AN INTEGRATED CLINICAL ROTATION:
RUSM clinical students completed a rotation in Nairobi, Kenya with Chamberlain nursing students

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It was the end of the day and we were running out of gauze and lidocaine injections at our dental clinic! The local dentist that I was working with asked me to let people know that we would not be able to see them anymore because there were not enough supplies. I saw that there was still a line of people waiting to be seen. As I looked out our room I saw an elderly woman, hardly able to stand, giving me the most beautiful smile of the day! Her son told me that she was in a lot of pain from one of her front teeth and had come long way today to have it dealt with. I immediately thought-- if not today, maybe never! The very deep wrinkles on her face and her very poor dentition--each remaining tooth pointed in a different direction as she smiled--spoke of a lack of access to healthcare thoughout her long, harsh life. I looked over and saw that there was just a single gauze left on our table! I took her hand and guided her to sit in our chair. The dentist asked her how old she was and with another proud smile she answered: 99!

The dentist noticed my immediate connection with the woman and asked if I wanted to take care of her extraction myself. I was so excited as I had never in my life dealt with dental extractions! He had supervised me doing injections all day so teased me about my shaky hand which was finally calming down as I gave my lady the last lidocaine of the day. The dentist talked me through the extraction as I held the tooth tightly with a dental forceps, loosened it with the movement of my wrist little by little and--Voila! There it was, my very first dental extraction. I looked at the tooth and then at my patient who immediately gave me the same beautiful smile, with the exception of a missing front tooth!

As I helped her to get up from the chair, she instantly gave me a huge hug of appreciation! Then, she started singing in Swahili for me with the last bit of gauze still hanging out of her mouth. She even attempted to do a dance of joy with the motion of her hands. All of a sudden, everyone in the dental room including myself and the two local dentists were dancing and laughing with our 99 year old patient! What a way to end our day! Such appreciative and warm people Kenyans are! Never will I forget Kenya and her people. 
 

For me, perhaps one of the most personally challenging parts of our trip was my experience at the Mitumba latrines! After debating for hours whether or not to use the latrine, I finally gave in! I started walking behind our clinic where I was told the latrines were located. I first noticed there was just mud everywhere--or at least that’s what it looked like to me! As we turned the corner, human feces were hard to miss. We walked extremely carefully to get to the latrines. I asked my friend who accompanied me to do the honors first. As I waited for her I saw rats running around! You know how you jump up and down when you see such little creatures around you? Well, in this case it turned out that it was not such a good idea to jump around since you were certain to step on something or another that you did not intend to step on! So instead I just stood very still and watched them make their moves.

Now it was my turn. I took a semi-deep breath before I went in. A hole in the ground was what we had to work with. Now don’t get me wrong as I am from a developing country myself and grew up using squat toilets. However, this was the most primitive of them all with no flush or ventilation system, a floor wet with mud and feces, flies everywhere, and an unbearable smell! As soon as I stepped in I stepped out, gagging uncontrollably! I tried to calm my nerves and went for a second attempt; this time covering my nose and mouth with my handy bandana. It worked!

For the entire day, I could not imagine how people manage to do this day in and day out. I already had a plan for the next day. I decided not to drink any water all day, although as a healthcare provider I was well aware that it was not such a great idea given the possibility of dehydration in such a warm climate! In my mind, it was a temporary solution, but one that I was going to stick with! But what about them? This was not temporary for them! They did not have other choices! I began to think about one of the courses I took as part of my MPH about the importance of latrines and how they are considered as one of the most basic means of public health for communities. Most communicable diseases originate from lack of sanitary conditions of latrines with flies and rodents being the best vectors for these diseases. THIS WAS REAL; not something in books or lectures! I was in it and witnessing the reality of it all!

I later learned that piles of garbage we came across on our way to slums contained plastic bags filled with human waste.