2018 - Doctor as teacher: an interview with Fred Ochieng'

August 29, 2018

Fred Ochieng' is the Inaugural Fellow in Cardiovascular Diseases and Global Health Equiy at Brigham and Women's Hospital.

What is your current position?

I am an Inaugural Fellow in Cardiovascular Diseases and Global Health Equity at the Brigham. It’s the first year that they set up this program, which involves spending about 4 weeks in Boston for the Global Health Delivery Intensive course and then a 1-week boot camp in Haiti. I will then travel to three different sub-Saharan countries where I will be training nurses on how to perform a basic cardiac ultrasound to diagnose and manage valvular disease and heart failure. I just finished my adult cardiology fellowship at St. Louis University and was planning on taking a general cardiology job, but this fellowship sounded more in line with what I want to do.

How many years have you been working in healthcare?

I finished medical school in 2010 at Vanderbilt. But before that, we were already doing some work setting up a health clinic in our home village of Lwala in rural western Kenya. We didn’t have medical degrees at that point, and we would just see patients together with their nurses—a little bit of community health work and public outreach, sensitization of the local youths to various healthcare challenges and how to change behavior.

After medical school, I did an internal medicine and pediatrics residency then three years of general cardiology, and now I am spicing that up with another year of global cardiovascular disease training. So, that’s seven plus years of post-medical school training.

What brought you to the position you’re about to start?

My involvement with a non-profit organization that we run called the Lwala Community Alliance based in Nashville, TN. My brother and I initially set it up to run our village’s first clinic but it has now evolved to provide holistic interventions to improve healthcare, education and economic opportunities for the communities at home in Kenya. Having grown up in a place that didn’t have access to medical care, electricity or running water and having witnessed the tragic consequences of lack of medical care and the burden of malaria, respiratory illnesses, HIV, and maternal deaths pushed us to do something for our community—especially after losing both parents to HIV/AIDS complications. The clinic has now grown into a small hospital. In our spare time when we are not in school or taking care of patients, we participate in our board meetings and conference calls and meet with various donors and organizations that support us with individual gifts and grants respectively to continue supporting the organization. The Kenyan Ministry of Health is also an integral supporter of the Lwala Community Hospital’s acute care and public health outreach.

What is something that you wish to accomplish in your career or any goals that you have?

One goal right now is to figure out what I am going to do with my life in the next five years. I am trying to figure out a combination between my love for clinical cardiology in taking care of patients, preventive medicine, teaching and research as well as this vision of how to support and build the capacity of the healthcare providers in limited resource settings. So that’s kind of my short-term dream job or goal.

In the bigger scheme, we’re looking at improving the quality of the care and scaling up the work in rural western Kenya. We have worked on strengthening the healthcare system in our rural village and made a significant impact using our community health worker model. Over the past several years, we have seen incredible results: increasing the number of deliveries in a healthcare facility under the care of a skilled provider from 25% to more than 95% using traditional birth attendants in the CHW network; increasing immunization rates from 50-60% to more than 95% and approaching 98% of children born to HIV+ mothers being HIV free in follow up visit tests. Having achieved these results in our catchment area of about 30,000 people, the Ministry of Health in Migori county has asked us to partner with them to see how we can scale this up to the whole county of about 1 million people.

What would be a challenge that you’ve faced so far or see in the general field?

One of the main challenges we face has been the lack of infrastructure in rural communities. Most people go into medicine thinking that we love to take care of patients, but then you look broadly and see all the other factors that play into the outcomes of the patients. Figuring out how to improve infrastructure (e.g., building effective roads so that we don’t get our roads flooded during heavy rains, improving latrine coverage, and clean water access) and how to partner effectively with the media to provide both effective education and raise awareness on our efforts — because being out in a remote area, not too many people in Kenya actually know about the work that we are doing. So the main challenge we face is pulling together the stakeholders and having everybody work together.

When you were applying to GHDI, what were you hoping to get out of this program?

I didn’t really know too much about GHDI to begin with, but it quickly became clear that although classes were going to be busy with lots of work and readings to do, it would be such an incredible course with such diversity of experiences highlighted by the work of my peers from 27 countries. It makes me think about what skills I want to acquire moving forward, and how to take advantage of all the opportunities here at Harvard.

What impact do you think GHDI will have on your career?

One great benefit from taking part in the course is the incredible network of connections that we’ve been able to make during the course. You look around the class and see all these people who are doing such neat things—I’d love to be able to visit them and see some of the lessons that they’ve learned, and how can we take some of those back to rural western Kenya. The professors here are just so full of energy, knowledge, and amazing experiences. I’m trying to think about how I can shape my career because it’s an unusual path that I’m trying to create. If there’s a place where people could help me make it work, this seems to be the right place. I’m hoping to get some invaluable guidance.

What are you most proud of in your career?

My brother and I came from such humble beginnings and our parents sacrificed a lot to invest in our education. I think about the work that we have done in Lwala, and to see the incredible odds and challenges we faced at the beginning and how the village came alongside us, and how we recruited the support of friends from across the globe. People in the community tell stories of how their lives have been transformed. Now we are seeing people from much larger facilities coming to seek care in the village.

To me, one of the most encouraging things is when community health workers, Many of them with not more than an 8th grade education take the challenge to support the health of their neighbors to a different level. Now everyone in the village is asking themselves what they can do to impact the community. So, when you reach that critical point where everybody is excited about doing something, a community is empowered to make a change.

What advice would you give to someone just starting out in healthcare in your country?

Working in healthcare is challenging, but to me, it’s an incredible honor that we get to take care of patients and their family members. When they come to seek care from you, they are weak and scared. They put so much faith and trust in us, so it’s important to take a step back and think about how fortunate you are to be trusted with somebody else’s well being, life, and health in general. You may be tired and frustrated by various things in the system, but it’s helpful to remember that it is an incredible honor.

The word Doctor is derived from Latin docere - to teach. I ’ve figured out that as part of taking great care of my patients, I always try to take time to teach my patients and their families because education and knowledge is empowerment. So, when my patients or family members are able to explain back to me in basic terms their medical condition and how they can modify it, to me that’s a really proud moment. So many times, we are so rushed; we just want to give a diagnosis and keep going. But just remember that it’s the patients and family members who live with these conditions. To me, an empowered patient or family member is such an incredible asset to the healthcare provider.