STEP Story: Laura Harris

4th Year Medical Student, UCSF
Ahero Sub-County Hospital, Kisumu Jan-Mar 2018

My clinical rotation with FACES, at Ahero Sub-County Hospital outside Kisumu, was exciting, difficult and inspiring all in one.Laura Harris The outpatient HIV clinics at the hospital - the purview of FACES - are incredibly impressive and so fun to be a part of. They are remarkably well organized and efficient, operating at a clip much faster than US clinics. Even more importantly, they are extremely effective at keeping patients healthy and on treatment. The clinics use midlevel and lower-level clinicians to their highest potential through protocols, teamwork, and coordination. On the inpatient wards, where I spent most of my time, I saw clinicians, staff and administrators continually go the extra mile for patients. They often faced hard choices: should the clinician treat blindly if the appropriate diagnostics weren’t available at the hospital lab, or put the patient on second-line antibiotics if the first line was out of stock at the pharmacy? Should the administrators waive a patient’s hospital fee even if it might mean that the hospital couldn’t buy necessary medications or supplies? How should they triage patients’ needs in the face of understaffing and busy wards? They managed to find a balance between these difficult issues, aided by keen clinical judgment, and to continue to do their best to support patients in the mix.

Challenges were present, as well - it was sobering to witness the death of ward patients who most likely would not have died in the US, and others who received inadequate care due to low resources. Not to be able to draw labs that in the US are considered basic (not to mention essential for diagnosis/treatment), finding out a sample won’t be able to be processed until morning because the power is out, recommending a CT only to learn that it’s out of the patient’s budget and thus treatment would proceed blindly or not at all: these shaped the texture of my experience, and helped me understand the frustrations of being a clinician in a low resource setting. I had been aware of these gaps while conducting health systems research in a past job, but during this rotation I was able to understand what they meant on a granular, personal level. I saw the intense joys on the inpatient side, too: healthy babies being born, cesarean sections saving women’s and infants’ lives, patients who improved and their grateful families.

I’m so grateful to FACES for this opportunity. After this rotation I have deepened respect for clinicians in public health facilities, and am thankful for their generosity in welcoming me to join them in their work. In my future work both in the US and abroad I will always think back on my experiences with FACES to remember the challenges and joys of working in low resource settings.