STEP Student Experiences

Sanjay Basu

Internal Medicine Resident, UCSF

FACES-Kisumu: Fall 2011

I went to the FACES Kisumu clinic as a 3rd year medical resident. Every previous rotation I've done in an international context has been besieged by feelings of guilt, as I've only see disastrous clinical sites with desperate patients who don't get the medical care they need, and who are treated poorly. The FACES program was a breath of fresh air. In addition to being very well organized in all respects for learning and teaching, the program is run and staffed by dedicated professionals who provide high quality, highly-competent, and highly effective medical care to a population that is actually very well served by them. They're a model primary care medical home and HIV center, and my faith in such endeavors was restored by the experience.

Emily Mangone

Master’s student in Global Health, UCSF

FACES-Migori: March-May 2011

As an MS candidate in the UCSF Global Health Sciences program, my fieldwork project was based at the FACES Migori site. My project was a qualitative evaluation of a gender-based violence screening pilot in a rural clinic. Being able to get the interviews myself was an extremely informative research experience that I would not have been able to have had it not been for the FACES infrastructure and staff on the ground. When I arrived I was paired with two fantastic mentors, Peter Manwari and Jannes Kodero, who helped me accomplish my projects and feel at home in the community. Truly the entire FACES team was extremely friendly and supportive. Despite the challenges of working in a rural area, in two months I was able to accomplish my project, participate in another project, attend several Continuing Medical Education sessions (CMEs) and even give one myself on my initial findings. It was a great experience and a great environment in which to do research. Thanks FACES!

Lucas M. Gikonyo

Final year medical student - University of Nairobi

FACES-Migori: October-December 2010

My elective experience at FACES was a memorable one. I had never been to Migori before and I remember the first thing I did upon receiving the confirmation email was to go online to try and locate Migori! I spent a total of 8 weeks with FACES undertaking a clinical elective and in retrospect, those 8 weeks were the best part of my 4th year.

It was an amazing learning experience and a chance for me to fine tune my clinical skills. Most of my time was initially spent in the clinic where we would offer outpatient HIV care services. The patients ranged from the newly diagnosed to those who had been on treatment for years. The joy on the faces of patients upon learning that their CD4 counts were improving is beyond words. Wednesday was the pediatrics day and sometimes it was heartbreaking having to attend to patients so young yet already infected with HIV.Their bravery and determination however always inspired us. The joyous times were when we would inform HIV positive women that their babies’ PCR results were negative; the smiles on their faces were always an inspiration.

Apart from my time at the clinic, we would also conduct ward rounds twice a week in the district hospital together with my supervisors who were qualified doctors. This was a great opportunity for me to put into practice all that I had been learning in medical school. I particularly enjoyed and looked forward to the ward round days. Sometimes my supervisors would let me lead the ward round and this was always a challenge I loved. We would attend to all patients in the ward and not only the HIV patients. This was of benefit since I would then get to see and learn about many other conditions not necessarily related to HIV. After the ward rounds I would stay behind to carry out various procedures such as phlebotomy, lumbar puncture, etc.

Voluntary medical male circumcision (VMMC) was particularly busy. I spent a good deal of time rotating there as well. The FACES staff there was very welcoming and willing to teach me on how to perform the procedure. I started out by assisting in several circumcisions and after a few weeks I was able to perform my first circumcision! My suturing skills were really perfected during my time there. Towards the end of my elective I was able to carry out a mini-evaluation on the timelines of early infant diagnosis (EID) via PCR. I relayed my findings to the FACES team during a CME.

It wasn’t all work at FACES; I had fun too! I would spend most of my afternoons after leaving the clinic playing basketball at a court in the town. My weekends were spent touring Migori and other towns nearby. Migori is just one hour away from the Kenya-Tanzania border and I was able to tour Tanzania as well. My last week of the elective was quite wonderful since I was given the chance to attend a one week seminar in Homabay, a lakeside town about two hours from Migori.

It’s impossible really to put everything down in words. I think I would need to write a book for that! I recommend FACES Migori to any prospective elective student. It’s quite an experience.

Walter Akello

Medical Student - University of Nairobi, Kenya

FACES Kisumu, October – December 2010

I am a final year medical student at the University of Nairobi. I undertook my elective term at the FACES Kisumu site from October to December 2010. My elective term was very successful.

I wish to take this time to thank FACES so much for the opportunity to work and learn at the facility. I was able to meet my objectives, and well beyond my expectations. My learning went well beyond the clinical work to involve health service management, participating in ongoing studies, laboratory and fieldwork. It was a wonderful learning and working experience.

The skills I acquired have been helpful beyond FACES; I am currently undertaking an online HIV management course and indeed have a strong foundation to build on. The skills and knowledge have equally come in handy in my ward work and daily care of patients at the training hospital.

Following my experience at and after FACES, I believe FACES is an excellent facility for training on HIV/AIDS comprehensive care, research, as well as for the management of health services. In this regard, beyond my many thanks for the opportunity given, I wish to suggest that where possible and resources allowing, FACES can grant more opportunities so that many more scholars may benefit from the ongoing operations even as they give back by serving patients.

It was wonderful to work with FACES. Thank You.

