Conversation on faith, work-life balance, parenting, stewardship, leading through the pandemic,
David: Tell me your name and then (laughter), that’s not the complicated part. What is your role at Kijabe Hospital?
Faith: My name is Faith Lelei Mailu. I trained as a family physician. I finished in 2019, and as I finished, I was offered a job to lead the quality and safety department. I think I was very silly in taking it because I don’t think I knew what I was getting myself into, especially because I think I only know of this position in two or three other institutions, that have a JCI accreditation and in Kenyatta. So that it’s very new in the Kenyan space. But it’s things that I would ask myself even before getting into the position… like, basically different aspects of it would intrigue me. So, I thought, ‘hmm’, let’s see where I can go with this. It ended up being bigger than I imagined. I still don’t think I have the full grasp, but I think…
David: So, what ended up happening, so we just went through this year, and I guess people in America would be very familiar with joint commission, because they do it at a lot of American hospitals. We ended up going with… what’s the name?
Faith: It’s Safecare, which comes out of a collaboration of three institutions, JCI being one of them, Pharmaccess, and the accreditation board in South Africa. It came out of the realization that many of the standards in JCI were almost out of reach for many hospitals in Africa. Yet, the question of quality and safety must be addressed somehow. And so… even when you compare the Safe Care standards and JCI standards, they are not very different. For instance, in JCI, for handwashing, very basic. They require a certain type of sink, a particular number of sinks per staff, always running water, elbow tap preferred. But in Safe Care if I have the modification of a bucket, and a receiver, and a tap, and a hand towel right next to it, I have met the intention that we are still washing our hands.
David: Because you have to, that’s the only way to prepare for COVID…we don’t have piles of money sitting around to build a new wash station every time the entrance to the hospital changes. . .which has changed like five times this year.
Faith: True that. I think that’s what I like about Safecare… that it is actually inspiring innovation, to still make sure that what needs to happen happens. Yeah, there’s a lot of local creativity. I like it that the purpose of safety is met, but with local input and creativity.
(agreement from David)
David: That’s good. And so, all of you guys who are listening to this, I’m sure you all have your own joint commission stories. So, that part of your job is complicated, so for everybody listening, you guys know that that’s complicated, but then that’s the easy part of your job. (laughter) Then, you’ve also been chair of the outbreak committee for COVID… right?
Faith: So, when I took over the post, one of the things that was put under me was infection prevention and control. That’s how I ended up with the outbreak position. Whoo, that was a learning curve. I’d never managed an outbreak before and yeah, this was quite a learning curve. And I think for two reasons: first, the disease was new, and we didn’t have a lot of information. It’s unlike Cholera and Ebola. Those are the ones we were used to, so this was very new. Not only to us, but globally. But two, I think as it came new, there was a lot of anxiety. So, I tell people, for the first 6 months last year, of COVID, my stress was not even the patients, it was the staff. It was the staff anxieties and the staff years. And I would want to term them irrational, but I couldn’t, because those were people’s genuine feelings and concerns. Even I had them at some point. Yeah, so those were the things that made it really challenging. Now that we’re in our third wave it’s a different strain, I think. And it has a different type of impact, but my anxiety now is not staff. It is other things, because staff have gotten more comfortable with the disease, and managing it, and wearing the PPE. Yeah, just going about life in our new dispensation.
David: How did you manage that? Like, when somebody’s stressed or saying, “aaah, I’m not going to come to work.” What do you say to them?
Faith: Or ‘I’m not wearing a PPE’. Or ‘You’re putting our lives at risk’.
I think the outbreak committee was very helpful. I didn’t do it by myself. The committee was big. And I think having communication from as many of us that is consistent. That we would agree, this is our stance. This is our position. These are the reasons why and this is why we will stick by it. So, doing it together as a team and referring people to legit websites. That was part of the challenge. There was a lot of media that was not right, that was very wrong. So, I told people, please have a look at the WHO and see what it is saying. Please have a look at CDC and see what it is saying. That’s how we won the battle for PPE, because everyone wanted those…
David: The suits.
Faith: The suits! I call them Ebola suits. They’re called hazmat suits. Everyone wanted them. And I said, ‘please look at what CDC is saying. Please look at what WHO is saying and then let us talk.’
I understand the anxiety part, but let us first get the knowledge part right, and then let us work through the anxiety. What does it tell me? Is it your children?
