What we can Learn from Ebola as Future African Health Workers

I use the term ‘future African health workers’ because the truth is that most of us will practice in Africa, if not Kenya. Emigration to other continents is a possibility but one that will only be taken up by a few of us. Some countries have been declared Ebola-free and incidence is at a decline, but as a continent we are still reeling from the after effects. Therefore here is a list of things I believe we can learn from the Ebola outbreak.

     1.We need African solutions to African problems

For a long time there had been contained sporadic outbreaks of Ebola with minimal casualties. Nobody really seriously researched on the virus, not even we who were on the ground because we never imagined we’d have an outbreak of this magnitude. This might have been part of the reason for a delayed response from the international community to the epidemic. Everybody just assumed that it would go away. But it didn’t. We have recorded over 27,000 cases to date with over 11,000 casualties. Those are startling numbers.

Furthermore, survivors are now experiencing what could be referred to as a ‘Post-Ebola syndrome’. Joint pains, eye inflammation, blindness and memory loss caused by a residual viral-load in immunologically privileged sites. Sequelae whose pathogenesis and management we are still trying to understand because we’ve never seen them before.

     2. We need to put more effort into primary prevention strategies

The sheer number of infections that could have been avoided if families had initially known how to properly handle the bodies of their loved-ones who had succumbed to the disease is staggering. Measures as simple as hand-washing have been shown to cause a decline in infections. And this applies to other diseases too. Sure community education does not sound as sexy as ultrasonography, venous cut-down, cardiac bypass surgery or all those other technical procedures we would secretly love to become experts at; but it goes a long way in preventing the disease conditions that might necessitate such procedures.

Let’s face it, we as medical practitioners, especially in Africa, are way fewer than our clients. Therefore, our work would be easier and better if we had a lower client-load at the end of the day. Don’t even get me started on the economic and social benefits of disease prevention.

     3. Proper investment is needed in healthcare

I think we’ve all watched at least one movie where there’s an outbreak of a dangerous contagion in a 1st world country and the CDC swoops in and sets up quarantine measures and does a battery of highly-specialized but needed tests with rapid results to decide the next step in handling the said outbreak. Ebola was/is a situation where such action was needed and in many places, it was severely delayed by lack of personnel or equipment. As of now there is no rapid test for Ebola diagnosis and the gold-standard is ELISA. Anyone who’s seen an ELISA machine knows that it needs specifically trained personnel for operation. We need to demand more from our leaders. Africa may have dodged the SARS, Bird flu and Swine flu bullets but this time Ebola got us.

I remember people discussing how Kenya would deal with an Ebola outbreak…it was a scary question. Not that our health system is as bad as what is in Sierra Leone or Liberia, but it isn’t what it should be either. Yes strides have been made and are being made to improve it, but we need to demand more of our leaders until we are where we want to be. Decades of health mismanagement don’t just go away overnight.

     4. Medicine is a risky profession

This is an ode to all those health-care workers who lay down their lives while treating the infected. It really puts the Hippocratic Oath into perspective. When you are promising service to others, would you go as far as laying down your own life? Because that is literally what they did. That is the kind of heart that they had for their patients.

This also reminds us that as we treat patients, we must also take measures to protect ourselves. Therefore hygiene and protective equipment become key.

     5. Cooperation is important

Also admirable was the sheer influx of volunteer health professionals from all other countries in Africa and the world at large. And that is the reality of our vocation. You cannot work alone. You need colleagues to assist, seniors to consult and juniors to teach. Therefore, consider actually being nice to these people, no matter where you are on the food-chain, so to speak. Because one day, that junior will become your colleague; and that colleague may be the specialist you need to consult, or the doctor who treats you and your children in your old-age.  I’d like to think that we are all working towards the same goal; the betterment of humanity. So it would be nice if we put aside petty side-shows and focus on that.

By Vallery Logedi

University of Nairobi

Editor, MSAKE

Why do these things happen to us?

