IU nursing student Kayleigh Cook hadn’t been particularly interested in labor and delivery before a longtime university program took her 7,000 miles away from Bloomington this summer.
For child births in Kenya, it’s common for nurses to do medical work only physicians are allowed to do in the United States. That’s because there are fewer doctors in Kenya.
“My second day I assisted in the birth of twins, which was a little overwhelming for someone who only has like one day on labor and delivery in the States,” Cook said. “At the end of the day, I was able to do a delivery on my own.”
After delivering the baby, Cook dressed him and did his assessment. She said the process created a connection between her and the mother and child.
“Being there from start to finish was really amazing,” she said.
Cook, a rising senior in the IU nursing program, spent the first twenty days of her summer over 7,000 miles from Bloomington in Eldoret, Kenya working at Moi Teaching and Referral Hospital through AMPATH’s Global Health Initiative. Alongside five other IU nursing students, Cook gained experience in a world of medicine completely different from any she’d ever seen.
AMPATH stands for Academic Model Providing Access to Healthcare. It began in 1989 as a partnership between medical schools at IU and Moi University and has grown into a worldwide group of universities coordinated by IU’s Center for Global Health.
Almost every department at the IU School of Medicine participates, and IU’s schools of nursing, dentistry, journalism, law, and public health.
In the US, nursing students like Cook spend their clinical hours shadowing licensed nurses—observing and assisting when needed. In Kenya, there was no waiting to get involved.
MTRH is Kenya’s second largest hospital, holding over 1,000 patient beds and handling over 1,500 patients per day. To compare, IU Health Bloomington hospital has 190 beds and sees around 160 patients per day.
In the United States, hospitals operate on a nurse to patient ratio of about one to six. In Kenya, there is about one nurse for thirty patients, meaning the MTRH requires nursing students to be on the front lines—delivering babies, administering medication, and providing the bulk of patient care.
“They have to deliver 25 babies to graduate, and when they're in the emergency department, they're taking the orders from the doctor and getting the meds and starting them,” Cook said. “It’s expected that the student nurse will provide a majority of the care.”
Cook said the reality of the hospital was unlike anything the students had ever experienced, clinically and culturally. Every day she would experience someone who spoke a different language or had a different outlook on death and would treat them using different methods and medications.
She said she is leaving the program with a deeper understanding of how to connect with patients from different backgrounds and cultures.
“I feel like I understand how to work with people better that may not have the same beliefs as me or may not come from the same background as me,” Cook said. “I also think I've learned to be resourceful and use what I have in ways that the object wasn't initially designed for.”
Beth Murray, an IU nursing clinical assistant professor, said resource scarcity in Kenya teaches a kind of problem solving not generally seen in the US. In Kenya, a rubber glove might become a tourniquet or an ice pack, or a broken MRI machine might mean adjusting a treatment plan.
“I think that will definitely be something that people take home—thinking, ‘Okay, I don't have this equipment. What do I have? How can I modify it? How can I how can I use my mind to kind of make this work?’” Murray said.
Learning to adapt wasn’t just about the equipment, it was also the environment. Unlike the relatively controlled, resource-rich hospitals of the US, MTRH is crowded with patients and their families, and everything is in constant motion.
“The vast number of people, the chaos experienced, is very different from most of our emergency rooms at home, where we have smaller hospitals, more contained environments, and medical procedures are up to date,” Murray said.
While the hospital is equipped with machines for MRIs, CAT scans and other specialized procedures, MTRH doesn’t have a large quantity. Often when one breaks, care can be significantly delayed. Murray said that limitation forces Kenyan medical staff to be flexible and teaches students to think on their feet.
This is the second year IU nursing students have been involved in AMPATH Global Health Initiative. Murray said the students were able to step into roles they might never experience again, such as delivering babies.
During the program, the IU students were partnered with two Kenyan medical students from Moi University. Fourth year Moi students Dancan Kirabi and Nancy Nyaga Muthoni will spend six weeks in Indiana studying at IU starting in August.
Over the 20 days the IU nursing students were at MTRH, the Kenyan and American students worked side by side learning clinical skills together, observing each other’s techniques and helping each other adjust to the motions of the hospital. Kirabi said the students taught and learned from each other’s unique cultural experiences.
“They've brought their experiences from the US, and they've taught us a lot, and we've gained a lot,” Kirabi said. “That has really impacted our practice, even as we are learning.”
Kirabi highlighted that the IU students had different methods of care that they brought with them from the States. He said they will translate into his future working in the medical field.
“The Indiana University students are very keen to provide holistic care for the patients,” Kirabi said. “Such things have really impacted even the quality of care that is being given, and we look forward to adopting those practices into our daily routines.”
By the end of the rotations, the students became close friends. They shared meals, told stories about their lives and spent time together outside of the hospital. The day before the IU nursing students left, Kirabi spent the evening with them to say goodbye.
“We got to interact and became friends,” Kirabi said. “Through the friendship, we've learned a lot of things and shared a lot of things. And yeah, I think I’m much better than how they found me right now.”
Kirabi and Muthoni will travel to the US in August for clinical rotations in three IU Health hospitals—first in Bloomington, then Indianapolis, then Fort Wayne. Kirabi said he is excited to see the IU nursing students again.
“I can't wait to meet them, because we are now friends,” Kirabi said. “We are not just colleagues. We are now friends. So I can't wait to meet them.”
For Cook, the highlight of the program was meeting the Moi University students. She recalled how Kirabi and Muthoni greeted them on the first day and how they were able to travel together on weekend excursions.
“A lot of the places we went, they hadn’t been to either, so we got to see Kenya through their eyes,” Cook said. “We’d tell them about America, they’d teach us about Kenya—we asked so many questions. It’s been a great resource, but more than that, they’re great friends.”
Cook said she never could have expected the experiences she gained from this program when she applied last September.
“I think this is one of the experiences that, 30 years from now, I'll look back on and remember the things I learned and the people I met and be so proud of the work that we did here, and the fact that I stepped out of my comfort zone and came,” Cook said.
