Great Ocean RoadTwelve Apostles, Victoria (West of Melbourne)Snorkeling, Great Barrier Reef, CairnsWaiting to go on the Submarine Tour
As I’ve noted before, I’m an introvert by nature. As a locums physician, I meet new and interesting people at each placement. This gives me the opportunity to push outside of my comfort zone. In fact, I try to make at least one friend in each city in which I work, especially on longer assignments. As a part of this exercise, if asked to attend an event or go out to dinner, I typically default to yes.
Sydney Opera House
Sydney Opera House
One day, in the operating room, I looked up to a warm smile above the mask. For those of us who work in the surgical subspecialties (or any profession that requires your face to be covered, I imagine) you learn to do a lot of communication with your eyes. At the end of the case I met my anesthesiologist, and soon to be friend, Dr. Tanisha Robinson. Before long, we had a routine, at least twice a week we would head to the gym or walk in the park, followed by dinner. We attempted to explore all the cuisine options that Danville, PA had to offer.
Art Gallery of New South Wales
Royal Botanical Garden
I worked in Danville over the course of 8 months before moving on to my next job that year. Tanisha and I stayed in contact and last year she said, “Hey you like to travel…want to go to Australia next year?” My answer was my default, “Yes!” I must admit, I was a little nervous. Tanisha and I had never traveled together domestically, let alone abroad. Other than the dates, I had no idea of the proposed itinerary once we arrived. The plans evolved over the course of the year and at one point, I was even worried they would fall through. In January, I received the flight plan, including a stop in New Zealand on the way home. It was official!
Kuranda Scenic Railway from CairnsKurandaKuranda Koala Gardens
Transitioning back from Kenya, I didn’t have time to ask many questions about the trip leading up to our departure. Due to my work schedule, I had to leave for Australia a few days after my travel companions. Even with arriving on the continent later than the rest of my group, I still had plenty of time to create some amazing memories. From the Opera House in Sydney, to snorkeling and the Great Barrier Reef in Cairns, to the majestic views along Great Ocean Drive in Melbourne, to the quaint shops in Christchurch and lunch in the Sky at Auckland’s Sky Tower. I left these two countries with the desire to return. And I found a new go-to traveling buddy in Dr. Robinson. I’m glad I defaulted to “yes.”
Sky Tower, Auckland, New ZealandSky Tower, Auckland, New ZealandSky Tower, Auckland, New Zealand
Today, I would like to introduce you to Piia Hanson, a small town girl from Beaumont, Texas, with a big heart and an even bigger laugh; you immediately feel the warmness of her presence and the compassion of her spirit.
Piia and I were destined to meet each other. Though we both went to Xavier University of Louisiana, we never crossed paths there, so the universe gave us another chance. Piia moved to Nashville to start her Master in Public Health (MPH), just as I was completing my Ob/Gyn residency at Meharry Medical College. We became fast friends; and have continued to support each other, as we have transitioned through our careers, moved across the country and traveled around the world.
Most recently, I had some unscheduled nomadic time, and landed in Houston. Piia, nearby visiting her family, volunteered to pick me up. As she put it, I had no plan, but lots of options! Over the next week, we spent time in Houston, Beaumont, Baton Rouge and New Orleans. We found our way to a little bourbon, caught up on life and brainstormed about our next steps. Sharing a love of adventure, good food, maternal child health and serving the underserved, our discussions always seem to lead back to how can we live our best life and help others live their best life in the process.
As I reflect back on my goals from the beginning of the year, Be Better, Be Balanced, Be Bold, Piia reminded me of how to take action to heart. I’m sharing Piia’s journey here. Because sometimes we all need a little encouragement. Sometimes we just have to Take the Leap.
I’m unabashedly a daddy’s girl. However, this in no way diminishes my relationship with my mother. My mother and I are extremely close. I will take my mother anywhere (and I have). She chaperoned the prom and project graduation, went on college visits, we have traveled to Mexico, Hawaii and the Dominican Republic. She’s been my plus one for more than a few weddings, she’s kicked it with me in Vegas and we’ve chilled in beach towns like Tybee, SC. Most of my friends feel like she’s part of the crew and have grown to not only expect her but to ask for her if I show up sin mami. Even with our unquestionable friendship, she reminds me quickly and often, She’s still the Mama!
