STEP Student Experiences

Nicholas Kirui

5th year student - University of Nairobi, Kenya
FACES Suba: there I had an experience like no other

When I told my friends I was going to Suba for my elective term they looked at me with amazement and asked: where is Suba? Though most of my colleagues are Kenyans none had travelled to this lakeside town, some knew it was in Nyanza and had only heard of it but did not know of it. I think I chose Suba because I knew very little of it and I wanted to experience a totally different culture from the one I grew up in. I spent 4 weeks in Suba, November and December 2007.

My experience in this lakeside town on the shores of Lake Victoria was eye-opening, having to interact with persons of a different culture and belief system. It was a humbling experience to listen to the different perceptions of disease and their afflictions. Compared to the other parts of the country this was a really resource poor setting.

Of particular importance to me was the working of the Comprehensive Care Clinic at the District Hospital at Sindo with the counselors and community health assistants playing a pivotal role in the provision of health care. They provide an essential link between the clinicians and the patients especially in the areas of drug adherence, lifestyle change and the role of good nutrition in health. On the first of December I attended the celebrations of the World AIDS day and different HIV positive individuals came forward to talk about the different challenges they face daily, the stigma associated with HIV/AIDS is slowly being overcome in this region.

The decentralization of health care with daily visits by clinicians was commendable. I enjoyed the rides through the park with its beautiful scenery and its wild animals: giraffes, roan antelopes e.t.c in their natural habitat. The impassable roads during the rainy days were a real challenge.

Finally the coordination and cooperation among the staff at the clinic was commendable. Their support was sincere and they were always willing to explain the different activities they engaged in. Given a whole day I can in no way put down in writing my Suba experience, you have to experience it to feel the excitement that is within me. If you have thought of doing your elective in Suba, don’t hesitate you shall not be disappointed

Jennifer Albon

I did a project elective at FACES in Kisumu for two months during the summer between my first and second years of medical school at the University of California, San Francisco. My project was to set up a football (soccer) program for HIV prevention for HIV positive and HIV negative youth, including youth affiliated with the clinic. FACES has a lot of projects going on and are ever expanding – the manpower to get things started is an obvious limiting factor. This is a great organization to work with for grassroots projects because of the amount of support you get– from the medical officers to the staff and everyone in between.

FACES is a big family with each dedicated and inspiring family member welcoming you with open arms. There are also a lot of other community based organizations in Kisumu to coordinate your work with, and every Friday morning at the CDC you can listen to / participate in presentations from many different organizations working in the area to broaden your perspective. My experience at FACES was invaluable in shaping my career plans and ambitions and I hope to return to Kisumu in the future.

Janell Routh

My name is Janell Routh, and I am a third year pediatric resident at the University of California, San Francisco. I completed a four week international elective at Suba District Hospital in January-February of 2007.

During medical school, we learned about the spleen. For me, however, it was always the most elusive organ on physical exam. Despite knowing it was there, I could never feel it. And in pediatrics, trying to appreciate an enlarged spleen on a crying, wriggling two year old was outside my capabilities as a clinician.

Not any more. The most valuable lesson I will take home from my time in Suba is learning to feel a spleen, trust my clinical exam, and make medical decisions based on that information.

For the past four weeks I have managed a pediatric ward at the district hospital with guidance from the Medical Superintendent of the hospital-a Kenyan trained pediatrician. The ward has on average approximately 10 patients at any given time: some “routine” cases of malaria and others severe enough to be in an ICU back in America. For the first time in my medical career, I had to rely solely upon my neurological exam to tell me whether to perform an LP. There is no CT scan for backup. I depended on peripheral edema to judge sodium levels, as there is no method of checking electrolytes. We used hepato-splenomegaly in conjunction with fever as evidence for malaria. Conjunctival pallor became the preferred method of diagnosing anemia, and at the end of the month I could tell a hemoglobin of 7 from 10! It is here in Suba that the information we learned in medical school actually becomes important, because there are no diagnostic studies to confirm your “impressions” on exam. The exam is all you have to decide whether this person will get treatment for TB, or for malaria, or for typhoid. And occasionally, in the sick child, they will get treated for all three diseases.

