After it was all said and done, I think our entire team would agree that we felt like we were trying to fill an ocean with an eye dropper. The people that we saw at these clinics had many more health care needs than we could possibly take care of with our mobile clinic. These people need clean water, better housing, and long term health care. Yes, the health care, physical therapy, medications, and education that our team provided does benefit these people, but our eyedropper only made a small puddle in their lives.
As human beings we must always seek to see one another as valued individuals. Diversity is a gift. We can, and should learn to value differences. By following these three steps in your own life, you can grow and become more connected to the differences and needs of those surrounding you.
As we traveled through the country of Cambodia we sang worship songs; it was incredible to me that 9 American girls and 2 Cambodian men knew almost all of the same worship songs. We all come from different backgrounds, histories, and families but we were all in the same place, worshiping the same God together.
Once I stepped off of the plane and into the gate entrance leading into the airport, I was greeted with the warm, muggy air. Once our group had made it through customs, gathered our luggage, and headed outside to meet our bus drivers the fiery heat hit us like a brick wall. Even though the heat will take some getting use to, I am overjoyed to finally be in Cambodia.
I will be traveling with a group from Belmont University; this group includes professionals and students of pharmacy, physical therapy, and nursing. We will be traveling to many locations in Cambodia (Phnom Penh, Battambang, & Siem Reap). We will be taking part in nurse education and patient care in the hospital, clinic, and home visit settings.
I’d gone to Haiti with Hope Through Healing Hands, a Nashville-based global health organization founded after the earthquake in 2010. Because of my global health reporting and interest in the welfare of mothers and children at home and abroad, I was invited on a “learning tour” of health initiatives there.

It has been about two months since I left Nashville. Kisumu has become my new “home” since we started the hospital visits in Western Kenya. Almost 3 weeks after leaving Kisumu; I had been in 2 counties referral hospitals and 1 sub county referral hospital that are located in 3 different cities. After completing the data collection in these 3 intervention sites, I was a bite afraid that the data collection would not go well in the intervention sites since KRNAs who were my biggest helpers were not in the rest of the sites that I had to visit. Surprisingly, the leadership teams in the control sites were very supportive and they understood that the information would be beneficial to their institutions. Port- Victoria sub-county hospital in Busia County was the first control site that we visited. This hospital is located few miles from the shores of Lake Victoria facing Uganda and Tanzania beyond the horizon. This remote hospital is located about 3h away from Kisumu but the road conditions make the drive longer. The facility assessment was completed in less than two hours upon arrival. This is not because the information was straight forward but because this hospital did not have most of the supplies and infrastructures that the facility assessment was capturing. This small hospital serves about 25 000 people and it had only 4 physicians and 1 Registered Clinical Officer anesthetist (RCOA). Surgical procedures were very limited since the hospital had only 1 operating room, 4 surgical sets. When we were visiting the hospital; the hospital did not have water for a month due to delays from the government to pay the water and electricity bills. This was only one example of several other challenges that public hospitals face in rural Kenya. In Western Kenya several women who have complications and require a Cesarean section run into numerous obstacles before safely delivering their babies; thus the huge numbers of maternal deaths observed in Western Kenya.

I was left speechless after our visit to Port Victoria and we continued our journey towards the other sites. After a long drive to Migori, we were able to check in our rooms and I appreciated having a weekend to prepare for the marathon that we were going to do visiting the remaining control sites. The Migori county referral hospital is located few miles from the border with Tanzania and has a catchment area of about 52 000. Even if this is the estimated catchment area; the hospital receives several referrals from several hospitals and clinics within and around the county. This visit was followed by a visit at the Homebay county referral and the Rachuonyo sub-county hospitals in Homebay County. The functionality of these two geographically close referral hospitals reflected issues that patients and health care providers face in government hospitals since measures and decisions are taken on the county level. Homebay county referral hospital has a catchment population of about 50 000 people; even if these two institutions serve approximatively the same population catchment, the administration and politics that were in the two county referral hospitals were very different.

