Connecting With Patients in Kenya

Dr. Andy Baldwin’s first visit to Kenya was for an endurance event – an ultramarathon that served as a fundraiser for vulnerable children in Kenya, Ethiopia, and South Africa. He chose to return last fall for a different type of endurance event: A month of medical practice and teaching as part of his family practice residency.

"Being in the Navy, I have traveled all over the world and have really come to love global health," he said. "The impact you can have is so rewarding." When he knew he would have an elective month as part of his residency, Dr. Baldwin did some research and learned of Chepaiywa Health Center in Kipkaren, Kenya, which is supported by Empowering Lives International.

Describe health care in this part of Kenya.

The clinic is located outside Eldoret, Kenya, and there are few other options for medical care in that area. There is a high infant mortality rate, and there are many problems associated with HIV/AIDS. They especially need doctors who can help educate nurses and laypeople about neonatal resuscitation; many babies are born at home, which means in mud huts, and they are not getting good postnatal care.

What resources are available in the clinic?

The health center, which they call a dispensary, started by meeting very basic health needs and providing medications. In recent years, with volunteers and donations, it has gone from one room to four. But it is still a very difficult experience. Many of the medications are expired, for example. They now have a makeshift delivery table and a portable ultrasound machine, but there is no continuous external fetal heart rate monitor, and sometimes it’s hard just to find gloves to wear to help deliver babies.

Photos courtesy Dr. Andy Baldwin

I also became very familiar with low-tech laboratory testing. They had a lab but no centrifuge, so the patient would have to wait all day for gravity to do its job and separate the plasma from the blood samples in the test tubes.

What types of conditions did you tend to treat?

We were running tests for typhoid fever, not the salmonella that doctors see in the United States, and also brucellosis. Every patient was tested for malaria, and we would look at it under the microscope. I would say that approximately 50% of the people there had malaria; it is almost as common as the flu is in the United States. There was medicine available, and most people who were treated recovered fairly quickly. People who are naive are at increased risk, so I made sure to take my malaria prophylaxis medication.

What were some memorable cases?

There was one case of a woman with a massive bowel obstruction. She came in and was in a lot of pain and I couldn’t diagnose what she had. I had to use my basic clinical skills because there was no imaging and our medications were limited. We kept her hydrated and finally we were able to send her elsewhere for higher-level care.

There was a particularly sad case involving a young girl with bacterial meningitis who died because we simply didn’t have the resources to treat her and we couldn’t get her to another facility in time. And there was an HIV-positive patient with a very low blood count and severe anemia who died because we didn’t have any blood to give him. And in some cases, people were unable to receive care because they didn’t have the money to pay for it. In many ways the limited resources made me furious, but it also made me realize the things we take for granted in medical practice in the United States.

What type of training were you able to share with local health care providers?

Probably the most important part of my trip was the teaching, because that will endure after I leave. I saw a lot of patients, but that is of finite benefit. If you teach someone, they can teach others. I taught a lot of neonatal resuscitation and perinatal care, including the importance of suction and clearing the airway, and performing positive pressure ventilation if the baby isn’t breathing. Ideally, the people I taught can teach midwives and other caregivers, and I have heard that they are already seeing the benefits from this training in terms of reduced infant mortality.

I also tried to explain the importance of cooking outside rather than inside, which is the main cause of chronic obstructive pulmonary disease there, and I talked about the importance of using bed nets to help control malaria. We had a health fair, and people really appreciated that. We also did a community outreach program distributing eyeglasses from a van. We also brought a dentist who was able to remove abscessed teeth. It was so rewarding to be able to provide that kind of relief. Giving simple things like the ability to see or to take a bit of the pain away is one of the things I enjoy most about medicine.

What were some other differences in medical care in this part of Kenya compared with the United States?

There were no real expectations from the patient’s standpoint. In the United States, patients expect doctors to treat and cure them, but in Kenya there is no malpractice insurance or litigation. Whatever you can do to help, you do. Doctors are seen more as the source of medications.

Also, a lot of the health care we provide in the United States, especially in internal medicine and family medicine, has to do with the treatment of chronic disease. We do a lot of screening and prevention, but also a lot of tertiary prevention for things like diabetes, hypertension, or heart disease. Those chronic conditions don’t really exist in Kenya, because the food they eat is completely natural, and they live active lives out of necessity. They walk or run everywhere they need to go. So if they don’t develop cancer or an infection, they tend to lead very long, healthy lives.