That being said, It would only make sense, that since my dad dropped me off in Kenya, naturally, my mother would come and pick me up. She was a little nervous about the long flight. She doesn’t move as quickly as she used to after her knee replacement a few years ago. And we all know TSA can be quite intimidating for the occasional airport traveler. (If she could have gone to Kenya on a train, I think she would have). To allay some of her anxiety, I coordinated her travel with some other friends who were coming to Kenya to visit me before I left. She didn’t have to brave the distance alone.
Due to the length of their trip, I wasn’t able to introduce them to Mutomo, but I tried to capture the essence of what I’d grown to love about Kenya in 8 short days. We visited the Giraffe Center and the Nairobi National Museum. We ate at Carnivore, a restaurant known for showcasing a variety of meat and game and boasting the best Dawa in the country. We had an unforgettable bottomless Prosecco brunch at Sankara, one of the five-star hotels in Nairobi. The trip ended on the coast. Two days of fun in the sun spent in Diani and a day of culture, learning the history of the port city of Mombasa.
I should tell you my mother has never met a stranger. She has an infectious spirit, a big smile and an even bigger laugh. She made fast friends on the plane and several more during the week. She has a heart of gold, going out of her way to do for others, because that’s just the right thing to do. She has been my constant supporter, reminding me to stay focused during those trying days of college and medical school. She let me nap in her bed, no questioned asked, when I needed a little break from residency. She has encouraged me to be me, unconventional, nontraditional, nomadic me, even though she worries 🙂
For that and all the other wonderful, thoughtful and sometimes unacknowledged things that you do… Thank you Mommie. I love you.
The community of Black Americans living in East Africa is thriving. Those who have been seeking a real life Wakanda. A safe space where we are less likely to be judged solely based on skin color. However, evidence of British colonialism is still alive and well in Kenya, as the country only achieved independence in 1953. The book Weep Not, Child, by Kenyan author Ngũgĩ wa Thiong’o details how Kenyans struggled to reclaim their land that had been controlled by British or Mzungu immigrants in a brutal and demoralizing war.
Mzungu. This Kiswahili word, originally coined to refer to those of European descent in East Africa, has evolved to include foreigners or more specifically light-skinned foreigners in the area. More than once I have been taken aback by young children shouting “Mzungu!” as I walked or rode by. This has been an unexpected part of my experience being a light-skinned Black American in Africa. At times, there are those who recognize me as that, especially once I start speaking. There are those who are confused by me, they know that I’m not white, but I don’t fit neatly in the black box either. And some are adamant– my skin is not black, so then of course, I must be white.
To me, I look black. I have broad features and kinky curly hair. There are no white people in my family, my parents are black, their parents are black, and their parents were black. My great-great grandmother could pass for white; but nope, she was black too. Yet, in Mutomo, my racial identity is often a subject of speculation. Not just with Kenyans, but also with the foreign-born white people who either live or have volunteered here during my stint at the hospital. Today, I will not go into a tangent on the social construct of race based on skin color that makes little sense outside of the confines of the Americas. But I will say, having to explain why I am light-skinned but call myself black can be tiresome. In one conversation of which I was a part, a few Kenyans and a couple from Denmark were trying to reconcile the hue of my complexion and remarked, “oh, like Obama.” Now, I will never rebuke any likeness to President Barack Obama, and in my exhaustion I conceded. But in reality, no, not like Obama.
