Volunteer Reflection: Marissa Firlie – Kenya III, 2024

Marissa Firlie, a 4th year medical student from George Washington University.

Mission to Heal: Gatab 4/17/24 – 4/27/24

In reflecting on my time volunteering with Mission to Heal in Gatab, Kenya has been a deeply enriching experience, both personally and professionally. Gatab, a community facing numerous healthcare challenges, required a tailored approach to address its unique needs. Unlike typical missions that primarily focus on surgical services and training for local practitioners, our team adapted to predominantly enhance history-taking and examination skills among healthcare workers, aligning with the specific demands of the community. Dr. Dan Olsen, a remarkable leader with extensive experience, guided us through this process. Under his mentorship, we learned the importance of structured patient presentations and effective clinical communication—skills that are foundational for quality healthcare delivery.

One memorable aspect of our routine was the morning clinic sessions followed by chai breaks, providing valuable opportunities for informal education and discussions. These sessions fostered a deeper understanding of healthcare challenges, including neglected tropical diseases prevalent in Kenya. For instance, my presentation on trachoma shed light on its epidemiology, pathophysiology, and challenges related to eradication efforts. I spoke on the last day about trachoma, a keratoconjunctivitis that affects the lids and can lead to irreversible blindness. Trachoma is a topic that I became familiar with during my research with a corneal specialist at OHSU who had been designing an artificial intelligence model to detect trachoma from photos of the everted lid; this is a tool that we are hoping will standardize diagnosis and monitoring of the disease as we push towards total eradication by 2030. As trachoma is still active in Kenya, I found it fascinating to read about some of the reasons why it has been difficult to provide mass drug administration to the community, specifically because of the nomadic tribes that often cannot be tracked and located at the exact moment of Azithromycin distribution. I had the opportunity to see these nomadic peoples close-up on my 14 hour drive from Nairobi to Gatab as well as the opportunity to speak with our driver, a Samburu County native, about their way of life. Their migration does not typically follow a pattern, but rather is dictated by weather and climate and abundance of greenery for their livestock, for which caring for their animals consumes their days. They place high value on their cattle ($800 USD a piece) and their camels ($1000 USD a piece) so much so that more primitive tribes will engage in “cattle wrestling” when there is a dispute over an animal’s owner – these physical altercations oftentimes produce many human casualties. It can become violent for passersby, especially those who drive through the land by truck, when these nomadic tribes approach vehicles for food and water – something that the people who live off the land cannot get enough of, especially during the dry season. These encounters underscored the complexities of healthcare delivery in such remote areas, where even basic necessities like food and water can trigger conflict. Understanding these dynamics informed our approach to community engagement and healthcare provision.

Gatab’s healthcare needs were diverse, spanning vision, dental, and general medical care. As a graduating medical student months away from beginning a residency in Ophthalmology, I felt that this may be one of the last opportunities that I could take advantage of to provide generalized medical care to the developing world, as opposed to more specialized ophthalmic evaluation and treatment. I was surprised to see just how many people presented for vision changes… I would venture to say every other patient that entered the clinic inquired about their eyes. It was beneficial for me to understand just how great the burden of ophthalmic disease was in the developing world. I recognized that without an abundance of eye care providers in even urban cities, the care available to people in the rural developing world was likely lacking. It was heartbreaking to see that the eye care available to these rural people was, in fact, nonexistent. And even more heartbreaking to realize that, without the equipment needed to properly evaluate and without ophthalmic medications or interventions to offer, we could not offer these eye patients anything more than +1.25 reading glasses. I felt helpless in these instances, when we were simply unable to meet the needs of the community who desperately require vision care, while also feeling simultaneously validated in my reasoning for pursuing a career in Ophthalmology in the first place. 

From my early experiences volunteering abroad in Central and South America, I had always knew that I wanted to devote myself to caring for those in the developing world, who simply did not have access to the most basic health care that we take for granted. We evaluated a 90-year-old man with total vision loss in both eyes, who presented with the assistance and guidance by his son, Ruben, who spoke English with me. His son told me that his father had not been seeing well for years now, and felt depressed and isolated now without his ability to interact with his family or to care for himself or his home. His son pleaded with me to help, telling me that many in his town struggle to see and it impacts much more than just their ability to navigate their dirt roads… it impacts their overall physical, mental, emotional, and spiritual wellbeing. He shared with me a quote that his father always says, “without my eyes, I am nothing”. I so desperately wanted to help. I told him that I wouldn’t forget them and that once I got my ophthalmologic training, I would return.

My time with Mission to Heal in Gatab was transformative. It reinforced the importance of flexibility and cultural sensitivity in addressing healthcare disparities. Collaborating with local practitioners and experiencing the community’s challenges firsthand deepened my commitment to global health initiatives. As we continue our collective efforts towards eradicating diseases like trachoma by 2030, I am motivated to contribute to sustainable solutions that prioritize community empowerment and long-term health outcomes. My dedication to communities in remote corners of the world has once again grown even stronger, and this time, with direction. These people desperately need access to eye care and do not have anyone trained to provide it. I am excited about the opportunity to collaborate again with Mission to Heal and to expand upon the services that they are able to offer these communities. I am encouraged that my residency program will be motivated to collaborate with Mission to Heal as well, and be able to sponsor the donation of ophthalmic diagnostic tools, imaging, and medications. In doing so, I will be able to lead the efforts to expose more ophthalmologists in training to the unique needs of the underserved and to embrace those physicians who find that they, too, can’t help but leave a part of their heart in places like Gatab. I am so grateful for the opportunity to have been able to understand the healthcare landscape in Kenya and I am so eager to be able to build on this experience. I vow to carry this experience with me, and I am motivated to return with more skills and knowledge to better cater to the needs of the communities that Mission to Heal serves.