The Student Perspective - Lisa Zagroba

Overall I really enjoyed my 8 week rotation in Kenya. This is not to say that there were not challenges along the way, but I do believe everyone that comes here makes a profound impact. It definitely took some adjusting, but after the fist few weeks I felt like I was able to contribute on rounds. We rounded with a team of physicians, nurses, and pharmacists in the Moi Teaching and Referral Hospital (MTRH) wards on a daily basis. This was a good learning environment because there are so many opportunities to use your clinical judgment to impact patient care and educate staff members. I often found myself question physicians about drug regimens, helping fellow pharmacists’ dose medications, educating patients on how to properly use inhalers, and educating nurses about various medications. I really enjoyed getting to work with the vast array of medical personnel from all over the US, Kenya, and other parts of the world. This truly was a global and very uniting experience. Sonak did a great job of helping us adjust and learn from this unique environment. I got to see many different areas including outpatient oncology, the diabetes clinic, and some of the rural clinics. In each of these very different practice settings pharmacists were making an impact.
I also really enjoyed the opportunity to do presentations and complete projects. I assisted in developing antiemetic regimens for chemotherapy treatment, helped make pediatric ARV handouts, and worked with IU medical students to complete a morning report presentation. My favorite project was a presentation about the treatment of chemotherapy induced side effects. This was a good chance for me to review the treatment options, especially since my next rotation is in oncology. This is also an area that I am considering specializing in, so it was very pertinent. It was interesting to see how their oncology program is developing, since it is still in the early stages of organization. It was frustrating, but educational at the same time. They do not even mix the chemotherapy drugs in any kind of a flow hood, just next to an open window.
I think I learned the most at our afternoon topic/ patient case discussions with Sonak and the other pharmacy students. These were great opportunities to learn from each other and better the care of our patients. Plus Sonak did a great job of asking us questions and making it a learning experience. I also enjoyed our fireside chats that related to public health topics. This was a great opportunity to lean more about the world and understand different perspectives. We discussed different topics ranging from the street kids in Eldoret to contrasting the health care systems of the US and Canada. These were good discussions because they involved people with different backgrounds and from different parts of the world.
Lastly, I enjoyed the opportunities to see some of the non-pharmacy related work that is done through AMPATH, such as the Orphans and Vulnerable Children (OVC) program, Sally Test Center, and farming. OVC was a great opportunity to see people helping each other. The stories of these families were amazing and really moved me to want to help. I met a grandmother that was caring for 11 of her grandchildren because two of her daughters had died from AIDS. The organization had helped her find a small one room home for her to live in with her grandchildren. She was incredibly grateful; the experience was very moving. The Sally Test Center was such an enjoyable environment where we could play with the children from the pediatric wards. The kids always greeted you with a smile and were ready to have some fun and forget about the hospital. I also enjoyed learning about the farming initiative, because with out food, the patients ARV regimens would useless. AMPATH tries to look at the big picture when caring for patients. Honestly, adjusting to life here was not as hard as I had expected. I had many opportunities to grow both as a pharmacy student and as an individual. I hope I was able to make as much of an impact here, as I this experience has made on me.

The Student Perspective - Serena Harris

As my first flight, of many, was about to take off I had a mixture of emotions running through my head. This would be my first experience outside of the US for longer than a week and I knew I was about to be immersed in a new culture. Everything would be different from the food and living arrangements to the lack of medical resources and healthcare facilities. I’m happy to say that although I had my worries, this experience has helped me grow both personally as well as professionally.

My experiences at the Moi Teaching and Referral Hospital were very different from any other hospital experiences thus far in my 6 months of rotations. As I walked into the hospital my first day there was a distinct, overwhelming smell that nearly took my breath away. This was only one of the many things I would become accustom to over the next 8 weeks. Multiple patients to a bed, medication not being given, unreliable lab results, and lack of resources were encountered daily. It’s indescribable the feeling you get when you know a patient will soon die because they either don’t have the money to pay for proper treatment or it simply is not yet available here. I sometimes found myself near tears during rounds and frustrated to the point of almost walking out. These were the bad days. The most rewarding experiences came when I improved quality of life for my patients and watched the transformation of the sick into the healthy. Whether it is managing glucose in a newly diagnosed diabetic or changing anticonvulsant medication to control seizures, the potential role of pharmacy in Kenya is immense.