I was diagnosed last year. It wasn’t caught early enough, and so the doctors couldn’t operate on me. I was taken to theatre though, for staging under anesthesia and for biopsy harvesting. They told me I had stage three cervical cancer. I kept wondering what it all meant, what it meant to have stage three disease, until a young girl, with a smile between easy and plastic, in her twenties( most certainly), explained it to me. Now this girl was so good with words, the way she put everything almost gave me hope that I would live long, long enough to see my babies grow, long enough to retire and earn my pension, long enough to become a grandmother. I do not blame her, how can I abuse her good manners? How can I judge the poor thing yet I don’t know how she deals with women who are younger than me who have been diagnosed with cervical cancer? I appreciate all the hope that she gave me although it was too much I wish she told me the truth. I appreciate the time that she spent with me, she said people are different and disease progresses fast or slow depending on an individual, I agree, problem is, I belong in the category of fast progressors. Do you know what that means? It means that I die soon, maybe today or tomorrow or next week, or probably next year. I do not know when I want to die. I want it soon and later. I want it soon because living is costly. These days I leak shit and urine just trickles down my legs, adult pampers are too expensive, and I hate the smell of my beddings. I am tired of becoming anemic every now and then, I have received too much blood, and I wonder why my bone marrow can’t just make enough blood these days. I have slept in the hospital too many times, and I am just tired, I am tired of white beddings, of rude women dressed in blue and white in the name of nurses, of little boys and girls in white lab coats asking me every day of the number of children I have had, of the number of sexual partners I have had, and all those clinic questions.

Maybe now it has become stage four disease, maybe it is my two feet on the grave now not just one. I am dying.  Who will teach Kanana how to become a woman? Who will teach her how to make chapattis? Who will show her how to wear her pad when she gets her first period?  Who will even buy her pads? Who will be the woman in my son’s life? If I die now when he is only eight, then from whom will he learn how to treat women? Who will hold my children as I am being lowered into the earth? Who will hold them as they listen to the earth falling on the box wherein I will be contained? Cancer oh stupid cancer, I have only had thirty five years on earth. My twenties went just like that, when thirties came, I settled down with my babies, I was ready to make something out of this life. Then, I set down to work, to be the best wife, the best mothers, did I have many years to carry out my dream? No. you came knocking, just when I was beginning to know the meaning of life, just when I was learning how to be a mother. In just a year I am reduced to bones with a coat of thin flesh hanging here and there. I no longer wear clothes, I hate the frustration of looking for the smallest size and besides, where is the money? This is not about money though but I must admit that I am poor now, I wonder how my funeral will be like, and huh si cancer has siphoned all the money?

The doctors don’t understand how I, a young beautiful educated woman sat at home with cancer, how I passed through stage one and two without ever going to the hospital. They don’t understand that I am a subject, I am part of the ruled, I have no luxury of walking to the hospital, the money in my pockets is too little. I am society and we in society, we only fight real battles, if there is no pain, then there is no need of going to the hospital. The hospital is for the wounded, for those who are bleeding and for the overly sick. We never worry about weight loss and lack of appetite, these only worry our leaders, but we, the ruled, cannot worry about lack of appetite when we don’t even have enough to eat. We are too emaciated that we never recognize additional weight loss; it is only our fat leaders (no pun) who can recognize as their necks become thinner and as the fats over their tummies melt. We, we only learn these things about screening and vaccines in KNH and Mulago hospitals as we struggle to be booked for radiotherapy. Then we are left imagining how this knowledge would have been good had we gotten it ten years earlier. But we the ruled cannot do much; we live in a country where we are governed. Whether I live through this week or not depends on whether the striking doctors resume work soon enough coz I am pale again. I know I need blood so badly. But the provincial general hospital has no doctors. I know they know that people are dying. But they don’t know that it is me, who is dying, leaving behind two small children and a husband who has married, because being a widower sucks. Whether I live through this strike depends on whether God wills me to. Oh the pains of living. The struggle we go through, we who have terminal illnesses.

By Doreen Oyunge

Egerton University

Editor

Medical Education-Need for Greater Human Interaction

I have observed for more than the three years I have been in medical school  that we medical students are people on the automatic  path of alienation. Some might not have the same perspective as I do, but the fact is, we are far distant from the interaction we had back in our primary and secondary school life than do our brothers and sisters undertaking other courses.  Medical education, though fancied, valued and highly esteemed, has got its limits in one basic  principle of  human survival –interaction.

Medical course takes us away from the greater human interaction and directs us towards solitude. Every morning, from as early as 7a.m, a medical student is glued to the pages , busy transferring information from those five kilogram books, or is in the wards scribbling down some shoddy history and doing a rush physical examination to be presented at the start of clinical rotation, for six hours, followed by a  one hour lunch break and later a  three to four-hour lecture  for 5 days a week.

In the evenings, everyone is tired, most of us go to our rooms for a nap and thereafter, study till late into the night, getting at most five to six hours of sleep; a limitation to the consolidation and integration of information. Over the weekends , owing  to the pressure from the over ambitious and poorly designed policies and the rogue lecturers who derive their pleasure from imparting some fear and insecurity into the students through constant harassment by asking questions which are aimed at proving a point, no one ever misses to get back the books after  laundry.

