(from Eric McLaughlin)
The teacher has become the student, that the student might become the teacher.
Rounds at Tenwek often had a list of patients and diagnoses like this:
- HIV with tuberculosis meningitis
- HIV with cryptococcal meningitis
- Severe anemia (Hb 3) from bleeding esophageal cancer
- Complete dysphagia from esophageal cancer
- Suicide attempt from organophosphate poisoning
- HIV with unremitting gastroenteritis
- HIV with respiratory distress: Pneumonia vs TB vs PCP
- Renal failure and no idea why
- Bacterial meningitis
- TB pericarditis with bilateral TB pleural effusions
- HIV with Kaposi's sarcoma and HIVAN, etc.
And if it was Peds, there was a whole other realm to deal with: worms, malnutrition, tetanus, rabies, malaria, typhoid...
If there was a visiting US doctor, sometimes after rounds they would ask, "How much of what you do every day did you know how to do before you came to Kenya?" It was a good question, and I can only guess. But my guess is about 30%. The other 70% I had learned since coming to Kenya from books, the internet, veteran missionary doctors, and Kenyan colleagues.
The point is that it is very different. And though I definitely feel that we all gained some good ground on tropical medicine while we were in Kenya, we were often learning on the ground, i.e. just learning it the way we did it at Tenwek, or the only way we could do it with our resource limitations.
Then we commit to going to Burundi, to serve as clinical faculty for the medical school at Hope Africa University. This means that we will be primary educators for Burundian doctors, including tropical topics. This led us as a team to feel that some of us needed more formal tropical medicine training. So, Alyssa (who wrote about her experience in Peru earlier this year) and I were delegated, and thus our family relocated again to Baltimore, MD, last week, for me to start the Summer Institute of Tropical Medicine at Johns Hopkins University.
It is a 4-week program, and I just took my first exam (the first one for me in almost 3 years, since my board certification) yesterday. It is intensive, with 8 hours of lecture everyday. There are 29 students from about a dozen countries, including three Kenyan ladies, so that is fun. The lecturers thus far have been quite impressive, and I have loved the chance to learn from them.
Over two years in Kenya, we would encounter the same clinical questions again and again: How do HIV meds need to change if treatment for TB is also required? Are traditional herbs known to be a cause of liver damage or failure? What is the best way to approach persistent diarrhea in an HIV patient? We would toss these questions back and forth and search the literature, but overall usually continued in the dark. It is truly one of the challenges of the medicine we do.
However, now I have had the chance to pick the brains of world experts on these questions, and it's really an exciting experience. This is not only gratifying, but will hopefully result in better care for the years of patients I am likely to encounter with these problems, as well as for all the patients that our future Burundian students and residents will treat, all across the country.