HARAMBEE newsletter, 2006.
I’ve delayed chronicling all we’ve done in 2007 because a good update for 2006 wasn’t yet completed. I hope this isn’t a character flaw—just the result of a sinking feeling of too many tasks & little time, so a newsletter slipped down on the priority list.
To briefly address 2006: Our carefully planned medical student volunteer program went very well, with gratifying support from many donors & these results:(1) further exposure & help for those in the world who are most in need; (2) a scholarly publication & two presentations at an international health meeting; (3) participation in a university student leadership conference; (4) several radio & newspaper interviews.
The months spent planning a solid itinerary for the May, 2006 mission proved a good investment. At times, idealistic medical students working in
There were three components: Education, service, research.
Education: Seven students & I met periodically during the winter to plan & learn about
We had planned next to teach basic hygiene and HIV prevention: education/service in various Kenyan clinics & villages. However, it quickly became clear HIV prevention education was not the fundamental problem; rather, HIV & accompanying health concerns are the manifestation of pervasive economic &
cultural issues. These are complex, but with a simple answer: when people have control of their own destiny & can provide for their families, a healthy culture thrives. Poverty is the real pandemic; HIV is merely its flower.
Students quickly understood this & abandoned HIV education modules in favor of community-building efforts. They focused on one village, EmBulBul. We identified local resources for health care & education & attempted to foster a relationship & commitment on both sides; we began a soccer team for the children & investigated how the local church might be more fully engaged. We tried to identify a market for crafts made by a youth workshop group. These are small efforts to solve a big problem, but the motto of HARAMBEE is “One drop in the bucket is better than no drop in the bucket.” Students who returned to EmBulBul in February of 2007 reported a slow, modest success.
A central task of our trip was the health care needs assessment study—both for the valuable information it gave us and because it provided for dialogue and a unique window into the lives of those we wished to help. We were trustingly invited into Kenyans’ homes and into their hearts as we queried them about their lives and health. These encounters engaged us in a way we did not anticipate; information disclosed to us invariably led to strong emotions, tears, and increased resolve to work for social justice.
Once again, economics stood out as a primary determinant of healthcare. In a country where unemployment stands at 70%, how could it be otherwise?
Students reported the questionnaire as a transformative feature of their medical education. Below is a piece written by Justin List and published in Virtual Mentor, an online ethics journal of the American Medical Association. If you read nothing further in this lengthy newsletter, I urge you to read Justin’s article.
Learning to listen in a resource-poor international setting: a medical student’s encounter with the power of narrative in
by Justin M. List, MAR
After talking with a woman who was living with HIV and caring for an HIV-positive child in the resource-poor community of Kawangware in Nairobi and completing a public health needs assessment for her, one of my medical school colleagues posed the following question to our volunteer group as we were working at the clinic: “What do I say to her at the end of the needs assessment when she asks me if I have hope that she’ll live?” I remained silent. How can I as a healthy, educated, middle-class medical student from the
Most members of the group had just completed their first year of medical school only days before we arrived in
For some of those interviewed, it was the first time they had ever felt listened to, as we found out from them or their translators. And hearing about the power of having a voice and feeling heard illustrated for me a learning point that I might have missed had I come to
I did learn some of the science of medicine, though, if not explicitly clinical. We used a needs assessment to acquire quantitative and qualitative data that—we hope—will serve the community through its analysis. But because we designed this trip from a public health perspective and left the stethoscope and Bates’ Guide to Physical Examination and History Taking behind, my education in the art of the medicine remained a key component of my experience in
I did not need to go to
Medical students working abroad in resource-poor, low-income settings will encounter a host of experiences and confront a variety of feelings, perhaps including some I have described. Students bring a rich array of experiences and feelings with them that affect their ability to truly listen to the content of the patient’s words, and it is to our benefit to explore these feelings before, during and after our international immersion. Like me, students may find themselves seeking clarification about how to incorporate international health care into their future careers after short-term, life-changing work. And medical students traveling abroad for the first time in their burgeoning professional capacity should be prepared to expect the unexpected despite extensive planning and pre-trip education; to experience complementary or conflicting feelings of duty, ignorance, education, helplessness and purpose all in a matter of days or weeks; to anticipate an unfolding lifetime of further professional and vocational reflection and action.
Remaining truly present and attentive may be the most difficult aspect of learning the art of listening in medicine, especially where unfamiliar contexts, cross-cultural issues and language barriers coexist. As physicians-in-training, we have a potentially easy exit—turning our focus to the rigmarole of the chart, looking down at the survey with intent, deflecting a consideration of the often difficult-to-comprehend social determinants of health or concentrating on the biomedical components of the present illness. For me, listening to these difficult stories took more energy at times than I could have imagined listening could possibly require. And yet listening is a skill that we as medical students must continue to practice consciously as we discover our personal limits in relation to our pursuit of justice and caring for patients holistically.
Listening is an end unto itself, but it is also a means and a beginning to addressing aspects of patients’ lives that lie outside but impact the biomedical context. In seeking out patient narrative, especially in international resource-poor settings, we must ask questions (in a culturally sensitive manner) to which we may fear to know the answers, answers that expose injustice yet open a new world of possibility to the patient and physician.
1. I want to acknowledge my partners and team members, Lisa Dunning, Kathy Hakanson, Mark Hakanson, Andrew Loehrer, Terri Parks and Jaime Sua, and Kathleen Harrison, Ph.D, Founder and Director of HARAMBEE (www.projectharambee.org). All of them opened themselves to the power of narrative through these needs assessment surveys and, through our shared stories from survey participant encounters, they provided me valuable insights.
Justin M. List, MAR, a former fellow at the American Medical Association’s Institute for Ethics, is a second-year medical student at
A somewhat lighter part of our work came when we visited the Mukuru women’s group, organized in one of
We ended our 3 1/2 week sojourn totally exhausted but inflamed with desire to return and continue this important work. We have a million memories, a million stories, only a few of which are related on the website (www.projectharambee.org).
Good things were accomplished during our short stay in
We want to thank those who contribute materially and spiritually to our mission. We can only do what we do because of your help.
We thank our Kenyan friends for their inspiration in our quest to make life’s playing field more even. From you we receive more than we give, and you help us to be God’s hands here on earth.
Bless us all...