In addition to the clinical experience I am gaining, I have also had the opportunity to learn a great deal about the public health concerns facing Kenya and the world. Although I am inspired by the physicians and patients I have seen so far, I am deeply saddened by the state of healthcare in Kenya. I have witnessed firsthand people coming into the ER with severe traumatic injuries waiting hours to be seen, people unable to receive the care they require due to the cost of medications or necessary imaging, and sick children and adults sharing beds due to lack of space. Upon learning more through discussions with the doctors I shadow and my International Medical Aid mentors, I now have a better understanding of just how under-resourced the public hospitals in Kenya (and elsewhere) can be. For starters, the doctor to patient ratio at a hospital like CPGH is 1:16,000—compared to the 1:1,000 ratio recommended by the World Health Organization. Additionally, despite Kenya’s high economic growth rate, 36.1% of Kenyans live below the poverty line, earning less than 200 KSH (2 USD) a day. The cycle of poverty creates a much greater disease burden, as people often do not understand health risks or simply cannot avoid these risks. Further, when ill, it can be impossible to get transportation to a hospital, or to pay for the needed prescriptions. Wait times are incredibly high and very few hospitals have resources like MRIs, dialysis machines, chemotherapy and radiotherapy, etc.
Upon contracting a bacterial infection during my stay here, I was sent to the hospital where I was given a full consultation, blood work, lab results, and sent home with three prescriptions all within an hour. The difference? I am among the fortunate few who has the privilege of going to a private hospital here in Mombasa. The disparity was unbelievable to me. The following week, when I was able to return to my internship, I asked one of the ER doctors about this. He told me that almost all of the physicians (including himself) at CPGH work in private hospitals for their salaries and at the public hospital as either community service or a requirement by the state. Due to the lack of government funding, doctors cannot make a decent wage in public hospitals (making upwards of 10x as much in private settings), which largely accounts for the shortage of medical personnel at CPGH and beyond.
These experiences have opened my eyes to the issues in public and global health, and although I still aim to attend medical school, I am now looking into Masters of Public Health programs at home and abroad. My time in the Comprehensive Care Clinic at CPGH made me understand the scope of public health initiatives and I knew almost immediately that I wanted to be involved. Being the most well-funded department in the hospital, the CCC provides daily education sessions, monthly support groups, as well as consultations, frequent checkups, and medications free of charge to all of its 4,000 HIV-positive clients. Prevalence of AIDS has dropped remarkably and mother-to-child transmission is largely a thing of the past. The doctors, nurses, and case managers working to control HIV in Kenya have made huge strides and have inspired me to explore a field of study that is almost entirely new to me.