This is the trend the whole year for the five to six years or more (for those who by design, lack of luck or by complete misfortune get several retakes and re-retakes). The so-called holiday is something that is not factored in, in the design of most medical programs.This has created a bonding gap between medical students and their family. The outcome of this? Irrationally diminished thinking; people who are just there for the sake of being alive; people who are never in touch with the world, and in summary, people who are reduced to just learning, eating and sleeping.

On the other hand, the comrades who take other courses have half a day, the whole night and all weekend for sleeping, partying and politicking – a real interaction with the world. These are the people who are up to date. They are the ones who live up to their dreams-utilizing their talents and abilities. Why? Because they can easily match their lives with situations and accordingly adjust their lifestyle in line with the current demands in this dynamic world. But we in the medical school live by old principles, some of which do not agree with this evolving world. How? Our mentality and thoughts are biased towards the old thinking-a tendency that limits our capacity to come up with new theories which will form part of new research for quality and patient-centered care, efficient management and  delivery of medical services. It limits our responsiveness to emerging health issues.

Ultimately, reduced interaction has led to a hiatus in service delivery that has been exploited by quacks with excellent interpersonal skills. They “treat” their patients by word of mouth and simple study of their minds and heart. This explains the rise in number of patients consulting herbalists, witch doctors, and all other alternatives.

Personal relationship skills cannot drive away disease. They cannot kill that bacteria. They cannot reduce the viral load. They cannot  eliminate that parasite siphoning the human blood and nutrients. Neither can they eliminate chronic devastating genetic conditions.

However, inasmuch as this course diminishes our contact with humanity it should not overshadow the fact that we are still the cream of society. We are actually blessed to have been given the privilege by the Almighty, the society and the government to undertake this course and to offer service that works to prolong life, while reducing suffering.

We can easily change our style of living without any negative impact on our academic performance. As medical students, we need to create time for rest and social interaction. It is through this that we get to understand the needs of the current world we live in. We need to spare some time for imagination. We need to learn to analyze problems and provide practical solutions. All of which comes from having a vivid understanding of our surroundings through interactions. Have a little more interaction today than yesterday. And if you’ve read this to the end, that was a good start!

Koech Titus

Kenyatta University

Editor, MSAKE

 

Technology is a darling of the futurist medics, isn’t it?

Well, it’s a non-refutable fact that we have all become puppets and puppeteers of technology. Medicine is not lagging behind either. It is dominating the technology field with such gusto and astute medicos will embrace this fact sooner than later. Tracing back to the 18th century when smallpox masticated precious lives to this era of resonance imaging, milestones have been covered.

Today, telemedicine is paving the way for quick and reliable exchange of medical information. An idea conceived at Harvard University spreads to other institutions of research like bush-fire. Doctors can consult with their peers at the comfort of their consultation rooms. Surgeries can be performed remotely where experts do not have to take the tortuous course of jetting into a foreign n country to perform the procedure.  Emergence and explosion  of an IT savvy generation has led to the development of applications where Homo sapiens living in the most remote areas of the earth can key in their symptoms and get a diagnosis.

However, this being worthy a cause, it is imperative that medical attention from a clinical setting is superior to computer aided diagnosis. This fact is sacrosanct and inalienable, since laboratory and imaging applications may be needed; hopefully computers of the future will be equipped with scans! Who knows?

A capsule endoscopy tablet

The continuous use of our ingenuity has sealed loopholes that previously led to loss of lives. Imagine swallowing a camera the size of a tablet to take images of your gut! While this technology remains far from being used in our third world countries, it is no longer a pipe dream.

 

What baffles me and will definitely baffle free thinkers is the application of suspended animation. At a glance, I thought it had all to do with cartoons we watch, but my mind was blind. Suspended animation is akin to putting a patient in limbo since terming the word death would be meting ignorance on ourselves. The practice involves stopping the heart of a patient under surgery, lowering the core body temperature to thirty degrees and replacing blood with saline. The metabolism of a patient is lowered and critical operations are done. The patient is then resuscitated by application of charge directly to the heart. This may seem like fiction or mere parroting but it is happening: when it will happen in our country remains in question form.

Lastly, did you know that some people believe that medicine will make a breakthrough and bring back the dead? These scientists have been cryopreserved in liquid nitrogen since 1967.

The first man to be cryopreserved, James Bedford

A woman preserved in cryo “I will be frozen when i die.”