There’s such a lack of health care there, but I think we could learn a lot from the Kenyans in terms of the simplicity of their way of life.

What can you take from your experience in Kenya that you will apply to your medical practice in the future?

As a Navy physician, my main priority for my patients is to help them maintain their physical health and readiness to accomplish the mission.

It’s all about keeping the active duty persons and their families healthy, so physical fitness and nutrition are top priorities, and I want to continue to stress making those things part of my patients’ way of life. We should try to live more like the Kenyans in terms of eating more unprocessed, natural food and being active and exercising every day.

I also want to continue to focus on helping my patients decrease stress to improve their health. I was never as stress free as when I was in Kenya, and there were no cell phones, no TVs, none of the distractions, and you are living in the moment and surrounded by nature.

All the high-tech things that we have in the United States keep our cortisol levels sky high all the time, and that’s not good for overall health.

My experience in Kenya also reinforced for me that I want to have a wellness-centered practice, with a holistic approach that includes physical trainers and nutritionists who provide good care and education about how to live the best life you can and be as healthy as you can be.

Working overseas can give physicians a perspective that you cannot get any other way. I think you become a much better doctor. You appreciate how good we have it in some ways, but also what we can learn from people who have less.

Think globally. Practice locally.

U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column.

Dr. Andy Baldwin’s first visit to Kenya was for an endurance event – an ultramarathon that served as a fundraiser for vulnerable children in Kenya, Ethiopia, and South Africa. He chose to return last fall for a different type of endurance event: A month of medical practice and teaching as part of his family practice residency.

"Being in the Navy, I have traveled all over the world and have really come to love global health," he said. "The impact you can have is so rewarding." When he knew he would have an elective month as part of his residency, Dr. Baldwin did some research and learned of Chepaiywa Health Center in Kipkaren, Kenya, which is supported by Empowering Lives International.

Describe health care in this part of Kenya.

The clinic is located outside Eldoret, Kenya, and there are few other options for medical care in that area. There is a high infant mortality rate, and there are many problems associated with HIV/AIDS. They especially need doctors who can help educate nurses and laypeople about neonatal resuscitation; many babies are born at home, which means in mud huts, and they are not getting good postnatal care.

What resources are available in the clinic?

The health center, which they call a dispensary, started by meeting very basic health needs and providing medications. In recent years, with volunteers and donations, it has gone from one room to four. But it is still a very difficult experience. Many of the medications are expired, for example. They now have a makeshift delivery table and a portable ultrasound machine, but there is no continuous external fetal heart rate monitor, and sometimes it’s hard just to find gloves to wear to help deliver babies.

Photos courtesy Dr. Andy Baldwin

I also became very familiar with low-tech laboratory testing. They had a lab but no centrifuge, so the patient would have to wait all day for gravity to do its job and separate the plasma from the blood samples in the test tubes.

What types of conditions did you tend to treat?

We were running tests for typhoid fever, not the salmonella that doctors see in the United States, and also brucellosis. Every patient was tested for malaria, and we would look at it under the microscope. I would say that approximately 50% of the people there had malaria; it is almost as common as the flu is in the United States. There was medicine available, and most people who were treated recovered fairly quickly. People who are naive are at increased risk, so I made sure to take my malaria prophylaxis medication.

What were some memorable cases?

There was one case of a woman with a massive bowel obstruction. She came in and was in a lot of pain and I couldn’t diagnose what she had. I had to use my basic clinical skills because there was no imaging and our medications were limited. We kept her hydrated and finally we were able to send her elsewhere for higher-level care.

There was a particularly sad case involving a young girl with bacterial meningitis who died because we simply didn’t have the resources to treat her and we couldn’t get her to another facility in time. And there was an HIV-positive patient with a very low blood count and severe anemia who died because we didn’t have any blood to give him. And in some cases, people were unable to receive care because they didn’t have the money to pay for it. In many ways the limited resources made me furious, but it also made me realize the things we take for granted in medical practice in the United States.

What type of training were you able to share with local health care providers?

