Month: December 2017

Life in Kenya - Life Lessons - Living Your Best Life

From Kentucky to Kenya: My Definition of Family

December 25, 2017 by 0 Comments

One of my colleagues in Mutomo asked me what I was doing for the holidays.  I said, “I’m going home, to see my family.”  He responded with a quizzical look, “I thought you didn’t have a family.”  Now, I was confused.  Did I imply that I was an orphan…?  Maybe something got lost in translation between my English and his?  He quickly followed with, “You told me that you didn’t have a husband or kids.”  Oh…now it was clear, his concept of family only included marriage and procreation.  Another physician in the room piped in, “Maybe you need to broaden your definition of family.”  Indeed, I would agree.

My biological family is great!  And, all four of my parents have been there along my journey, even when they didn’t understand what I was doing or why I was doing it.  They trusted me to believe in myself and follow my purpose. My extended family has continued to grow over the years.  I posted a few weeks ago about how I love my friends.  And truth be told, I consider most of my friends, family as well.  I make friends for life so, I make an effort to maintain and strengthen those relationships.

In my professional role, in order to provide good medical care, I need to understand the community in which my patients live and my co-workers work.  On the residency interview trail, I asked one of my interviewers where most of the residents lived.  She responded, “well you can’t live around here.”  My feelings were hurt and I wasn’t even from that city.  Needless to say, they slipped to the bottom of my rank list.  On one of my other residency interviews, I laughed so much at dinner, I thought, “I feel at home; this feels like family.”  And, I knew that was where I was supposed to be.  When I moved to Pennsylvania for my first job, I asked for recommendations on where to live.  The response, “well if you want, why not live around here?”  I moved into an apartment less than 2 miles from the hospital.  One of the toughest decisions leaving that job was leaving my Montgomery work family.  I still love them dearly and they have continued to be there for me.  That’s what family feels like.  As I traveled doing locums before venturing to Kenya, I liked to take assignments that lasted long enough for me to a get a sense of the local community.  I accepted invitations to dinner and church, to potlucks and to happy hours.  I didn’t want to just work there, I wanted to live there.

I have those feelings from time to time, that fleeting, intangible moment that you know you are at the right place at the right time.  I have had that feeling in Kenya.  One weekend I found myself sharing a meal playing cards with my Mutomo work family, and I knew I’d found my tribe.  I don’t know how many of you have had the experience of traveling to a new city, and one of your parents says, “call so-and-so when you get there.  She’s your cousin…”  A cousin that you’ve never seen before, met before, heard of before.  But you call as instructed, and that cousin takes care of you like she’s known you since birth.  Similarly, a friend introduced me to a friend of his who’s American but lives in Nairobi.  She invited me over for dinner shortly after I arrived a couple months ago, and if you saw us today, you would think we had known each other forever. In the same vain, my CMMB family has been incredible in making my time here as comfortable and rewarding as possible.  It was only fitting that I celebrated Christmas with them, before returning to the states for the Holidays.

Family to me, are the people around you who support and encourage you to be your best self.  I look forward to spending the holidays with my family, all of them, whether related by blood or by spirit.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Life in Kenya - Life Lessons

An unfortunate reality: Maternal Mortality

December 14, 2017 by 0 Comments

Kuzaliwa kumoja, maisha mengi = Swahili Proverb, translated:  The same birth, but many lives. Human beings are born in the same way but their lives may be different.

Taken behind my house in Mutomo

 

A friend and colleague forwarded me a story from NPR this week. You may have seen the article circulating about a mother who recently died soon after childbirth. Maternal mortality is defined as the death of a woman during pregnancy, delivery or shortly thereafter.  In the United States, it represents the 6th leading cause of death among reproductive age women from 25-34. Recently, the rate of maternal mortality has been on the rise in the United States, with the rates among black women being 3 times as high as for white women.  And, according to JAMA, “Even if you look only at white women in the United States, the rates of mothers who die is greater than those in other developed countries.” In the developing world, the statistics are even more startling.  The WHO reports, “The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 000 live births in developed countries.”  Here, in Kenya the number is 510.  Reading this article made me reflect on my evolution as a physician, and how stories like Shalon’s motivate me to continue the work that I do.