So it would be evidence (first) and then let us work through the emotion.
Dr. Mary Adam helped us do frequent debriefings with people on that too. We realized part of it was just fear that was not informed by anything.
So, once you know what the right thing is, it still would not sort, ‘Am I going to take this to my children?’ ‘Am I going to live?’ ‘Is my job secure?’ you know.
Knowing that did not address the emotional bit of it. Having the debriefs was necessary. We also got some psychologists who were willing to do sessions online, and so, for some particular staff we referred them to that option as well.
I think also crafting messages around, ‘we care about you.’ Because it’s true. We do. The human resource is the most important resource in an institution.
And wording our statements in that way. Salome was very helpful in saying, ‘we care about it, we want to provide PPE to take care of you. If you have any concerns please reach out to Faith, or so and so.’
I don’t think we would have done it without staff feeling we actually do care.
David: So how do you resolve that for yourself? You’re in the same boat. What do you say to Daniel and Josh when you’re walking out in the morning? What are you thinking?
Faith: I remember very early on there was all this media, and we were following the news early on, and we didn’t realize that he (6.5 year-old son) is following it with us. One day he asked me, ‘Mom, are there people with Corona in the hospital?’ and he asked me ‘Mom, if you get Corona will you die?’ I was like Woah! (laughter)
Yeah, I had my initial assumption in the wrong place, that this is not a disease for young people. I am young. I am fit. I am otherwise healthy. If I get it, I should settle through just fine. It is true that that is scientifically the basis. But I lost a cousin who was 27, who was young, fit, and otherwise fine, who ended up needing intubation.
So, you know, when that happens, you’re like- ‘I need to put my faith in something else.’
It can’t be in the fact that I am otherwise fit and healthy. It has to be in the Lord, that he will protect us and care for us.
Josh amazes me in the conversations we have. We had to talk about it and said, “God takes care of us. This disease is affecting mainly old people. That’s why I’m not taking you to Gogo and Agui (that’s grandma and grandpa in Kalenjin) so that we can take care of them. We continue to pray that God will protect us.”
And so, we would pray together in the morning as we leave for work, helping him realize that’s not the only risk. There is a risk in going to any Kenyan highway. And that is the reason that we need to continually trust God for protection and for his cover. We’d pray, and he’d see me come home more times than not and he’d be more relaxed. Nowadays, it’s not a bother in the house.
David: When we first sat down, you were telling me something good, how you manage life as a doctor, because you have these massive jobs but you’ve got two kids, you’ve got a husband, you’ve got a lot of people that need you. How do you manage that?
Faith: I think it took a burnout for me to realize I need to change a few things. And one of them was how I disconnect when I get home because you get to work at eight and it is almost often firefighting the whole day. (laughter) It feels like sometimes of my own, because I have procrastinated, but sometimes just because things come up in the environment in which we work in.
There was one time we did an exercise somewhere and we were coloring a football that was black and white. In the black place we were asked to write things that take away your energy, and in the white it was things that increase your energy.
You need to find ways to do more of those things that increase your energy, and for me that includes, playing with children, exercising, cooking, I don’t know, anything but job related, so that when I get home at five that’s what I do.
I will kick my phone aside if I’m not on call, it will be on do not disturb mode. And if you call the second time then I know you really wanted me, therefore I will pick. And just really trying to disconnect from 5:00 pm until when I get to bed. In the morning when I wake up the things will find me.
I have just finished reading the book Tyranny of the Urgent. I’d read it at the beginning of residency, and it was good to refresh my mind on just not letting the important things get sidetracked, because they will become urgent one day.
Also, just getting into the habit of in the morning I plan what are the most important things I must achieve for that day, and schedule time for that and make sure I get those done. I can’t say I have perfected it but I am getting better.
David: You are still here, and you are still smiling, twelve months into the pandemic. (laughter)
You must be doing something right. That’s what’s crazy, it’s April 21st. A year ago, none of us were sure if any of this would be here. I mean, I think we all assumed, we would probably still be around somehow, but will the hospital be here? Will anything be happening? There was so much uncertainty and so much fear. And then it develops into this long, slow, everyday. . .just being beat up.
Faith: It’s true. Like, I’m remembering the conversations we had with my husband around this time. If something happens to us, who are our children’s care givers? You know… talking to people, making sure your house is in order. Looking at your financial plans and asking them, can these last for a year?