Probably the most important part of my trip was the teaching, because that will endure after I leave. I saw a lot of patients, but that is of finite benefit. If you teach someone, they can teach others. I taught a lot of neonatal resuscitation and perinatal care, including the importance of suction and clearing the airway, and performing positive pressure ventilation if the baby isn’t breathing. Ideally, the people I taught can teach midwives and other caregivers, and I have heard that they are already seeing the benefits from this training in terms of reduced infant mortality.

I also tried to explain the importance of cooking outside rather than inside, which is the main cause of chronic obstructive pulmonary disease there, and I talked about the importance of using bed nets to help control malaria. We had a health fair, and people really appreciated that. We also did a community outreach program distributing eyeglasses from a van. We also brought a dentist who was able to remove abscessed teeth. It was so rewarding to be able to provide that kind of relief. Giving simple things like the ability to see or to take a bit of the pain away is one of the things I enjoy most about medicine.

What were some other differences in medical care in this part of Kenya compared with the United States?

There were no real expectations from the patient’s standpoint. In the United States, patients expect doctors to treat and cure them, but in Kenya there is no malpractice insurance or litigation. Whatever you can do to help, you do. Doctors are seen more as the source of medications.

Also, a lot of the health care we provide in the United States, especially in internal medicine and family medicine, has to do with the treatment of chronic disease. We do a lot of screening and prevention, but also a lot of tertiary prevention for things like diabetes, hypertension, or heart disease. Those chronic conditions don’t really exist in Kenya, because the food they eat is completely natural, and they live active lives out of necessity. They walk or run everywhere they need to go. So if they don’t develop cancer or an infection, they tend to lead very long, healthy lives.

There’s such a lack of health care there, but I think we could learn a lot from the Kenyans in terms of the simplicity of their way of life.

What can you take from your experience in Kenya that you will apply to your medical practice in the future?

As a Navy physician, my main priority for my patients is to help them maintain their physical health and readiness to accomplish the mission.

It’s all about keeping the active duty persons and their families healthy, so physical fitness and nutrition are top priorities, and I want to continue to stress making those things part of my patients’ way of life. We should try to live more like the Kenyans in terms of eating more unprocessed, natural food and being active and exercising every day.

I also want to continue to focus on helping my patients decrease stress to improve their health. I was never as stress free as when I was in Kenya, and there were no cell phones, no TVs, none of the distractions, and you are living in the moment and surrounded by nature.

All the high-tech things that we have in the United States keep our cortisol levels sky high all the time, and that’s not good for overall health.

My experience in Kenya also reinforced for me that I want to have a wellness-centered practice, with a holistic approach that includes physical trainers and nutritionists who provide good care and education about how to live the best life you can and be as healthy as you can be.

Working overseas can give physicians a perspective that you cannot get any other way. I think you become a much better doctor. You appreciate how good we have it in some ways, but also what we can learn from people who have less.

Think globally. Practice locally.

U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column.

Dr. Andy Baldwin’s first visit to Kenya was for an endurance event – an ultramarathon that served as a fundraiser for vulnerable children in Kenya, Ethiopia, and South Africa. He chose to return last fall for a different type of endurance event: A month of medical practice and teaching as part of his family practice residency.

"Being in the Navy, I have traveled all over the world and have really come to love global health," he said. "The impact you can have is so rewarding." When he knew he would have an elective month as part of his residency, Dr. Baldwin did some research and learned of Chepaiywa Health Center in Kipkaren, Kenya, which is supported by Empowering Lives International.

Describe health care in this part of Kenya.

The clinic is located outside Eldoret, Kenya, and there are few other options for medical care in that area. There is a high infant mortality rate, and there are many problems associated with HIV/AIDS. They especially need doctors who can help educate nurses and laypeople about neonatal resuscitation; many babies are born at home, which means in mud huts, and they are not getting good postnatal care.

What resources are available in the clinic?

The health center, which they call a dispensary, started by meeting very basic health needs and providing medications. In recent years, with volunteers and donations, it has gone from one room to four. But it is still a very difficult experience. Many of the medications are expired, for example. They now have a makeshift delivery table and a portable ultrasound machine, but there is no continuous external fetal heart rate monitor, and sometimes it’s hard just to find gloves to wear to help deliver babies.