Ruth Mbadi

Medical Student - University of Nairobi, Kenya

FACES Rongo, October – December 2010

My name is Ruth Mbadi; I am a final year medical student at The University of Nairobi. I did my elective term at Rongo District Hospital. Rongo is my rural home and it is a beautiful coincidence that I ended up there for my electives.

Rongo is a small town, recently made district, in Nyanza province. It’s quite a busy town since its in the middle of 3 major towns, Homabay, Migori and Kisii. I knew the now Rongo District Hospital (RDH) as Rongo Health Centre, that was in my early days there. I was therefore pleasantly surprised by the transformation it had undergone from a health centre to a district hospital.

My experience as a STEP student there was very rewarding both intellectually and socially. I rotated in all the departments i. e. Reception, Clinical room, Laboratory, Pharmacy, MCH/FP/PMTCT (maternal and child health, family planning, prevention of mother-to-child transmission of HIV), TB clinic and VMMC (voluntary male medical circumcision).

I loved working in the clinical room especially on Mondays which was the day most paediatric cases were seen; there was always so much to learn. I saw so many conditions most of which I had only read of in books! It was a great learning experience especially when I saw the discussions that were carried out in CMEs and clinicians’ multidisciplinary meetings being applied in real life cases.

Another favourite of mine was the MCH/FP/PMTCT clinic. It was humbling to see tears of joy in mothers’ faces when their children were declared HIV negative after 18 months of PMTCT intervention. The FP clinic also gave me insights into the women’s preferred methods of family planning and the reasons behind that. It was also a nice opportunity to hear and correct misconceptions the women had concerning family planning.

The laboratory and pharmacy were also educative. I got to learn of the available ARV combinations and dispensing technique for both adults and children. I also worked at the VMMC. It was nice especially since there was a rapid results initiative going on. I managed to take part in a number of surgeries.

I also visited almost all the peripheral sites. The work being done in those places is commendable. It enables care to reach even the most remote places!

The social aspect of my elective term was just as great. I looked forward to Friday meetings which were very interactive and enjoyable.

I could go on and on. I had a great experience and am so thankful for my time at FACES-KEMRI Rongo District Hospital.

Mai-Khanh Bui-Duy

4th year medical student, Mount Sinai School of Medicine

FACES Suba

The conditions in Suba District are challenging: an HIV prevalence in the double digits, and rural conditions with limited transportation options for clients. But the energetic atmosphere within FACES builds tremendous support to face these difficulties. I spent 6 weeks on a clinical elective in Suba, a rural area bordering Lake Victoria. Although I could not visit all 20 FACES-supported facilities, a particular highlight included

the mobile boat clinics to Ringiti and Remba Islands. All of the staff’s willingness to share and learn from one another really made it wonderful to be a part of such a hardworking team!

Mai Khan Bui_Duy at Takawiri beach , Sena in Suba with Oscar, Lindah and Manwari

Masuma Bahora

M2 student – University of Tennessee Medical College

FACES Rongo

Summer 2009: For these two months, I spent my time in Rongo - a small roadside town enroute to Migori and beyond, Tanzania. Barely gracing even the most detailed of maps, life in Rongo is incredibly full and its inhabitants intensely kind. Beginning with the gregarious FACES staff to nearly every individual you meet in your daily interactions, the community is eager to know its few visitors and envelop you into the folds of their day.

My project was to get an Early Infant HIV Diagnosis pilot project up and running in Rongo’s district hospital. Implementation was not obstacle free – but every negotiation gained was a lesson learned in collaboration and sustainability. Working with both patient populations and providers, we set into place a program that has the ability to capture HIV positive children in a non-PMTCT setting, while also disseminating education to a wider net of mothers bringing their children in for routine vaccinations.

In addition to running the pilot, I was able to participate in male circumcisions, school-based outreach, and clinical care both on and off-site. My overall experience primarily speaks to the abounding generosity of the Rongo FACES staff to accommodate your every smidge of curiosity. I came away with a wealth of knowledge about HIV/AIDS care and treatment, but also a deeper instilment of Kenyans’ spirit to fight for the next day, no matter the barriers that have been erected along the way.

I’m further solidified in my desire to pursue medicine in a global setting and to return to eastern Africa in the coming years. I could not have envisioned a more fulfilling and memorable adventure to partake in for the summer.

Anthony Fong

International Health Resident, University of British Columbia

Elective: FACES Suba, February - April 2009

It’s not often in medicine that one gets to see so many aspects of humanity in such a short time. As a family doctor finishing an international health residency in Kenya, I saw some of the sickest people in the world, in one of the least resourced settings in the world. While struggling with small tragedies that come hand-in-hand with any developing world setting, FACES Suba unabashedly struck me as a centre of excellence. Getting to know the systems of HIV spread among fisherfolk on Lake Victoria was an intellectually amazing public health opportunity, and I was awash with the irony of how the “First World” could learn so much from the Third.

This experience was uniquely rewarding to me in ways that some would see as mundane. I greeted and complimented each client and colleague by name in my poor Dholuo, and occasionally, worse Swahili. I listened more than I spoke and learned more than I taught; recognizing that when it comes to HIV, perhaps life experience sometimes trumps a university education. Lastly, as I would do in any town back home, I made a concerted effort to build bonds and nourish working relationships and lifelong friendships. This experience enriched my life, affected my practice back home, and I hope that many other students take the humbling opportunity to see it in a similar light.

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

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