examine symptoms the patient brought up as well as anything they would have missed e.g. skin rashes or mouth lesions. The consultation would end with the patient understanding all the information being presented and patients were asked to come back for another visit. We had to update them with a full summary of what was discussed in terms of patient health and progression or regression of HIV.

Tendwa and Nancy have masks on their faces

Tendwa and Nancy at the HIV clinic

Challenges:

One of the challenges was the language barrier. It was difficult to communicate with some patients who could only express themselves fully in Xhosa or Zulu. To combat this challenge, the doctors and nurses went out of their way to translate whenever possible and give us English speaking patients to clerk.

Acknowledgment:

1) We would like to thank Dr. Titus Kahiga for his exemplary role in making our exchange possible. He conducted regular meetings with us, guided us every step of the way, and took great measures to ensure we gain the most out of the experience. He acted as a link between us students, the university and the GEMx program. We are not sure that if we were under anyone else our exchange would have even been possible.

2) We would also like to extend our gratitude to Dr. Faith Nawagi. She was always present to respond to questions and concerns right from the first day we began the journey. She was always efficient in communication channels and would reply to emails within a very short time. This helped us with our planning and preparations. We are positive that the program will see greater heights with her commitment and passion for the students.

3) We extend our hearty gratitude to Professor Mergan Naidoo. The professor provided very good mentorship right from the planning phase to the end of our exchange. He also made time for regular interactions to address any concerns we may have had. We would also like to extend our gratitude to Mr.Ifukho, Mr. Vincent and the projects team in Kenyatta University as well as Ms. Anitha from UKZN. They were quite helpful in the processing of required documents both for visa applications and for exchange purposes.

4) We would like to thank the individuals who stood out in our elective term. These individuals managed to take time for us students and gave us an exceptional learning experience. The staff’s enthusiasm and warmth remains entrenched in our memories as well as their motivation to providing us with a good amount of knowledge. These people include Dr. Ayubola, Dr. David, Dr. Daniels, Dr. Mbaiza, and Dr. Ryan.

5) Our sincere gratitude to the office of the Dean at Kenyatta University school of Medicine and our Dean Prof. Agina for ensuring we had all we required during our stay at KZN, as well as selecting the two of us to represent the school for the elective program at UKZN, South Africa.

6) Lastly, we thank the nursing staff as well as the interns who helped us settle in each department and allowed us the opportunity to help wherever we could.

GEMx Elective Reflections: Exchange From Makerere University College Of Health Sciences To Kenyatta University School Of Health Sciences

August 18, 2017

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Wasukira Bugosera Sulaiman, Bachelor of Medicine and Bachelor of Surgery student at Makerere University CHS (Uganda), who went on a GEMx regional exchange to Kenyatta University School Of Health Sciences (Kenya)

Medical camp at Huruma Children’s home

The first clinical year at Makerere University College of Health Sciences is always climaxed by doing a clinical placement in a field that a student is interested in and done from places of their own choice. Well, this was my opportune moment to hunt and grab a site and an opportunity to do my placement in a very resourceful fun and skill- impacting environment for one month (4th July – 4th August).

In just the same time, a rare and perhaps a first time opportunity presented itself in which a call for students interested in undertaking exchange electives through the GEMx exchange system was put up.

Application and Vetting

Having been an ambitious highly motivated and open-minded medical student ever looking around for opportunities and trying out on each of them, I went ahead to initiate the application for the GEMx elective exchanges through the GEMx web based system. Application was through the international office and was consequently followed by an interview, which I presume to have just excelled in and followed by being successfully nominated to undertake an exchange elective at Kenyatta University School of Health Sciences, through the GEMx- MEPI partnership. This was with two other classmates: Namingira Simon Peter and Barigye Aston.

The rest of the process involved obtaining a couple of documents as required by the host University. I was amazed by the way the GEMx web system eased the whole process of document submission and with the fact that I could actually store these documents for another application in the future. At the end of the whole process, all documents were submitted through the web system! By this moment, I just had to hold on for the host institution to review and accept my application which came in through on the 9th June 2017.

Preparations before travel

GEMx exchange students in front of a monument

Just as the Luganda saying goes “Okutambula kulaba, Okudda kunyumya” literally meaning that “to travel is to experience and returning home is to tell stories”, the preparations were quite filled with a lot of expectations and excitement; new experience, a lot to learn, first time in Nairobi and so much more. As all preparations were under way, I am sincerely grateful the support given to us (me and the other two colleagues) both from the home institution (Ms. Phiona Ashaba and Dr. Isaac Ssinabulya) and Host institution (Dr. Kahiga Titus and Mr. Vincent) plus the GEMx staff (Ms. Faith Nawagi). As a team, they ensured that the funds to facilitate our electives were processed in time, bookings for accommodation made, bus station pickups arranged, plus guiding on what we need to carry for daily living in Nairobi. At this moment, the GEMx checklist was important since it acted as a measure of the progress in the preparation process. The GEMx web system also played a big role in the preparation process as it provided the emergency contacts from both the host and home institution. This greatly eased communication towards and during our travel.