Photos courtesy Dr. Andy Baldwin

I also became very familiar with low-tech laboratory testing. They had a lab but no centrifuge, so the patient would have to wait all day for gravity to do its job and separate the plasma from the blood samples in the test tubes.

What types of conditions did you tend to treat?

We were running tests for typhoid fever, not the salmonella that doctors see in the United States, and also brucellosis. Every patient was tested for malaria, and we would look at it under the microscope. I would say that approximately 50% of the people there had malaria; it is almost as common as the flu is in the United States. There was medicine available, and most people who were treated recovered fairly quickly. People who are naive are at increased risk, so I made sure to take my malaria prophylaxis medication.

What were some memorable cases?

There was one case of a woman with a massive bowel obstruction. She came in and was in a lot of pain and I couldn’t diagnose what she had. I had to use my basic clinical skills because there was no imaging and our medications were limited. We kept her hydrated and finally we were able to send her elsewhere for higher-level care.

There was a particularly sad case involving a young girl with bacterial meningitis who died because we simply didn’t have the resources to treat her and we couldn’t get her to another facility in time. And there was an HIV-positive patient with a very low blood count and severe anemia who died because we didn’t have any blood to give him. And in some cases, people were unable to receive care because they didn’t have the money to pay for it. In many ways the limited resources made me furious, but it also made me realize the things we take for granted in medical practice in the United States.

What type of training were you able to share with local health care providers?

Probably the most important part of my trip was the teaching, because that will endure after I leave. I saw a lot of patients, but that is of finite benefit. If you teach someone, they can teach others. I taught a lot of neonatal resuscitation and perinatal care, including the importance of suction and clearing the airway, and performing positive pressure ventilation if the baby isn’t breathing. Ideally, the people I taught can teach midwives and other caregivers, and I have heard that they are already seeing the benefits from this training in terms of reduced infant mortality.

I also tried to explain the importance of cooking outside rather than inside, which is the main cause of chronic obstructive pulmonary disease there, and I talked about the importance of using bed nets to help control malaria. We had a health fair, and people really appreciated that. We also did a community outreach program distributing eyeglasses from a van. We also brought a dentist who was able to remove abscessed teeth. It was so rewarding to be able to provide that kind of relief. Giving simple things like the ability to see or to take a bit of the pain away is one of the things I enjoy most about medicine.

What were some other differences in medical care in this part of Kenya compared with the United States?

There were no real expectations from the patient’s standpoint. In the United States, patients expect doctors to treat and cure them, but in Kenya there is no malpractice insurance or litigation. Whatever you can do to help, you do. Doctors are seen more as the source of medications.

Also, a lot of the health care we provide in the United States, especially in internal medicine and family medicine, has to do with the treatment of chronic disease. We do a lot of screening and prevention, but also a lot of tertiary prevention for things like diabetes, hypertension, or heart disease. Those chronic conditions don’t really exist in Kenya, because the food they eat is completely natural, and they live active lives out of necessity. They walk or run everywhere they need to go. So if they don’t develop cancer or an infection, they tend to lead very long, healthy lives.

There’s such a lack of health care there, but I think we could learn a lot from the Kenyans in terms of the simplicity of their way of life.

What can you take from your experience in Kenya that you will apply to your medical practice in the future?

As a Navy physician, my main priority for my patients is to help them maintain their physical health and readiness to accomplish the mission.

It’s all about keeping the active duty persons and their families healthy, so physical fitness and nutrition are top priorities, and I want to continue to stress making those things part of my patients’ way of life. We should try to live more like the Kenyans in terms of eating more unprocessed, natural food and being active and exercising every day.

I also want to continue to focus on helping my patients decrease stress to improve their health. I was never as stress free as when I was in Kenya, and there were no cell phones, no TVs, none of the distractions, and you are living in the moment and surrounded by nature.

All the high-tech things that we have in the United States keep our cortisol levels sky high all the time, and that’s not good for overall health.

My experience in Kenya also reinforced for me that I want to have a wellness-centered practice, with a holistic approach that includes physical trainers and nutritionists who provide good care and education about how to live the best life you can and be as healthy as you can be.

Working overseas can give physicians a perspective that you cannot get any other way. I think you become a much better doctor. You appreciate how good we have it in some ways, but also what we can learn from people who have less.

Think globally. Practice locally.

U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column.