The beginning of an end

So it’s finally time for me to write my last blog post. I was avoiding the task all weekend because a) I wanted to spend as much time as possible with the wonderful people I have gotten to know this year and b) I’m not really great with goodbyes and saying bye to the blog was just one other thing to add to the ‘this is the last time…’ list.

The one great thing about transitioning from one adventure to the next is that it encourages me to reflect on the old experience, take note of what I have learned, and figure out how to apply it moving forward. I have tried not to include too many posts on this blog about ‘my feelings’ but I think it’s appropriate to at least recap what I’ve learned and accomplished the past 11 months.

I wrote down a few goals on my first day in Nairobi last August and going back through them made me laugh a bit…

1) Learn what it takes to conduct clinical research in a low-resource setting.

Wow. Could I have been anymore broad? That’s equivalent to ‘Learn how to cook international cuisine’. But anyway, I think it’s amazing that I never realized what constitutes clinical research in the global health arena and how many different ways you can do ‘research’.
At the Fogarty interviews, I explained to my mentor the following: “We have all of this evidence based medicine and guidelines on one side, and on the other we have healthcare workers providing care…I want to work on connecting the two.” She smiled and responded, “well you know…there is a name for that. It’s implementation science or operations research!!” I’m sure my jaw dropped to the floor. I was completely sold.
My projects this year have all focused on implementation and it’s very apparent to me that this is the type of work I want to continue in the future. People take logistical issues for granted and often think “here’s a new guideline…let’s start using it.” It’s not that simple. In order to actually be successful in using the guideline, time needs to be spent to identify and analyze a strategy to implement the new principle in an efficient and sustainable manner. This is particularly crucial in a developing country where resources are limited and clinics are often understaffed.

2) Figure out what field of medicine to pursue that will fit in with my global health interests.

This one was creating a lot of anxiety for me last August. Everyone around me seemed to know exactly what they wanted to do and were passionate to get started with their training. I knew I was interested in global health, but how was I going to get there?
During my first weeks on the wards in Kenya, I saw many patients with complications from preventable and treatable diseases. Children were dying from rheumatic heart disease and malaria. The only thing that I could think of was “why isn’t someone finding the strep throat that led to the rheumatic heart disease in the rural communities?” And that’s when it all came together…I would go into family medicine so that I can focus on primary care, prevention and education. Wooo. I hope that in my lifetime we will triple or quadruple the number of family medicine residency training programs in Africa (currently there are only 5).

3) Become proficient in Swahili.

Eh…my understanding is definitely there, but my speaking skills still need work. I guess this just means that I need to come back asap and work on it. :)

4) Learn the challenges and joys of collaborating with an international counterpart.

As an American, we somehow have this attitude that ‘we know best’, when in reality what we know is simply a small piece of the enormous global puzzle. Working with my Kenyan colleagues has been extremely valuable because I learned how their culture and upbringing influences how and why they work differently then I do. I think that it’s important for both parties to recognize this and be able to laugh about it. Being rigid is not an option, and sometimes it was glorious to have another work style rub off on me. (see chai break)

5) Establish a side project.

I knew that I would be helping out on an ongoing project at first in order to get my feet wet, but my goal was to eventually find an area that I was passionate about and create something that I could leave behind. Only time will tell if the child contact register and child tracker projects will remain functional once I’m back in the states. However, the process of envisioning the project, grant writing, getting IRB approval, and troubleshooting throughout the initial months has been invaluable.

Alright, I think that's enough sharing! Hopefully I didn’t bore you too much.

In summary, I could not have asked for a better year and I’m so grateful for the experience. I am particularly thankful for all of my wonderful Kenyan colleagues/friends and for my amazing hilltop family.

Here are some pictures from the going away festivities this weekend and my final week in Kenya!

This is Nancy - one of the cough monitors from the pmtct TB screening project, currently the child tracker, and a great friend.

My friends from work took me out to an Indian restaurant on Friday...

And they surprised me with my very own Kenyan outfit which they insisted I try on in the middle of the restaurant...haha.

Some of the Tumaini staff making nyama choma (roasted goat) for the going away party.

The hilltop family on my last night doing what we do best...

Astrid, Laura, me, and Rakhi. These wonderful ladies put up with me at my best and worst this year, and I wouldn't have survived some days without them.

Thank you for reading the blog, and I appreciate all of your comments and words of encouragement throughout the year. See you on the other side of the pond! :)