Eyes of Africa: Medical student interns in Kenya


 

HWCOM student Geoffrey Collett examines a patient during his internship in Kenya

HWCOM student Geoffrey Collett examines a patient during his internship in Kenya

Geoffrey Collett is a second year medical student at the Herbert Wertheim College of Medicine (HWCOM) and is president of the Ophthalmology Interest Group. This first-hand account of his summer internship in Africa first appeared in the October edition of EyeWorld, the news magazine of the American Society of Cataract and Refractive Surgery, and is published here with its permission.

By Geoffrey Collett

When I initially considered my father’s advice of visiting Kenya for a medical internship, I was hesitant more than anything else. Recent terrorist activity in the country’s coastal region was well-documented by media outlets and my father, who worked for a Nairobi-based NGO at the time, had shared one or two unsettling stories. However, the prospect of contributing to the health care environment of a relatively poor country gave me the courage necessary to at least explore the option. A few months later, I was officially invited for a 10-day ophthalmology internship at Kenyatta National Hospital and by this time, my bit of courage had evolved into determination.

My journey began on a humid July night in Miami. The air route to Nairobi included a short layover in London, but that was the only short stage of an otherwise lengthy process. Being greeted by my dad upon arrival was a welcoming sight and it made me feel this trip was simply meant to occur. However, a hitch soon presented itself: my first scheduled day on hospital grounds had been cancelled due to an opposition-party rally in nearby Uhuru Park. The demonstration was deemed potentially dangerous, but fortunately this was incorrect and the rally proceeded peacefully. I reported to KNH at 8 a.m. the following day, where I was greeted by Professor Dunera —  chair of the Ophthalmology Department and my primary contact. After a warm introduction to the physicians and residents, all was back on track and it was time to get started.

I was left in the hands of the ophthalmology residents running Kenyatta’s eye clinic, whose focus that day was corneal diseases of the eye. Their knowledge and training obviously surpassed those of a first year medical student (such as myself), so the next few hours were a non-stop learning experience. Crash courses on visual acuity, cataracts, corneal ulcers, keratoconus kept coming my way. I actively participated in the examination process, using the slit lamp to gauge our patients’ eye health. Majority of patients had good prognoses, such as refractive errors that could be corrected with discount eye glasses. After a relatively long day, it was great to join the residents for a traditional meal of rice, beans and ugali — followed by, of course, a cup of tea.

The next day, retinal diseases were at the forefront. And since I lacked the ability to use indirect funduscopic methods, I kept my direct ophthalmoscope handy the entire time. Slowly but surely, I began to recognize changes the posterior of the eye undergoes as a disease progresses. For example, the small dark lesions that develop in early stages of retinitis pigmentosa or the increased cup-to-disc ratio in advanced glaucoma. Most patients this time were diabetic and hypertensive and suffered from retinopathies as a complication — unlike the prior day, prognoses were significantly worse. It was a tougher day in that regard, but I tried to mirror my superiors and remained upbeat as we helped these folks as much as possible. I was with the residents for the remainder of the workweek, with clinic days being more generalized than the first two. The amount of knowledge and experience I gained, however, remained at a high level. All in all, KNH’s eye clinic attended 50–70 patients each day and the small contributions I made to their well-being is something I fondly remember.

HWCOM medical student Geoffrey Collect examining the eyes of a patient during his internship in Kenya

Professor Dunera and I met on Friday evening to discuss my experiences. She was pleased with my progress so far and suggested I should participate in an upcoming project that would make my visit truly unique — a medical safari. I was immediately sold, but asked her to elaborate to avoid coming across as compulsive. This journey would take me to Mwingi, a small town east of the capitol, and would be the last stage of my internship. Professor Dunera was confident that experiencing the work of an ophthalmologist in a rural setting, with limited resources, serving patients in dire need of eye care would increase my passion for the specialty and she could not have been more spot-on.

Professor Karimurio and Dr. Muchai led a team of six residents on this medical safari. During the drive, Dr. Muchai assured me I would play a significant role in the outreach project and although this made me somewhat nervous, my excitement trumped those feelings.

When we arrived at Mwingi District Hospital, I was struck by the lack of essential components it suffered from. The eye clinic had no running water, it had to be carried over from another hospital wing. The waiting area had space for only two patients — the remainder sat on the ground outside, where some had camped for the night. The operating theater was short on almost everything, ranging from scalpels to gauze. Fortunately, our microbus was loaded with plenty of medical supplies and the hospital staff helped us set up shop and get going.

The rest of the day was spent examining patients, most were elderly and suffering from severe vision loss due to cataracts. My primary role that day was to gauge visual acuity, so I experienced first-hand just how poor their vision was. In many charts I recorded HM or LP, meaning the patients could only recognize a waving hand or bright light. There were a few who were completely blind and unfortunately, we could not do much for them. However, most patients were deemed good candidates for surgery and the next day we arrived at dawn to set up theater.

The limitations the physicians dealt with were very challenging. For example, disinfection of surgical equipment had to be done using a large water pot and a gas burner. The amount of work, patience and dedication on their behalf was simply extraordinary. I was given the task of preparing patients for surgery, which included the pupil dilation process and retrobulbar blocks (restricts eye movement and provides local anesthesia). I also assisted three rotating surgeons in theater, carefully balancing observing/listening when they were teaching and quickly following instructions when they gave a command.

Over the course of 14 hours, 27 ophthalmic procedures were performed — exhausting yet satisfying work. Our final day was by far the most rewarding, for we got to examine patients and gauge their progress. My favorite was checking on those who underwent surgery — the vast majority had improved vision and it was nothing short of uplifting to see how joyful they were with the results. Even when the results were minimally positive, clinically speaking. It was the perfect way to cap off one of the most memorable activities of my life.

My time in Kenya did not come to an abrupt end as soon as the medical safari concluded. I then celebrated the successful outreach project with the doctors; explored Nairobi and hiked the nearby Ngong Hills; and went on nature safaris to Lake Nakuru and Maasai Mara with my father.

Each experience was amazing in its own right, but cannot be compared with my ophthalmology internship because during it, I got to live out a dream. A dream to contribute positively to this world and leave it a little better off than when I arrived. I am very thankful for this humbling experience because it reminded me how rewarding this noble profession can be if it is carried out in noble fashion.

 

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