"Faith is a big deal, and it's part of our prescription to patients."
About Kabarak University-Kijabe Hospital family medicine training, healthy communities, the advantage of learning in Kijabe (access to advanced equipment/clinical opportunities), and a little about Friends of Kijabe.
MILLICENT Wangui Family Medicine Interview
DAVID:
So, I'm David Shirk. I'm director of Friends of Kijabe.
And maybe tell me your name and what you're doing in Kijabe.
MILLICENT:
Okay. So I'm Millicent Wangui Family Medicine Resident currently in my third year and yes I've been around Kijabe doing my current training here, and also started a while back as an intern.
DAVID:
Excellent. Oh, when were you an intern? What year?
MILLICENT:
Just after COVID so 2021.
DAVID:
Okay. Excellent. Maybe you could explain - I have many questions about family med. You could probably explain some of them. The organization is Kabarak, but then do you spend all your time in Kijabe?
MILLICENT:
That's a great question. So yes, family medicine is currently in the country in a couple of universities and Kabarak is one of them. Okay. It's a bit more unique in that we are under Kabarak University but then stationed in different hospital sites most of them being faith-based but we also have Naivasha District. So, I do have classmates all over the country.
DAVID:
And do you do you see them like do you have events together or get together?
Yes. So, we do have sessions. We started out together and we had basic modules for like 3 months but then in the course of our training which is a four-year training we have certain moments and trainings that we do come together in either of the sites and actually this week we've been together uh we've been doing a common HIV module so it's been a special time to reconnect with them. Yeah.
DAVID: Good. What does family medicine look like in Kenya and then what does it look like in Kijabe? That might be two different things.
MILLICENT: Right, that's very true. So in Kenya, in general, Family Medicine is that doctor who can do everything you know and especially for our setup where we still don't have a good ratio of patients to doctors so in our counties and down there to the level and the grassroots we really do need that doctor who and helping even the surgical aspect and the broad preventive primary care. That's the big idea for Kenya and many African countries.
However, in Kijabe we are privileged for sure in that we do have various trainings the surgical programs and we also have pediatric residency that started up and we hope to have also more. So, we do get as family medicine residents we do get to have better experience and in that we have more exposure into what we could say in-depth. Like if it's pediatric care it's a slightly more advanced so we are privileged to be also in like a PICU setup uh which we may not really have back there in our practice in other setups in Kenya.
So here training in Kijabe our minds are more, we get to involve into the real care and not just outpatient but also into the inpatient care.
DAVID:
I like that. Do you do much with palliative care?
MILLICENT:
Oh yes, again we are privileged in Kijabe and that we have - the department of palliative has been coming up and so that means we get to be supported with the upcoming palliative guys who work there.
So, we do get to see many patients and not just and understand the true meaning of palliative and palliation and all the other aspects and not just end of life but also long-term care and follow-up and aspects of working together with caregivers and uh initiating discussions and being comfortable initiating the discussions. So, it's a good mix to be in this time where we can get to see palliative. It is actually an avenue to progress if I would consider to do that. So, I'm privileged to actually see it and think about considering it as possible future way of or a fellowship.
DAVID:
Oh, I love that.
This is a very broad question, but what are the needs? What area do you come from and maybe what are the needs in your community medically?
MILLICENT:
Okay. So, I come around the same area as Kijabe. So I come from the central area of Kenya which is mostly Kikuyu but also within and near Nairobi and we've seen a great rise of the non-communicable diseases majorly being diabetes and hypertension and that's really struck our community and it's a place where these are conditions that can be handled right from the very low-level preventative care and that is talking about early screening and diagnosing and also modifying a little bit of our habits, how we eat, a little bit of exercise here and there. Incorporating this knowledge into our patients that can help to see the disease before it gets there. preventive care and, also at least screen it and treat and maintain them so that they don't get into now the complications that arise and debilitating palliative measures.
DAVID:
In an ideal world what does that look like for family medicine, I mean, because you're doing a specialty but your specialty sounds like part of it is to try to keep people... it's behavioral preventive... help try to keep people out of the hospital
MILLICENT:
Yeah. So, the very dream would be to work with communities down there and to work with everyone. You know this is family. So, we want to go into the families and see what are the dynamics that you make them make certain behaviors and decisions and what affects what they're buying at the end of the day. How do they go about in movement? Are they in vehicles or are they walking some distances? So that would be being down there and having a lot of education, you know. So, I would really love to see a world whereby our patients are empowered to live better and live within and do the most and make the most with what they have. You know, if they farm greens, know how to add fruits into it. If they are in a community where they predominantly eat meat like around the Masai which is near Narok let them know that they can have meat, they can have fruits and vegetables on the side you know like small kitchen gardens you know. Yes. And add…I know most of them don't know how oranges taste like, but it would be nice for them to know oranges are really important other than that cow, that meat all the day. Yes. And this will definitely have a great impact in their health and have them avoiding getting the to the co-mobilities and diseases that we had discussed.