And we are here a year later, right in the middle of our third wave, and where I think, we are beginning to see the numbers dipping. When you look at projections it’s like, it’s going to be like this until maybe December 2022.
How do you fuel yourself enough to get until there, because it drains your energy? And some of it for me has just been the emotional part of it. When we don’t have the spikes, I have a better time. When we don’t have the peak waves, things are very manageable. I’m even able to focus back on the accreditation, operations and other things.
But, during the waves, especially this particular one, where we’ve had a lot more infected, the pressure has been on the turning away of patients. No one ever get used to that.
Someone has (oxygen) saturations of 60% and you’re telling them please go to the next hospital. And you see, no one wants to do it. We see it needs to be done at triage. The nurse there doesn’t want to do it. So, we say, OK, let them go to the OPD (outpatient department). The clinical officer says, I can’t do it. Let them come to the casualty. The casualty nurses, Daktari, we can’t do it. You know? It comes to you finally as a consultant, and you think, I can’t do it, but I have to do it. (laughter) You know? And even as you make the decision to send the patient away, you get the sense that everyone is disappointed in your decision.
David: Including yourself.
Faith: Including yourself. And even the family members can’t believe it. In fact, some will say, “But you are Kijabe, you are compassionate.” I don’t think there’s a way of dealing with that. Even if you debrief - because I did eventually have to get to debrief myself – but, even when you debrief, it’s like, I didn’t train as a healthcare worker to strategize on how to chase patients away from hospitals. I never went to school to be taught on that. You know?
You have the responsibility as a leader to also look at the overall situation and ask yourself, “What is the correct thing to do?” The correct thing to do is see that the oxygen capacity can take in 15 patients. Anyone above that, I will be harming other people. It’s as a leader to say, our staffing establishment can safely handle fifteen patients. In fact, even this current 15, we are already stretching our staff. Everyone is at the elastic end. And the correct thing is to say, “I have to take care of staff, to take care of the ones that I can.”
So, the fifteen (patients) that we can take care of, we will take care of them very well. There is a Whatsapp group formed of different COVID heads of facilities, and people would post on their page, today I have one bed, tomorrow I have one bed. That made it slightly easier because you say, “go to this hospital, I know here you’ll have a bed.” But that is the hardest to deal with during peaks, when you are extremely stretched. I think the numbers are beginning to come down. I was on call over the weekend and I had three extra beds, and I didn’t chase anyone so that was good. So, it feels good that we are beginning to break a little.
David: Wow.
So, you and Jeff have this big interest in missions. Kijabe is interesting in a lot of ways, one of the big ones being it is a “mission hospital.” For someone in America they’re like, “Oh David, you guys are missionaries, you’re at this hospital in Kenya.”
But you and Jeff are thinking, we want to do mission work. For your husband, that means going to Garissa, or all these places around. What is mission to you, in the Christian-medical sense?
Faith: Yeah, I’ve actually been thinking a bit about that, because a few people have been voicing concern that we are not as missional as we used to be, especially those who were in the hospital, like ten years ago and now.
I think, what should differentiate a mission hospital from any other is the intentionality of spreading the word of God. How you set up your services to ensure that anyone who walks in through that door gets to know Christ, to feel the love of Christ, and to make a commitment towards Christ. I think that should be our defining thing.
In 2012, when I came for internship, there was a sense in which fellowships were warmer or that more people attended the fellowships. There was probably a more “spiritual” environment then than there is now. I don’t know if that’s what makes people feel that we are less missional then than now.
I wonder if we are using the wrong yardstick to measure ourselves in terms of spirituality. I don’t think it should be about religion or the outward show necessarily. I think it should be about “How am I as an individual connected to God and how am I fulfilling His purposes in this institution together with my other brothers and sisters in Christ?” So that the fellowships are a time to spur each other on as opposed to a marker of how religious we are. The engagements we have, the staff meetings we have, the audits we have, whatever it is, it is how am I fulfilling God’s purpose alongside my colleagues, in this bigger purpose of ensuring that everyone in the hospital gets to know and feel the love of Christ. So, for me, that is how I look at it, it’s that when I come to work there are the days like, it’s already nine-thirty and I need the day to end. But it should be, what does God want me to do today? You are asking yourself that same question, and someone else is asking themselves that same question. In the overall picture, that everyone I meet and interact with, it should be that God would use me to help them feel his love.
