Eyeworld

82 EW INTERNATIONAL by Geoffrey Collett A medical student describes his time in Kenya assisting the ophthalmology department W hen I initially con- sidered my father's advice of visiting Kenya for a med- ical internship, I was hesitant more than anything else. Recent terrorist activity in the country's coastal region was well documented by media outlets, and my father, who worked for a Nairobi-based NGO at the time, had shared one or two unsettling stories. However, the prospect of contribut- ing to the healthcare environment of a relatively poor country gave me the courage necessary to at least explore the option. A few months later, I was offi cially invited for a 10-day ophthalmology internship at Kenyatta National Hospital (KNH), and by this time, my bit of courage had evolved into determination. Journey to Kenya My journey began on a humid July night in Miami. The air route to Nairobi included a short layover in London, but that was the only short stage of an otherwise lengthy pro- cess. Being greeted by my dad upon arrival was a welcoming sight, and it made me feel this trip was meant to occur. However, a hitch soon presented itself: My fi rst scheduled day on hospital grounds had been cancelled due to an opposition party rally in nearby Uhuru Park. The demonstration was deemed poten- tially dangerous, but fortunately the rally proceeded peacefully. I reported to KNH at 8 a.m. the following day, where Dr. Dunera Ilako, chair of the ophthalmology department and my primary contact, greeted me. After a warm introduction to the physicians and residents, all was back on track and it was time to get started. I was left in the hands of the ophthalmology residents running Kenyatta's eye clinic, whose focus that day was corneal diseases. Their knowledge and training obvious- ly surpassed those of a fi rst year experiencing the work of an oph- thalmologist in a rural setting, with limited resources, serving patients in dire need of eyecare would increase my passion for the specialty, and she could not have been more spot-on. Drs. Karimurio and Muchai led a team of 6 residents on this medical safari. During the drive, Dr. Muchai assured me I would play a signifi cant role in the outreach project, and al- though this made me somewhat ner- vous, my excitement trumped those feelings. When we arrived at Mwingi District Hospital, I was struck by the lack of essential components. The eye clinic had no running water; it had to be carried over from anoth- er hospital wing. The waiting area had space for only two patients; the remainder sat on the ground outside, where some had camped for the night. The operating theater was short on almost everything, from scalpels to gauze. Fortunately, our microbus was loaded with medi- cal supplies, and the hospital staff helped us set up and get going. The rest of the day was spent examining patients, most of whom September 2014 Eyes of Africa: An ophthalmology internship in Kenya medical student, so the next few hours were a non-stop learning experience. Crash courses on visual acuity, cataracts, corneal ulcers, and keratoconus kept coming my way. I actively participated in the exam- ination process, using the slit lamp to gauge patients' eye health. The majority of patients had good prog- noses, such as refractive errors that could be corrected with discount eyeglasses. After a relatively long day, it was great to join the residents for a traditional meal of rice, beans, and ugali—followed by, of course, a cup of tea. The next day, retinal diseases were at the forefront. Since I lacked the ability to use indirect fundu- scopic methods, I kept my direct ophthalmoscope handy the entire time. Slowly but surely, I began to recognize the changes that the posterior of the eye undergoes as a disease progresses. Most patients this time were diabetic and hyper- tensive and suffered from retinopa- thies as a complication. Prognoses were signifi cantly worse than the previous day. It was a tougher day in that regard, but I tried to mirror my superiors and remained upbeat as we helped patients as much as possible. I was with the residents for the remainder of the workweek, with clinic days being more general- ized than the fi rst 2. The amount of knowledge and experience I gained, however, remained at a high level. All in all, KNH's eye clinic attended 50 to 70 patients each day, and the small contributions I made to their well being is something I fondly remember. Medical safari Dr. Ilako and I met on Friday eve- ning to discuss my experiences. She was pleased with my progress so far and suggested I should participate in an upcoming project that would make my visit truly unique—a med- ical safari. I was immediately sold, but asked her to elaborate to avoid coming across as compulsive. This journey would take me to Mwingi, a small town east of the capitol, and would be the last stage of my intern- ship. Dr. Ilako was confi dent that Mwingi District Hospital Geoffrey Collett and Dr. Karimurio in the operating theater at Mwingi District Hospital. Source (all): Geoffrey Collett

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