 

Going into medical school my plan was to be a forensic pathologist.  I’ve known I wanted to be a doctor since I was seven but this particular aspiration grew from reading novels in high school in which the main character was a forensic pathologist.  The field intrigued me for many reasons, one was that it functioned between two worlds, the law and medicine, it allowed me to work with my hands and avoid a traditional clinical practice…  I have been described as quiet, shy, reserved, introverted or all of the above at different stages of my life.  For this reason, I was nervous about how I would be able to cultivate the doctor-patient relationship.  Pathology gave me a way out.  Those patients didn’t talk back. You can only imagine how devastated I was first year of medical school, when I discovered, I did not like pathology or histology, or the microscope really.  I would fall asleep looking at slides…

 

As with this lesson, I learned a lot about myself in medical school.  I now credit my personality as an asset to my bedside manner, not a hindrance.  Thanks to that revelation and to a few other serendipitous events, I found my way to Obstetrics and Gynecology.  And without a doubt, it is the field for me.  But old dreams sometimes die hard, so my fourth year, before submitting my Ob/Gyn Residency applications, I signed up for a forensic pathology rotation housed at the Metropolitan Government of Nashville and Davidson County Medical Examiner office.  And I loved it of course!  But it was time to let it go.  In order to merge my old interests with my new ones, I presented on Maternal Mortality for my Externship project that month.  As I was learning to articulate my interests in public health and health disparities, this subject underscored both and I have carried it with me through the rest of my training and into my career.  I encourage you to read Shalon’s heartbreaking story, which tells the story far better than I can.

 

Shalon’s story:  https://www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth

 

References:

http://who.int/mediacentre/factsheets/fs348/en/

https://jamanetwork.com/journals/jama/fullarticle/2645089

https://www.cia.gov/library/publications/the-world-factbook/fields/2223.html

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm

Life in Kenya

Mama na Mtoto (Mother and Child)

December 4, 2017 by 0 Comments
Nairobi National Museum

Throughout my training, I have been drawn to organizations or institutions that have a mission to serve the underserved.  To start with… I attended a college that was founded by a Saint!  Katherine Drexel, born to a wealthy family, instead of spending her fortune on finite possessions she chose to join the Sisters of the Blessed Sacrament and dedicated her life to improving the lives of black and brown children in the South.  The Salt Wagon Story describes an act of kindness, which prompted Samuel Meharry to found the medical college, where I eventually did my residency training. This legacy, started to educate a then disenfranchised Black American population in the South, continues to address health inequities in this country.

While in residency, our hospital served as the city’s safety net hospital.  Though we did care for insured patients, we also provided services for those under and uninsured populations of Nashville.   Tennessee at the time funded a state system called TennCare which worked to fill the gaps for small business owners or those who were unemployed.  However, there were those who still fell through the cracks and they came to us.  The hospital population included many Black American Women and Latina women, who bear a higher burden of uterine fibroids.  Fibroids are benign tumors of the womb that can cause heavy bleeding, pelvic pain and anemia.  Multiple treatment options exist, but the definitive treatment is still a major surgical procedure, a hysterectomy.  There were times when uninsured women could not schedule their surgery due to their inability to pay, literally going home with the fear of bleeding to death with their next period.   When I was looking for my first employed position, I chose to work for a group in Norristown, Pennsylvania, where one of their offices provided similar services for the women of that community.

Here in Mutomo, some patients have the National Health Insurance.  However, many still pay out of pocket for their care.  This week I cared for a young woman who had been transferred from another facility due to the infant being in breech presentation (specifically the foot was visible at the opening of the vagina).  She was rushed for cesarean section on arrival, she, and the infant recovered well.  On the day of discharge (day #4), the infant was noticed to have yellowing of the eyes.  We tested for and diagnosed him with neonatal jaundice. A relatively common condition of neonates that is treated with light therapy.  This treatment requires further hospitalization and monitoring, and therefore an increase in cost.  After two additional days in the hospital, the mother asked me if she could be discharged.  I said no, the bilirubin levels were still elevated.  She was visibly upset and frustrated with me.  I reassured her that it was in their best interest to stay.  I tried to explain (with the help of the nurse) that yes, her infant appears fine now.  But left untreated, neonatal jaundice can lead to serious complications.  She replied, “Daktari, you don’t understand…the bill.”

I get it.  I do understand.  In that moment I was disheartened that she thought I didn’t understand, but also that I could do nothing to change the dilemma that she faced.  Was it possible that she could go home and her newborn son would recover well?  Of course.  Was it also possible that if left untreated the condition would progress to cause seizures or brain damage?  Yes, of course.  In either case, why is it fair that a new mother has to weigh the mounting health care costs with the costs to her child’s health?

Many women, many people face these complicated decisions everyday in hospitals and clinics across the world.  I hope that this generation continues to move the needle forward toward supporting the basic right of universal health care coverage for all people.