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
Monday 28 July 2008
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 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
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
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
Sunday 27 July 2008
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
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
Subscribe to:
Posts (Atom)