Issue 19, 2013 - Balliol College - University of Oxford

student news
Student project grants
Each year a number of students are successful in their
applications for College Grants for academic-related
projects. These grants, which range from £25 to £2,000,
are made possible by generous bequests and donations
from Old Members and others, often people who have
a connection with Balliol, and are made available via
A hospital in Kenya
By roB sTABler (2010)
the College Trust Funds. Some grants go towards
enabling students to attend conferences relevant to
their studies, while others help them get involved
in interesting and inspirational projects around the
world. Here, two students report on what they were
able to do with their grants.
We arrived eager to learn but apprehensive
about what we would be asked to do, and
particularly what we should agree to do –
before arriving we had been explicitly warned:
‘the patient may say “i don’t want to be treated
by the doctor, i want to be treated by the white
man.”’ our concerns were not allayed when,
after watching our first surgery (a patient who
had extensive lacerations and three missing
digits after being attacked with a machete),
a second-year medical student from ireland
informed us that she had just been performing
a Caesarean section.
in fairness, the interns asked us to do things
not because they thought we knew how, but
because we were there to learn. nevertheless,
the shift from learning via textbooks and
demonstrations in oxford to the ‘learn by
doing’ attitude of Malindi took us by surprise,
and we were often left unsure of how best to
act. We frequently asked each other: ‘Would
we do this to a patient in england’, wishing
to treat Kenyan patients with equal dignity.
istockphoto.com/Stefan_Redel
‘What would a Western medical student be expected to do’
‘What can we do’ ‘Ethically, what should we do’ These
thoughts were rattling through the minds of Richard Dumbill
(2010) and me as our bus pulled into Malindi, a town on the
east coast of Kenya, at 5.30 in the morning. We only had time
to deliver gifts to our hostess and briefly rest our eyes before
starting our first day at Malindi District Hospital.
But there was clearly a cultural difference
between the two healthcare systems. During
rounds one day we saw a patient with ascites
(built-up fluid), and i asked the intern to ask
the patient if i could palpitate his abdomen as
well. ‘if you want to examine a patient just do
it, you don’t have to ask,’ came the reply. Worse
still, consent was not the only right overlooked
here: patients were talked about, not to, during
investigations, and never had any choice
in their treatment. the ‘doctor knows best’
attitude clearly still prevails in Kenya, and this
has been thrown out of British medicine so
forcefully that the contrast took us by surprise.
in the end, although there were some
useful things we could do, such as testing
patients’ blood samples for HiV and dressing
minor wounds, we spent more time talking
to doctors and patients than we spent
on practical activities. We learnt lots
about the treatment difficulties
faced in poorer hospitals,
and also revised much of
our medical knowledge, especially with regard
to AiDs and tuberculosis. We hope to have
brought some patients comfort, and i have a
particularly striking memory of a paraplegic
patient waiting for a skin graft who spoke
relatively good english and who was so bored
we talked for two hours straight. Another
highlight for me was reaffirming that ‘the whole
world loves football’ when we took a ball and 20
children from the orphanage associated with the
hospital to the beach one sunday afternoon.
towards the end of our stay i had some time
alone with one intern, and after watching him
place a number of cannulas (thin tubes) we
agreed that i could try. introducing myself to
a patient (‘Si si si daktari, si si ni wanafunzi’ –
i am not a doctor, i am a student) i felt
certain i was more scared than he was,
but he agreed and i proceeded.
When i was sure the needle
was in i felt a huge wave
of relief, and indebted
to that patient for
allowing me
to learn.
in the end i
know that our most
useful contribution to
Malindi District Hospital
was the fee we paid them on
arrival. Despite this, i returned to
england excited about medicine, excited
about the prospect of clinical school, and
excited about our sixth-year electives. it may
still feel a lifetime away, but i know it’s not
that long before i will be able to make a useful
addition to the staff at a foreign hospital.
Rich and i agree that, once we are qualified,
working in less developed countries will
be incredibly rewarding and something we
both want to do, and no doubt the contacts
we made and things we learnt in Kenya last
summer will prove helpful.
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