At home in the states, I rarely get any questions about my race or ethnicity. Though one time that I did stands out in my memory. I remember in second grade, one of my classmates asked me if I was “mixed.” I believe I asked him what he meant. My response, was, well let me ask. I knew I was black and that everyone on both sides of my family was black. But at the time, I didn’t know what “mixed” meant. That day, I asked my mother if I was or if we were mixed. Her answer, — well, yes, the way most black people in America are mixed. She explained the African Diaspora in a way a seven year old could understand. She explained slavery of African people, the oppression of the Native Americans and the mixing of the native African people with the white immigrants, slave owners, and indigenous populations. What I understand even more keenly now is that my coloring is not a consequence of a voluntary relationship borne out of love or lust between two consenting individuals of different backgrounds, it is a result of coerced, forced and often humiliating sexual relationships with enslaved or oppressed black women who arrived in this country as a consequence of American slavery. We, Black Americans, are descendants of those who were brought here in bondage, and from that pain, was born the beautiful spectrum of blackness that is us.
Kenya is in East Africa, so it is unlikely that any of my ancestors came directly from here. But I, like many Black Americans, still feel a kinship to the whole continent, to a people that we have been disconnected from for generations and will never have the opportunity to fully know. Spending time in Kenya has not only helped me grow professionally, but it has allowed me to reflect on what it means to be Black, what it means to be American, and connected me to our shared African ancestry. Kenya, when I see you, I see myself.
One of my friends asked me to tell her the one thing I liked best about my time in Mutomo, Kenya and one thing I liked the least. I decided to expand the list and give you my 5 favorite and 5 least favorite things about my trip. If you have been following my posts, you can probably tell that I had a wonderful experience. However, spending 6 months in a remote town in a country that you’ve never stepped foot in, does bring a certain set of challenges.
My Favorite Things:
The People. I loved meeting and working with new people. From the patients to the staff to the other volunteers and physicians and I can’t not leave off my CMMB family, learning from and with this group was definitely the highlight of my experience.
The Pace of Life. Living and working on the hospital compound definitely changed how I interacted with the workday. The short commute. Afternoon tea at the canteen. Walking over to a friend’s house after work to chat or play cards, was a welcomed change from traffic, overpriced coffeehouse coffee and mind-numbing reality tv.
The Stars. The night sky in Mutomo is captivating. Walking home after dinner and looking up to a bright moon and sparkling stars never got old.
The Weather. Even though there were days that I complained or when I sweated through my scrubs in the OR, I still prefer hot weather. The temperature range was pretty narrow and it rarely rained.
I love Kachumbari. It’s a simple dish. It can be as basic as just tomatoes and red onions, lime juice with a dash of salt. Or the way I preferred to prepared it, adding cilantro, hot peppers and avocado when they were in season.
My Least Favorite Things.
The Mosquitos. All in all, I saw more bugs than I knew existed, in Mutomo. Every time it rained, a new variety of bugs would pop up. Despite trying to be diligent with mosquito repellent and a mosquito net at night, I still received more than my fair share of bites.
Being so remote. At times, Mutomo feels isolated. Being 5 hours from Nairobi, with up to 2 hours of that trip along a dirt road, travel required some preparation (both logistically and mentally). The bumpy, dusty ride was also rough on the back and the sinuses.
The Language Barrier. The nurses and technicians were awesome in interpreting for me. But I missed connecting with the patients on a more personal level. I learned a few Swahili words over the 6 months, but I will definitely plan to have more formal lessons before I return.
Intermittent Electricity. Some days the electricity would go out for a few minutes or a couple of hours. However, occasionally the electricity would go out for days at a time.
Lack of Diversity of Food. While I absolutely enjoy Kenyan food, nyama choma, ugali, chapatti and of course my beloved Kachumbari… I did miss having a big salad or pizza or greek yogurt or fried seafood, I could go on…
I used to think I was kind of smart until I came to Mutomo. One, the amount of new information was daunting at first – new names of medications, different policies and procedures, new languages. Two, I have always been in awe of Family Medicine Physicians at home and this respect even multiplies for the General Practitioners in Mutomo. There’s a phrase that describes FM physicians as caring for the patient from the cradle to the grave. How profound is that? Being versed in all aspects of medicine – from pregnancy and newborn care to orthopedics, surgery to hypertension and diabetes, cancer to end of life care – is amazing. I’m just an Ob/Gyn and happy about it. In addition to commanding such a broad range of medical knowledge, the physicians here also take phenomenal care of patients with limited resources.