DAVID:
It's interesting. Kenya is moving rapidly the direction of many hospitals. This is a common problem elsewhere.
There's a hospital that I've been kind of following from afar in Alaska. They have huge behavioral health departments. It's like clinicians, you know, so it may be some like you - family medicine clinicians, but then social workers and then, admin people and then they create a dashboard for patients to monitor their own health. Like how do they log in to be able to see how they're doing?
MILLICENT: That's like it's really, really amazing.
DAVID:
But it's it takes a lot of people and a lot of reinforcement to because these kind of things - it's about when it's about behavior change. It is behavior. You can't just tell them a Masai "go eat mboga" (vegetables). How do they find it? How do how does it become acceptable, you know, to their community? Hey, "this is who we are."
There's a famous phrase "people like us do things like this."
Okay. So, you're trying to create a culture where... like Christians like you go to church on Sunday, right? Or footballers, like you go run around in the afternoon, you train. And so, you're trying to create a culture of health "people like us," you know, maybe we go to KFC sometimes, but not all the time. We can do healthy things also.
MILLICENT:
For sure. Yeah.
DAVID:
Good. Well, tell me about how is faith incorporated into your into your curriculum? Like what you're learning and then how you interact with patients. Yeah, that's an amazing question.
MILLICENT:
In particular to our training, we do have the faith aspect really highlighted early on from even recruitment in that it's tailored to make you aware that you're not just entering a vocation and training, but we need also that wholesomeness, the spiritual aspect for you to grow as you're growing in your academic journey and your career path. And so, jumping into that boat where everyone recognizes that faith is a great aspect in care for patients, also for your general training at a personal level.
It makes us every day think that, "oh, I'm just not treating this patient from their physical needs, but there's also a faith standpoint." There's an emotional standpoint that's coming out as well and that's going to really impact on what we're going to discuss and go ahead on as they go home. So I have been growing in that.
These days I'm quite comfortable to initiate a faith discussion with my patients at least probably 60-70%. It's still growing for sure, but it's not like how I started out. And, also how to bring it out even in different and difficult circumstances. Because we do meet our patients in vulnerable situations. And some may be willing to openly discuss about faith and God. And others may be having a hard time of questioning and asking why. "Why me? Why would God allow this to even happen?" And those are the moments that they need us the most to know and to reassure them for sure God is still within the picture. So, faith is a big deal. Faith is a big deal and it's part of our prescription to our patients as we continue with care.
DAVID:
Anything else we should talk about? What should what should I ask you?
MILLICENT: Oh, you did mention about friends of Kijabe. Yes. Yeah. Which we have really... I've really seen of great things even especially within pediatric care and it's part of the avenues we get to see and feel the good impact that our patients can benefit with and also for us as residents. So maybe you could let me know.
DAVID:
Absolutely. Yes so you witnessed on pediatrics it's. . . most people come, most of them have social health authority insurance, some have private insurance, but then some will come and they don't have family resources or they're stuck in some way, like they they're unable to pay, they've exhausted their resources. A lot of times it's sad situation, but it's a bit of grace that we can help those patients go home and the families.
So, that's that's part one.
Then part two is equipment and infrastructure trying to find the machines and things. I mean you've been in PICU like that's it's a that was a long long long process or even NICU like getting the things that are needed to provide good care. Cancer center was one of the recent projects. It was outfitting that place. Then there are many more things that are in our dreams.
And then the last one is is education. Mostly we do scholarships for nursing students. We provide some funding to the other organizations that are doing sponsoring sometimes but most mostly...like family medicine has a good source of funding. A lot of PAACS has a good source of funding. But right now, we're doing a support project where we're building housing. So, it's to benefit all the people who are coming to train, but we want to build housing on campus so that can live close by, have a really nice place to stay that you can you know, if you want to if you want to deliver a baby, you know, if you want to catch a baby at 2 a.m., you can come catch a baby comfortably and run back to sleep afterwards.
MILLICENT:
That's really amazing. "For such a time as this." For such a time as this. I love that. Yes. Yes.
DAVID:
Thank you so much. Well, I appreciate you. This is really fun. Thank you so much, MILLICENT.
MILLICENT:
Thank you, too.