Travel to Nairobi

Right after securing our fund facilitation for electives, we booked the bus to Nairobi on the eve of our travel with travel date of 3rd July 2017, and opting for the 7am bus because we wanted to experience the epic scenery as we go sight-seeing the way to Nairobi as long as no one interrupted my peace in my window seat.

Our journey was a fine one with a lot scenery along the way and with most of the attention after crossing the border. The stops in Kisumu and Nakuru, made the journey was less tiresome and awesome.

I should say my eyes are wiseacres as they immediately identify and report to me the good and unique things they see. The same thing happened upon entry in Nairobi, it was the beaming street lights and the skyscrapers that welcomed me then I knew this is the capital of the famous Kenyatta land!!! The great hospitality we received made me feel like actually we sometimes have 2 hearts- one that pumps blood and the other one for caring. Our arrival time in Nairobi was 9:30 pm and we were picked up by Mr. Vincent, one of the administrative staff members at Kenyatta University. Off we went to Kahawa-Wendani, where our accommodation had been booked in a Destiny Park Hostel, a student hostel approximately 500metres from Kenyatta University.

Stay in Nairobi, Kenyatta University and the elective site

With our supervisor Dr. David Galgallo

HABARI!!!! Our Kenyan life begun with a visit to Kenyatta University where we were given a tour around the university by a medical Student (Kiema Lucky) and later on met the GEMx coordinator, Dr. Kahiga, Mr. Vincent and Dr. Francesca Ogencha. The three were to be in charge of our stay in Kenyatta University.

The lecturers strike and Nurses strike.

I thought we had left the habit of lecturers’, non-teaching staffs’ and other government workers’ strikes in Uganda. But little did we know that this would be our big welcome in Kenya. By the time period we arrived at Kenyatta University for our electives, the lecturers in all public universities had gone on strike and so was the case with the nurses in Kiambu hospital, which is the teaching hospital for Kenyatta university school of Health Sciences.

These happenings put our rotation on the clinics and wards on a halt for a full week as the staff at Kenyatta University tirelessly worked around to get us a nearby hospital to undertake our elective at. By the second week, Dr. Francesca had managed to secure us a place at the Mater Misericordiae Hospital, where I and Barigye Aston were to do Pediatrics and Child Health and our colleague Namingira Simon Peter was to do Obstetrics and gynecology. The group in pediatrics and child health were to be supervised by Dr. David Duro Galgallo and the colleague in Obstetrics and gynecology was to be supervised by Dr. Irungo.

The Mater Hospital: The clinical experience

With a colleague at Mater Miseracordiae Hospital

Mater Misericordiae hospital is a catholic founded missionary hospital, a multispecialty hospital with many branches worldwide, and the Nairobi branch being one of them. Located in Nairobi South B, having our clinical rotations in Mater Hospital meant that we had to travel an approximate distance of 20km to reach hospital from our residence in Kahawa, which is north of Nairobi city. A tiring but rather good opportunity for me and my colleagues to learn how to go around Nairobi by ourselves.

At the Mater Hospital, we were given a great hospitality with all the staff mindful to teach us whatever they could.

Outpatient clinics

At the OPD clinic

The outpatient clinics in The Mater hospital are conducted by consultant pediatricians and during the clinics, I was involved in clerking the patients to take history and also do clinical examination under the guidance of the attending consultant for the clinic. This was followed by forming a diagnosis and a management plan. Subsequently, we discussed the patient’s condition with the consultant and participated in patient education about their conditions including informing them about what the diagnosis is, helping them form decisions about treatment course of action and preventive measures for recurrence of certain conditions.

The outpatient clinics are mainly for follow up and review of review of patients who were discharged from the inpatient care.

At the outpatient clinic, patients who had symptoms that pointed to a diagnosis for which a patient needed inpatient care were admitted on the pediatric ward.

At the outpatient clinic, I also participated in the immunization of children and the consultant taught me about the recommended immunization schedule as per the ministry of health in Kenya.

Pediatric ward (Lourdel Ward) and Special Care Unit

Student poses with the admin staff at Kenyatta University

At the OPD clinic With administrative staff at Kenyatta University

On the pediatric ward and the special care unit, I was involved in clerking the patients to obtain history and also did clinical examination then later presented the patients to the consultants. After the patient presentations, we were engaged in the patient condition discussion and later patient education. I also participated in the request for the required patient investigations and follow up on the patients’ progress on the wards. The whole process was incorporated with bedside teachings about the common conditions experienced on the ward.

