AMPATH Success Stories: Medical students Shukri and Summaiya

Background: Shukri and Summaiya are both 6th-year medical students, which means they are in their final year of schooling before becoming interns. They are also among the first friends that we made living at the hostels, and since then, they have taken us under their wings. This was the most boisterous and charged interview I've had yet, and they are truly inspiring to me because it is their passion and dedication to medicine that shows that they, along with their peers, are the future of Kenyan medicine. I am straying from my typical interview format in this entry simply in an attempt to capture the flow of their exchanges.

Summaiya: I've always dreamed of being a doctor, but it can be frustrating being a medical student. It is frustrating, but rewarding too. When I went to the wards, I realized the impact students could have on patients. The story I always remember is of a 4 y/o patient named Sharon whom I met in my 4th year rotation in Peds. She had presented with multiple fractures and stab wounds, and she was clearly a case of child abuse. However, everyone was so busy that no one noticed, except for the medical student whose job it was to take detailed histories of the patient. Now in the US, you would probably get an x-ray and see old, healed fractures, or have a psychologist, but here, we don't have that. So it often ends up being the medical student who spends the most time with the patient, and when I looked into her story, I found out that she was being abused by her step-mother. But, even after this, it is frustrating since it doesn't matter; she still went home. This is an issue of culture, not government, since the government has given us community health workers, social workers, the Child Protection Act; but we need community acceptance that such things are happening and they need to be reported or addressed. This story is the reason I want to go into pediatrics.

Shukri: I don't really have a story that I remember since I think I deal with problems by forgetting. I actually ranked law school as my first choice in high school, but then I decided to pursue medicine, and I went to Poland to study. However, it was hard. There were five of us Kenyans in the program, and I was very homesick. Every day I would talk to my mom about coming home, and she would say, "yes, come home". I would then talk to my dad, and he would say, "no, don't come home". The NGO that was supposed to sponsor us didn't end up giving us as much support as they promised, so my parents were paying around 20K per month. Plus, once the money reached me, there wasn't much left after rent and groceries, so I felt like my parents were struggling for nothing. The language was different and not many familiar faces around. I became depressed, we all were. After that, I knew I had to return to Kenya, and when I did, I requested a transfer to Moi University School of Medicine, and they accepted me, so I came here!

But in Kenya, the working conditions are pretty terrible for doctors. It is nice in MTRH (Moi Teaching and Referral Hospital), but in the periphery health centers, there can be no gloves or antibiotics. Interns can work for 72 hours without sleeping.

Summaiya: Except for naps when you can. Plus, interns only get peanuts for pay. Then once you're a Medical Officer (MO) [like a resident], the government doesn't want you to continue your studies to become a consultant [like an attending] because you would have to leave and then there'd be fewer workers, plus they'd have to pay you. But then if you just want to find a job after your internship, they no longer place you randomly either, you have to apply. And if you apply, you will only apply to your home area or areas like that because counties will also only hire those of their own tribe.

Shukri: Counties and states were created after devolution happened [in 2010] in Kenya. Each area was given their own power to make rules, have their own governing body, and have their own funds. Health was partially devolved. This really helped some counties who used their money well, and they have progressed a lot, but for other counties that have local corruption, it really hurt. Plus now, doctors can't stand up and fight the government since the local government probably knows you personally, since it is small, and people could walk into the hospital and slap you. The government also ordered a lot of new equipment for the states to use, even before the states had personnel or training to run it. So a lot of the equipment is being leased and paid for, but just sitting in Nairobi, not being used.

Also, there are so many ambulances, but they're not maintained. If a patient needs an ambulance, they have to go to the county government, clear it with them, then pay for fuel…in fact, there was a patient once in Kisii who emergently needed an ambulance, but it wasn't available since a MCA (member of county assembly) had used it to transport the tomatoes from his farm.

Summaiya: See, the problem is not the central government. If you give the government a proper budget, they will accept! The issue is local corruption. The local government can say they're spending 100,000 shillings to buy a wheelbarrow, or 50,000 shillings to buy a pen. Like seriously dude? We'd be better off having one government handling the money and dividing everything equally.

Shukri: I mean, they can steal 20 million, we're OK with that. Not 300 billion!

Summaiya: The thing is we need to nip the problem in the bud. These big thieves come from being small thieves. Even at the university level, there are thieves, and students just accept it! Before, the hostels were clean and the toilets flushed. Now, there is no one to fix these things.

Shukri: They just say the university has no money. We don't even get printing anymore. Then if we don't pay school fees, they will come and take your mattress.

Summaiya: And as students, we accept this. We won't stand up together and hold the school accountable. We just want to finish and graduate without more problems, so today, they don't print our logbooks. Tomorrow, our toilets don't work. Then our projectors are gone. Then what? We are left with blackboards? Every weekend we don't have water at the hostels, but everyone is busy with their lives, so we just say "we can deal with it. It's just a weekend after all". We are supposed to be the voice of our community, and we can't even protect ourselves!

Even with the doctor's strike. Every year before the elections, the government chooses a sector to suck money out of for campaigns. This year it was health. Last election it was education. Primary school level kids were out of school for ½ year. For the doctors, we wanted more health infrastructure, more students graduating and employment, as well as higher pay. The public supported us in the beginning. But then it got twisted into how doctors just wanted higher salaries, and in the end, even my own family didn't support the doctor's strike.

Shukri: Mine supported me.

Summaiya: OK, well that's just you!

But anyways, every election year, everyone just points out the negatives about our country. But in the end, there are so many good things. Our country is amazing.

Shukri: Yes! We are so diverse. I remember when there was a terrorist attack by Al-Shabaab where they stopped a bus with both Christians and Muslims on board, and they wanted to call off all the Christians and kill them. Instead, the Muslims on the bus gave the Christians veils to keep the terrorists from being able to differentiate between them, and protected them.

Summaiya: The goal of the terrorists was to start a religious war between the Christians and Muslims, but everyone stood up and said all for one and one for all. That is one of the most amazing things about Kenya. During this time, our government even told the media to only show positive messages in support of one another. Heightened security checks based on religious grouping stopped, and by doing so, we stopped giving the terrorists power. We were unified. The media didn't capitalize on tension between the groups, which was obviously going to be there. We didn't give it power. We educated and loved.

Shukri: After the Westgate shootings too, the immediate relief response was so fast and so much blood was given that we ended up with enough to respond to the crisis, plus enough to store as extra reserves for the hospitals in the future.

Summaiya: At the end of the day, it doesn't matter what tribe you are in. If someone speaks out against Kenya, everyone is Kenyan together. "