Fifth-year residents return from elective rotation in Kenya as more intuitive and adaptable clinical physicians
U of T residents spent nearly two months at Moi Teaching and Referral Hospital in Eldoret
This winter, fifth-year residents Rosa Lakabi and Caroline Leps spent nearly two months immersed in a different clinical culture in Eldoret, Kenya, as part of the U of T-AMPATH partnership program. Their elective rotation at Moi Teaching and Referral Hospital made them more intuitive and adaptable clinical physicians, and they returned home with a desire to make international collaboration part of their future.
The AMPATH–U of T partnership is a global health initiative that aims to improve reproductive health in Western Kenya through knowledge transfer between physicians.
“Caroline and Rosa are ideal representatives for the AMPATH program,” says Julia Kfouri, an assistant professor in the department and director of the residency program. “Their openness to new experiences and perspectives has fuelled their remarkable growth as physicians. I’m excited to see that they’re both inspired by their time in Kenya and look forward to their future contributions in global health.”
Writer Matthew Tierney asked Lakabi and Leps about their experiences during their Kenyan rotation.
How did you come to participate in the global health program?
Leps:
I first heard about the exchange to Moi Hospital when I was a medical student at U of T. Residents and faculty who participated in the program told me about their experiences, and I knew I wanted to be able to participate as a resident, if at all possible. It was one of the reasons why I wanted to go to U of T for my ob-gyn training.
Lakabi:
I remember first hearing about the Moi–U of T partnership during the CaRMS tour, and it clicked immediately that the ob-gyn U of T program would be the right fit for me. I’ve always been interested in pursuing global health through various avenues. I believe that exposure to various clinical settings is an amazing vector for growth as physician.
What was your day-to-day routine like at Moi?
Leps:
We spent time on gynaecology oncology, benign gynaecology, maternal fetal medicine, and the labour ward. Each day was a little bit different — this is what makes ob-gyn so fun! Within each subspeciality, we had clinic days managing outpatients, ward days coordinating care for complex inpatient, and OR days. We also helped teach the Kenyan residents foundations of laparoscopic surgery once a week.
I was truly amazed by the communal nature of the wards in the hospital. Families are so supportive of one another. Sometimes two patients have to share one bed, and they could not be kinder to each other — even if they had only just met.
One of the biggest adjustments I had to make was the pacing of care. We’re so fortunate in Toronto to be able to place orders easily and get results back quickly. In Eldoret, certain tests may take hours or days to come back with results, or sometimes patients have to first purchase medication or equipment before getting treatment.
Lakabi:
We were assigned to a different subspecialty every week, which allowed us to gain insight into the on-the-ground reality at Moi in all aspects of ob-gyn. We also saw patients on the ward through various levels of acuity. We were always paired with a fellow or a resident — a key part of the experience as the discussions were always so welcoming and enriching.
The training model was certainly an adjustment for me! For example, in Toronto, although we have a lot of autonomy, we tend to review every single decision with attendings. In Kenya, residents would usually contact attendings only for difficult situations.
What will stay with you as you continue your career in global health?
Leps:
Watching Moi build their laparoscopic surgery department taught me a lot about global health partnerships and capacity building, something I hope to do in my future career. I realized how small details can be overlooked by donors or organizations that are not locally based. Important questions need to be asked, everything from “where will we store this new equipment?” to bigger picture ones, like “how do we get department buy-in?”
Lakabi:
This experience solidified my interest in international collaborations and global health partnerships. It has been an amazing opportunity to learn about capacity building, lessons which I hope to build on through other projects.
How did your time in Eldoret change you as a doctor?
Leps:
I think expanding your worldview teaches a lot of humility and flexibility. Ultimately this makes you a better physician — you improve clinically, you become more empathetic and better communicate with patients.
For example, trying to practice medicine in Eldoret as you would in Toronto is not a productive approach. If you arrive as a senior resident, you already have strong ideas about how to manage different clinical scenarios. It is incredibly important to be an observer at the beginning to get a better sense of how things work. How are patient encounters organized? How are tests ordered? What is available? How do you consult other services?
I learned to listen more and speak less. I learned to stay curious.
Lakabi:
Our patients come from all walks of life and expanding one’s worldview helps understand them better. When you first learn to become a doctor, there are a lot of growing pains and eventually, you become comfortable, develop ways to deal with change — but it is easy to forget how hard it was at first.
In a completely different the clinical culture like Eldoret, you gain an interesting perspective, and some nuance, on the automatisms you’ve developed throughout the years. You learn patience and reflection, and that nothing in our profession is mundane, no matter how common things may appear.