Through my interaction with Kenyan and American physicians and medical students on rounds, it has become clear the effect we can have on patient care when working closely together. The Kenyan interns are often responsible for over 25 patients a day, a truly mind boggling thing once you understand the amount of work required in each patients care. I found my role on the team often changing from typical pharmacy related medication issues to recommending appropriate labs, calling attention to electrolyte disturbances, and addressing untreated medical problems. Purdue pharmacy students have a unique opportunity to truly make a difference in all aspect of patient care. Once you earn the trust of your team, they will look to you as the expert in all things related to medication. I not only recommended dosing, but also specific agents we should use based on patient and disease specifics.

Learning did not end with ward rounds. We had daily patient discussions with Sonak that enhanced not only our medication knowledge, but also our critical thinking skills. We used this opportunity to present difficult patient cases and determine the best management for each patient. Other unique learning opportunities came from our interaction with Kenyan pharmacy students. They made the transition from work in America to Kenya much easier. As I looked down at a treatment sheet for the first time, I had no idea what half of the medications were treating. Disease such as typhoid fever, PCP, malaria, toxoplasmosis, and tuberculosis are a common diagnosis here rather than a rarity. We were able to share our knowledge base with each other and form friendships along the way.
My eight weeks in Kenya have offered much more than just a learning experience.
The opportunity to experience a new culture and meet people from around the world has been amazing. I’ve tried new things and stepped outside my comfort zone. I clearly remember my first time walking through town. I felt like an outsider for the first time in my life. All eyes were on me as I walked through the dirt streets of Eldoret. To my surprise, I was greeted with smiles, waves, and best wishes for the duration of my stay here.

There’s a sense of camaraderie and respect for one another found here that we’re often lacking in the US. I’ve met a lot of amazing people here and I’ll never forget the kindness and generosity they’ve shown me. I’m grateful for all of my experiences in Kenya, the good with the bad. I hope that in some small way my stay in Kenya has made a difference because it sure has left a lasting impression on me!

The Student Perspective - Shauna Santare

After completion of the Kenya rotation, I have been able to better evaluate the impact pharmacists can make to improve patient care. As my first experience with clinical pharmacy and also within any hospital setting, I had to quickly learn to adjust to following many patients with different disease states and following up on their care daily. I gained a lot of experience in multidisciplinary care rounds, which definitely influenced my interest in clinical pharmacy. MTRH was the first opportunity where I have had involvement in important (life or death) patient care decisions and in-depth discussions with physicians. I felt as though my opinion and knowledge were respected, and that confidence boost provided self motivation to continue my efforts.
I enjoyed this rotation for more than the obvious perks of weekend trips, new friendships, and cultural broadening. Reviewing charts may have felt tedious at times, but I learned to filter information for pertinent lab results. This skill is necessary at my new rotation site, where I am “rounding” in a different ward every day of the week and have many more patients.
I felt very intimidated in the beginning of the Kenya rotation because we were immediately thrown into the experience and had to learn to fend for ourselves. Looking back, I realize this was the only way it could be done. As for the rotation itself, I cannot recommend anything to be changed.