Courtesy of CMMB
Dr. John Amollo has been here at Our Lady of Lourdes Mission Hospital for nearly 20 years although his home is in Kisumu, in western Kenya. I venture to guess there are very few people in town who don’t know him or garner the utmost respect for him as a physician. Over the years, with transition of staff, he has been known to be the only medical officer on the premises, holding responsibility for the medical, surgical, pediatric and maternity wards. In the course of a week, he can attend cesarean sections, set fractures, perform biopsies, hysterectomies, prostatectomies, pericardiocentesis and reassure a frail geriatric patient about her shortness of breath. He approaches patients with compassion and respect, understanding both their medical and financial needs in formulating treatment plans. I can’t say I’ve ever met a more versatile doctor.
Newest to the team is Dr. Bella Musaniwabo. Originally, from Burundi, she joined the staff here in July of 2017. True to her name, she is the Belle of Mutomo. She always greets you with a smile and her effervescent personality is infectious. She never meets a stranger, so walking through town with her comes with many salutations of “Hi, Dr. Bella!” Though young in her career, she is an astute physician, intent on caring for the whole patient. She provided my first orientation to the hospital, yet left me to fend for myself on day two! Over the past several months, we have seen many patients together, done ultrasounds together and assisted each other in the operating room. An aspiring Ob/Gyn, we of course became fast (and I expect, life-long) friends.
Hometown boy, done good, is Dr. Francis Mutua, an exceptional physician, a trustworthy collegue and a great friend. As a child, he aspired to be part of the military police, then a nurse. But with some encouragement and counsel from a mentor at the hospital he set his sights on a career as a medical doctor. After training in Uganda then completing his internship in Nakuru, his journey brought him home, to Mutomo. He is invested in both the health and the economic growth of the community. He along with his sister have invested in a petrol station nearby in anticipation of a new road coming through the town. Greeting everyone with a, “Mambo” “Sasa” or “Habari,” frequent stops to shake hands are common as we walk through town, the pride of the locals evident on their beaming faces.
I thought I’d take a little time to get an inside perspective from Dr. Mutua today.
What was your motivation to become a physician?
I finished my high school education in November 2003, and had more or less NO clear plan for my future life after I failed to secure a placement in the public university. College education as self-sponsored individual was beyond imagination. Having been raised by a single parent and a peasant farmer, things weren’t easy.
I am an unlikely person to have become who I am today.
The journey of my life since then to this point began with a casual job at Mutomo Mission Hospital; my first assignment was to cut grass at the hospital compound right in front of your house Mary!
This then led to my subsequent enrollment into the Youth Peer Education Programme where I would meet and interact with Anita (a senior administrator for the hospital) for four years, and through whom I secured sponsorship to study medicine in Uganda.
My main motivation to pursue this course was from the enormous interactions I had with patients, especially the infected and affected by HIV/AIDs. And through good mentorship and wise counsel from a clinical officer friend working at the hospital, I made an application and got an admission. Thanks to him and my Swedish sponsors for making it possible.
How is Mutomo different than when you left to attend medical school?
Very different. When I left, the town consisted of a small shopping centre with countable shopping outlets. With no power connection to the national grid, life ended at 6pm with the fall of darkness; safe for the hospital compound that enjoyed the luxury of generator powered light until 10pm. There was no major economic activity and businesses that existed were run on a very small scale.
Six years later, banks (5 different companies) have invested in the area. Businesses are run on a much larger scale and animal and poultry farming are part of the economic activities taking place. The dream for a better Mutomo is much alive especially with the increasing connectivity to hydroelectric power, the road upgrade to bitumen standards and the piped clean drinking water project that is near completion.
What makes Mutomo special, why was it important for you to return?
I wasn’t thrilled by the fact that I was coming to work in my home town. As a matter of fact, my coming to Mutomo was more of honoring a MOU I had with my sponsors and the hospital to work for at least 3 years as a sign of appreciation for sponsorship.
Know what, as I write to you, I am the most happiest person and glad to have made the decision to come to Mutomo. The good interactions with colleagues, good friendship and networking with visiting doctors like you Mary, have given me a solid foundation.
