Policy and medical care: Why we need more doctors in policy and advocacy

Dr. Mellany Murgo knew that she wanted to be a doctor at 9 years old. She also knew in medical school that she wanted to make an impact in the field of medicine. Her interest in medical research, advocacy and policy makes her journey compelling. Here is her story.

Question: Why medicine?
Mellany: I wanted to be a doctor since I was 9 years old. I was a member of the scouts movement, in charge of the health club. My interest grew and I joined with the First Aid Club from both primary and secondary school. These clubs gave me exposure on health care, but I only got the real picture in medical school.

Question: How did you get into research?
Mellany: In my second year of medical school, I realized that I needed something more than just being a mainstream doctor. I discovered that there is a lot of medical research all over the world. I looked up what others were doing: from Harvard School, to New York State University to the World Health Organization. This was what created the research interest.

Question: How did this interest grow into a viable career choice?
Mellany: I was mentored into research by a student who was a year ahead of me in medical school. He was enrolled in an parallel medical program that would see him graduate with two medical degrees. The program included certain aspects of research which are not part of the regular medical degree. I shadowed him and carried out some research projects with him just so that I could learn the research process. We ended up publishing together. When I started visiting the clinics and wards and interacting with patients,  I realized that there were so many gaps in medical care, right from when the patient walks in to their departure. There was a difference between the standard of care given to patients and that taught in class. Lecturers would say “In an ideal situation,…” justifying why things are different! I consulted my lecturers on the situation and their response was that there is a big gap in research in Africa. Since very few doctors in Africa go into policy and research, medical policies are adapted from the Western world. An example of considerations that should be made for medical care for Africa is the difference in  genetic disposition as well as culture.

medical-school2Question: How did you determine the area of research to focus on?
Mellany: First, I read widely to gain understanding and find a broad area of study would interest me. Then, I found lecturers who have published in the broad area of health policy, specifically, access to medicine and treatment. In my fourth year, while learning Obstetrics and Gynaecology, I visited a cervical cancer ward where I spoke to the patients. One of them, a 21 year old lady, was on palliative care since the disease was too advanced. She had been diagnosed 6 months prior to arriving at Kenyatta National Hospital. Instead of seeking treatment immediately, she opted to take pain killers. This broke my heart because cervical cancer is treatable when detected early. I realized that attitudes, lack of knowledge and lack of funds are the biggest challenges in healthcare. Some ladies mentioned the attitude towards cervical cancer, that it is associated with promiscuity, which is untrue. I realized that the time between diagnosis and treatment was such a huge gap between 3 and 6 months. My lecturer challenged me to get actual figures and determine whether it was a pattern. We worked on a research proposal together and submitted it for ethical review. And that is how my interest in access to treatment in cervical cancer started.

Question: What notable findings have you had in research so far?
Mellany: What really struck out from the first research in cervical cancer was that women get a lot of information from each other (word of mouth). Very few women knew that there was a vaccine for Human Papilloma Virus(HPV), which causes cervical cancer. In my fifth year, I wrote a few online articles about access to treatment. I conducted a survey to find out whether my colleagues visited other doctors for prescriptions or self prescribed. The study found that most doctors self prescribe, at times not prescribing the correct drug.

Question: How has your career in medical research progressed since medical school?
Mellany: After graduation, I went for advocacy training by the American Cancer Society, just before commencing my internship. I was trained on aspects of advocacy and the policy making process. My focus was solely on access to drugs for cervical and breast cancer. When I started my internship at Mbagathi hospital, the issues surrounding access to medicine were glaring. Patients would not purchase prescribed medication for two reasons: 1) they could not afford them, or 2) only one drug was available within the hospital pharmacy. Very few patients were even aware of the benefits of the national health insurance scheme. Using a grant given by the American Cancer Society, I started a study in November 2016 on access to specific drugs relating to cervical and breast cancer in the major referral hospitals, that is, Kenyatta National Hospital and Moi Teaching Referral Hospital. I am also interviewing patients, pharmacists and administrators to find out where the major issues affecting access to medicine are. I am also the African coordinator of Young Professionals Chronic Disease Network, which was set up to counter the injustice for lack of access to treatment for non-communicable diseases. I helped to set up the group in Kenya and in 14 other African countries. The group is housed by medical schools but has membership of different careers, lawyers, engineers, artists, farmers, environmental specialists and so on. We look at all aspects of non communicable diseases, from chronic illnesses like cancer to road crashes.