The Student Perspective - Tobie Rogers

Before arriving in Kenya, I was very apprehensive about the experiences that I would have. I had heard horror stories about the sights and smells in the hospital. I was also still slightly nervous about the environment that I would be living in, especially after the post-election violence. However, I knew that Purdue would not let us go if we were not going to be safe. The first week or so of rounds, I was very overwhelmed. I was fortunate enough to have rounded on a medical team before; however, I had never covered a patient load of this magnitude. The charting and lab reporting system is very different from what I am accustomed to and made thumbing through the charts somewhat challenging at times. I was also not used to being a member of such a large team, which reached over 20 people occasionally. Fortunately, the sights and smells were not nearly as horrible as I had envisioned them in my head. Eventually, I was able to somewhat adjust to their system and become more at ease with my role. Looking back on the experience, I was able to identify some of the challenges and benefits associated with it.
In the beginning, rounds were very trying for me, in that I often felt useless and unhelpful in many ways. One major barrier was actually hearing the Kenyan medical students and doctors as they tend to be very soft-spoken. This coupled with the fact that I was at the very back of the pack of students made deciphering what was going on very challenging. However, as I began making pharmacological recommendations to the team, I began to earn their respect and a spot nearer to the front. As time passed, I found that the interns would seek me out while they were admitting for recommendations. At the end of my time with my team, I felt I was a very vital member of the team.
Another major frustration stemmed from not knowing which medications were carried by the hospital and the lack of medications available for use. We were given a ‘formulary’ at first, but it was never updated over the course of the rotation. It may be beneficial to actually develop a formulary and printout a list of stock outs either daily or weekly for the entire medical staff including pharmacy, nursing, and medical students and interns. Another alternative for the pharmacy students is to hold a brief meeting every morning to give updates on current medications that are not available. I found often that I was halfway through rounds before it was brought to my attention that a medication was out of stock, which required me to go back through all the treatment sheets to change those medications on the patients that had already been seen.
Finally, the nursing staff is overworked in that there are not enough nurses scheduled to work for the number of patients that are in the hospital on any given day. This leads to less than exceptional care for the patients; which means that medications are often not given appropriately. I feel that it may be beneficial for the pharmacy students to present brief in-services to the nursing staff on a weekly or bi-weekly basis. It is important to discuss the treatment of infections and disease and emphasize the importance of compliance and receiving the medications at the time they are ordered.
Although the rotation was challenging at times, there were positives as well. First, the pharmacy students from Nairobi are a great addition to the medical teams. Their knowledge of the name brand medications and standards of care in Kenya are invaluable to the team. Also, their ability to speak Kiswahili is an added benefit. Communication with patients would have been much more challenging without them. I feel that we learn just as much from them as they learn from us.
This experience also exposes us to various disease states and infections that are not often seen in the United States, offering a great learning experience. I felt that I learned a great deal of information that will help me as I pursue a career in clinical pharmacy. A large amount of information that we were exposed to is applicable while practicing in the United States, while the rest is merely a great learning experience. I also enjoyed venturing to the clinics to work in the pharmacy. It was great to interact with the patients and practice speaking Swahili.
I have been home for a week now and looking back this experience was more than I ever thought that it would be. Although it was frustrating at times, it was also very rewarding. My most memorable experience at the hospital was with an HIV+ woman who was experiencing symptoms associated with zidovudine-induced anemia. I went to the AMPATH pharmacy and switched her zidovudine for stavudine and took it back to her. A few days later, I was standing at the nurse’s station reading charts and she came up to me to tell me that she was feeling better and that she would be going home. She said thank you, shook my hand, and walked away. A week or so later as I was walking through the hallway in the AMPATH clinic, someone grabbed my arm. When I looked down, it was the same woman. She told me that she was there for her follow up and thanked me again for helping her. I felt amazing knowing that I helped someone and made a difference in their life, even if it was only that one person.
I learned a great amount of medical and pharmacy information in the time I was in Kenyathat will help me professionally. However, I also was able to learn a lot about the people of Kenya and its culture through talking to the Kenyans that live and work at IU House and to the pharmacy students from Nairobi. It was definitely an experience that I will not soon forget. My hope is that after graduation, I will be able to go back to work at Moi and visit with the friends that I have made. Who knows, maybe one day I will be the first psychiatric pharmacist in Kenya!! I am quite certain Sonak is counting down the days until my joyous return!!!

