Sarah Boudova, MD, PhD, completed a rotation in Eldoret, Kenya with AMPATH in the Spring of 2022 during her 4th year of residency at IU School of Medicine’s Department of Obstetrics and Gynecology (OB-GYN). She holds an MD and PhD from the University of Maryland School of Medicine and an MS in chemistry from the University of Pennsylvania.
What made you choose Indiana University School of Medicine’s OB-GYN program for your residency?
I was attracted to IU School of Medicine because of the strong focus on global women’s health. This included IU’s Global Health Residency Track and faculty like Dr. Caitlin Bernard. The ability to do electives outside of the country and have protected time to go abroad during a surgical specialty like OB-GYN is unique to IU and a major reason I came here.
In terms of OB-GYN, I went to medical school assuming that I would go into pediatric infectious diseases. But I did my PhD on malaria during pregnancy and fell in love with the “two-patient problem” in OB-GYN from an intellectual and scientific standpoint. And as an MS3 in OB-GYN, I loved the procedures, the social justice aspects and the patients.I know the lifestyle is not always great, but I love the work.
What was your rotation like at Moi Teaching and Referral Hospital?
While I have done global health research before, I came to Kenya to experience the clinical side of global health and see if this is something I want to do with a future career as a specialist in maternal fetal medicine (MFM). I spent time on both the MFM and labor and delivery services.
I stayed in a consultant/observer capacity most of the time, largely because of the vastly different protocols and language barriers. A pelvic exam is a sensitive procedure even when you speak the language and understand the social context. Most patients did not speak English and I didn’t want to waste the time of a Kenyan colleague to translate for me. In some ways I felt like an obstreperous third-year medical student or a brand-new attending who knows nothing because of these differences in standard of care and language. I did occasional teaching and scrubbed in to a few procedures. On rounds, my role was advocating for the more acutely ill patients and to try to answer the attending physicians’ teaching questions if the med students and registrars (Kenyan version of residents) didn’t know that answer, which was a good inspiration for continued studying.
I saw some really interesting cases such as rheumatic heart disease in mothers which I had not ever encountered in the US and a lot of fetal anomalies.
What surprised you about the experience?
Having worked in multiple African settings, it was largely what I expected. However, while I knew there was a human resource shortage in Kenya, like many of the places I had done research, it was different seeing the health care worker gap in practice. For example, a labor and delivery nurse here may have one to two patients, but in Kenya nurses might have six patients in labor and are doing the deliveries themselves.
The postpartum unit had some very sick mothers that in the US would have been in an ICU.But in some ways, MTHR had a better capacity to serve mothers. For example, physicians are very well-versed in caring for mothers requiring dialysis after kidney failure from pre-eclampsia with severe features, or treatment for severe malaria.
How was your stay at IU House?
It was great and even nicer than I expected. It was a welcome break to have someone help cook and clean for you – every resident’s dream. IU House feels a lot like an adult dorm filled with doctors. The staff were wonderful. I always felt safe and had power, water and internet. The western food was great and the Kenyan food was even better.
I was even at IU House on “IU Day,” which I didn’t know existed prior to going to Kenya. We had a great celebration with red cupcakes by the chef Elly, basketball games and a faculty member who played the IU fight song on trumpet.
What advice do you have for residents considering rotations in Kenya or abroad?
Just do it. It’s worth it and really educational.
And when you go, constantly check your assumptions.For many of us, medicine has become so protocolized. You follow the protocol without even thinking about the context or the why behind it. For example, in the US, I just automatically deliver babies at 34 weeks if the mother has pre-eclampsia with severe features or PPROM without thinking. However in Kenya, based on NICU capacity and capabilities, the calculus on when to deliver these patients changes as the risk of preterm delivery is much greater. This is further complicated by poor gestational age dating that is often only based on the last menstrual period. Going to Kenya made me think about the ‘why’ behind so many things we do and just how much context and setting matter.
Any final thoughts or comments you’d like to share?
I’m so incredibly grateful for the warm welcome I receive at Moi Teaching and Referral Hospital in Eldoret and to have had the opportunity to do a rotation in Kenya. My Kenyan colleagues were so kind, welcoming and patient. The community at IU House was great with weekly educational Fireside Chats on topics like street youth, strikes and elections in Kenya.
I’m also particularly grateful for the funding I received to go to Kenya provided by the Learman Award supporting global health activities for residents in the Department of Obstetrics and Gynecology.
Photos: Dr. Boudova enjoying a safari in the Masai Mara (top); with nursing students after doing some practical teaching on shoulder dystocia maneuvers; and hiking Mt. Kenya.