Matrix of Clinical Exposure During Our Global Health Programs
During your elective or clerkship, you will be placed at a public or mission health facility offering comprehensive medical services to the general population. Of the different destinations where we work, Kenya has the most comprehensive listing of facilities with classifications and descriptions of health facilities, the Kenya Master Health Facility List, an application with all health facilities and community units in the country.
To get a sense of the nature of what your experience will look like, in terms of the work and routines you will likely have, it is important to have a basic understanding of the different medical services offered at your placement hospital and the nature of health systems in your destination country.
For basic reference, all the facilities in all destinations where we provide placements are at the equivalent of a medical facility classified as a Kenya Essential Package for Health (KEPH) Level 4 facility in Kenya or higher. The hospitals feature a wide array of services offered under various wards and departments and will generally include, at the very least, the following services:
- Basic and Comprehensive Emergency Obstetric Care (Obstetrics),
- Antenatal Care and Maternity Services (MCH & Gynaecology),
- Surgical Services,
- Accident & Emergency Services (Casualty),
- Emergency Preparedness and Ambulance Services (Referral services),
- Nursing Services,
- ENT Services,
- Ophthalmic Care,
- Radiology Services (e.g. X-ray, Ultra Scan, MRI, etc),
- Curative Services, Integrated Management of Childhood Illnesses (IMCI),
- Mental Health Services,
- Laboratory Services,
- Oral Health Services (Dental services),
- Rehabilitative Health Services—Occupational Therapy,
- Dental Laboratory Services,
- Nutrition Services,
- Rehabilitative Health Services- Physiotherapy & Orthopaedic Services,
- Environmental Health Services,
- Rehabilitative Health Services-Substance Abuse, HIV/AIDS Prevention Services,
- HIV/AIDS Services- Care and Treatment,
- Diagnostic Services,
- Family Planning (FP),
- Blood Transfusion Services
- Port Health Services,
- Forensic Services,
- Mortuary Services,
- Comprehensive Youth Friendly Services including reproductive health education and services for gender-based violence survivors.
The placements are administered on availability based on individual applicants speciality preferences. Participants can also get a sense of the tasks and experience they are likely to gain by reading past participants feedback on our international health programs.
Some Key Medical Services and Specialties at Our Placement Hospitals
OBSTETRICS: Basic & Comprehensive Emergency Obstetric Care (BEOC & CEOC)
Participants taking this speciality will be able to observe and participate in basic and comprehensive emergency obstetric care as well as neo-natal care for the management of life-threatening obstetric complications. These services include:
- Administration of antibiotics, oxytocics, and anti-convulsants.
- Post-delivery procedures including removal of the placenta and neonatal care.
- Removal of retained products following miscarriage or abortion.
- Regular and assisted vaginal delivery using vacuum extractors.
- Surgical procedures, including Caesarean section.
- Safe blood transfusion services.
- Resuscitation care to low birth weight and sick newborns.
Generally, the minimum standard of infrastructure for BEOC that the hospitals will have includes equipment (delivery kit, MVA kit, vacuum extractor), electric/power, running water and a pharmacy or a dispensing unit with the availability of adequate drugs, sterilization kit, placenta pit and lab. While, the minimum infrastructure requirements for CEOC include operating theatre, laboratory, blood transfusion services and incubator services. Many of the hospitals will have the full complement of these services and infrastructure. However, the majority of the hospital environment will likely be resource-deficient whether in terms of services, personnel or infrastructure. Participants will have ample opportunity to observe and participate in the clinical procedures including baby deliveries, observation of complex obstetric and gynaecological procedures. While the hospital departments will often feature a full personnel complement of obstetric consultants (medical doctors), nursing and clinical teams, anaesthetists, lab technicians/technologists and pharmacists, the facilities will often be overstretched, sometimes with more than one patient per bed or with burdensome workload to staff ratios.
Our placement health facilities will generally provide a wide range of surgical services from basic clinical procedures including simple stitching, dressing, splint fractures, resuscitation, arrest bleeding, placing cervical collars, and emergency catheterization to relieve the bladder.
Additionally, they will also have the capacity to undertake more complex procedures including incision and drainage, circumcision, excision of ganglions, lipomas and removal of foreign bodies in nose and ear. The hospitals also perform most elective surgical procedures, provide general anaesthesia and regional anaesthesia e.g. spinal anaesthesia, caesarean sections, laparotomies and herniorrhaphy; urological surgeries e.g. hydrocoele; basic orthopaedic surgeries e.g. plating, K-nail, amputation; as well as insertion of chest tubes.
Participants will also be able to observe mastectomies, thyroidectomy and skin grafting as well as craniotomy, cardiothoracic surgery and plastic surgery. Besides basic surgical kits such as stitching trays, autoclave, splints, bleeding dressing (BD) packs, resuscitation trays, basic crash packs, portable lights and a separate room for procedures, the hospitals will also feature several surgical theatres with both Intensive Care and High Dependency Units, and the teams of personnel to operate these facilities, possibly with some basic facilities for telemedicine. The personnel complement to handle surgical cases will likely include surgical doctors, medical officer, RCO anaesthetist, anaesthetists assistants, and theatre nurses.