The Student Perspective - Alex Fohl

Practicing pharmacy at Moi Teaching and Referral Hospital in Eldoret, Kenya revealed a health system highly influenced by pharmacists and demonstrated effective management of patients in a resource-constrained setting. The past two months have re-enforced the difference a pharmacist can make in patient care. MTRH has made a permanent impression on how I will practice pharmacy in America and has demonstrated the positive impact pharmacy can have on patient care regardless of the setting.
Moi Teaching and Referral Hospital currently has a number of outpatient clinics (cardiology, diabetes and oncology) to accommodate the follow-up of patients. Doctors are involved in the clinics, but the pharmacists take significant responsibility in ensuring patients understand their medication regimen and monitor their own therapy. The pharmacists act as the first line in the clinics, and they defer complicated patients to the doctors and ensure the doctors agree with the assessments of routine patients.
During our rotation, we assessed the need of an anticoagulation clinic in Eldoret based on a chart review of cardiology clinic patients. Currently, patients are being anticoagulated in the hospital and either sent home on a dose which will hopefully maintain a therapeutic INR or they are sent home without any anticoagulation at all. Most patients are sent home without any anticoagulation because there is no means to reliably monitor the patient’s INR due to the lack of resources and funds. Kenyan patients also lack a regular diet which may result in alterations in their INR. The anticoagulation clinic we are setting up will help to manage patients on their anticoagulation medications and may eventually yield an opportunity to establish a valve replacement clinic within the hospital.
Something that really surprised me during this rotation was the condition of the wards. Upon walking into the hospital the smell nearly takes your breath away and no one breaths through their nose for the rest of the day. Proceeding down to the Nyayo wards, the men’s ward is to the left and the women’s ward is to the right. Each ward is divided into six cubes with each cube holding eight beds. Normally there are two patients to a bed with their heads facing in opposite directions. There is no identification for these patients, and I do not know how the nurses ensure that the correct patient receives the correct medication. There are times when I am not sure we are talking about the correct patient when we are holding the patient’s files during rounds. The condition of the wards really surprised me, but patients do receive their medications and improve.
AMPATH is very impressive and it is hard to imagine that it started in 2003. Currently, it is an integrated and established department for Moi Teaching and Referral Hospital. AMPATH has helped so many patients and doctors in the hospital refer patients regularly to AMPATH. This is an excellent example of the influence pharmacists can have in the practice of medicine with some determination and effort. I know there were a lot of people that told professor Mamlin this would be too daunting of a task, but his confidence in his abilities remained strong and currently AMPATH is a reality.
The experience I will remember most regarding my clinical experiences in Kenya revolve around a little girl who presented with an exacerbation of sickle cell anemia. She may have been eight years of age, but weighed only 25 kg. She was in so much pain she winced every time we touched her stomach or moved her. She refused to talk to us or even smile. Her father, a man suffering from the effects of polio since birth, remained at his daughter’s side day and night. Family remaining at the patient’s bedside for the duration of their stay is a common occurrence in Kenya. Although there are visiting hours, patients are permitted to have one family member present at all times. This often proves useful during rounds because the patient’s representative is able to update us on the patient’s status over the night better than the nurses. The patient’s representatives act as the patient’s primary caretakers while they are in the hospital. After a couple days in the hospital, we realized that our patient with sickle cell disease was not receiving the medications we were requesting. After talking to the nurses and the pharmacy multiple times, we were able to get our patient the care she required. After a couple of days, she made a full recovery and became a very happy young lady once again. Her father was so thankful her daughter was back in good health again, he shook my hand every time he saw me in the streets. Seeing our patient smile as she walked out of the wards has left a permanent impression on my patient care.
The practice of pharmacy in Kenya demonstrated the importance of pharmacists taking an active role in the care of patients. Pharmacists have established multiple clinics to patients’ needs and work directly with patients during follow-up visits once they are discharged from the hospital. From this experience, I have a thorough understanding of the common tropical diseases present in Kenya (ISS, malaria, tuberculosis, PCP, cryptococcal meningitis and toxoplasmosis), but I also understand the importance of pharmacists establishing themselves as active participants in patient care both in the hospital and in the community. If patients can be effectively managed in the resource-constrained society of Eldoret, Kenya, patients can be effectively managed anywhere in America, but pharmacists have to become essential to the practice of medicine.

