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It is Through Our Differences That We Learn

Coptic Hope Center

Tara Ness, MPH

One aspect of my rotation at Coptic Hope Hospital is the opportunity to participate in continuing education sessions on Tuesday, Wednesday, and Thursday mornings. The Tuesday morning sessions are geared towards clinical staff in the outpatient HIV building; generally focused on an aspect of clinical HIV care, such as reviewing a recent article or going over patient cases. The Wednesday morning sessions are for non-clinical staff (nutrition, social work, counseling, etc.) and feature topics such as financial planning or the empowerment of women. On Thursday mornings, the clinical staff travels to the main hospital building where they have “medical grand rounds.” The speakers are often invited from other institutions and talk on subjects such as gout, optimal infant care, or chest pain management. As an individual who is rotating through all of the different departments, I am fortunate to be able to attend any and all of the sessions, supplementing my hands-on learning with a variety of different lecture topics.

One morning, I joined a session where the issue of HIV disclosure came up. The topic itself was about skills to help our clients disclose their status to individuals in their life, but I was struck by an interesting difference in policy. Here in Kenya, it is not required that you disclose your HIV status to your sexual partners, even your spouse. One may be putting their partner at risk of HIV acquisition themselves, but the burden for disclosure is placed solely with the patient, with providers and counselors encouraging, but not forcing, the patient to tell those they may be exposing.

I found myself conflicted by this discussion and, embarrassingly, my first thought was “Well, that’s not how WE do it.” I was used to a system where disclosure was required, and my instinct was to assume the policy I had learned under in the United States was the “right” one, and it was only a matter of discussion needed to elucidate the reasons for why it was the more optimal strategy.

I took a moment and reflected. I was not in the United States. I was in a country with an entirely different healthcare system, culture, and HIV epidemic. The individuals I worked with had an immense amount of knowledge, far more than myself on HIV management, and had been dealing with the epidemic in a far more expansive way than I had or ever will in my lifetime.

I could write about how, even in the United States, only 24 states legally require that an HIV positive individual disclose their status to all of their sexual partners1. I could write about how many of these laws were passed prior to effective antiretroviral therapy, and so don’t take into account that we’re in an era of being able to suppress the HIV virus so it has a low chance of infecting sexual partners. I could also write about the pros and cons of one policy versus the other. The issue that I found the most important, however, was my own reaction.

As human beings, we have perspectives and opinions based on our scope of life experiences, and we provide advice or even suggest ideas based on these. I have, and will, make many mistakes through both my personal life and pursuance of a career in medicine. In this situation, I jumped to draw upon my own experience in the healthcare system and immediately applied it to a foreign system, with an arrogance that was completely unfounded. I made a cardinal mistake of global health work, which is to assume a strategy in one country will play out the same in another country. It is imperative each policy and intervention is crafted to the needs of the particular community it serves, and my ego had quickly led me astray from this.

I’ve learned an exceptional amount of clinical management, as well as counseling skills and the importance of social work, during my time at the hospital. In addition to this, I’ve been able to make “rookie” mistakes in a safe environment and expand my understanding of what it means to work in global health. While I hope not to make the same mistake twice, I also hope the future holds many more mistakes for me to continue to learn from. I’ve often been asked what the value of doing a global health rotation is when you are “just a medical student” and to those people I would say the following: If you hope to do global health some day, you will be in a position where your opinion on clinical policy and programs carries weight and authority. Before then, it is absolutely imperative you understand the complex nuances of your work and the background knowledge needed for your decisions. I am exceptionally grateful for the opportunity to learn, misstep, and learn again- so that when I one day am a full-fledged physician directing a program, I think back to my time as a medical student, and humbly realize there is always, always more to learn.

  1. Centers for Disease Control and Prevention. HIV-Specific Criminal Laws; https://www.cdc.gov/hiv/policies/law/states/exposure.html. Accessed March 7th, 2017.