Kenyan nursing student learns from the best

By Maureen Gilmer, IU Health senior writer, mgilmer1@iuhealth.org

Dancan (Dan) Kirabi was only 6 in 2009 when he lost his 7-year-old sister, who passed away from leukemia in Kenya.

That and other tragedies (including post-election violence in 2008 and the passing of another sibling in 2010) shaped the young boy’s future as he struggled with the need to help in some way amid the pain and loss he witnessed.

“I got to see the people who cared for her and people who wanted to make life easier for us, and I wanted to be like them,” he said.

Fast forward 15 years and Kirabi is in Indianapolis learning about new medical treatments and skills that he can take back to Kenya as he completes his final year of nursing school, with the goal to become a pediatric oncology nurse.

The 22-year-old has been in Indianapolis for six weeks as part of the AMPATH/Indiana University Center for Global Health exchange program, which invites nursing and medical students to come here to learn, then take that experience back to their home country.

Kirabi is headed back to Kenya on Friday, armed with new knowledge and training gained within the walls of Riley Hospital for Children and other IU Health hospitals.

One experience he had was visiting 5E at Riley and seeing a stem cell transplant in progress.

“It was so fascinating because we don’t have that in Kenya. I learned a lot and it is something that if it was brought to Kenya, it would lead to better outcomes.”

He spent his last day in training shadowing Riley pediatric nurse Katelyn Jaglowski in the outpatient hematology/oncology clinic. Jaglowski has worked in the global health space, including Kenya, as part of Samaritan’s Purse, so the two have a natural connection.

“It is super exciting to have this international internship program,” Jaglowski said. “So many places haven’t had this opportunity, and they are seeing death that is preventable.”

That can be due to a lack of resources, a lack of clinical education or simply not enough money to pay medical staff.

“In Kenya, the dream profession is to become a doctor,” Kirabi said, “but I realize that in Kenya a doctor will come into the room one time in the morning and that’s it.”

Meanwhile, nurses are trying to support patients and families beyond taking care of their physical health, he said, even when the nurse-to-patient ratio in a pediatric oncology setting in Kenya is troubling.

Kirabi said in Riley’s hem-onc clinic, one nurse cares for two patients at a time. In Kenya, he said, there might be one nurse caring for 15-20 patients simultaneously.

“People here do things the right way,” he said, making sure to assess a patient’s overall physical and psychosocial well-being with help from a multidisciplinary team and to involve families and caregivers in the process.

“Something I’ve learned here that I want to take back to Kenya is (the need for) patient education and family involvement. It’s very important to teach patients how to take care of themselves, so these conditions can be prevented,” he said (or at least better managed).

Right now, Kenya is decades behind in cancer care for kids, according to Riley pediatric oncologist Dr. Terry Vik, who has been traveling to the African nation for more than a decade as part of IU School of Medicine’s involvement in the AMPATH partnership.

In 2019, he completed a Fulbright Scholar program, training the first class of pediatric oncology fellows at Moi University School of Medicine and Moi Teaching and Referral Hospital in Eldoret, Kenya.

In high-income countries, survival rates for pediatric cancers approach 80 percent, but in sub-Saharan Africa, survival rates are around 20-30 percent in children who are treated.

Kirabi can’t know whether his sister could have been saved from leukemia, but he does know that too many Kenyan children are dying needlessly from treatable conditions.

“We’ve made huge progress, but we are not yet there. We have many children dying from sepsis and neutropenic fevers. A lot has been done. A lot still needs to be done.”

Too often, he said, medical practitioners in Kenya manage patients for their symptoms, but not their conditions, because of a knowledge gap.

“By the time the patient gets to a facility that can manage the condition, sometimes it is too late,” he said.

That’s why he was honored to be selected to participate in this international internship and is grateful to AMPATH, the IU School of Nursing and Moi University School of Nursing for the opportunity.

“We are not going back the same way we came,” he said. “We’ve learned a lot, and we know that it is possible to have a functioning (healthcare) system. It is possible for patients to come into the hospital and go back home and they are safe.”

Just as in the U.S., there is a serious nursing shortage in Kenya, but the job market is daunting due to a lack of financial resources within public health facilities, he said.

Still, he will continue to pursue a nursing career in pediatric oncology, inspired by the memory of a sister who never got to grow up.

Photos by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org