medical-schoolQuestion: Where do you see your research going in the next five years?
Mellany: The Sustainable Development Goals are focused on non-communicable diseases like cancer. Increasing access to essential medicines and technologies is one of the action points for this. Based on this, I would like to build capacity in this area by bringing in more students, particularly at undergraduate level to learn about research, advocacy and policy making. In September 2016, I organized the first ever training in East Africa for medical students on non-communicable diseases(NCDs), access to treatment and advocacy. This training involved 60 students from East African countries. The students are currently using the knowledge gained to undertake research projects on access to treatment of specific NCDs over the period of 1 – 2 years. In the next 5 years, I would like more conversations on access to medicine.

Question: You have had mentors along your journey. What impact have they had?
Mellany: I have grown picking up mentors for each aspect. I found a weakness in research capacity and struggled through personal initiative to learn what I did not know. Getting mentors who knew what I needed to learn helped me a lot. I have mentors, both locally and internationally, for different aspects of research from grant writing to publication to policy making issues, highlighting the issues they come across and suggesting approaches for me to follow.

Question: Comment on two things: 1) Finding a mentor and 2) Leadership
Mellany: Getting a Mentor: Start with a broad vision. What do you really want?  Find a mentor who can help you focus on a specific direction. What I have realized is that though my mentors are on  different paths, they still helped me narrow down my vision. They still mentor me despite our different paths.
Leadership: First, you have to lead yourself before leading others. Find and understand yourself, accept that you are not perfect and know where to run to when you face seemingly insurmountable challenges. Second, work as a team and identify the potential of other people. Though I may lead the process, other people lead specific areas such as reviewing literature, ethical issues and so on. Together, all these team leaders lead to success of the project. Working with a team has made me a better person. Third, look for opportunities to grow yourself, mentorship, training, fellowship programs and so on, to open up your mind and make you a better leader.

Question: What advice would you give to girls wishing to pursue science?
Mellany: I will use a medical example. After conception we are all the same before we  differentiate into male and female. We are the same way in life. There is no difference between a boy and a girl. The people we interact with are the ones who shape our future. But the most important person in shaping your future is you. Look at what your ultimate goal is.  Begin with the end in mind and work towards it. Look at what qualifications will you need to get there. If someone tells you you cannot make it, you will always have that end goal in mind.

Question: What is your favourite quote?
Mellany: My favorite quote is from a speech by Nelson Mandela.

Our deepest fear is not that we are inadequate. 
Our deepest fear is that we are powerful beyond measure.
It is our light, not our darkness that most frightens us
Your playing small does not serve the world.
There is nothing enlightened about shrinking so that other people won’t feel insecure around you. 
We are all meant to shine, as children do.
It’s not just in some of us; it’s in everyone.
And as we let our own light shine, we unconsciously give other people permission to do the same.
As we are liberated from our own fear, our presence automatically liberates others

Question: What do you do when overwhelmed?
Mellany: I plan what I need to do in chunks and prioritize.  I realize I cannot do everything, so delegating has been of great help to me.  I am not afraid to say I don’t know because this helps me to plan. Sharing with these  people helps you realize you had nothing to worry about in the first place. I really count on my people. Another thing I do is to have set times to relax. For example, Sunday is my rest day. When I travel a lot, I make sure to schedule an extra day for relaxation as a way to refresh. The people I surround myself with are also very important.

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