A Once in a Lifetime Experience
1. What are the main reasons as to why you choose Kenya as your destination of choice?
In my opinion, having clinical attachment in developing countries is the best experience in medical school. The health care system and diseases in developing countries are entirely different from that in developed countries. It would be the best chance for me to learn tropical disease and HIV related diseases in Kenya. If I have elective in other countries e.g. England, I could not appreciate the difference of health care facilities and resources between Hong Kong and developing countries
2. What was your general expectation as you travelled to Kenya, and as you started off your rotation?
I would like to have more hand on experiences e.g. taking blood, setting intravenous line, assisting delivery and Caesarean section. In addition, I wanted to learn more about tropical disease e.g. Dengue fever and malaria. I also expected to interact with doctors in Coast Provincial General Hospital, to let them know more about the health care system in Hong Kong.
3. What are some of the key health concerns in the region you were placed for an elective?
I like internal medicine so I spent most of the time in the medical ward of Coast Provincial General Hospital (CPGH). The major health concerns would be HIV associated illness. The most commonly encountered conditions would be cryptococcal meningitis and pulmonary TB. Poor compliance to antiretroviral drug is also a major concern in Kenya.
4. What are some of the experiences you had in the hospital of placement, that shaped your rotation/elective?
After the elective, I have learnt more about the clinical presentation and management of various tropical diseases. Moreover, I have deeper understanding on different classes of antiretroviral drugs, side effect of each class and various complication of HIV infection. In addition, I had intensive hand-on exposure to various procedures especially blood taking and setting an intravenous access. Attachment in CPGH provided me chances to polish up my clinical skills prior to commencing residency.
Since Kenya is a developing country with serious corruption problem, resources in hospital are very limited. There is limited investigations. Therefore, clinical judgment would be the most important diagnostic tool. I have learnt how to manage and stabilize patients when investigation is not readily available.
5. What would you say in your opinion are the challenges in the delivery of care in the hospital you were placed at?
Because of the limited resources in the hospital, the result of investigation usually come late. Therefore, it delays the proper treatment of a patient. Moreover, imaging and investigation are limited in Kenya. Even the investigation is available for the patient, he/she may not be able to afford the cost of the investigation, which also significantly affect the delivery of care in the hospital.
6. How different is it from Hong Kong?
In Hong Kong, investigations and imaging can be easily ordered. Hence, we tend to overlook history taking and physical examination. In CPGH, I have learnt how important the history taking and physical examination are. In addition, blood transfusion cannot be available all the time in Kenya. Hence, the hospital encourages the relatives of the patient to donate blood to the patient instead. However, there will be risk of transmission HIV and hepatitis to the patient. Therefore, in Hong Kong, blood donation from the relatives of the patients is not allowed.
On the other hand, health care system in Kenya is extremely different from Hong Kong. For example, we have various sub-specialties in internal medicine and surgery, but, there is none in CPGH. Moreover, infection control is poorly done in CPGH. There is no isolation for patients who have pulmonary tuberculosis. There is no air-conditioner inside the ward and each patient is surrounded by dozens of flies. However, infection control has been a great emphasis in Hong Kong.
7. How did you find patients’ awareness and involvement in care within your placement hospital (Ethical Issues that you encountered that differs with your home country)
Most patients in Kenya lack of health awareness while people in Hong Kong are always anxious about disease. There are lots of body check program and screening program in Hong Kong, so that we can detect diseases in asymptomatic stage. Prevention is always better than cure. Hence, people in Hong Kong do a lot in disease prevention e.g. safe sex, vaccination and healthy lifestyle. However, people in Kenya usually seek help in an advanced stage of illness, which makes management become difficult.
8. What was your best moment during your placement in Kenya?
The best moment during my placement in Kenya was my interaction with patients. Since I cannot speak Swahili well, I was too shy to talk to them. Unexpectedly, they are all very friendly and some patients could even remember me because I followed the medical ward round every day. They were willing to talk to me in English and their smile could always melt my heart.
9. Any unexpected event that you came across during your placement?
Unexpectedly, I joined the case discussion organised by the physicans in the hospital. I have learnt a lot by joining the discussion especially on the management part. I could learn how to prescribe medication in the correct dosage and choose the best drug in the class.
10. What would advise student seeking/ considering an elective abroad (Africa)?
Don’t hesitate. Having attachment in Africa would be the most memorable experience in your life. Just stepping out of the comfort zone.
11. Is it something you would like to have again?
I would like to come again in the future after I have become a specialist. I hope I can help more and do more for the developing countries when I gain more experience in Hong Kong.
13. Any Swahili word that you can remember?
I can remember words which can be used in daily life:
Jambo, Asante, Karibu, Pole, Sawa, Wapi, Ngapi
14. What will you miss most about Kenya?
I will miss the medical students and doctors in Kenya because they are all very friendly. They were very helpful and taught me a lot during my attachment.
Moreover, I will miss Elective Africa especially Phares and Benson. They have arranged our trip and attachment very well.