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On Mistaking Africa and Medicine (an excerpt)

This is absolute hell. I’m tired, my brain is completely burned out, and I need to sleep. Why do I have to even know this? Who cares about the life cycle of Plasmodium . . . I really hate doing this: the reading, the memorizing, the daily routine, and pretty much everything about this downright stinks. I could not be enjoying myself any less . . . I’m starting to think this was a huge mistake . . .

If I ever kept a journal of my medical school experience, these sentiments would almost certainly reverberate throughout its pages. I suppose this is why I never kept one—its utter negativity would have only discouraged me further. To be perfectly honest, medical school is absolutely awful. Endless hours of studying and little sleep coupled with anxiety and frustration hardly seems like my calling in life. Amidst this ordeal, I began to wonder why I aspired to this in the first place—I had always thought I knew, but I was not quite so sure anymore. I was in serious need of a reminder as to what it was I was doing with my life, and this past summer in Kenya as a Slemenda Scholar most definitely refreshed my memory, and helped to renew my love for the career path that I somehow stumbled upon. What follows is most of what I could recall from my experiences as a Kenyan medical student—my impressions, my misconceptions, my discoveries, my friendships, and all that has educated my mind and helped me to realize that maybe I haven’t been stumbling after all.

Week Three
…My overall impressions of Kenya thus far have been incredibly positive. They are very different from what I and so many Americans have been raised to believe about Africa. Growing up, any complaint concerning what I possessed in material goods prompted a lecture about how fortunate I was and how unfortunate African peoples were: "You have so much and all you do is complain about what you don’t have; think about people in Africa who have nothing and how happy they would be to have a fraction of what you have." If this is the Africa my parents told me about, the standard to which all human suffering is measured, then I am in the wrong place. Even though I feel that simple living and disparity of technology do not correlate in the least bit with human suffering, there is much technology here, with cellular phones, automobiles, and laptop computers abound. I wonder how the regular Kenyan or any African must feel when his country is frequently regarded as the measuring stick of human disparity, misery, and poverty—it must be frustrating to say the least. I want so badly to change these perceptions. On the other hand, I know that there is enough sickness, corruption, and poverty to go around in this nation, but I have yet to truly experience this side of Kenya; this may very well change in the upcoming weeks. Despite its problems, Kenya seems like a wonderful place to live, a place where one can derive as much joy and pleasure as any other place in the world. If there is one thing I have learned on this trip and hopefully will continue to discover, it’s that there are so many faces to Kenya, and to portray only one side would be to grossly misrepresent the reality of this remarkable country.

Finally, Africa . . .

The community health curriculum at Moi University also comprises a field component, which gives students the opportunity to translate book learning and lecture material into actual hands-on clinical experience. This program is unlike any in the US for first and second year medical students, both in its hands-on nature as well as its focus on community health. Medical students are sent out to rural health centers for three weeks to participate in the COBES program: Community Based Education and Service. In these rural communities, students learn about the country’s healthcare infrastructure and its health problems, participate in providing health and educational services to the community, and carry out relevant epidemiological research.

In early July of that summer, thirteen Kenyan medical students and I were sent to Chulaimbo, a small village located in the Maseno Division of the Kisumu District of west Kenya.

We arrived at Chulaimbo late, tired, and damn hungry. I could definitely tell that these Kenyans were not used to being hungry: I never heard the end of how hungry everyone was, although it had been only eight hours or so since we last ate.  Nevertheless, I was equally famished, so I joined them in the search for something to eat. It was late Sunday night, so little was available in the way of food; we walked a couple miles down the road from the health center in complete darkness and returned with nothing more than a loaf of bread. While the loaf most definitely did not fill our bellies, it did give us a good chuckle . . .

