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Trial by Fire

Photo credit: Ahmed Galal, Unsplash

After a lot of sweat, laughs, and tears, I finally returned to full-time clinical work. It is common knowledge among the residents here at the University of Nairobi that if you pass the surgical sciences exams in the first year, life becomes more manageable. Of course, that is true for most parts, but full-time clinical work comes with different challenges. Time has gone by so quickly; I'm halfway through year two! It seemed only a little while ago when I learned I had passed my exams. I moved into the second year with a certain sense of confidence. Even though I knew I would rotate in some unfamiliar surgical disciplines, I felt ready. I had worked in Surgery for the better of 4 out of the last 6 years, so I was prepared to dive in and build on my experience. Well, the welcome party went differently than planned. (Lol). I forgot that I was moving from a 70-something-bed NGO hospital to a >1500-bed public hospital in a different country.

On the first day of my rotations, I showed up in my scrubs and white coat, feeling like a rockstar. I walked into the ward and boom! Reality check. Nothing was familiar- not the faces, not the ward set-up, and most certainly not the language. I said hello and smiled behind my mask, but no one responded. Everyone was busy getting ready for the morning ward round. I didn't understand half of what was being said around me. I just found myself being asked to take blood samples, do lab errands, and check vitals (measuring blood pressure, temperature etc.), which was different from my job on a typical day back home. The nurses used to do this. I just had to make sure it was done. Now all of this was part of my everyday tasks. I quickly clocked more than 15,000 steps daily in my first week just doing errands.

All of this was a very rude awakening. Still, the most challenging part is not communicating because only some people speak, understand, or choose to communicate in English. I had spent the last year in a classroom full of doctors who speak English, so I had forgotten that I don't speak Swahili. I walked into the ward, and when the patients saw my white coat with my name and Orthopaedic Surgery boldly written on my left chest, they quickly asked me for help. I couldn't understand nearly everything they said, and even when I did, I barely knew anything about the ward. My face screamed, confused. It was evident (not by choice) that I was the 'rookie' in the team. This was the beginning of my baptism and trial by fire. Fun times are ahead!

My first day in the outpatient clinic left me feeling a way I hadn't felt in a long time. I felt so inadequate. I loved working in outpatient when I was home. It was my chance to get to know and make small talk with the staff and the patients. I took for granted that I could always communicate with them in languages we all understood (almost all the time). I don't have that privilege anymore, which has been the worst part of my clinical work. I have learned a few essential words in Swahili. Still, I need more to make complete sentences or completely understand the patients and/or their relatives who don't speak English. I try to follow their explanations, but before I can make out the first sentence, they've said five more, and then I'd need help. Whenever I'd ask the patients if they spoke English or ask for help with translation from my colleagues, they'd look up at my name tag. I wonder if they judged me because my name looked foreign, and I couldn't understand them or wondered why, as black as I am (lol), I don't know Swahili. A few weeks into each rotation, I'd eventually establish a small network of people that help me translate, but again I'll move to a new department or team, and the cycle starts over again.

I am in awe of the foreign surgeons I used to work with back home. They made it seem so easy. I'm sure they faced the same challenge, but they carried it with so much grace that I hadn't given it too much thought. It's truly humbling to feel so vulnerable. I miss the morning chats and banter in the call room with my colleagues at work and the small talk with the hospital security guards when I enter or leave the hospital. So often, my colleagues here try to be polite and speak English so I can be a part of the conversation, but they quite easily slip back into Swahili. Other times, they continue the conversation in Swahili. I'll hear them say 'Muzungu or Kizungu' (which means 'white person', but it's casually used for foreigners who don't speak their language). It can get very lonely, but it may be all the motivation I need to learn a new language. Kenyans will call all of this 'character development'😂.

I've often heard that a big part of communication is non-verbal, which can be true in many instances. However, in medicine, this theory only partially holds true, not in this part of the world anyway. Most interactions involve directly talking to patients and understanding their problems and needs. It's one thing surviving random people on the street asking for directions in Swahili or guys saying 'mrembo' (which means beautiful) and a whole bunch of stuff I don't understand. However, not being able to explain and talk to patients in my own words is a different kind of heartbreak for me.

I can't tell you that I am on top of my game and have found the happily-ever-after to this story, but you already know I am not one to give up. There's a difference between surviving in a new country and letting it fill your soul and being. I want my next few years in this beautiful city to be about something other than survival. I want to experience this city and all it offers with every fibre of my being. I want to join in conversations, laugh with patients and make small talk with random people because being able to communicate efficiently is truly an unspoken superpower.

Maasai Woman
Photo Credit: Denice Alex, Unsplash

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