Above all, I have had utmost satisfaction and joy interacting with almost every patient that I have seen; some strangers, many known to, several related. Of course, there are those I am unable to totally solve their suffering and that pains me. It gives me a challenge-that’s why am definitely going back to school, and then, I SHALL RETURN.
What are the major challenges for the area?
Socio-economic: majority have low to no income, lack of employment for the young and most productive persons. Poor infrastructure.
Climatic: semi desert area, therefore, very poor rainfalls that hardly sustains agricultural activities, which is the main economic venture to majority.
Educational: Many people are semi illiterate. The cost of education is too high for the majority to afford.
Disease Burden: Especially with the upsurge of non-communicable illnesses like HTN, diabetes and cancer. Ignorance plays a key role in disease progression. Many patients present at advanced stages when little to nothing can be done. Lack of specialized care.
What are your hopes and dreams for the community in the future?
The future is bright, better days are yet to come. That is why going back to school is a MUST. I dream of a day when no patient shall be sent to a far town for an ultrasound or CT scan or this and that test; I see a day when every specialty shall be available under one roof. I foresee myself carrying out laparoscopic surgery for a poor young man with an intestinal obstruction right here in Mutomo.
The road will be complete in a few years, water soon flowing, the market will grow and businesses shall thrive. An all new record for the local economy will be set…
Thank you Mary for finding time to be with us. I appreciate it.
Dr. Amollo and Andrew (OR technician)Dr. MusaniwaboDr. Mutua and Dr. Musaniwabo
Dr. Musaniwabo, Dr. Britt (Swedish Volunteer), Dr. Mutua, Elizabeth (Dr. Mutua’s wife)
This past weekend I had the opportunity to visit Arusha, Tanzania with a group of dynamic women. Just a road trip, a girls’ weekend, time to see something new and decompress. Of the five women, I only knew one, the one who invited me. As those of you who have traveled with a group know, there is always a little apprehension when traveling with new people. We were all pleasantly surprised that we got along well, seamlessly well in fact.
For me, this experience was one of many transformational moments during my time here in East Africa. Crossing the border of Kenya and entering Tanzania, felt different yet familiar and comfortable. Arusha is a small town, but extremely clean and well maintained. From town you can see both Mt. Kilimanjaro and Mt. Meru. Expansive green spaces and a mix of both traditional and modern architecture. The people are extremely gracious and inviting and the food was phenomenal. We had several types of Tanzanian nyama choma (roasted meat) and mtori, a traditional soup made from plantains and seasoned beef or goat. We sampled Tanzanian coffee and tried a local spirit called Konyagi, which just like my travel companions, mixes well with others. 🙂
MtoriSwahili Fish Cakes
Nyama Choma @ Andrew’s
One of the highlights of the trip was spending time at the United African American Community Center (UAACC) with Mzee and Mama C (Pete and Charlotte O’Neal); two former Black Panthers who have been living in exile for more than 40 years. For those of you who are unfamiliar with the Black Panther Party, they were a revolutionary organization founded in the United States in the late 1960’s. The group formed in reaction to the continued attack on the civil rights of Black Americans, police brutality and food injustice in minority communities. Though notorious for their “by any means necessary” rhetoric, the core values of the party centered on community social programs that increased health care access and provided free breakfast for children. However, due confrontations with authority, especially law enforcement agencies, members of the Black Panther Party found themselves victims of false convictions and imprisonment. This was the case for Mzee, forcing him to flee the county in 1970. In 1972, the couple settled in Imbaseni, a village right outside of Arusha. They used this time, to create an impressive center dedicated to education. Education of local children, as well as visitors from all over the world, on the subjects of racism and the devastating consequences of continuing to ignore the racial injustices in American and around the globe.
This trip gave me time to bond with inspiring and encouraging people, sample new cuisine, catch glimpses of two of the tallest mountains in Africa and to reflect on my next steps after my time in Kenya, in Mutomo. I can only hope to build a legacy as important and life-altering as the one Mzee and Mama C continue to build at the UAACC.
For more information or if you’re interested in donating to the UAACC, please see below.