Gynaecology/MCH: Antenatal Care & Maternity Services
Participants taking this speciality will be able to observe and participate in the treatment, care and monitoring of pregnant women relating to their pregnancy, with the important aim of identifying women with high-risk pregnancies and the likelihood of complicated deliveries and managing them to make pregnancy, childbirth and the immediate postpartum period safe. Within these hospital departments, the provision of maternity services includes:
- Promotion of healthy nutritional behaviours, recognition of danger signs for mother and baby that require referrals, the establishment of community-based referral system for emergencies, the establishment of community-based FP distribution network, the establishment of maternal and newborn death reviews and community-based health information system.
- Focused Antenatal Care (FANC) (BP, weight, physical exam, urinalysis, counsel on danger signs and emergency preparedness, individual birth plan, TT immunization, hMIP (IPT, ITN), Iron/folic supplement, De-worming, Syphilis screening, PMTCT, TB screening (clinical), identification of complications and management and/or appropriate referral), normal labour and delivery (use of partograph, SVD, AMTSL, identification of complications and management and/or appropriate referral, PMTCT),
- Essential Newborn Care (ENC), early initiation of breastfeeding, newborn resuscitation, counselling mother and family on danger signs of the newborn, immunization.
Targeted postpartum care (PPC), advice on danger signs, emergency preparedness and follow up, family planning (FP), record keeping (HMIS) and immunization register. Cd4 count, rhesus incompatibility and ultrasound CEOC, essential newborn care (management of severely ill newborns, management of low birth weights/prematurity, management of congenital anomalies, phototherapy and exchange transfusion, family planning (sterilization BTL and vasectomy) and record keeping-theatre register
The placement hospitals will generally have capacity in essential medical, and non-medical facilities and supplies (warm water, light meals &sanitary towels), equipment (fetal scope, height & weighing machine), laboratory support and with the right attitude from maternity staff and feature the full complement of nursing and clinical staff, gynecological consultants (medical doctors), lab and pharmaceutical technologists.
CASUALTY: Accident & Emergency, Ambulance Services
The casualty departments in public hospitals receive a wide array of outpatient cases and are perhaps the nerve centres of the busiest environments within the hospitals you will be placed in. These hospital departments provide comprehensive emergency-preparedness services including Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Trauma Life Support (ATLS) and Paediatric Life Support (PALS); and Acute Psychological Support and Counseling.
Participants will be able to engage in triaging patients, taking patient histories, participating in basic clinical procedures and observing patient management approaches. In the busy referral and teaching hospitals, participants will work with other doctors-in-training, getting to learn the ins and outs of managing public health care systems and will also learn some of the more complex practices in the medical management protocols for disease outbreaks. The departments will feature the following resources and tools to manage their workload: well laid-out disaster preparedness plan, triage, mouthpieces, splints, dressing materials, neck collars, spinal boards, Ambulance bag resuscitation room with monitors, defibrillators and ventilators. Portable and stationary x-rays and ultrasounds, laboratory, pharmacy and a fully equipped theater to manage minor and major operations in emergency care, blood transfusion services, observation room, paediatric room, plaster room dressing room, isolation room, medical records, CT scanner, and continuum of care services- ICU (Intensive Care Unit) and HDU (High Dependency Unit) and referral services.
The personnel participants will work closely with include the nursing staff, lab technologists, phlebotomists, radiology teams, support staff trained in BLS, nurse clinical officers trained in ACLS, ATLS and PALS. The hospitals will also offers ambulance and mobile clinic services to reach patients where they can receive care.
Integrated Management of Childhood Illnesses (IMCI)
Our placement hospitals offer basic community-based services in the management of childhood illnesses including home case management, community dialogue and counselling of mothers through community health extension workers; management of acute respiratory infections (ARI), diarrhoea, measles, malaria and malnutrition among others; ETAT (Emergency Assessment and Triaging) inpatient services with resuscitation services and inpatient services.
Participants will also be able to observe and participate in the treatment and management of an array of diseases, including unique tropical infections and malnutrition conditions. They will be able to administer ORT (Oral Rehydration Therapy), collection of samples, observing tests and diagnosis, taking patient history, resuscitation, administering intravenous fluids and other drugs, cannulization.
Participants can be engaged in several public health initiatives conducted by the hospitals at community-level to support lower-level facilities such as community health centres and dispensaries where cases are referred to these main hospitals, and where primary healthcare initiatives are promoted which interested students can participate in.
Nursing & Curative Services
Within every hospital ward, services essential to the preparation and necessary in the promotion, maintenance and restoration of health and well being or in the prevention of illness (generally referred to as nursing) are provided.
Participants on our global health programs will assist the nursing staff in the respective specialities where they are deployed to assist with patient management processes including triaging and taking patient examinations, participating in diagnosis and treatment of communicable and non-communicable diseases, common infections and other conditions, and facilitating referrals; basic laboratory investigations and in-patient care, observing admission and treatment procedures for complicated cases e.g. malaria typhoid, diarrhoea TB, uncontrolled diabetes, hypertension etc.
