Review: Medical Internship for Teenagers in Kenya by Esme D

Monday 11th July: Town Tour

Nanyuki is only a small, quiet town but also very diverse; after staying in our host family’s (almost) mansion to walking past the local ‘slums’ it made me feel guilty and very aware of the divide. Small children waved at us.

They obviously knew we were volunteers, and said things like “Give me sweeties”. I waved back, as did everyone else. Despite the initial chilling feeling I got at first glance of the slums, their relaxed and joyful way of life, (everyone had a smile on their face and everyone would stop to say hello), gradually gave me an air of optimism.

Tuesday 12th: Huruma Hospital

I observed the calm composure kept by the nurse as she inserted a nasogastric tube into a geriatric patient. This was difficult to watch as it was distressing for the patient, but the reassurance given by the nurse was genuine and kind, even though she must have inserted a thousand of them. Although I only played a minor role in passing the equipment to the nurse, I learnt that efficient organisation is essential in order to prevent unnecessary pain for the patient, since the quicker it is finished, the quicker the patient can relax.

Multiple Sclerosis patient in 30s. Doctor was gentle and softly spoken when assessing his reflexes. This was important because the patient was in pain, and couldn’t talk properly to express his pain, but only use facial expressions.

So even something as small as speaking softly could perhaps soothe the patient. I tried my best to distract the patient from his pain by talking to him in some basic Swahili I learnt yesterday, even if it was just introducing myself so he felt like he wasn’t on display as some sort of specimen for me to observe.

I shadowed the doctor as he assessed a young boy with a sore rash and skin lesions around his mouth. It was dripping with pus and clearly very uncomfortable. The doctor explained to me how he had had this before, but was unsure of the cause.

This showed me the importance of not feeling rushed when diagnosing a condition that is difficult to figure out, since the doctor was not afraid to take his time to examine the rash in silence for a minute to make sure he could rule out any common condition that was not an allergic reaction.

Wednesday 13th: Maternity Private Hospital

I watched a caesarean section. The doctor had a really steady hand and showed manual dexterity when making the incision with the scalpel as well as stitching up the uterus and the skin. I believe I showed a (much, much) more basic level of this skill of a steady hand when I poured out the iodine solution for the doctor, as although this is a simple task, I was very nervous since this was my first ever experience of surgery, so it would have been easy for me to shake and spill the solution.

The doctor also expressed a calm and somewhat relaxed mood, which made the atmosphere much less intense. I believe this was so important, because although the mother was under anaesthetic, she was still very much awake and conscious, so if the doctor had been stern or un-optimistic, it would have been extremely disconcerting for the mother, and cause unnecessary stress for her.

In the afternoon, I got taught by a lab technician of how to test for HIV, as well as many of the possible conditions that could be indicated by blood, protein, glucose, ketones, nitrites etc. in the urine. This made me appreciate the intricate work that goes on behind the scenes, and how important thoroughness and accuracy are.

Not to mention how vital it is that the results are communicated to the patient in a clear and comprehendible way, whilst also being very receptive and sensitive to their emotional response.

Thursday 14th July: Vital Signs

I was taught by a nurse how to measure vital signs to prioritise patients who should be seen by the doctor first. Blood pressure, pulse, temperature, weight – these were the measurable signs that allowed an organised system to be maintained.

This is different to the UK’s NHS, as patients simply turn up, and bookings are not necessary.

Friday 15th July: Village Outreach

Today we went to a village in the rural suburbs of Nanyuki. It didn’t take long for the children to become comfortable around us as we played some sort of mixture between football and rugby when we were waiting for the doctor to arrive. I think that this was a great way to communicate with them, since many didn’t speak English, as well as to show them that although we look different and speak a different language, we’re all the same on the inside.

I found so much joy in letting the children hang off of me so I could barely walk and picking them up as they felt how different my hair was. Although they may have been excited to see us, I am so grateful that they gave me an experience that will stay with me forever; they allowed me to experience humanity in a way I never knew.

I think that the appreciation and awareness of the human condition in all walks of life is an essential quality for a doctor to possess.

During the outreach work, I firstly took the blood pressure of adults. Even though this was a simple task, I believe it helped to develop my communication skills, since most did not speak English, so I had to gesture, use body language and gently position their arm into place.

After taking blood pressure, I stood by the door and took the temperature of adults and children, as well as measuring the circumference of infants’ arms. Being the first person they met at the entrance, I believe I was approachable and I made sure to be especially friendly and welcoming to help ease any nerves.

Monday 18th July: Pharmacy Work

Today I helped in the pharmacy. I enjoyed the organised system they used to ensure that every patient received the correct medication in good time. I was glad to be of help in a small way, even if it was just putting 15 amoxicillin tablets in an envelope over and over again.

