L to R: Drs. Ashley Mack, Arcella (consultant) and Elizabeth (intern); and Carol (nutritionist)One of our PGY 3 residents, Dr. Ashley Mack, spent a month in Kijabe, Africa with a former resident of ours, Dr. Arianna Shirk (Class of 2010). Please see Ashley’s wonderful reflection on her time spent in Kijabe!
March 2023 was a month of growth, challenge, laughter, responsibility, and gratitude, as I worked on the pediatrics floor at AIC Kijabe Hospital in Kijabe, Kenya. Based on prior experience, I knew there would be things I’d forget if I didn’t write them down, so I kept a journal and made lists during my time there. This will be in part an abbreviated version of that.
There were plenty of times when my plans for patients were met with “we don’t have that,” and I felt stuck. I learned to adapt and adjust - and to realize that we can get a lot from history and physical exam without relying on fancy tests. At the same time, I’ve seen a two year old from a rural community present with severe malnutrition and get diagnosed with double outlet right ventricle (on one of the few days each month echos are available) and a three month old get diagnosed with likely congenital hypothyroidism (in the absence of routine newborn screens). Without abundant subspecialists, my knowledge was stretched beyond general pediatrics to just about everything else. Glucose and calcium and bilirubin and temperature scales were unfamiliar, until I slowly learned a new normal. My reliance on supportive staff was exposed, as I leaned on others to draw labs, collect urine samples, and place IVs - things doctors routinely do there. My vocabulary grew to include HB for hemoglobin, “sawa” for “okay,” convulsions for seizures, and ondansetron for zofran. Rounding independently with the interns (who are rotating through every specialty) both prepared me for decision making as an attending and reminded me of the great privilege we have to take care of children and their families. My co-workers - interns, consultants (attendings), PECCCOs (PAs-ish), nurses, nutritionists, therapists - became dear friends and trusted colleagues from whom I learned every day.
Outside of the hospital, I developed the habit of getting home and wondering if the water was on, until the recent rain that was celebrated amidst drought. I discovered a love of samosas and mandazi and passion fruit fanta. The sight of monkeys or baboons on my quick walk to work became routine, as did my shortness of breath while taking that walk at altitude. Driving on the left side of the road never quite clicked, and while I never had to drive, I did have quite a few awkward sidewalk shuffles. The women at the vendors market knew to expect me to buy muffins, pineapple, and avocados. I shared a house and experiences with people from around the world.
As stark as some of the differences were, the similarities were too, and I think that’s the beauty of global health. There is still bronchiolitis, prematurity, asthma, cancer, cellulitis, and even the beloved social admission. Sometimes there are more layers to familiar things, like pneumonia (but could it be TB?), gastroenteritis (what about amebiasis?), malnutrition (and rickets?), fever of unknown origin (malaria? rheumatic fever? leishmaniasis?). At Kijabe, the rooms on the pediatrics floor, which are shared by up to eight patients, are labeled by letters corresponding to values. Courageous, furaha (happiness), grace, joy, kindness, and hope are among these. Wherever we are, I think we have an opportunity to instill and demonstrate those values to our patients. Among the knowledge, perspective, and souvenirs I took with me, I took that mission as well, just as much as I hope I left it.
Ashley Mack, M.D.