Medical interns Pranet and Juulia in Kenya: ‘What moves us most is the dedication of doctors to women with genital fistulas’

Medical students Pranet and Juulia are spending the summer in Kenya. There, they provide information about female genital mutilation, menstruation and contraception, while also working in the local hospital for their internship. For EM, they are keeping a diary.

Day 13 – Visit to Kapenguria Hospital and Terry’s home

Our internship supervisor, Paul Mertens, played an important role in setting up Kapenguria Hospital. Today, we are given a tour by Michael Lotekori, a doctor who will be visiting Erasmus MC in November.

The differences between Kapenguria Hospital and the Dutch hospitals we know are striking. This hospital has several clinics and departments. On arrival, patients can arrange health insurance if they wish, before taking a seat in the packed waiting room to register. Emergency patients are triaged there and may sometimes be referred directly to a specialist, without first seeing an emergency doctor.

During our round, we see a patient who turns out to be a prisoner. He is lying in a bed in the middle of a shared ward, undergoing thyroid surgery for an infection. He is guarded by five soldiers; three stand around his bed with guns, one guards the outer door and another is stationed outside by the exit.

After our hospital visit, our supervisor Terry Chepyatich and her husband James Kietch welcome us warmly at their home. Terry has prepared our favourite dishes: chapati, minji, cabbage, potato and pumpkin.

James is passionate about music. Jokingly, he tells us he dreams of a career as a dj. He even has an artist name: dj Skyd. After dinner he puts on Jamaican music and says that next time we will see him on stage in the Netherlands – with braids. He even promises to grant our request for pink ones.

How did they meet? When 26-year-old Terry was standing by a river, 29-year-old James saw her and said: “You look good, baby.” Terry wisely ran home, after which James followed her but was turned away by her parents. He waited five years, and after Terry finished her studies he finally got their permission to marry her.

Day 17 – Internship at the Gynocare Women’s and Fistula Hospital

On our first working day at the Gynocare Women’s and Fistula Hospital, we join the morning ward round on the fistula ward. We are present for the follow-up of a 15-year-old girl with a genital fistula. A fistula is an unnatural passage between two body cavities, or between a cavity and the skin. Often, this develops after an infection in a cavity or gland.

In this girl’s case, the exact cause of the fistula is unknown. Her family brought her to Gynocare but has had no contact since. On admission she suffered from incontinence of urine and stool, anaemia and malnutrition. Thankfully, the latter two have since been resolved. After two months of treatment and surgery, the catheter check shows no further leakage. The hospital is now trying to contact her family so she can return home; otherwise, she will go to the rehabilitation centre.

In the evening, we face the most exciting moment of the day. Pranet traps a large spider in our room using an upturned bin (after an extended discussion about the best approach). The upside: free exposure therapy for Pranet. The downside: no bin for the next five days.

Day 19 – Surgery day at the Gynocare Women’s and Fistula Hospital

“In Africa there is no rush”, one of the doctors said this week. This morning, we learn what he meant. We arrive at the hospital at nine o’clock, but the first operation does not begin until half past eleven.

The patient is a 23-year-old woman from Sudan. She speaks neither Swahili nor English, making communication difficult. Previously, she awoke after fistula surgery with no memory of what had happened and, in panic, pulled out her urinary catheter.

This time she is again scheduled for surgery due to persistent incontinence. Although the doctor explains everything in advance, she sits fearfully upright on the operating table and tries to get down when the anaesthesiologist approaches with the spinal injection. Only when her sister is allowed to join her does she calm down and the procedure can proceed. The operation goes smoothly. She is expected to have only mild residual incontinence, which can improve with pelvic floor exercises.

Spider update: housekeeping has removed our spider.

Day 23 – Last day of internship

We say goodbye to the doctors and hospital staff. During our week at Gynocare, we have learnt how healthcare in Kenya functions and how a small hospital with limited resources can still deliver quality care. What moves us most is the dedication of the doctors to women with genital fistulas, who sometimes have suffered symptoms for years and are shunned by their communities.

The case of the 15-year-old girl made a deep impression on us. Fortunately, her family was eventually willing to take her back, giving her future a hopeful turn. We also learnt how crucial additional support is after medical treatment. This highlights the wider impact that good aftercare can have on recovery and reintegration into society.

Day 24 – Travelling

In Nairobi we visit the City Market, a smaller version of the famous Maasai markets. Here you can buy handmade products such as jewellery and wood carvings. Now that our work is finished, it is time to explore more of Kenya.

The next day, our guide Steve takes us on a trip to the Maasai Mara and Amboseli, two national parks where we go on safari. Along the way we laugh a lot and enjoy the view over the Great Rift Valley and the town of Narok. In the park, we stand on the car seats to get a better look at the animals Steve has already spotted from afar. Singing Poesje mauw, we try to call a cheetah – and to our surprise we later see one actually running.

In search of lions, we come across a car that has been stuck in the middle of the savannah for twenty minutes. The reason: two lionesses sleeping in its shade, one beside and one beneath the car. Nothing disturbed them – not the rumble of the engine, shouting or stamping. Only when one of the safari passengers knocks on the car door do the lionesses finally move irritably from under the car, at which point we are able to take our photos.