I still laugh to myself when I think of thirteen Kenyans and one muzungu in a cramped room passing around a loaf of bread and the little clean water I had left in my water bottle. I remember fondly the beatdown we gave to my good friend Kevin when he killed the last of the water with half the class yet to take sip. I remember the good-natured humor and conversation we shared that night over bread and water. I doubt it mattered in the least bit to any one of us that we went to bed hungry that night; what we had instead meant so much more than all the ugali and samaki (cornmeal mash and fish) in the world.

It was not until the next morning that we actually saw Chulaimbo. It is such a beautiful place; an American friend of mine likened it to the elvin kingdom Rivendell in Lord of the Rings. This feels like the Africa of my expectations—mountains, mosquitoes, jungle, boiling our own water, cold bucket baths in the morning, and washing our own clothes by hand. I have finally experienced the "real" Africa! I know in reality, however, that such a life is merely one of the many that Kenya has to offer. Still, even this village life itself is not one-dimensional: many villagers have cell phones and we all get full signals out here; there is running water and electricity most of the day in the health center; and we even have a television here, with all the international news and American sitcoms to satisfy the biggest of TV junkies. I am witnessing a collision of two worlds, the coexistence of simple living and technology in the same plane.

That night I had the opportunity to talk to James, a native of Chulaimbo and the health center’s night watchman. He has lived here his entire life, never leaving this part of the country to experience what lies outside of these mountains. In his conversation I sensed not regret nor bitterness, but a sense of wisdom and content that only many fruitful years on this earth can bring. He told me all about his wife and five children, and I told him about my family. We talked about international politics, about George Bush, and about Mwai Kibaki. We talked about religion and philosophy, about what it means to have a fulfilling life, and what it means to live well. And for James, living well means making the most of what he has been given, however much or little that may be. For James, a simple life does not equate to ignorance, poverty, and unhappiness. I feel, then, that such Kenyans don’t deserve our pity nearly as much as they deserve our ears, so that we may listen to what they can teach us about life. They can teach us how joyous and wonderful life can be, and how this joy is rooted simply in human contact, interactions, and relationships . . .

"Education will open doors where none seem to exist . . . "
This line from Mark Mathabane’s autobiography Kaffir Boy describes the transforming power of education as perfectly as I have seen anywhere else. It has always been my contention that education is the solution to so many predicaments, if we can only find a way to make it accessible to everyone. The educational campaigns being launched in Kenya aim to do just that—they are just beginning to reach Kenyans of every age and socioeconomic group, they are changing the way people think and behave towards infectious disease, and they are giving us hope.

The headway being made in terms of HIV/AIDS education, awareness, prevention, and treatment is incredible. It seems as if everyone is getting tested. Educational posters and ads are a common occurrence, raising awareness of this deadly virus in every demographic. Free condoms are made available in dispensers on the walls of every health clinic. People from the world over are working with and volunteering for groups such as the IU/Kenya Partnership’s AMPATH (Academic Model for the Prevention and Treatment of HIV/AIDS) program, Kenya’s most comprehensive treatment program for people living with HIV/AIDS. AMPATH, along with the Ministry of Health's VCT (Voluntary Counseling and Testing), is responsible not only for the testing and treatment of patients who have already been stricken with this debilitating illness, but also for preventative and educational efforts in Kenya. Such groups are the lifeblood of Kenya in the fight against HIV/AIDS . . .

Our visit to the Sinyolo Secondary Girls School gives me hope. We went for the purposes of educating young women about HIV/AIDS and other female health concerns, and strangely enough, they ended up teaching us something instead, namely about the successes of a good education. We were all greatly impressed by how much they already knew about HIV/AIDS, and the questions they asked were extremely educated. Although exceptionally disciplined, each girl also carried with her a definite sense of independence and open-mindedness. I was struck not only by their intelligence and articulacy, but by their openness and candidness in discussing sex and other issues that are deemed taboo topics of discussion in American secondary schools . . .

. . . COBES gives me hope. It is great for Kenya, placing both Kenyan and American students at the focus of the county’s major health problems, reminding them as to why they are in medicine, and encouraging them to return to the communities of greatest medical need . . .