I’ve mentioned before in this blog that I’m a naturally quiet, reserved person. For most of my life, you could even call me shy. I feel most comfortable when I have the ability to fade into the background. As a student, I showed up on time, completed all my assignments and prepared for all my tests, but I detested class participation. I would not raise my hand to answer a question even if I knew the answer. If I had a question, I would patiently wait to approach the teacher after class. I had to temper my anxiety if I knew that my grade required that I speak during class. Medical training has abated some of those fears and of course, I have now given my fair share of patient histories, public speeches and presentations. But to be honest, I have no problem with the days when no one even knows I’m in the room.
Well in Mutomo, it’s difficult to fade into the background. Mutomo is located in Kitui county, 70 km from Kitui and 230 km from Nairobi with 17,000 inhabitants. It is clear that I am not from here. One, because it’s such a small town, everyone knows everyone. Two, the hue of my skin stands out from most other people here. Yet mostly, due to my style of dress and my American English. When I first arrived to Mutomo, I was introduced and asked to stand up and give a few words to the group after the weekly educational sessions held on Thursday. It was pretty standard, I was expecting it… A few weeks later, one of the other volunteers left. He too was asked to stand up and say a few words about his experience. As was his wife. Then other members of the staff were asked to stand up “give a few words,” to the volunteer before he left.
This sequence of events happens each time more than a few people are together. And not just in the professional environment and not just in Mutomo. We attended a holiday/family event of one my CMMB co-workers in his home near Nyeri, Kenya. After we ate, each person in attendance was asked to come up and greet the family. Each person! It was not a small gathering. Recently, I attended another event celebrate the life of one of the neighbors who had recently passed away. She was a young woman, 44, pregnant, and died suddenly, unexpectedly, reminding us of the unfortunate reality of maternal mortality. As each guest arrived, each person greeted each guest individually. At the close of the gathering, with about 10 of us left, one of the older couples led a small spontaneous prayer session. At the end of which, we were asked to share a few words with the husband of the neighbor who was recently lost. I commented, “I’ve been here for 3 months, but every time… I’m not ready.” I composed my thoughts and spoke of being present in the moment, offering my sympathy and condolences for something I cannot even imagine.
This Kenyan tradition has prompted me to recognize the value of acknowledging people around me. Each day is a blessing and tomorrow is not promised. I’m sharing this tradition with you now to encourage you to remember to appreciate those around you everyday. We often move quickly through our day, through our to-do list, through our meetings and extracurricular activities. Slow down to say hi to a stranger, help a neighbor, congratulate a co-worker, reply to a text or email from a friend, tell your family you love them.
One of my colleagues in Mutomo asked me what I was doing for the holidays. I said, “I’m going home, to see my family.” He responded with a quizzical look, “I thought you didn’t have a family.” Now, I was confused. Did I imply that I was an orphan…? Maybe something got lost in translation between my English and his? He quickly followed with, “You told me that you didn’t have a husband or kids.” Oh…now it was clear, his concept of family only included marriage and procreation. Another physician in the room piped in, “Maybe you need to broaden your definition of family.” Indeed, I would agree.
My biological family is great! And, all four of my parents have been there along my journey, even when they didn’t understand what I was doing or why I was doing it. They trusted me to believe in myself and follow my purpose. My extended family has continued to grow over the years. I posted a few weeks ago about how I love my friends. And truth be told, I consider most of my friends, family as well. I make friends for life so, I make an effort to maintain and strengthen those relationships.
In my professional role, in order to provide good medical care, I need to understand the community in which my patients live and my co-workers work. On the residency interview trail, I asked one of my interviewers where most of the residents lived. She responded, “well you can’t live around here.” My feelings were hurt and I wasn’t even from that city. Needless to say, they slipped to the bottom of my rank list. On one of my other residency interviews, I laughed so much at dinner, I thought, “I feel at home; this feels like family.” And, I knew that was where I was supposed to be. When I moved to Pennsylvania for my first job, I asked for recommendations on where to live. The response, “well if you want, why not live around here?” I moved into an apartment less than 2 miles from the hospital. One of the toughest decisions leaving that job was leaving my Montgomery work family. I still love them dearly and they have continued to be there for me. That’s what family feels like. As I traveled doing locums before venturing to Kenya, I liked to take assignments that lasted long enough for me to a get a sense of the local community. I accepted invitations to dinner and church, to potlucks and to happy hours. I didn’t want to just work there, I wanted to live there.
