Dr. Annviola on her journey to pediatrics, why she loves Kijabe, growing up in Kibera, amazing patient stories. Why Pediatrics? "If I don't do it, who will?"
All right. So, I'm David Shirk, director of Friends of Kijabe. And tell your name and what you're doing in Kijabe.
Annviola: My name is Dr. Annviola Nalugala and I am a pediatric resident at Kijabe Hospital. The first the first group. The first class.
That is awesome. Congratulations. Thank you. We're excited. And but you've been in Kijabe some time, right? Yes. Since I was an intern.
And when was that?
Annviola: In 2022. I finished in 2023.
Why are you still here? What do you like about Kijabe?
Annviola: Actually after internship I left. And then one day I got a phone call and they were like they're looking for an MO (Medical Officer) and I quit that very same week where I was and I came back mostly because I felt in my career I was still at a place where I needed more mentorship. Where I was practicing, we really were just left to practice and you weren't really sure if whatever you were practicing was the correct practice or just the practice that is like people are used to doing something a certain way and also just the sense of community that you find in Kijabe and I think also just being able to pray with patients.
I still used to pray with patients there but there are some would look at me like I'm crazy. So that freedom of being able to express your faith was something that made me come back. And I was called back for pediatrics. So I was like, "Oh yes, I'm coming back."
David: That's awesome. I was think about a patient that you prayed with recently like what is your prayer for them like when you're talking to them like especially for babies like I don't know walk me through it. What is it? What does it sound like?
Annviola: I will use a case that happened this week when I was on call because I'm still recovering from that call. We had this patient who has neuroblastoma. . . actually it's I think Wilm's tumor, had come from surgery and was otherwise okay. You can imagine this patient has gone through chemo. They've gone through I think they had also done not not done radio but chemotherapy. They finished their initial courses. they've gone to theater and something happened in theater and they became quite sick while on the operating table - hypotensive - they were given blood but they were not improving and such patients just make me really sad. It's sad to say, but there are some patients who walk in and you're like, I don't think this one will go home. But there are those who walk in and you're hopeful, especially with such a patient who's fought through chemo. Finally, they're getting their tumor removed and hopefully they're going to go into remission soon after with further treatment. And so when we were getting handover, I was looking at this patient, I'm like, "Oh no, this one does not look good." He had really low blood pressures, like blood pressures like that of a premature infant, and they're already on a presser. they've already given boluses. I think they had actually given around 700 ml of fluids plus blood and they were just looking terrible. And I was like, "Oh God, please let this baby just make it through the morning. Just let this baby make it through the morning." By around midnight, we on three pressers and they really did not look like my prayer was working. But in the morning, we were weaning down one of the pressers and I was just so relieved. We had other problems but for this one I was just so relieved. And by evening when I went to check on them we were off one presser completely and by yesterday we were off two pressers and today we are about to be off the third presser. I think my prayers were answered even though at midnight I was like "oh no something is going wrong."
So this is so this is a prayer just of desperation.
Annviola: Yes. I don't think. . .okay there are some times where you pray like yeah hope whatever but there just times you're just like "Oh God please make them live."
Oh that's awesome. What do you like doing? Do you like critical care? Do you like the floor or do you like being in PICU?
Annviola: I think I like critical care to be honest because even when I'm on the floor or in NICU I just find myself in PICU doing something. I think I like critical care mostly because I think they're the most vulnerable and where I was practicing after internship before I came back I noticed that not many people like working with kids I don't know why so we will get children come to the emergency department and everyone else. . .let's say it's an accident everyone else will have someone to take like someone is putting a line someone is doing this and then the child people are just talking to the mother no one is touching the child. So I used to to try to bridge that gap, because we used to deal with a lot of trauma and putting lines 'cause they just assume like it's a difficult cannulation and also I think they don't want to be attached but I think that made my love grow more 'cause I felt like they're the most vulnerable but no one is is touching them.
And also for PICU, like they will come really sick. There are some who die but most of them go home and that just makes me feel happy because you saw them. Like for example, the one I'm talking about and now she's talking. It's just amazing. It's almost like an adrenaline rush but in a good way. You see this really really dramatic turnound.
David: You see that and and sometimes it's literally death to life. Like sometimes their heart is actually stopped. You have to resuscitate them and then they walk out of the hospital later.
Annviola: Oh yes. Like there's this one still the same call. We had this neonate who just became unresponsive all of a sudden was pulseless. We ran the code and it ended up being hypoglycemia and within like the first five minutes the baby came from heartless to crying and being vigorous. And that's just amazing. And I tend to think that children don't pretend. If they're okay, they're okay. And if they're not okay, they're not okay. And like adults who when they see the consultant, they become sicker.
David: There's certain type of person who can take care of kids. Like there's some people I look around, I'm like, "Oh, you could have been a great pediatrician." They're like, "Nope, nope." They love kids so much, but they can't stand to like put in a needle. They can't stand to cause a cause a child any any pain. So that's so they go into ortho or whatever other kind of program.
