December 28, 2014   

As 2014 comes to a close, I reflect on the milestones, tribulations, and quiet joys that shaped this latest chapter. Writing brings clarity and closure as I process all that has transpired in my corner of the world. In the future, I will smile looking back on these frozen moments.

The Intern

This year, I completed my internship at the hospital and am now reflecting on the highs and lows of this formative chapter. I have come to understand the critical importance of hierarchy and teamwork, which has paved the way for my success. My focus remained centered on what matters most - the well-being of my patients under my novice care. These principles served me well on rotations, but there is still room for improvement in terms of uniformity.

Each department operated independently with its cultural norms. Endless presentations took up valuable time that could be used for practical learning. Trust in my abilities felt limited, as senior physicians often oversee patient interactions when my goal is to learn.

The need to tiptoe around sensitive topics also hinders growth. When can I ask questions without fear of judgment or overstepping? True learning requires an open and transparent culture. The most effective mentors approach mistakes with wisdom and patience. Unfortunately, not all mentors follow this approach.

It could be argued that the nature of medicine makes it difficult to standardize training across specialties. However, lessons learned must inform the development of future programs. We owe the next generation of medical professionals a balance of broad clinical exposure, mentorship in the art of medicine, and a focus on patient advocacy above all else. The medical hierarchy should support trainees and encourage a long-term perspective, rather than stifling it.

I am deeply grateful for the challenges and triumphs of this year, which have equally contributed to my development as a physician committed to lifelong learning. I hope to pass on the guidance I have received and promote change in the training cultures of the future. If we all speak up, one day interns may experience equity, and patients may become care partners.

Minted Doctor

Looking back on my years in medical school, I recall a mosaic of indelible memories and formative experiences. Late nights spent cramming answers with classmates, celebrating our first successful sutures, and puzzling over bewildering symptoms all helped to shape us into fledgling physicians. We passed tests of knowledge and resilience alike, donning our white coats with pride on graduation day.

However, as the celebration fades, a sobering apprehension creeps in. Seasoned doctors will no longer hover close by to guide clinical decisions or catch oversights. As I pedal ahead solo on the frontlines of care, I must have the competency and confidence to navigate all that comes my way. I must trust my instincts to guide treatment where textbook cases grow rare.

Perhaps a bit of anxious self-doubt oils the engine of learning in these early years out of the nest. As Dr. Rookie, my first challenge may be finding the line between imposter syndrome and prudent humility. Perhaps complete confidence ever eludes those who understand the gravity of holding life and health in their hands. More experienced physicians can hopefully provide insight on where that delicate balance lies. I cannot predict all the triumphs and tribulations that my fledgling career holds.


Upon arriving in Bosaso, the city of my parents’ upbringing, the intense dry heat immediately reminded me that I was no longer in rainy Mombasa. My decision to move back was driven by a desire to connect with my heritage and assist my family in navigating old age. However, establishing this city as my new medical home would prove to be a challenging task.

In addition to the harsh climate, every aspect of life appears to be permeated with gossip and personal affairs being openly discussed. Job applications and hospital work feel like ruthless, winner-take-all contests. Each meeting with a person results in unsolicited questions, ranging from rashes to erectile dysfunction. Confidentiality is not always observed.

The hospital struggles to survive against all odds, facing constant power outages, supply chain disruptions for basic items such as gloves or IV fluids, and severe staffing shortages that impede care. Few workers have medical training, and there is no infrastructure to provide it. The most accurate diagnosis is often an educated guess, as there are no labs, scans, or specialists available to assist.

Most healthcare is in the hands of the private sector. These people prioritize the bottom line over the well-being of the patient, with business-minded individuals with no healthcare training pulling the strings. I once faced the possibility of losing my job at a local clinic because I refused to prescribe antibiotics for minor illnesses, citing the risk of antibiotic resistance. They openly suggested that I prioritize their business interests over clinical considerations, stating that if they don’t, they will go out of business and patients will go to clinics or hospitals where antibiotics or other medications are prescribed like candy.

Despite obstacles, my people have touched my heart with their humor and resilience, instilling hope. However, without system-wide changes and improvements in bedside culture, doctors will burn out and patients will suffer. My current responsibility is to balance my own limitations with the demands around me. By taking one step at a time, despite the risk of falling, I hope to eventually become familiar with this unfamiliar environment. At present, I hold onto the vision of a revitalized system that can provide proper care.

Real Doctor

Although frustrations are common in practicing medicine here, there are also moments of professional reward. Without relying on fancy technologies, I can focus more intently on honing the fundamentals, such as mastering the patient’s story and examining the physical details. I have become more comfortable with ambiguity and formulating differential diagnoses through the lens of likelihoods rather than absolutes.

In a way, I have become a jack of all trades, improvising the right treatment plan with the resources available. My hands have learned to do more, such as setting fractures, draining abscesses, and suturing lacerations seamlessly. I have developed true grit in troubleshooting supply shortages, knowing that delays risk lives.

My perspective has expanded through obstacles, allowing me to see how social factors, access issues, and health literacy intertwine with the disease itself. I have absorbed wisdom from patients’ remarkable resilience despite the inadequacies of the system. Not a day goes by without witnessing the dignity with which people face suffering here.

No textbook or simulation can instill the critical thinking, equanimity, and essential empathy that underpin the art of medicine as profoundly as this experience does. Although I never would have chosen to plant my roots in such a challenging environment, I question my stamina daily. Nevertheless, this baptism by fire undoubtedly shaped me into the healer I aspire to be. Wherever my path leads, I will always remember the lessons that hardship has taught me. Healing comes not just from the tools at hand, but from building trust and understanding with the patient before you.

Future Doctor

As a physician, navigating through relentless hardships leaves little bandwidth to unravel office politics. However, power dynamics subtly shape my everyday work. As a fresh-faced rookie, I all too often become caught in the middle, handed all accountability but little authority or support.

Senior doctors throw their weight around without considering implications at the frontlines, while administrators fixate on revenue, handing down policies that compromise care. Unfortunately, patients get lost in the shuffle.

I chose this career to make a difference, but I find myself unable to speak out against the entrenched culture. The competitive environment does not allow for solidarity or standing up against what is wrong. Nevertheless, I persevere, comforting myself that healing hidden wounds can bring about change, even if it goes unnoticed.

However, the truth is that I cannot continue to sacrifice myself when the system I work in continues to deteriorate. Perhaps other doctors have become desensitized to the reminders of how things could be different. As an outsider with a fresh perspective, I am struck by the absurdity of the risks, exhaustion, and constraints on my conscience daily.

Therefore, I have decided to move to Kismayo, my hometown which is now recovering and in need of healthcare heroes. With only three physicians, there is a chance to make a profound impact and positively affect the lives of the people I have known since childhood. The road ahead is still long, but by redirecting my purpose to more fertile ground, each step becomes lighter. I will enter Kismayo with humility, as a part of the community fabric once again - helpful, not entitled. Where there is great need, even small acts of healing can gradually mend and strengthen the whole. I go now with hope.

As the year comes to a close, I am excited about what the future holds. Here is to 2015 and all that is yet to come. Another year has passed, leaving behind richer colors and perspectives. Let’s move forward together to the fresh start of a new year!

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