In the afternoon we drove a few hours to visit the Masaai people. They performed a welcome dance, which involved a lot of jumping for the men. Then it was the women’s turn: I held hand with a woman as we danced and bounced our huge beaded necklaces up and down.

Then Joseph and Moses made a small speech about their way of life. I admired their traditional clothing and jewellery.

Moses showed us inside one of their tiny ‘houses’. When a woman gets married (age 20-24) it is her duty to build this house out of sticks, and what looked like cardboard and other recycled materials. The process takes a mere 3 days. Inside was dark and musty. On the floor there was animal skin. There were two ‘rooms’: the mother and father’s room and the four children’s room.

Each area was no bigger than the size of a single bed. In the centre was a place for a fire (no wonder it smelt of smoke). Their diet consists of mainly blood and milk (usually goat, sheep or cow).

A woman can be a wife to a husband who has many wives, it depends on how many cows the husband can give in exchange for a wife (the dowry). 6 cows gets one wife. The woman’s job is to provide food, fire wood, look after the children and much more. The man’s job is given the name of ‘warrior’; this involves keeping watch at night to ensure no wild animals attack their livestock.

To bathe, they go to the nearest river, but one person must always keep watch and occasionally fight off crocodiles.

They had laid out a market of beautiful things on cloth on the floor - mostly beaded jewellery.

Tuesday 19th July: Another Outreach

Today was another outreach but to a different, and much further away village. This time the children were much more reserved - I’m not sure if this was just their culture or perhaps because we didn’t get a chance to get to know them and play games with them like last time.

This time I began at the blood sugar and malaria testing station. There were four of us working at this station, so we thought it made sense to work in pairs, where one person from each pair either took the blood for the malaria test or for the sugars test. This demonstrates our teamwork, as we had a very efficient system going on, which meant we could see more people more quickly.

We also had to have good communication skills, as again, many didn’t speak English, so I made do with body language and gesturing. I reassured many people that the small prick to their finger wouldn’t hurt much, and would be over really quickly.

Thursday 21st July: Huruma Hospital

I had to show a steady hand when I prepared dilutions for cannula injections. After this, I gave out medication to the elderly patients – I made sure to be careful and slow when placing the tablets in their hands and holding the cup for them to drink the water.

Friday 22nd July: Final Outreach

I washed the feet of school children with jiggers - a type of flea that lives under the skin. I was gentle and made sure to observe the child’s reactions and facial expressions in case they were in any pain.

In the evenings after working at the hospital or outreaches, we had some downtime to relax and socialise with the other volunteers – all but two of the volunteers staying with the same host family as me were helping to renovate a school and play with the children, so we liked to exchange our stories of what happened that day.

I became really close with my two roommates – the Japanese girl who was also doing the medical volunteering with me, and Italian girl who was volunteering at the school. We all brought each other gifts from our countries, and showed each other pictures of our lives at home.

The Japanese girl taught us how to make some origami, (my first attempt was questionable), and one evening she and the boy from Japan made us all sushi which was really kind of them. Another evening, the Italian girl made tiramisu for dessert, although she will say it wasn’t ‘proper’ tiramisu, as some ingredients had to be substituted, but it tasted delicious all the same.

I loved to go to the outreaches because it meant we would have so much fun joining with the other volunteers from different host families during the long, bumpy journeys – most of them were a bit older than me and the Japanese girl and boy, as some were on their gap year or already at university.

At the maternity hospital, we always joined up with a Canadian girl and a girl from Texas, who were really friendly and liked to help show you around, since they volunteered there almost every day of their time in Kenya.

Visiting the local market felt as if you were really experiencing the local culture. We got to try fruit we had never seen before, and we saw huge bags of different grains and beans. It also meant that if you wanted to buy anything, you had to bargain. We laughed so much when we made each other bite into a really hot chilli pepper.

I was so excited for the weekend, because we got to go on safari! It was an early start – but I would have got up at any time if it meant I could see the amazing African animals. We were picked up by the huge safari 4-by-4s and watched the sun slowly rise as we drove to Ol Pojeta Conservancy.

The day was surreal – I couldn’t process the fact that I had seen wild elephants, giraffes, monkeys, lions, buffalo and even the last white rhino, on a more sombre note. We stopped at the memorial site for all of the rhinos who had died, many due to poaching, feeling a mix of hurt and anger and disbelief.

On Sunday, we got to climb up Mount Kenya! I was so grateful that we got to experience the sheer beauty of the mountainous landscape in Kenya, especially because it would be my first time going up a mountain. It really felt like we were all in it together, as even though the air was thinning, making it particularly hard for a girl with asthma and another with anaemia, we all waited for each other and stuck together.

It was great to get to know each other even more.