Saying “Asante”: A Reflection From Authority Health Resident, Earl Carlos

Earl Carlos is an Authority Health medical resident who spent two eight-week terms serving at Mutomo Mission Hospital in Kenya.  In the piece, Earl reflects on two of the most important words in every language.

The most impactful words in the human dictionary, found in every language, culture, and race is thank you.

In Swahili, it is Asante.

Although many people in Kenya speak English, Swahili is the official language and in Kitui county, the local language is called Kamba. Despite this being my second time in Kenya, my ability to speak Swahili is still poor. During morning rounds, I will haughtily greet every patient with habari meaning – how are you. But, in no time I find myself looking at the nurse to help me translate from then on.

One day, I caught myself saying asante several times to each person I saw. Asante is a pretty easy word to use. The right moment and context to say thank you in any language is similar in most cases.

EG (left) and his fellow volunteers spending some time with one of their young patients, Josh.

The whole process of giving thanks and saying thank you to someone is really interesting to me because giving thanks is an action that can’t really be seen. We know and understand the context of giving thanks, but there really is no one way or right way to give thanks to someone.

Yet, we say it all the time, in any language, as if we all understand and know how to give thanks.

Whenever we say thank you to someone, we are acknowledging not only their good deed, gift, or talent, but we are also acknowledging their humanity – their ability to give some type of blessing to you and your ability to thank them and bless them back.

I feel absolutely grateful to be here.

EG and the other CMMB volunteers have been spending a lot of time getting to know each other and learning from each other.

Paulo Coelho, a Brazillian novelist and songwriter,  said that when you want something, the universe conspires in helping you achieve it. I worked my way through my undergraduate despite all of my insecurities about my own capabilities. I battled my way through self-doubt during medical school and now, I find myself in a program that has allowed me to come here – to rural Kenya, for a total of four months out of a 36 month residency program.

I am so grateful for my program, Authority Health, and CMMB for allowing me to be here for another two months.

I could have been in any other program. I could have focused on a more traditional route in family medicine and yet, I believe the universe, fate, God, or all of the above brought me back to Kenya.

A glimpse of EG in action!

With all that being said, despite these feelings of purpose and reason for my return, I have not reached those awe inspiring peaks as I had last year. My experiences and shock with the tropical diseases, HIV, tuberculosis, and also with the poverty that continues to exist and the avoidable deaths that continue to occur, is not there as it was during my first time in Kenya.

A few weeks ago, my very first patient here was a young, twenty something HIV patient who stopped taking his anti-retroviral medication. He was diagnosed with cryptococcal meningitis. By the time he arrived, he was already unconscious. He did not last more than 36 hours with us before he passed, and, I remember feeling nothing.

We experienced more avoidable deaths, patients coming in too sick at the very last minute. And I had that same feeling – nothing.

Deep down, I began to ask myself, am I okay? Am I depressed? Is there something wrong with me? Why am I not being hurt?

As I struggled through these thoughts, I came to the conclusion that I can do all that I can in the medical ward and try to help these patients to the best of my ability, but at the end, the most impact that I can make is outside of it.

There was one day I went out on a HIV outreach with a clinical officer and we saw about 15 patients with HIV, who were on anti-retroviral medication. The job is rather tedious because of all the documentation and pill counting. The patients we visited during this outreach were not all that sick, they had been diligently taking their medications. In situations like this, “heroic” medical actions are not needed.

And yet, this is where the most impact is made. This is where lives are saved, where people are liberated from unnecessary death and suffering and where changes occur.

I can do all I want in the medical and surgical wards, but if I cannot make a difference out in the communities and give people access to good primary care, then what’s the point? When a patient comes to the medical ward unconscious or tachypneic because of a late-stage,  AIDS defining illness, it is already too late and we have failed that patient. The impact of outreach programs, prevention screenings, and primary care is insurmountable and will never be fully accounted for no matter how much research is put in.

Maybe, this time around, I had to experience this feeling and question myself in this way. I graduate medical residency this upcoming June and I feel an even stronger pull towards global health and humanitarian medicine. I am grateful for this experience and these emotions, despite some confusion in the beginning.

One of my favorite quotes is from Fyodor Dostoyevsky’s The Brother Karamazov,

“Love in action is a harsh and dreadful thing compared to love in dreams.”

The idealism in this line of work is far from reality. Unfortunately, I will see people die, I will see people hurt, and I will see avoidable suffering. But, with the life that I have, I know that I can help and do something about it.

And for this, I am very grateful.