Western Kenya is known to have the highest prevalence of HIV in Kenya, which leads to having a lot of HIV NGOs and programs in the region. In some places, these programs were a burden to other patient care activities since and strong conflicts of interests are observed in work places. Some of the nurses work for the hospital but furnish extra efforts to enroll patients and follow up with the subjects since the NGOs provide compensations for these efforts. This brings a huge weight to the health system that is already unbalanced with insufficient health providers and limited resources. Rachuonyo located only few miles away from the Homebay referral hospital has a catchment population of about 40 000 people. The hospital is smaller in size but has also fewer infrastructures and limited specialized doctors. The facility assessment was concluded by visiting the Vihiga county referral hospital and Malava subcounty hospital in Kakamega County. The Vihiga county referral hospital had more infrastructures than the other hospitals and 3 different theaters which seemed to be an exception in the region. On average county referral hospitals had 2 theaters while sub- county hospitals had one or none. 

The hospital visits were concluded in about 5 weeks. During this time, I was in 6 counties, 12 different cities for the hospital visits or the visits at the county offices of health. The needs that were identified in these communities varied from anesthesia machines, to simple things like shoe covers and electricity in the theater rooms. I was exposed to a new environment where our collaborators from Kijabe or Kisumu were not able to point me to people who would fix things when we got stuck. Every hospital visit was unique and brought its own challenges. Patience was my best ally and persistence helped me go through the entire process. Even with a letter coming from the county offices of health; some facilities tried to resist and each department seemed to have its own reaction to the facility assessment that I was planning to conduct. Something that was interesting during the visits is the way different hospital medical staffs were reacting to idea of having Kenya Registered Nurse Anesthetists (KRNAs). Some hospitals were embracing the idea of reinforcing their capacity by shifting some tasks to the KRNA graduates in their facilities while others were still resistant. These last ones did not believe in the idea of task shifting and the importance of leveraging responsibilities among medical staffs. 

The hospital visits were followed by a couple weeks spent transcribing the in-dept interviews with the women and KRNAs that were recorded in Bondo, Yala and Siaya. The post- data collection time was also spent double checking the data and making phone calls to get information that were not provided or that needed to be confirmed with key people who were not there when the hospitals were visited. My experience working with the student from Maseno University was eye opening since I learned how to communicate well my expectations with a collaborator in a project and not make assumptions that everyone handles their responsibility as expected. I learned that a valuable experience doesn’t just produce expected results (data, connection, etc.) but that any experience is richly packed with a variety of teaching lessons (interpersonal & intrapersonal). I had the privilege to meet nurses and doctors who had very limited supplies, infrastructure and support but who were fighting to save lives as much as they could regardless of other opportunities that they might get in bigger cities. On another hand, I also met people who were working in environments with more resource and support but where mothers in labor were standing for hours before being taken care of by the medical staffs. Post-surgical follow up was something that was neglected in most of these facilities and none of these facilities were following up with discharged patients. Even if the personnel numbers were low in all the different referral levels; these hospitals had important concerning issues of not having supplies and equipment.

Looking back, the 3 months that I spent in Kenya exposed me to different circumstances and every obstacle that I run into turned into a learning and growth opportunity.  Bureaucratic procedures in government institutions surely bring awareness of what is being done where as well as insuring that ethical measures are taken by different projects but the delays encountered during these processes are unbelievable. Corruption is a huge barrier to development since services are not delivered as they should be delivered in different layers of the system which creates unbalanced systems and the resource do not get allocated to places that need them the most. Patient care services are delivered differently in every hospital and standardized guidelines and procedures for caesarian section and safe anesthesia are not followed in most places. Ideas that were drew on a board in the Vanderbilt University ended up taking shape and got refined with time. Taking this project from conception, to development, refinement and implementation is an experience that benefited me a lot. The data that have been gathered will contribute in the improvement of the training program and patient care in the hospitals visited. As continue my journey in public health, I will use the skills learned to take a lead in similar projects and embark into other experience that will continue to enrich my knowledge and skills.

 

In Destine's case, if she can continue to have access to contraceptives to limit the size of her family, she has optimism for a more successful future for her children and her community.
It’s no secret that I believe investing in global health is absolutely essential, and investments in women and girls—particularly maternal and child health—does nothing less than change a country’s trajectory.

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