Jessica Alderman’s idea was sound, says biology Professor Phoebe Lostroh. Alderman applied for a venture grant that would enable her to volunteer in and observe a Western-style hospital in Nakuru, Kenya, a city of 1.2 million. On her days off, Alderman planned to visit rural villages to talk with traditional healers about their tools and tactics. She brought a video camera, hoping to make a documentary film of her observations.
But not all good ideas come to fruition.
Alderman interviewed some of the doctors, nurses, and medical students she worked with, but indigenous practitioners were hard to identify. She’d visit a “traditional” healer in an outlying village, only to find the person had Western training. To locate what the local people called a “witch doctor,” she’d have to go farther afield than she felt safe alone.
“I had already realized that my original plan wasn’t possible, and was looking into other ways of comparing Kenyan and U.S. medicine,” says Alderman. So she focused on the potential for low-cost improvements. Resources were scarce at Rift Valley Provincial Hospital, the third-largest public facility in Kenya. The wealthy go to private hospitals, she says, “and we saw everyone else: the uneducated and the impoverished.”
After nine weeks of rotating among four 40-bed wards, Alderman concluded that Western and Kenyan hospital practices are “almost noncomparable. They try to do the best they can with what they have, but I feel they could do better. I identified four ways: patient care, sterility, corruption, and organization.”
Alderman found the doctors’ attitudes toward patient care most difficult to accept. “I ran into ethical issues. For example, they don’t take thorough patient histories. Once a woman with stomach pain came in during a busy time. They spent five minutes with her, did not even listen to her stomach, and gave her a prescription for gastric ulcer. I asked why they didn’t try to find out the cause of the pain, and as usual they said, ‘We don’t have time.’ But if a pharmaceutical rep came in, they always had 45 minutes to spend with them!”
Other aspects of patient care disturbed Alderman too. “They have pain medication, but they don’t use it. Sometimes doctors would do painful procedures without anesthetic even if the patient was screaming. In the maternity ward, if a woman screamed, the doctor might slap her on the leg and say, ‘Don’t yell!’”
Alderman worked three weeks in the maternity ward, where laboring women lay three to a bed. When a baby started to crown, the mother walked to a single bed, gave birth, and walked to another bed to be sewn up if needed. “I could do the most service there,” says Alderman. “I had hands, and that’s what those women needed most.
“Sometimes I felt like I was expected to do things I wasn’t trained to do. A man came into the ER not breathing, and the residents were discussing pumping his stomach because he had taken poison. ‘He’s not breathing!’ I told them. I had to start CPR. Then I had to teach them how to do it.
“I knew they’d be lacking supplies, like oxygen tanks and gowns. But I didn’t think they’d be lacking knowledge like CPR.”
While plenty of sterile syringes, needles, and gloves were on hand, other materials were missing or unused, even around highly infectious TB patients. Some doctors didn’t change gloves or gowns between patients, or wash their hands. “Sometimes spills, like blood, just sit around. People say someone else will clean it up, but no one does, so other patients are exposed to it,” says Alderman. “Infection is a huge problem. One girl came in for an IV for malaria, got an infection that caused brain swelling, and that caused paralysis on one side of her face.”
Poor pay and inadequate funding have led to corruption, Alderman found. One medical officer told her, “Most of the donations and even some of the government funding never make their way to the patients.” Lack of resources also sets the stage for organizational problems. She found patient records incomplete, disordered, and difficult to access. Doctors and lab technicians spar rather than problem-solve over each others’ paperwork; discrepancies and errors can lead to haphazard diagnosis and incorrect treatment.
Accustomed to the privacy standards of Western medicine, Alderman was dismayed that the HIV interview area was simply curtained off from a public area. She cleaned out a closet and moved the interview area there, thinking that people might be more willing to be tested if they were more comfortable and in a private setting. But when she left the hospital for a week, the staff moved it back. “I could question what they did, but I didn’t have the authority or knowledge to say they should change it,” she realized. “There’s a system in balance, and I had to be careful to contribute without causing that balance to collapse.”
So the balance of care at Rift Valley remains the same, Alderman says. “I don’t think I changed anything in the system, but maybe I made a difference in the lives of a few individuals,” like the patients she escorted to surgery or the scared street children whose hands she held. When a man was beating his wife next door to her home, she argued for calling the police, only to be told that domestic violence is legal in Kenya. “You learn from both the bad and the good things that happen,” says Alderman. “I really got interested in the anthropology of health care, and the practice of medicine in the developing world.”
Lostroh, the professor who helped Alderman apply for the venture grant that partially funded her trip to Kenya, says, “Jessica has always had deep resolve toward her health care career goals. The venture grant experience has tempered her enthusiasm with the kind of realism that can only come from seeing real people who are underserved. She has matured and emerged from the experience an optimist, but not a starry-eyed one. I’m very proud of her.”