In particular, participants on assignment in the general wards, paediatric and psychiatric wards, including those in the sub-specialities such as nephrology, cardiology, and neonatology will have close interactions with the nursing teams in their wards.
The placement hospitals we work with feature several admission wards with varying bed capacities, as well as several follow up clinics, labs, pharmacy and post-discharge care units. Participants will be working closely with the full complement of nursing staff and clinicians to deliver these services.
The services provided include full haemogram, sickle cell screening, blood grouping gram stain, Zeihl Neelsen(ZN) staining, wet preparatory KOH, bleeding time, prothrombin time, ESR, compatibility testing, coomb’s test gram stain, and urine microscopy and chemistry, culture and sensitivity testing, semen analysis, blood glucose, stool microscopy blood slide, pregnancy test, syphilis screening and HIV testing; liver function tests, renal function tests, Widal, ASOT, Hepatitis B &C screening, Rheumatoid facto, CD4/CD8 counts; Hb electrophoresis, Lupus Erythromatosis, Lipid Profile, viral load, p24 antigens for paediatrics, pap smears, cytological examination of smears and aspirates, histological examination of tissues, biopsies, bone marrows.
All major departments within the placement hospital will have designated rooms subdivided into sections (for haematology, transfusion service, microbiology, clinical chemistry, parasitology, virology, Virology, immunology, HIV/AIDS and reception), Autoclave, Sluice, store, media preparation room, offices, staff room, patients waiting bay. They will be adequately outfitted with proper ventilation, and light, wash areas (sinks), sample taking and registration room, running water, lockable doors and cabinets, power supply, closed drainage, a deep pit or access to an incinerator and fire fighting equipment.
While the hospitals may not have the full complement of infrastructure requirements for the adequate functioning of the department, participants will generally find that the placement hospitals make up for any shortcomings in the adeptness of the personnel teams of pathologists, laboratory technologists and technicians working in these departments supported by the nursing staff and health records information officers.
ENT & Ophthalmic Services
The ENT services offered include examination and treatment of minor ENT conditions, the performance of minor ENT procedures, prevention of deafness, promotion of ENT health. The hospitals we work with will have clinical rooms for ENT procedures, minor theatre, minimum ENT surgical equipment and ENT table, soundproof odometer room ENT and assorted surgical instruments and facilities for training. They will generally have the capacity to provide comprehensive ENT services including surgeries of the nose throat ear, tonsillectomy, adenoidectomy, tumour resections, ET tubes etc
With regard to ophthalmic services, KNH offers services in eye-health promotion and education, identification and referral of common eye diseases and treatment of simple eye ailments; medical and surgical treatment of eye diseases and refractive and rehabilitative eye care services;
The hospitals may feature standalone Eye Clinics/Unit with several consultation rooms, wards and surgical theatres. Ophthalmic clinical attachments (training) are also available. In addition to an on-staff ophthalmologist, there will also be a visiting or attending ophthalmic surgeon to deal with common eye conditions like cataracts, as well as ophthalmic clinical officers, ophthalmic nurse and optical technologist.
Other Common Services
- Rehabilitative health services including Occupational Health & Therapeutics,
- Physiotherapy and Orthopaedics.
- Oral health services (dentistry) and orthodontist services
- Mental health services and drug-rehabilitation therapy
- Forensic Services and Pathology (Mortuary Services)
- Environmental Health & Disaster Preparedness
- Immunization, Family Planning & Counseling Services and Blood
- Port health services, specialist nutrition services
- Infectious disease diagnosis, treatment & management (TB, HIV/AIDS,)
36 Of The Top Global Health Placements We Recommend in East Africa
This guide comprehensively lists 36 of our top recommended placements in East Africa in 8 destinations spread out across the region with a quick reference guide to each of the specific placements we recommend.
It was published to promote a robust, student-oriented approach at medical elective and global health placements that encourages open and independent organization, enabling interested participants to independently manage their placements and customize individual program experiences.
This 46-page publication is free to download.
What Others Have Said About Us
Your compliments mean the world to us!
I took my elective in two separate locations; one in Nairobi, Kenya, the other in Ndejje, Uganda via Student Exchange Africa and Community and Family Health Initiative, an NGO in Uganda, taking a two-week travel intermission between the two sites. The travel experience surpassed my expectations. My Travel Coordinator was just exceptional at organizing everything for me!
Both Lizzie and I couldn’t have asked for more. David and Victor were really helpful right from our arrival through to organizing and coordinating our work and travel arrangements; helping settle us into our daily routine, internet and phone service, banking and so much more. They even assisted us to run errands. It was really great to have someone there to ease into a new environment and help us find our feet.
This was a great experience for us and we had the most amazing time in Kenya! We had a lot of doubts coming to Kenya but the trip was so well coordinated that we always felt so comfortable. We were very keen to travel widely besides the opportunity to work in the hospital and volunteer in the community and we got to do all this and much more! I am most grateful to John and David who were our TA’s – you guys rock!
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Tel: +254 20 235 0000, +254 20 2500195
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