STEP Story: Ugochi Nwosu

Internal Medicine Resident, UCSF

Kisumu County Hospital, April 2018

My initial goals for the rotation were to learn more about the clinical management of patients with HIV and understand how health systems can produce high-quality care in resource-limited settings. The Comprehensive Care Center (CCC) at Kisumu County Hospital served as an excellent case study because despite operating at a fraction of the budget of American clinics, the CCC cared for a large patient population and achieved viral suppression in most. My time there showed me that the staff there were the secret to its success. From reception to clinicians, nurses and counselors, I saw that the key to the clinic’s success was the highly-dedicated team who wanted to help every patient achieve viral suppression and long-term good health.

When I joined health counselors in home visits, I better understood the magnitude of the challenge the CCC faced to care for its patients. Although house calls were once the mainstay of medical practice, my clinical rotation with FACES was the first time I had visited a patient’s home. From remote rural shambas to very high-density urban areas, each home visit provided unique insight into the patient’s physical and emotional barriers to achieving good health. From muddy roads that were unpassable during rains to the challenge of hiding medications when HIV status is not fully disclosed to nosy neighbors, the staff understood their patients and provided guidance that was tailored to their individual needs.

At the CCC, I learned many things I will incorporate into my own clinical practice but none more than the importance of an in-depth “social history” to good clinical care.  The CCC staff taught me the importance of the social history as context to help patients find practical ways to fit their health maintenance and medication adherence into their already busy, hectic lives.