David: I like that. Something I’ve been struck by - it’s happened several times lately - where something that’s really bothering me, I’ll take it to someone else, and find that this is bothering them also, and I’ll take it to the next person, ‘this is bothering me too.’ And when you get to that third person, maybe God is in this thing that we’re trying to do. It’s not just my crazy idea, but God is actually leading us somewhere…
I like how you differentiate religiosity verse spirituality. I’ve heard stories that ladies had to wear skirts, below the knee, and that was the measure. But it brings up the question, what is God really calling us to?
There’s the spirituality of it, and then there’s also the working with excellence.
I think you’re a great example of someone who has gone through the entire training process, and now thinks about the world through this lens. I mean, you probably would be anyway, but there are people who come here to learn to be medical, with a godly framework. Even when you do interviews, that’s sometimes part of the process. I’ve heard stories, ‘this one (applicant) was perfect, but this other one really needs us.’ (agreement from Faith). That’s part of why you accept them to internship or the training program, and I think that’s significant.
Faith: That’s true. I think the opportunity to rub onto each other, a sense of living for God.
Stopping the dichotomy of my work life and my spiritual life, and making it one, because that’s what God desires of us. And the opportunity to rub on each other, to remind each other, to encourage each other, to learn from each other, so that even when you leave, you know. . .?
I think that’s one of the things about Kijabe, many come, many are trained, many leave. You hope that you are spreading seeds, so to speak, that grow in other areas, so that you are ambassadors, not only of good medical practice, of excellent medical practice, but also of good work ethic, inspired by our Lord Jesus Himself.
David: That’s awesome. I love that.
Last question, what does generosity mean to you?
Faith: You may have interacted with many of us in an African context, where we have so much of a burden from our families, our extended families, because for us families are still extended. And it is few of us that have broken through, and your entire family looks at you.
David: When you say broken through, like higher education?
Faith: Yeah, higher education. We’ve gotten to high school, then we went to have our first degree. And even Master’s, you know? Many of us come from that sort of setup.
Everyone looks at you, and because you drive a car, they think you are such millionaires and you have endless resources that just never run out.
And that was such a dilemma for us because you have these resources and there is this big need, and they’re your family, so even if you say no today, you’ll still go home and visit them and they’ll still have the opportunity to ask again. Some of them, it’s like the persistent widow and it’s like, ‘let me just do something.’
For Jeff and I, we have had to define generosity in the context of stewardship. Let’s say we earn 100 shillings. What are our responsibilities in the context of stewardship and contentment? What are the things we can do that are not extravagant? What are the things our children really do need? Answering that question in a very honest way.
There are times when Joshua compares us, because we have friends in the same circles who have more leeway financially. And Joshua says, “Mom, we don’t have this, we don’t have that.” He’s beginning to notice differences in our spending with other families. Even this is helping him to understand, this is what we need, and the rest are all luxuries that we maybe don’t need for now.
How do you answer the question of what do you generally need? What are your other needs? What percentage of our income are we going to spend on anything besides us? If we look at that and decide it’s 30%or whatever, then using that 30% to address whatever it is you need to address.
I think, without looking at it in the context of individual stewardship and contentment at an individual level, you will burn your fingers and you lose sight of responsibilities that will still come to you eventually. You still have responsibility to support or to share or whatever. But you do it knowing that God has given us these resources and expects us to be good stewards about it and not neglect our role to the poor and needy in society.
David: I like that.
Faith: Granted, there are times there are times you will still overshoot what you have allocated for the month. But also realizing that God is faithful to meet and provide.
It’s hard for me to discuss money without having to remind myself that it is God, in the first place, who has given it to us. You have to keep reminding yourself, “Yes, you worked hard, yes you earned that money. But, yes, it is God who has allowed you to work hard. It is God who has allowed you to be in that place to be paid.” Ultimately realizing, it is God that has given us all this.
David: That’s a really good framework. I think it’s a helpful answer that somebody could understand. It’s the same for everybody in the world. I’ve never been one of these people, but I’ve heard even wealthy people say the same thing, there’s no point at which you have enough money to do everything you want to do. Like Bill Gates, he would love to push a button right now and end the pandemic. And he trying to, but even he doesn’t have enough money to make the big challenges go away.
