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Volunteers' Stories



Hong Kong

Medical Work Experience Internship in Kenya

This group of interns from Hong Kong did their internships in Diani in Kenya as part of their university requirement. They comment below on the various aspects of experience they received at the Hospital.
Experience from Male Ward:

As usual, I started the ward round with the clinical officers in the male ward in the morning. While we were doing the ward round, a new patient was just admitted to the ward. The chief complaints of the patient were headache and loss of consciousness. The working diagnosis was cerebrovascular accident. But I was surprised that CT scan was not available in the setting and clinical examination could not confirm the CVA as the diagnosis. I discussed with the clinical officer, and she was thinking of hysteria as the diagnosis, and she would refer the patient for CT only after excluded hysteria. I felt very sorry about the lack of resource in Kenya. And I think investigation to rule out life-threatening condition must be provided.

Medical elective at Msambweni District Hospital

4 weeks of clinical attachment at Msambweni District Hospital was one invaluable experience. Diseases which are rarely seen in some parts of the world (especially developed countries) e.g. malaria, sickle cell anaemia, HIV etc., are being dealt with on a daily basis here in Kenya. Management strategies for patients are very different from that in Hong Kong. Firstly, it is due to the lack of basic investigation facilities such as chest x-ray, CT scan, and even a simple complete blood count. It poses a great challenge to the practicing clinical officers to provide suitable treatment under these circumstances. Secondly, most patients being seen at this government hospital are living in poverty. It is very difficult for them to pay for some of the medications and surgeries. With so many limiting factors here, it is encouraging to see some young clinicians working with enthusiasm and trying their best to provide care to the patients.


A patient was having his wound cleaned when I entered the dressings room. The patient had been working late at night and came across a gang of three that stole his money and attacked him leaving him a fractured little finger of his right hand and an extensive wound across the hand, with his little finger almost completely detached and hanging by the skin. He was originally having his wound cleaned by Doctor A when doctor B (doctor A’s senior) walked in to assess his wound. Doctor B just walked up to the patient and pulled across the wound without warning the patient. The patient experienced immense pain so he pushed the doctor away. Doctor B misinterpreted as the patient wanted to fight him so he got very angry refused to give the patient further treatment at casualty.

Apparently doctor B was planning to give the patient surgical toilet at casualty to prevent the wound from getting infected. However as the patient crossed doctor B, he is now forced to be admitted to the ward to receive the same treatment in the theatre which would cost him 2500 Kenyan shillings. I would never forget the patient’s expression of helplessness and hopelessness as doctor B abandoned him and advised doctor A not to give him the surgical toilet at casualty. The patient could not afford to pay the 2500 KS and so doctor A was left at a very difficult position as she understands that the wound is likely to get infected without that treatment yet her boss was against her treating that patient. I was very disappointed at Doctor B’s attitude and arrogance. One should always act in patient’s best interest and should not put their pride before the patient’s best interest. After some discussion with Doctor A, she decided to give the patient the required treatment despite doctor B’s disapproval. I was extremely impressed by doctor A’s attitude and judgement. Although she is only an intern I know that she will become an excellent doctor.

Elective at Msambweni District Hospital

The 4-week experience in a local hospital in Kenya was an unforgettable one. Working in an environment with constraints of resources, I learnt to use every single piece of available clinical information to formulate a diagnosis and the subsequent management plan. I remember meeting a patient with jaundice and shortness of breath; back in my home town, my immediate response will be doing a chest X-ray and liver function test; however both of them were not available here. Instead, after careful bedside workup, history revealed usage of anti-tuberculosis medications and a 10-year-history of hypertension, and physical examination showed severe generalized oedema. The diagnosis of congestive heart failure and acute hepatitis secondary to anti-TB drugs became obvious. The lesson reminded me instead of being an investigation-result-analyzer, I am trained to evaluate patients as a whole, starting from talking with and touching them. After all, medicine is not only a science but also an art.

During these four weeks, I learnt many things from doctors and patients in MDH. Most of the diagnoses were made clinically, which should be true in clinical medicine. We were taught in medical school, that just by thorough history taking and physical examination, over 90% of diagnoses could be made, and investigations were just for confirmatory purpose. However, in a developed city like Hong Kong, we (doctors and patients) tend to depend on the investigation results, so some doctors throw out a list of differential diagnoses and investigate accordingly. That practice could be luxurious in Kenya for there is lacking of resources. The X-ray and hemogram machine were even out of order recently. Basically, there are only few investigations such as culture, blood slide or renal function test that could be done. So, we need to go back to basics! Most of the time, patients are treated empirically, and only if conditions worsen would they be referred to other hospital.

The four weeks in Msambweni District Hospital was our first clinical experience since graduation from the medical school. We had been very blessed to be able to contribute to the care of patients in this ill-equipped district referral hospital. It had always been a pleasure to participate in the various clinical activities and to exchange ideas related to patients’ care with the local healthcare professionals.

Majority of the clinical duties were carried out by the clinical officers. With limited training their clinical skills and judgments were often quite unsatisfactory to our eyes. Most of them were more than happy to listen to our argument and, after prudent consideration, heed out advices. Of course, there were some occasions when their arguments were proved to be superior and naturally it would be our turn to learn from them.

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