So much work has yet to be done, and in this way, Kenya is a work in progress—a work, however, that encourages and inspires greater efforts. It is one that encourages me to return in the near future to experience all that it has to offer, to be part of this great effort in some way. But most importantly, it is one that will inspire my Kenyan classmates to do even more than those who came before them, so that they may someday come to realize their country’s greatest potential.

Let’s Roast Some Goat
Our last night in Chulaimbo saw us throw a good old-fashioned Kenyan goat roast party. It was joyous occasion, a celebration of the end of COBES, the finishing of our report, and of the friendships that were made during our time here. But in many ways, it also had the feeling of a farewell party, and nobody likes to say goodbye . . .

The goat roast was an amazing time. I was volunteered to slaughter the goat, a first for me. This trip has been defined by firsts, so it was most fitting that I be the one to do it. We did everything ourselves, from the skinning and gutting to the cooking and eating; the entire process took almost five hours. But it was five hours for us to joke around, to act like kids again, and to muse over all that we had been through together, from the moment we took our seats in the university lecture hall six weeks ago to this moment now. Over the last three weeks I began to feel less like a traveler and more like a native of this country. This has become a place I can call home. My classmates refuse to see me as a foreigner any longer, and instead conferred upon me the status of an honorary Kenyan. And although I cannot lay claim to the same experiences as my classmates, I honestly feel as if I fit the part. I will never forget these guys, Kevin, Ester, Ruth, Chero, Cindy, Abel, Bramwel, Mercy, and so many more. I will always remember our conversations, our experiences, and all the stupid things we did together. It saddens me that I may never see them again, but I really hope I do . . .

Life is Funny

I am sure that what I experienced in Kenya in no way reflects the entire reality of this diverse country. The above merely reflects the reality of my own experience, and this is all I can honestly relate to you. I could have recounted all the horror, poverty, disease, and misery that is commonly associated with western perceptions of Africa, but that would be dishonest, and to grossly skew the reality of my experience. Instead, I have told you of the lessons I have learned, incredible people I have met, the amazing friends I have made, the people I may have touched, and those who definitely touched me. I have told you how I have fallen in love with medicine once again after a long year of disillusionment and of how I have been reminded as to why I am a medical student. I will leave you with the last entry of my journal, the final words I sloppily threw down before I retired to my safari tent for the night, our last night at Masai Mara national park. There was something about that night and place that seemed to bring everything together, allowing me to reflect on the whole of my experiences.

This last day on the Mara was dreadful, but surprisingly fun. Whether it was something I ate or drank I will never know, but I was having serious problems with my plumbing, to say the least. Our safari van made five unscheduled stops today, and to make a long story short, I became very well acquainted with the tall grass of the African savannah.

One of these "stops" was unnervingly close to a migrating herd of wildebeest, and another was conducted in the presence of two curious giraffes that were eyeing me rather closely. I cannot believe that I left nearly 5 lbs of myself on the African savannah today—I would never have dreamt it in a million years. Life is so funny, the shit that it throws at you.

In many ways that moment summed up my entire trip. I have learned to open up my mind a little bit wider, to expect anything. This trip has allowed me to take a step back and put everything into perspective, to reflect on what I have been doing for the past few years.

And I realize that maybe I’ve been on the right track all along, and that the detours have been blessings in disguise . . . I realize what this trip has been all about; it has not been about safaris, infectious disease, or international politics, but instead about goat roasts and good conversation over bread and water. It has been about human experience and interaction, and that is what I will remember about my time here.

This is what I believe Bob and Ron had in mind when they set up this partnership, and this is what I believe medicine is all about; it is not about surgeries, drugs, or procedures, but about the human spirit. Experiences such as these are great for medicine, and they bring out the best in people. They remind us as to why we devote nearly a decade of our lives to long days, sleepless nights, and agonizing study—we do it not for prestige, for wealth, or even for science, but for each other.