Written by Deepika Parmar, MD, PGY-2 at Kaiser Permanente Oakland Pediatrics Program while on Global Health…
Arriving at the Nairobi airport on April 3 after 24 hours of flying, I was both excited and nervous about what my experience in Kenya would be. This was my first visit to sub-Saharan Africa. My experiences in Peace Corps Morocco certainly prepared me for traveling in a developing country, but I had no idea what to expect in Siaya and Ukwala.
We traveled to Kisumu via Kenya airlines and immediately drove to Siaya District Hospital where we had a tour of the facilities. While walking through the hallways, women came up to us with their pelvic ultrasound images asking us for advice and surgery. Even though it was a Monday (and not the GYN clinic day), we opened an impromptu clinic and started seeing women and booking them for surgeries. Then we continued on to a tour to Ukwala to see The Matibabu Clinic as well as the new Matibabu Hospital under construction.
Our first day at Siaya Hospital for the Tuesday GYN clinic started with a tall stack of charts and women waiting in the halls for us. We saw so many women I lost track of the number (perhaps 30-40?). We saw women with leiomyomata and uteri extending to the xiphoid as well as 4 women with advanced cervical cancer. Women do not receive regular cervical cancer screenings here due to lack of medical providers and education. It highlights the importance of cervical cancer screening, as we see so few advanced cervical cancer cases in the United States.
The following Tuesday, we again saw GYN patients in clinic. It’s amazing to me that they knew about our coming in advance and waiting for these particular clinic days to come to the hospital in hopes of having a surgery. There is only one trained obstetrician/gynecologist at the Siaya District Hospital. The other medical officers are essentially residents who teach themselves how to do cesarean deliveries and appendectomies so anyone who needs a hysterectomy or other specialized surgery has to wait for the one day a week that the surgeon operates. The overwhelming ratio of one gynecologist to an entire district of women highlights the need of the community for more surgeons.
We saw a woman with the complaint of copious vaginal discharge and bleeding and stated that a “white doctor” put something inside her vagina 2-3 years ago. Turns out she had not removed her pessary during all that time!
On our first OR day, we found out a laboring woman had died and had a perimortem cesarean delivery earlier that morning and the staff was still shaken from that event. We did an emergent cesarean delivery for a woman who had been laboring at home with a history of prior cesarean delivery in August 2010. She was taken to another hospital and turned away because of her bleeding and lack of blood products available. She was then brought to Siaya District Hospital for surgery and cesarean delivery was done for posterior uterine rupture. Her hemoglobin was 4.1 g/dL and she had large blood clots in her abdomen. Given the prolonged amount of time between uterine rupture and surgery, the infant did not survive. We also did an ovarian cystectomy for “Millicent” and noted significant tubal scarring which may have been causing her pelvic pain.
We had 2 more OR days while at Siaya District Hospital and performed some hysterectomies, myomectomies, and then ruptured a large tubo-ovarian abscess in an HIV positive woman.
I have to admit, I was completely unprepared for operating in Kenya. The availability of instruments, sutures, and staff is limited and many items that we consider single-use are used multiple times. It made me deeply appreciative of the equipment and OR staff that we have in the U.S.
I went to The Matibabu Clinic in Ukwala later in the week and spent time seeing patients. I had never seen a patient with malaria and I got the chance to see many! We went to a children’s club in the afternoon and talked about de-worming. We handed our albendazole to adults and children as well as USAID food/milk and vegetable seeds to the families.
I did two cervical cancer screening days with the community health workers and midwives and discussed cervical cancer education while I was volunteering with Matibabu, which was one of my favorite parts of my experience. In many ways, giving women education about their health and how to initiate change is an enormously empowering act, and it is a way that volunteers can profound impact the lives of many. There are only so many women that you can operate on or see in clinic but knowledge can be passed among women in a community indefinitely.
My experience in Kenya was one filled with gaining more clinical knowledge about OB/GYN in addition to learning about medical care in rural Kenya. The work I did there is small in comparison to the knowledge and experience that I gained from the patients I saw and the health workers I met. I saw advanced disease that is luckily rare in the U.S. due to our medical system and patients’ knowledge about their health, and it highlights the privilege we have in taking care of our patients here. I am grateful for the opportunity to volunteer with a community driven health center like Matibabu/Tiba Foundation during my residency training in OB/GYN, and it has given new purpose to my work here as well as my future goals to volunteer internationally.