I have those feelings from time to time, that fleeting, intangible moment that you know you are at the right place at the right time. I have had that feeling in Kenya. One weekend I found myself sharing a meal playing cards with my Mutomo work family, and I knew I’d found my tribe. I don’t know how many of you have had the experience of traveling to a new city, and one of your parents says, “call so-and-so when you get there. She’s your cousin…” A cousin that you’ve never seen before, met before, heard of before. But you call as instructed, and that cousin takes care of you like she’s known you since birth. Similarly, a friend introduced me to a friend of his who’s American but lives in Nairobi. She invited me over for dinner shortly after I arrived a couple months ago, and if you saw us today, you would think we had known each other forever. In the same vain, my CMMB family has been incredible in making my time here as comfortable and rewarding as possible. It was only fitting that I celebrated Christmas with them, before returning to the states for the Holidays.
Family to me, are the people around you who support and encourage you to be your best self. I look forward to spending the holidays with my family, all of them, whether related by blood or by spirit.
Kuzaliwa kumoja, maisha mengi = Swahili Proverb, translated: The same birth, but many lives. Human beings are born in the same way but their lives may be different.
Taken behind my house in Mutomo
A friend and colleague forwarded me a story from NPR this week. You may have seen the article circulating about a mother who recently died soon after childbirth. Maternal mortality is defined as the death of a woman during pregnancy, delivery or shortly thereafter. In the United States, it represents the 6th leading cause of death among reproductive age women from 25-34. Recently, the rate of maternal mortality has been on the rise in the United States, with the rates among black women being 3 times as high as for white women. And, according to JAMA, “Even if you look only at white women in the United States, the rates of mothers who die is greater than those in other developed countries.” In the developing world, the statistics are even more startling. The WHO reports, “The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 000 live births in developed countries.” Here, in Kenya the number is 510. Reading this article made me reflect on my evolution as a physician, and how stories like Shalon’s motivate me to continue the work that I do.
Going into medical school my plan was to be a forensic pathologist. I’ve known I wanted to be a doctor since I was seven but this particular aspiration grew from reading novels in high school in which the main character was a forensic pathologist. The field intrigued me for many reasons, one was that it functioned between two worlds, the law and medicine, it allowed me to work with my hands and avoid a traditional clinical practice… I have been described as quiet, shy, reserved, introverted or all of the above at different stages of my life. For this reason, I was nervous about how I would be able to cultivate the doctor-patient relationship. Pathology gave me a way out. Those patients didn’t talk back. You can only imagine how devastated I was first year of medical school, when I discovered, I did not like pathology or histology, or the microscope really. I would fall asleep looking at slides…
As with this lesson, I learned a lot about myself in medical school. I now credit my personality as an asset to my bedside manner, not a hindrance. Thanks to that revelation and to a few other serendipitous events, I found my way to Obstetrics and Gynecology. And without a doubt, it is the field for me. But old dreams sometimes die hard, so my fourth year, before submitting my Ob/Gyn Residency applications, I signed up for a forensic pathology rotation housed at the Metropolitan Government of Nashville and Davidson County Medical Examiner office. And I loved it of course! But it was time to let it go. In order to merge my old interests with my new ones, I presented on Maternal Mortality for my Externship project that month. As I was learning to articulate my interests in public health and health disparities, this subject underscored both and I have carried it with me through the rest of my training and into my career. I encourage you to read Shalon’s heartbreaking story, which tells the story far better than I can.
by 
This trip gave me time to bond with inspiring and encouraging people, sample new cuisine, catch glimpses of two of the tallest mountains in Africa and to reflect on my next steps after my time in Kenya, in Mutomo. I can only hope to build a legacy as important and life-altering as the one Mzee and Mama C continue to build at the UAACC.
