By Michael LeCompte
After >48 hours of traveling (including a delayed flight, a canceled flight and the normal 20 hours in the air), I was tired, disembarking in Nairobi Kenya at 10 pm Monday night. As I took my first few steps out into the cool night air, my energy returned as I was greeted by the familiar smells and sights. I had come home.
I grew up in Kenya, in a little town called Kitale, near the border of Uganda. My parents were missionaries, and I grew up in Africa from the ages of 5-12. This experience has shaped a lot of decisions in my life, including my decision to go into medicine and my choice to go to Vanderbilt for surgical residency. I was drawn to the opportunities in global health that Vanderbilt provides its residents, especially the opportunity to go to Kenya in the 4th year of training. I remember the program director “Tarp” emailing me pictures of some of the residents who had been to Kenya previously during my application process. Now it was finally my turn to go back to Kenya as a surgical resident. I had been back before as a medical student, serving at Tenwek hospital, but now I had a little more training under my belt and I was eager to get to work.
I was met by a driver and taken to a familiar guest house for a night of rest and then shipped off to Kijabe the following morning. The journey to Kijabe continued to fuel my nostalgia as I remembered the roads leading out of Nairobi, the sight of the Great Rift Valley, and Mt. Longonot in the distance. As a kid, I had spent some time at the local school in Kijabe called RVA. I had also visited the hospital once before as a patient after breaking my leg falling out of a tree. As we rolled up to the compound, I was struck by how much it had changed in the last 20 years.
I spent the first day getting settled in and undergoing orientation and tour of the hospital. I was assigned to follow one of the surgeons for the rest of the week, and I spent some time learning about the service and the patients. Then on days 2 and 3, we were off to the races. I spent my first official day on the service helping the attending surgeon on a few cases and then trying to navigate the hospital system late into the evening as one of the patients on the ward developed respiratory distress. I was reminded of the luxury that we take for granted in the western medical system as I searched for a working pulse oximeter and tried to get a chest x-ray done urgently at 10 pm. The next day continued this reminder as we stepped into a clinic full of about 80-90 patients all waiting patiently at 8:30 am to be seen. With appointment times also being somewhat of a “luxury” seen only in the western world, this meant that many of the patients would be waiting all day in the waiting room to be seen at the end of the day. Despite the long wait, these patients were happy to wait all day for the opportunity to see a physician. This is, perhaps, one of the most refreshing and humbling things that I am reminded of each time I return to Africa. While many would view healthcare as a personal “right” or entitlement in the west, in much of the rest of the world, it is still very much a privilege and is treated as such. I feel like it is becoming a more infrequent occurrence for most physicians to encounter patients on a daily basis who are genuinely appreciative of their services and care, even when things do not go as either the physician or the patient wanted. However, this is still encountered in Kenya. Patients are usually thankful, appreciative and respectful. I sat down, that afternoon with an elderly man and his family who had traveled to Kijabe after getting a CT scan at another facility. Unfortunately, the scan showed a tumor in his lower esophagus and upper stomach with, what looked like, a metastatic spread to several lymph nodes. I explained that the results were not good and that given the advanced nature of the tumor, a surgical resection would not be of benefit. However, we could offer an endoscopic procedure and stent placement in the esophagus that would help allow him to continue eating for some time. While I felt disappointed with what little we could offer the patient, the family and the patient smiled and thanked me and expressed their appreciation as I signed them up for the procedure.
Coming back to Kenya is like traveling back in time in many ways. It is like traveling back to a generation without the quotas, stress, paperwork and expectations that constrain the doctor-patient relationship. Though it is still very busy, the patient dynamics and environment, allow you to develop a rapport and trust with your patient. I believe that this helps motivate you as a physician to provide better care for your patients and it also allows you to enjoy the work that you are doing. It is refreshing to encounter this when I come back to a place like Kenya. It is refreshing to come back home.