David: So we're doing this housing project, you know, trying to move all of our trainees. And so when we talk about it I mean it's it's a really big project and Kijabe is growing rapidly right? So pediatrics is our newest training program. When are you a month old? How old is actually?
Annviola: Yeah we're a month old.
David: A month old. Happy happy - I don't know - not birthday - yes happy one month. But neurosurgery is starting soon, urology is starting soon, internal medicine hopefully soon, and so just growing and growing growing but we want people to be back on campus for a variety of reasons. What is what is your commute like what is your what is your day like? How how does life look right now is it hectic?
Annviola: Okay I think I think I adjust well generally. It can be hectic though. For example, today it was raining and I live in Kimende. So the matatus have - it's like the trains - they have a specific time and if you're late by one minute you miss that that one you have to wait for the other one. And we don't have like good bus stops and stuff and my hair is open and I'm an African. And you're preparing for an interview?! Yes. the the the the hair just decides to shrink and so it becomes a bit hectic. There are sometimes when I come with like a lorry or like there was a time I came with. . .
David: Wait, what do you mean a lorry? Yes. Like in the cab or in the back?
Annviola: No, no, no. In the (cab)
David: Okay, good. In the front.
Annviola: There was a time I boarded a matatu (minibus) and I was hearing like "baaah" so when I turn the back it is full of goats in the boot. I'm on the way to a shift and I had used my very expensive perfume but by the time I reach work I smell like goats so it motivates you to wake up earlier. But otherwise it's it's manageable 'cause luckily there are so many staff that stay there but it's different when you're a staff and when you're studying 'cause there are some things that you can only access in Kijabe, like patient files and like downloading with free Wi-Fi cuz you don't want to use up all your (data) bundles. So you need to stay sometimes a bit late.
I have learned that when we stay late enough coverage gives us an ambulance to go home so we save about fare. . .it's manageable but it can it can be quite hectic compared to those who who stay in the hospital.
David: Yeah. Wow. That is that is the best that is the best pitch for housing I've ever heard. We don't want to smell like goats. If if you're watching this and you never spent any time around goats, this is a it is real. Like that smell does not go like for days.
Annviola: No, it does not.
David: What are your big dreams? Why did you go into medicine? What do you what what made you want to do what you're doing right now?
Annviola: I grew up in Kibera for the first 16 years of my life and my mom is a nurse who worked in Kenyatta hospital. So, when I was growing up so many people would come to our house with various problems like oh my back oh blah blah blah.
David: So your mom is working all day at the hospital but then she's working all night at home?
Annviola: Yes. Like there's this night I remember I woke up to someone screaming and someone was giving birth in our sitting room. So, when I as I was growing up I used to wonder, now when mom gets old who's going to take over this role? I think that's how it started 'cause I saw and she never used to like ask for payments and I think we were one of the few people who owned a car. So she would, with my dad, take them to hospital in case of emergencies and things like that and look for like consultants to see them and things like that. So so it was mainly from seeing how my mom was.
Annviola: So actually as I grew up I thought I wanted to be a nurse because that's what I had seen but my mom was like "I think I think you need to be higher than me." I'm not saying nurses are lower. I think that was just my mom's thought process and I think that passion just just grew. I used to joke in high school that when I wanted to be a doctor. I was praying that by the end I don't just hope to be a patient just work hard to end make sure that I end up becoming a doctor. So I think that's how my love for medicine started.
Annviola: But my love for pediatrics was on my third year in medical school. So, in medical school, the the first two years it's like in our system it's like I think the pre-med system in the US where you do like the basics biology, biochemistry, pharmacology, anatomy and all that. Then in your third year you start seeing patients and it's mostly like learning how to take history.
I had gone for my first rotation in pediatrics. I have all this psych you know I've woken up I want to present and I don't even know how to present. So I saw this patient who actually the mom was motioning me to come. So I was like, "Oh, good." Because most of the times when patients see medical students, they're they look away, they don't want you to come near. So I was like, "Oh, this is my lucky day. Let me go to this mom." I didn't know she was calling me because she had a problem at the time. So I went, I took history. It looks relevant at the time, but it was so irrelevant honestly. Like what water do you use? What do you use to cook? How many rooms do you have? Is it stone house? You know, things like that.
David: So, you're taking like a social history, not a medical history?
Annviola: And in retrospect, now that I have a bit more experience in pediatrics, I was just wasting time because that baby was in shock. So, this mom was telling me the way the baby has been having diarrhea and vomiting. But the whole time I'm looking at this baby, they're breathing funny. So, I'm like, are you sure this baby doesn't have pneumonia or cough? Like, I don't know that background medicine aspect that you can actually be in respiratory distress in shock. So the whole time I was like this woman is lying to me. Should have gone to another patient. Why are they lying to me? So I'm just going to look like a liar to the consultant because I'm sure there's a respiratory problem. So I was so fixated on the resp problem. The baby was lying on the side. I asked the mom to let the baby lie on the back so that he can auscultate. And this is like my first time using a stethoscope. So I don't even know what I'm listening for. But I was I was so determined. So the baby lies flat. I start auscultating, and you can you can imagine how bad it was because the baby stopped breathing and I was still auscultating.