It is interesting, the family obligation that you have. I want to point that out. Our generation, probably 40 or younger (I’m sure there’s people out in the villages that have more kids), but maybe it’s 2, 3, 4 kids. But your parent’s generation, how many, 7, 8, 9, 10 siblings? So, when you talk about family you may have 40 or 50 or 60 cousins? That’s normal right?
Faith: I don’t know all my cousins, that’s reality. For instance, my grandfather married 5 wives. I know uncles of 2 of the wives, 3 of the wives, I still get introduced to them.
Let’s look at Jeff’s family, his grandfather had 2 wives, I think there were 20 children. Think now of the cousins are giving birth to more, think of those children. Jeff says he has more than 100 cousins, and now there are those children.
You can never help everyone. You can never address everyone’s needs. It is just about priority, which for us is education. At any given point, you’ll find us educating at least 5 other people. We believe that’s the equalizer. Any time we meet with them, it’s God and education.
David: From what I heard, that’s completely normal. If you talk to any consultant at Kijabe, they are putting a lot of people through school.
Faith: Thankfully, primary school is now free, so you have many people who have basic education. A lot of the burden comes at high-school level, which is more expensive.
David: University is largely government subsidized?
Faith: It depends. We tell our family members, “we have so many of you to educate, so you must enter a government sponsored program.” For those that don’t do well there are technical institutions in life skills like catering, or basic electrical training that will get you a job. Sometimes we have negotiations with with family, “if I help you in this way, that robs me from helping a child from this other family.” It’s how you balance that out.
David: The other side is you are being generous in this way on top of what you do all day for your job. At the core, medicine done well is about generosity, serving people in their time of need.
Faith: Many times, we think about generosity in the financial sense, but there is also the service sense. It’s striving to be excellent. Occasionally that means going out of your way. You are not on call, but it is following up on that person. You are not on call, but you are trying to make sure someone gets a bed for dialysis.
David: The extra mile.
Faith: The extra mile. What is that phrase, “you never have competition in the race to go the extra mile?” It’s never crowded.
I don’t think it’s me only, every doctor in Kijabe has it. I don’t know if it’s the environment or the workload. I see it in very many people here, and it’s commendable. Maybe it’s the culture, that people don’t fail to care just because it’s 5 pm, or don’t fail to care because (the patient) is not a relative.
David: Chege Macharia, the other day, had patient come from Sierra Leonne. So, to make the clinic appointment, he had to write a letter for (a travel) Visa, to arrange a driver to pick Nairobi. It was 20 emails before she came to clinic. And this lady is booked for surgery tomorrow.
I know all of you guys are doing that all day, every day.
Faith: That’s the part where we have to be careful, to ensure we don’t burnout. It’s the culture we found, or we hold dear. It’s not unusual for people to take work at home. How do we strike that balance?
I wonder whether that’s one of the reasons we are struggling to recruit. In government hospitals, people are just required to work two days per week. For instance, a surgeon is required to have a major ward round, a clinic, and a theatre list. So, if you can get to do that in one to two days, that’s okay. But here, you work Monday to Saturday morning, and you’ll be tired and complain a little about it, but the following day you wake up and continue.
The work ethic here is admirable, when struck with a balance.
David: It does make recruiting a challenge, but in some ways is good. It probably is good in that nobody comes here without a calling.
Faith: (Laughter) Very true. Selection. The culture itself selects the process for you. Everyone out there knows about Tenwek, Kijabe, and they know you will work.
David: Anything else you would like to talk about?
Faith: I think we’ve covered everything. For me, going back to the whole idea of “what does God want me to do?” Doing that obediently and excellently.
One time we were doing Sunday with Joshua on marks of obedience. Immediate, obedient, cheerfully, once the Lord has told us. What does God want me to do? Doing that immediately, obediently.
I think if we all answered that question, there’s a sense in which I feel my post (Quality & Safety Improvement) would not be necessary. My post is about “Are we providing quality care?” “Are we ensuring our patients are safe?” “Are we doing the right thing?” “Are we keeping ourselves accountable to the standards we held?”
If I was consistent in answering that question every day, “what does God want me to do today?”
Part of that means taking time, of course. Time to be with God, time to be in prayer, in reading the word, in meditation, to ask, “what does God want me to accomplish in this day, in this time, in this season?” And do it obediently, excellently.
David: That’s a good closing thought, I love it. Thank you, Faith.