 

 

 

 

 

 

They have been maintained in form and shape. Some may refer to it as a figment of fertile imagination. Since I have no blessings to be the moral police on ethical issues, I leave this for scholars and religious persons. Engaging in such a discourse will need the input of all and sundry, divine intervention being pivotal.

Have an available day, won’t you?

By Gibson Gaitho (The Alchemist)

Kenyatta University

Editor, MSAKE

SRT 2015: MAIDEN EVENT ALONG THE KENYAN COAST

Sub-Regional Training 2015

The dates on the calendar were marked and the countdown had begun. The dates 8th-14th June 2015.  The venue Southern Palms Beach Resort (SPBR from now on) located on the sandy beaches of Diani, Kenya.

For someone who had just finished a grueling 3rd year harassed by Pharmacology this was the perfect way to unwind, and a perfect learning holiday to convince the parents to go for ☺. The fee was reasonable for 5 days and 4 nights of interacting with medical students from across Africa (Kenya, Tanzania, Uganda, Ethiopia, Sudan, Rwanda, Egypt and Nigeria).

Seeing as various attendees had various tastes, transport was an individual decision. For those travelers close to the city centre and on a tight budget, our journey began at 2100hrs on 7th June 2015 where we would travel in the comfortable buses of Tahmeed Ltd. If you had detachment issues from your smart device, fear not as the bus had USB slots for you to charge them. Free Wireless Network was also included for one to save your valuable bundles (though bundles did come in handy when the Wi-Fi decided to mood swing on us). For those who wanted to travel in style and comfort they jetted down to the Coast and for the lovers of road trips they drove down; while the adventurous ones went by train.

We arrived the next day at around 0900 hours and are free till the evening opening ceremony to get acquainted with our new home and roommates for the week.

OPENING CEREMONY:

After the day’s explorations, we donned our finest dinner wear and attended the opening ceremony on a full stomach, courtesy of the SPBR buffet. The trainings and trainers and the faceless Organizing Committee that sent me emails prior to the SRT finally were known courtesy of a brief video and the usual Kenyan politician tradition of “Saying something small” introduction. We were also indulged in the history of how the SRT came from a dream to a reality and the breakdown of IFMSA.

After all was said and done, ground rules told, we broke into meetings according to our various trainings (Notification emails had earlier been sent to a number of us on which training we would be attending) and were free to either turn down for the night or turn up into the wee hours of the morning.

LET THE GAMES (SORRY SRT) BEGIN:

Tuesday morning was here with us and we were down to business; participants broke into their designated trainings which included:

• Universal Health Care (UHC) and Post 2015 Agenda
• Training New Trainers (TNT)
• IPAS
• Capacity building

NB: The order is biased on the authors grading of training intensity from most intensive to least intensive.

After an intensive day in UHC training, we were to wrap up the evening in Traditional/African night… Unfortunately, there was a power black-out so the social program was put on hold till KPLC felt sufficiently philanthropic to bestow the power back to us, which eventually happened later on that night and we danced till the early the next morning (read about 0100hrs since hotel guests complained about the noise).

But if you are still in doubt over the all you can eat and drink menu… Here’s proof that even birthday celebrations were part of the package☺. (Earlier that Tuesday night)

Wednesday morning, I groggily returned to my early morning session of UHC while my capacity building roommates had the pleasure of sleeping in till late in the morning as their trainings started later. As the knowledge and skills continued being imparted on us during the day, the light at the end of the tunnel continued shining all through the afternoon session courtesy of the all I can pizza, burgers and sandwiches waiting for me at the pizza bar after such an intense day. They say a picture is worth a thousand words…

Later on that night there was a treasure hunt; and various participants participated in the battle of brass vs. brawn. Though with its share of discrepancies the treasure hunt as successfully and the winning team crowned and awarded their prize of a bottle of wine.

THE GAMES COME TO AN END:

Thursday, the final day of training. The time to say those difficult good byes.; all the respective trainings came to an end and photos taken on the beach with fellow participants, now  turned friends. Then it was evening and what better way to wrap up the SRT, but with a White T-shirt party:

CONCLUSION:

The bar has been set very high for the 2016 SRT. However, inasmuch as the SRT 2015 was a success, a number of participants I spoke to did share that there is still room for improvement from the maiden SRT varying from logistics to trainings. All in all, majority do agree that despite the ups and downs encountered they will most definitely attend SRT 2016.

From my end, it was a memorable experience and I can’t wait for the next SRT.

Signing off…

Marie-Claire (MC) Wangari Muhoho

University of Nairobi

National Officer on Medical Education 2015/2016