Alex Fohl
PharmD Candidate, May 2009

The Student Perspective - Maria Thompson

The Kenya rotation is unique since we are able to learn and grow in many facets of life, not just in pharmacy knowledge. In addition to pharmacy knowledge, I have gained cultural experiences, inter-professional experience, and the opportunity to assist with improving the system through individual projects.
The pharmacy knowledge gained is phenomenal. As students, we are able to round on teams with doctors nearly everyday. Also, the opportunity to use your clinical knowledge on the patient’s treatment is a great experience to build confidence but can also be challenging. This was my first rotation so I felt a bit overwhelmed in the beginning but patient discussions assisted me with thinking through regimens.
This rotation is also unique in the diverse areas of pharmacy it exposes to the students. I rounded in both the women and men wards. The medical issues dealt in both wards were different which exposed me to many disease states. I was also given the opportunity to round on the pediatrics ward. I really enjoyed seeing the children even though it is tough to see them suffering. Pediatrics is interesting because your patients have a greater chance of recovering than geriatric patients but if they do not recover it is so much more devastating. In addition to rounding on patients, I attended the oncology and diabetes clinics. The diabetes clinic showed me an ambulatory setting for a pharmacist. Additionally, we traveled to regional AMPATH clinics to assist in dispensing medication.
The impact we are able to make as pharmacy students is enormous in this setting. I am currently preparing a spreadsheet of oncology regimens which I will calculate the cost. The information will assist the oncology clinic at MTRH in creating updated oncology protocols. This project will affect each cancer patient in Eldoret and will maximize the use of resources.
This experience has taught me the difference in American and Kenyan cultures. I found American lifestyle to be more fast-paced and very systematic. Kenyan lifestyle is more slow-moving and runs on organized chaos. However, being in Kenya humbled me more than anything. In general, Kenyans cherish family and relationships more than material items. Learning the differences has taught me to have patience in a new setting and to become flexible in new systems.
The two months in Kenya are spent living with many people from different backgrounds but all with the purpose of enriching themselves in a new culture. I was able to live and travel with medical students and physicians from America and Canada. Many friendships were created in Kenya with a variety of people from all over the world. Also, I was able to learn how physicians make decisions and see their thought process. The inter-professional exposure was exceptional since it gave me experience working with a team of doctors, medical students, nurses and clinical officers.
The Kenya rotation was a once in a lifetime pharmacy and cultural experience. Interacting with people from a different culture taught me more about myself than I could ever imagine. Most importantly, I learned this experience is more about a bilateral exchange of ideas and not the Americans coming over to change everything.
Maria Thompson
PharmD Candidate, May 2009

