Back To Africa

Wednesday, August 1, 2012

Today, I am a fellow. Officially. I am a Massachusetts General Hospital/ Contra Costa Regional Medical Center Global Health Leadership Fellow. Or a MGHCCRMCGHLF, for short. Kind of has a nice ring to it, huh? Sort of like trying to talk with one too many Fluffy Bunnies in the mouth. So here I am, a MGHCCRMCGHLF, sitting on a plane, heading from San Francisco to Nairobi, via Amsterdam (“Amster, amster, shh shh shh”, for those of you who know the song).  Over the next two years of the fellowship, we hope to help start a family medicine residency in East Africa in order to help address the shortage of trained health care providers in the area. 

I last posted on this blog when I was spending May and April in Juba, the capital city of the new nation of South Sudan.  I was working with a team of talented people who were partnering with the Ministry of Health and the national referral hospital to establish post-graduate training. South Sudan is the world’s newest country, born after two civil wars that spanned most of the last fifty years and claimed more civilian lives than all American military casualties since the birth of our own nation in 1776. This new country was born under a difficult moon; it is a country short on infrastructure and big on problems. Larger than France and not much smaller than Texas, it has about sixty miles of paved roads and some of the worst education and health indicators of any country in the world. Tensions along the incompletely demarcated border with the Sudanese to the north run high, inter-tribal warring within the many tribes in the south continues, and the almost entirely oil-based economy is balancing precariously.

Unfortunately, especially in the face of all the need, we’ve had to put our efforts to train family doctors in South Sudan on hold. There were many factors involved, and the decision was not an easy one. Overall, I think it’s the best decision for this point in time.  But for the young physicians interested in furthering their skills and career, and more specifically for the poor and often powerless patients of South Sudan, it is a loss.  Thankfully, other MGH/Boston programs in South Sudan, such as the training of front-line health workers in safe pregnancy and delivery management, the laboratory support program, and the government nursing collaboration will continue.  There are plans in the works between the Ministry of Health and NGOs to possibly implement advanced training for clinical officers in the country. Rapidly training mid-level providers who are more likely to stay and work in the country may be just what South Sudan needs right now.

But for the fellows, instead of returning to our little house and community in Juba, we are moving our efforts to western Kenya.  I admit, the switch feels a little strange. We are leaving a country where a woman has a higher chance of dying in pregnancy than finishing secondary school and arriving in one of the most developed nations in Africa. But there are a few reasons that make me think this is a good move.

For one, the need is there. Even though Kenya as a country is far more advanced than many in Africa, Western Kenya isn’t Disney Land. For example, about 14% of adults there are living with HIV, compared to an overall percentage of 0.6% in the United States.  Secondly, Kenya’s Ministry of Health is committed to furthering the development of family medicine. They have programs on the ground now, and they have a mandate for each medical school to have a training program in family medicine. Third, and most importantly, the local Kenyan medical school and associated hospitals have invited us in and are keen to partner with us.  Good intentions mean little when your vision doesn’t line up with what the people on the ground have in mind.

Tomorrow, hopefully, I’ll be meeting up at the Nairobi airport with Michele, the other MGHetc fellow, and Luke, an Australian doctor in training that is working with us.  They’re coming from Juba where they’ve been wrapping up the program, packing up supplies, and saying goodbye. We’re excited to be staying for the next few days in Nairobi with Megan, a family doc who is working with UCSF and Aga Khan University to establish their training program in Nairobi.  The next few months are likely to be full of meetings, some clinical teaching, and hopefully plenty of opportunities to get to know western Kenya. 

Thanks for reading,

jeff