So the mom was like "my baby has stopped breathing." Then I look I now look at the baby nicely. They're like, "Oh my god, they're not breathing." So I was in shock as well. But that weekend I had come to peruse through the ward and I had met one of the MOs (medical officer) who had taken me through now actual like septic hypoxic shock and I remember when I was in shock and I touched the baby they felt cold in the extremities. So I looked at the mom I looked at the baby then I ran out. I'm sure she was wondering what's wrong. I ran out to call for help and I saw some residents. They were rounding on another patient. I was like, "Doctor, I have a baby in shock." And then I ran back to the mom's bedside. So, she was the only one who followed me because I think they wondering what's this medical student saying. And then when she came, she was like, "Code blue, Code blue." And I'm just there. I don't know what is going on. that I think that was the point where I would have either chosen peds or not because I remember they had given me work to bag the baby but I think I was doing a good job because they didn't remove me from bagging the baby then they were putting an IO (intraosseous needle). I had never seen that before they just doing things I'm wondering oh my god why did I tell this baby to lie flat like? What did I do?
David: Obviously not your fault.
Annviola: So afterwards I went to class, they stepped up the patient to PICU but I came back I was just like "Did I kill this woman's baby. . . like what happened? So I met that doctor who had responded to the code and was like doc what happened to the baby? She said, "you know if you were not at the bedside this baby would have died." Apparently the mom had been trying to raise the concerns throughout the night but no one was like responding. So when she saw me and I looked like I had psych, she was like, "Please come." So that's why she called me to her bedside.
Annviola: And it's so interesting because if I had not come over the weekend because I didn't have a social life to learn about shock. I would not have identified shock. And I remember that that doctor saying...you know, I was like, I don't think I can I can do pediatrics, this is just too traumatizing...And then she asked me, you know, doc, if you don't do it, who will? That stuck and that has been like my thing. So I think even when I'm telling you about do it yeah about critical case because most of the time in PICU you'll be like like other consultants will be like "oh I don't I don't like being in PICU" but that that statement keeps on sticking to to me because I'm like "if I don't do it then who is going to do it." That really stuck and that's how I ended up in pediatrics.
David: Yeah. Wow, that's a great story. Oh my goodness.
Annviola: Because I don't think I can imagine doing anything other than what I'm doing now.
David: Arianna had a mentor when we were in North Carolina. And he told her that. . he said "if you can think of anything else to do, you should do that instead." But if God puts on your heart medicine, then then go do it.
I love that story about your mom. That is so cool. Were there were there clinics or facilities in Kibera at that time?
Annviola: Yes. I think the fact that we were in Kibera, we were lucky 'cause a lot of NGO's around there like gender based violence for children. So even when I was growing up, we rarely used to go to Kenyatta to be seen. We had so many other facilities at a lower cost. There were so many so many groups. So there were several clinics and they would provide either free or care at a subsidized cost, but it was mostly like just maybe outpatient OPD care, but for like emergencies, it was hard. But imagine even with all that people still didn't have that heart of going to hospitals. Yeah.
David: They would still rather go to your house.
Annviola: Yes. They will still. So we we I used I usually joke because in my house I also have this tin of medicines that I don't necessarily need, but becausea I grew up with so much medicines at home 'cause my mom will be like oh I have this one...this one this one might help.
And actually when we moved out, it was a really big culture shock because we moved out soon after the post election violence. I was in class 7 almost class 8 and in Kibera most of the people are from a different tribe from ours. So my dad. . . we are so light skinned. My dad was like "no no no we need we need to get out." So after that we we moved to Syokimau. We didn't really have a house. which was just a temporary building but we moved to Syokimau but to me they were they looked so rich. In Kibera there was this sense of community. Like, if I don't have milk someone will give me even if it's just a cup of milk, you know, or if I don't have matchsticks I can just go and borrow somewhere. It was just this big sense of community, and then we move in the middle of nowhere where in the morning you just see giraffes and zebras and I was like, "Mom, where where are we?" And people were just so far away. So, you know, if you open the door too, too fast, you'd hit someone in Kibera. But now, like we have land. It was just so weird. Such a big culture shock. But I really missed it. It was a very very amazing childhood. . . I used to have a pet rat.
David: No. What is amazing about that? You had a pet rat. Where did it live?
Annviola: My neighbor found the baby rats in their in their in their brother's box for school. They looked honestly they looked nasty, but they were babies." So we're like, "Oh, babies." So I took one of the baby rats at home and then I would like feed it and you know then my mom found it. It didn't even last 2 hours and she was like I was beaten so much anyway.
David: Annviola, thank you so much. This has been awesome. We're grateful for you and we're just excited excited for your pediatric training. We're excited to see you continue to grow in Kijabe and and lead and serve. I'm excited as well. Thank you.