The Student Perspective - Lauren Hull

After looking back on the last eight weeks, I am very glad that I had the opportunity to live and work in Eldoret. Before coming, I really had no idea what to expect. I knew that I would see multiple patients per bed, many medications would be out of stock, and I would encounter many HIV positive patients. Outside of these things, I was clueless to what I would experience and see. Throughout my time in Kenya, I have learned so much. Kenya has given me much more than I could give back. I have learned to be flexible, to try new things, meet new people, and step out of my comfort box.
Rounding on the wards was a completely new experience for me. Initially, I was very nervous and unsure of myself. I was afraid of touching anything and being touched by anyone. As time went on, I got much more comfortable and was able to turn rounds into a learning experience. I really enjoyed having patient presentations in the afternoon because it provided an opportunity for me to have an impact on rounds and to increase my clinical knowledge. I really liked the opportunity to learn by taking care of the patients we were seeing everyday. It is very rewarding to know that the interventions we are making will better someone else’s life.
I am also glad that we had so many presentations and projects. The best way to learn is by doing, and we were able to learn a lot through our presentations. It is also encouraging to know that our work is not without purpose. It is encouraging to know that our projects are going to last long after we leave. The HIV adherence project is going to have a lasting impact on patient care in Kenya and other parts of the world. I am so thankful that we are able to look back on our time in Kenya and know that we are making an impact on patient’s lives while we are here and it will continue when we leave.
The best learning experience for me were the people I had the opportunity to meet and get to know. My favorite parts of my time spent in Kenya are the times spent in the car with a Kenyan or working alongside a Kenyan and getting to know their stories. Many Kenyans have a much different outlook on life than the typical American, and it is a refreshing view. I was talking to an AMPATH driver who was a victim of the post-election violence. In telling me his story, he told me that he and his family were very, very fortunate, all they lost in the violence was their property, and his mother’s home was burned. He went on to tell me that God was so good to his family and they were so blessed. I was very surprised by his views, if the same situation happened in America, many people would say “we lost everything, our home is gone, our property, everything”. It showed me that many Kenyans have much different values and priorities than a stereotypical American. I was also surprised by the hospitality and generosity of the Kenyan people. Many Kenyans were so welcoming of us and what we are doing. I was pleasantly surprised by the hospitality and friendship we were shown by the Kenyans.
During these past eight weeks, there have been some really good times and some really frustrating times. Overall, I would highly recommend this rotation and experience to anyone. It is definitely not a glamorous job and you may not have a phenomenal, life-altering experience; but it is definitely worth the time and effort to be here. It is an experience that will change you, maybe in huge ways or maybe little seemingly insignificant ways, but it is a wonderful experience.

Lauren Hull,
PharmD Candidate, May 2009

The Student Perspective - Anthony Gentene

I am very glad I made the decision to come to Kenya and thankful I had the means to come as well. There is quite a bit to say about spending 8 weeks in Kenya. There are many aspects of the trip from experiencing and learning the culture, time spent in the hospital, relationships built with Kenyans, getting to know my current friends better, weekend trips, improving pharmacy practice skills, and meeting many unique people at the IU house.
I was very surprised by how friendly most of the Kenyans were. They were really quick to make friends with us. The first Friday we were here they made sure to include us in experiencing the social life of Eldoret. My first week of rounds, the resident of my team took another American medical student and me out to lunch one afternoon. Multiple families invited large groups of us into their homes for dinner and tea. So many of the people we would meet at the hospital or the IU house were quick to welcome us to Eldoret. Others invited us to church and made sure we felt welcome there. I hope to remember how friendly the Kenyans were to us so when I go back the US I can return the warm welcome to visitors.
It is important to remember the obvious poverty and comparative wealth we have in the US and incredible opportunities we have. I feel like it is difficult to even write about this topic because the differences can be so drastic. It is essential we don’t forget this lesson when we go back to the US. It is easy to slip into our own thoughts and situation when life is busy, but it is important to remember past experiences and what we’ve seen. Not only to help us appreciate what we have, but to do something about helping others and allow them to experience at least a part of what we have been blessed.
I was able to further my pharmacy knowledge and skills during this time as well. We had many opportunities to discuss patients, ask questions, present on a variety of topics, and interact with other healthcare professionals from a variety of regions within the US and Kenya. During my time spent in the hospital wards on rounds I had the opportunity to work alongside Kenyan medical students, nurses, interns, and residents, American medical students, an American oncologist as well as regular interaction with fellow pharmacy students and our preceptor. It was a unique experience to work with such a variety of people. I was able to learn from them as well as pass on knowledge from a pharmacist prospective and hopefully advance others’ opinions of pharmacy practice through these interactions. I had two unique opportunities to participate and develop projects that would extend beyond my time Kenya. Our group was able to gather patient information that is going to be used to assess the need of and hopefully begin an anticoagulation clinic. The clinic will enhance patient care in Eldoret and will extend many patients’ lives. Another student and I were able to develop a tool to aid HIV medication adherence counselors. The tool provides information for the patient when they meet with the counselors and also guides the information the counselors will discuss with the patients. The project has potential to be utilized for over 70,000 AMPATH patients.
Two specific interactions in my time at MTRH have had a significant impact on me while I was here. There was an HIV patient who was on my ward who was admitted for oral thrush and cryptococcal meningitis. He happened to speak English so I was able to talk to him everyday and see how he was feeling over the three weeks he was in MTRH. He was finally discharged after improving with amphotericin B then switching to fluconazole due to nephrotoxicity. One week after discharge he came back on his own when our team was rounding to say thank you for helping get better. I never expected this patient to return to thank me. I was able to see him once more when he was meeting with an HIV medication adherence counselor and talk to him one last time.
For about three weeks our rounding team had an American oncologist from Brown University who visiting MTRH. During the three weeks I was able to learn much from her about the care of patients medically. At the same time I was able to observe her interactions with patients making sure she provided individual attention to each one, and despite the fact that most could not speak English, she was able to hold a patient’s hand or lay her own hand on their shoulder to communicate her care to each one. Towards the end of her time in Kenya we were having a large group discussion one evening conversing, in part, about the current and future role of pharmacists. She made a statement that as a result of her experience on rounds in Kenya, when she rounds in the US she wants a pharmacy student each time on her team. This was very encouraging and motivating to me knowing that I was on her team in Kenya and was able to have a positive influence on and receive a compliment from an established practicing oncologist that I grew to respect much.
My time in Kenya has been a unique experience that will continue to affect my life both personally and professionally. I have had many opportunities others will never have. One of the most unique aspects is that I have had the opportunity to influence and affect lives in Kenya while experiences and others in Kenya have been able to influence me. My hope is to continue to help patients in Kenya, despite being in the US, by updating and furthering our projects completed here. I don’t know where this will lead or when it will end, but I desire is for these experiences to continue with me and shape my practice of pharmacy, care of patients, and overall values and character as a person.