Obstetrics theatre

During the caesarean section theatre sessions, I would occasionally attend with the pediatrician and participated in receiving the babies.

In front of Mater Miseracordiae Hospital

Postnatal ward

In the postnatal ward, we participated in review of the wellbeing of the newborn babies who were always kept at the hospital for up to a maximum of 4 days. During this period, all those who developed any complications like hemolytic disease of the newborn and neonatal sepsis, were isolated and taken to general nursery or special care unit for the necessary care to be given.

Continuing Medical Education (CME) Sessions

The Mater hospital holds continuous medical education sessions for its clinical staff, aimed at updating the clinical staff members about the latest advances in management and care of patients with certain disease conditions.

During my electives period at Mater hospital, I attended CMEs about management of Asthma, Ateriovenous malformations and Cholera. During these sessions I learnt in detail about the etiology, epidemiology, pathophysiology and management options of the above conditions

Nairobi city and Culture

GEMx Student in traditional African attire

Trying out the Masai attire

Learning on job has never been among my hobbies but as it’s said “a drowning man even holds on a straw to survive”, I was made to reproduce the spoonful Kiswahili that I had learnt ages ago as I needed to get along with some “rafiki” and also navigate my way through the city. However, this in most times never worked and my thick accented English made in Uganda had to come and bail me out. But save for the fact that I did not know a lot of Kiswahili which is the national language in Kenya, the rest of the cultural experiences were just amazing and since most of the ward round and clinic activities ended by lunch time, we used to utilize most of our afternoons to explore the beauty of the city of Nairobi and trying out the local delicacies. Tours to the Uhuru Park, Central park, Kenyatta International Convention Centre and many more other places enabled us view Nairobi from a variety of angles.

Most notable are the Matatus and the matatu culture. Matatus is the commonest public means of transport within Nairobi and the design plus the music in the matatus made using them to move around Nairobi a thrilling experience.

Kenyatta University: Involvement in student activities and Interaction with student community

While at Kenyatta University, even when we did not get chance to rotate on the wards with other clinical students due to the ongoing strikes, we were able to get time to meet with them in other activities. Important to mention is the Medical camp at Huruma Children’s home, which was organized by Kenyatta University Pharmacy Students Association (KUPhSA), where I was able to meet with many Kenyatta University medical students plus students from University of Science Philadelphia who were also visiting students to the Kenyatta University School of Health Sciences. During the camp, I was paired with a pharmacy student at the consulting desk, an experience which gave me a new touch of the importance of involving pharmacists in the day to day patient care.

At Dr. Kahiga’s home with students from Kenyatta University and University of Science Philadelphia

As we were coming to the end of our electives, we were privileged to be hosted by Dr. Kahiga Titus for a luncheon at his home in Kitengela-Kajiado. Here I was able to meet a lot more students from Kenyatta University, meet the Students from Philadelphia again and still meet many officials from the Kenya Pharmacy and Poisons Board. This was a moment to grow social and professional circles.

Lessons learnt

As the medical discipline is known to be a monkey see monkey do business, for the knowledge we can read and acquire but skills have to be passed on through apprenticeship. With a very good mentor assigned to me as my supervisor, my rotation in Pediatrics and Child health at The Mater Hospital made the love for the discipline glow more and more. Being in Mater Hospital, a state of art hospital, I learnt a lot about comprehensive patient care and the practice of medicine in the concept of family care. I also got a deeper understanding of the importance of team practice in patient care. These two aspects of which I believe will enable me grow into a better healthcare provider. With the disease patterns slightly differing in Nairobi as compared to Kampala, I was able to experience child health in a new environment and learn of management of common childhood diseases in Kenya as compared to Uganda. This enabled widen my scope of thinking as a clinical student which is an important aspect in patient care. This coupled with the many differences in health policies made me better appreciate some of the concepts of global health.

Future commitments

The name may be called GEMx exchanges but personally I customized it as GAME CHANGER for the experience, knowledge and skills acquired. I can undoubtedly say it has been a cornerstone in my medical education and I believe it has already shaped my path as a future health worker. Talent may be everywhere but opportunity isn’t, thus I am committed to pass on information about GEMx exchanges to other students within and outside my university so as they may be able to gain the same experience or even better.

GEMx Blog

Learning about the Healthcare System in Kenya

GEMx Exchange to UKZN

GEMx Elective Reflections: Exchange From Makerere University College Of Health Sciences To Kenyatta University School Of Health Sciences

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