Because of the reliance on exam skills in Kenyan hospitals, the clinicians at Suba are all wonderful, and good teachers. I appreciated the time they took to help me re-learn the skills I’d forgotten. I learned that to best feel a spleen, the patient should be on their right side! I am returning to UCSF with more confidence in myself as a clinician, and a different approach to diagnosis. While I will still use the resources available to me at my hospital, like the luxuries of being able to order electrolytes and blood cultures, I will also take more time with the patient. I will listen closely to the history, and do a very thorough physical exam.

Richard Currie

PGY-3, UBC Division of International Health
Elective: Suba District & Mfangano Island, Nov 27th 2006 – Feb 24th 2007.

The “Suba Experience” is one I’ll never forget. Impossibly muddy roads and impossibly surreal sunsets, impressively difficult living conditions and equally impressive warmth and hospitality – life in rural Kenya is one of endless contrast and surprise. No two days here are ever the same, and for this reason it would be difficult, if not impossible, to describe the “typical” elective experience. One morning you are traveling to a mobile clinic across a dusty game park with giraffes as your only companions, and the next you find yourself knee-deep in mud struggling to push your stranded vehicle out of a ditch. For those with a spirit of adventure who wish to experience the “real” Kenya, Suba is the place for you!

After a week of orientation in the city of Kisumu, I spent 6 weeks living and working on the mainland of Suba District, and then 6 weeks on the island of Mfangano and its satellite sites. Each experience was unique, and all were very much worthwhile. Kisumu offers the attractions and comforts of life in a big city, mainland Suba provides the endless challenge and variety of daily travel and 8 fascinating and remote satellite sites, and Mfangano boasts the peace and tranquility of “island life” without the hustle of electricity and cars. There is a choice to suit every personality!

The clinical experience is equally variable, albeit with the one constant that wherever you are in Kenya the challenges are formidable. Whether you are blessed with access to labs and xray, or left entirely to your own clinical devices, you will most certainly find that the daily challenge of providing HIV care in such a resource limited setting will, at times, be overwhelming. With an HIV prevalence rate of 32%, and a poverty level much higher than the national average, Suba District is an area of tremendous need. As difficult as the clinical conditions may be however, it is also a region of seemingly endless energy and hope. The Kenyan staff with whom you will have the privilege of working are expert clinicians, impressively resourceful, and will serve as a daily source of knowledge, encouragement, and inspiration. The patients too are equally resourceful -- many traveling several hours over extremely difficult routes to reach the clinics – and will move you with their warmth, generosity and courage. No matter how limited your time may be in Suba, the impact will stay with you for a lifetime!

The details of day to day life at each of these sites will vary, and I would be happy to answer specific questions by email. However the best way to learn more about Suba is, of course, to experience it for yourself! Pack a stethoscope, a penlight, more hand sanitizer than you could ever imagine needing, and, if you’ve got one, a helicopter would come in handy too. Also be sure to bring your clinical curiosity, your humility and humanity, your ability to adapt and accommodate and, above all, your spirit of adventure. This is a wonderful opportunity to briefly share in the lives of an incredible and inspiring people, and an experience not to be missed. Safe travels!

Lynn Farreles

I spent two months in Suba working alongside the tireless, energetic and committed FACES team. During my time, I had the opportunity to participate in key aspects of HIV/AIDS care namely clinical work, program management and design, and community development. Experience in all these aspects is important as most family physicians who work in resource-poor settings find themselves responsible for not only the clinical aspects of health care delivery, but also the programmatic aspects. Community development is also an important aspect to improving the health of communities. In Suba, the status of women is quite poor, with prostitution and violence being a common experience. So, during my time in Suba, I also had the opportunity to participate in the initial formation of a women’s support group. All in all, I had a very enriching experience—both personally and professionally. I highly recommend this rotation to anyone interested in working in resource-poor settings.