Tony Gentene
PharmD candidate, May 2009

The Student Perspective - Kathryn Ringenberg

My time in Kenya has been awesome. I would even go so far as to say it has been a life changing experience. Being immersed in a new culture for two months tends to have that effect on a person. I have grown in so many ways, both inside and outside of the realm of pharmacy. That is what is so great about this rotation. Your knowledge base and clinical skills are challenged and expanded through the direction of a preceptor who expects excellence. At the same time you are experiencing so much in addition to just pharmacy. The people, the culture, the food, the music…it is a refreshing experience.

Throughout this rotation the pharmacy students have had many different opportunities in many different settings. Our primary responsibility is patient care at Moi Teaching and Referral Hospital medical wards. This is an experience that takes some getting used to. The wards are like nothing you would ever see in the United States. The physical conditions of the facility take adjustment in and of themselves. Other challenges faced daily include out of stock medications, more than one patient per bed, no isolation for high risk patients (those with TB for example) and a nonsensical payment structure. These remained reasons for frustration, to say the least, throughout the duration of my stay here, but by the end we were able to adapt and really begin to make a difference. I saw how valuable pharmacists are to the medical team, especially during rounds. Not a day went by while working at MTRH that Purdue pharmacy students did not make an intervention on a patient’s behalf. More than once these interventions were significant enough to be life saving. Beyond this, during rounds my colleagues and I made friends with many Kenyan medical and pharmacy students. It took time to gain trust but I really feel these friendships will last beyond my two month stay in this country.

Outside of the hospital we spent time at various sites including AMPATH clinics. This was a great experience. Students worked with Kenyan pharmacists at these sites to dispense antiretroviral medications to HIV positive patients. It was during my experiences at the AMPATH clinics that I was offered a glimpse into the severity and extent of this epidemic disease. I looked into the eyes of 2 and 3 year old children infected by mother to child transmission at birth. They were destined to a life on complicated and not-so-benign medications by no fault of their own. It was heartbreaking but also rewarding to know that a difference was being made, and I was witnessing and even perhaps contributing to a small part of that. Without my time spent in these clinics I would still have no appreciating for the burden of this disease in sub-Saharan Africa.

