Reflection by Kenyan Medical Student, Joanne

During the fifth year of medical school at Moi University, students get to go for electives. This is usually a very exciting period as students get exposure to different perspectives in medicine and healthcare in general. Each year two senior Kenyan undergraduate medical students from Moi University School of Medicine complete a six-week medical rotation in Toronto under the AMPATH-RH partnership between the Department of Obstetrics and Gynecology at the University of Toronto and Moi University and Moi Teaching and Referral Hospital in Eldoret. I was lucky to be among those chosen to go for my electives in Toronto. I have always had great interest in Obstetrics and Gynaecology, so getting the opportunity to rotate in the Department of Obstetrics and Gynaecology in Toronto was just icing on the cake!

Preparations for travel begun earlier in the year through regular communication with Dr. Rachel Spitzer via email and Mrs. Sarah Ellen Mamlin in Kenya who ensured that we had everything ready before we set out. We did encounter some delays during the processing of our visas and it necessitated us to make several trips to Nairobi (VFS Offices). It was quite hectic as the school session was ongoing and we therefore had to work twice as hard to catch up on the things we missed in our absence. We finally got our visas just 5 days before our travel.

We departed from Nairobi on the 19th of August 2015 at 23:25, had a stopover in Brussels and Montreal, and then finally arrived at Toronto at 15:22 (about 24hrs later). It was one long and tiring flight. At that moment, I would even have fallen asleep on the ground given the chance, and very soundly for that matter! We were received warmly by Angela Ma who then took us to the hotel where we would spend the next 6 weeks. The room was really nice and spacious with a beautiful view of the city from the balcony.

The next day we met Joe George who gave us an orientation of the city on our way to register at the student centre. Things seemed so confusing at the time and the jet lag certainly wasn’t helping matters. I remember the first time on the subway train, I kept wondering how people could tell where north or east was, wondering perhaps if I was going to need a compass. But Joe was very patient with us and in no time we could independently commute from different places whenever we had to use the subway.

I spent the first 3 weeks rotating at Mount Sinai Hospital (MSH) where Sylvia Muir had a schedule ready for me to cover different areas of OBGYN at MSH. The labor floor was indeed state of the art with everything perfected to precision. It was very silent compared to back home where you instantly knew where the labor ward was located by just following where the most noise came from, which I came to learn was due to the choice of pain management patients opted for during labor (Epidurals). I was there for a 24 hour call twice and was expected to perform duties just as a medical student would do back in Eldoret. My first 24 hr call was with Dr. Rachel Spitzer and I really admired how she and the rest of the team were truly dedicated to the management of their patients. The team work displayed truly was amazing. I was also amazed by the patient’s spouses’ involvement during labor to the point they even got the chance to cut the cord. I learnt quite a lot as I assisted in the delivery of babies, conduction of third stage of labor, taking histories and physical examinations in triage, and assisted with cesarean sections. I also had the opportunity to be on call with two other wonderful doctors: Dr. Keunen and Dr. Okun who also taught me a lot.

At MSH I also rotated in various clinics and ORs with different doctors: Dr. Benerdini, Dr. Dodge, and Dr. Melanoski all of whom I gained so much knowledge from. At the clinics I was really pleased with how much the doctors took time to explain every single detail to their patients concerning their plan of management. I also learnt the importance of considering the mood and mental status of the obstetric patients and not only focusing on the pregnancy or the infant born as psychological wellness contributes a great deal to the patients well being. And also at the clinics I was yet again amazed by the male spouses’ involvement in the postpartum visits.

I spent the last 2.5  weeks of my elective at St. Michael’s Hospital where Charlotte Aziz received me very warmly and had everything ready for my rotation. The hospital building was like a maze and I constantly got lost in the corridors of the vast structure but I always managed to get to where I was supposed to be through the help of the friendly staff I asked for directions.

I rotated between various areas, including the Labor and Delivery floor, Antenatal clinics, Gynaecology clinics, Colonoscopy Clinic, Fertility Clinic and the operating room. I got a chance to shadow Dr. Adelmo Martoglio as he performed sonohysterograms and I got to learn tons of things, which would be beneficial for the Radiology rotation we do in our fifth year.  Dr. Martoglio was particularly nice to me and was so fatherly and showed great concern. He deserves a special mention and I wish him many blessings.

I also spent time with Dr. Geary, Dr. Robertson, Dr. Soroka, Dr. Steinberg and various residents whom I learnt a lot from. The fertility clinic with Dr. Sonny Sierra was particularly very interesting, as this was an aspect of medicine I had not truly experienced before. Watching transvaginal oocyte retrieval, in vitro fertilization and blastocyst transfer, was amazing. Listening to the patients made me realize that we take so many things in life for granted; the ability to conceive and carry a pregnancy to term is a miracle that deserves much appreciation.

I extend my heartfelt gratitude to every individual I got to interact with in Toronto as every single person played a role towards the success of my elective period.

Special thanks to Sarah Ellen Mamlin , our mother hen who ensured that we had everything we were going to need for our travel.  To Dr. Rachel Spitzer, who worked tirelessly to make sure we gained the most from our time in Toronto, and for being a wonderful teacher and mentor to me, thank you. To Joe George, for helping us settle into the system and for taking us round the city, plus for making us forget to miss home, we give our sincerest thanks.

In entirety, I had a wonderful life changing and eye opening experience in Toronto. I’ve learnt many things, met many people, made new friends and this is an experience that I will always treasure for life.

It is my hope that the knowledge and skills I gained will be of  benefit for the reproductive health of women in our country.

-Joanne

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