Just being on the content of Africa and interacting with the people has made me fall in love with this place. I have learned that it is a place of much need but also great hope. This rotation allows you the flexibility and great opportunity to interact with students living at the IU compound from many different universities in the AMPATH consortium. One student in particular had an impact on me. He was here on a return trip doing work with street children, or children who live on the street at least part of the day in hopes of making money and surviving under the oppression of poverty. I was deeply impacted by watching him work with these children and gained insight into the complex social implications of this problem. I say this to emphasize that although I came to Kenya intending to learn mostly about tropical medicine as it relates to pharmacy, I left with so much more than that. This place gets in your blood, at least it did mine. The opportunities are so vast. It is wonderful to come here as a student under the direction of a preceptor, together identify needs, and then have the freedom to implement programs or research initiatives to make a difference. That type of flexibility is unique to a setting like this. The needs are great but so are the opportunities. The more you put in to this rotation, the more you will get out.

It is also great to be in a setting with other pharmacy and med students all working together. Learning and working together as students is an avenue to doing the same as professionals. I was amazed to watch as barriers were broken down between the two fields and students came to realize how complementary the knowledge base is between pharmacy and medicine. It was energizing to me to be on a rotation where everyone was working hard and we learned together.

It is probably obvious, but I really have loved my time here. If you are thinking about coming to Kenya please view this opportunity as a privilege. It is not a vacation. You will work hard, which is ultimately for your benefit and the benefit of all your future patients. There will be plenty of time to travel and experience Kenya as a whole, but I challenge future students to take the work they do here seriously. The Kenyans have come to depend on us, and we have the ability to make a huge difference. With a proper attitude this rotation is an absolutely incredible and life changing experience. I am so thankful I have had the opportunity to experience this place. I’ll be back. You can count on it.

Katie Ringenberg
PharmD Candidate, May 2009

The Kenya Rotation after the Post-Election Crisis-Jessica Reiter

As I’m sitting down to write this blog, I can’t believe I’m actually in Kenya. A few months ago, I didn’t think I was going to be able to come at all. I had even donated all of the clothes I had saved up to the Salvation Army. But once the peace agreement was signed and Purdue gave us the ok, I jumped at the chance. This wasn’t an opportunity I wanted to miss, and in the short time I’ve been here, Kenya has been every bit of the experience I thought it would be.
I have only been here for two weeks and I know that I am a different person today than I was when I arrived and I won’t be the same when I leave as I am today. I may not be learning as much about clinical medicine as the other groups have been, but I am learning so much about people and culture. Granted, it is a pharmacy rotation, so I am learning about HIV/AIDS and opportunistic infections, but being out in the clinics and experiencing the people of Kenya is what is making this experience so memorable.
Our main project during our 4 weeks in Kenya is to help implement a computer data base system at the AMPATH pharmacies. This is quite interesting as most people have never even seen a computer before, let alone ever used one. Everybody is very excited to have a computer and very eager to learn. Well, they are eager to learn how to use the computer, implementing it into everyday prescription processing is another story. Just seeing the excitement on somebody’s face about something we use on a daily basis, makes you stop and think about how much we take for granted.

We, in America, have things so much easier and have so many more opportunities but aren’t as happy as a culture. No matter where I go in Kenya, everybody is eager to shake my hand, welcome me to the country, serve me tea and mandazis (Kenyan donughts) and make sure I have a place to sit. The Kenyans will stand just to make sure I have somewhere to sit. I don’t think I have met a rude or unfriendly Kenyan yet. And, they are very patient. I have not seen anybody get upset about waiting – and I mean waiting. When we all went to the clinic in Kitale to bring them their computer and set up the data base, we took over the pharmacy for a good 2 to 3 hours where no one could get their prescription filled, and I didn’t hear one complaint. That would never happen in an American pharmacy, people get upset if they have to wait 5 minutes. Most of the Kenyans aren’t the richest people financially, but they are some of the richest people in heart I have ever met. They would drop what they were doing the second you asked for anything. I hope to bring back to America a portion of the kindness, patience, friendliness, and thankfulness that I have seen in every Kenyan I have met so far.