September 14, 2018

Kiki Ogu: Crossing borders

International rotations broaden knowledge and cultural competency in med students

Every year, several University of Michigan Medical Students apply to join the Global Health & Disparities Path of Excellence. M4 Kiki enters her final year of medical school after recently completing an international rotation in Ghana as part of her Path. Here she shares how she initially became interested in exploring health care disparities, what led her to Michigan, and why experiencing another health care setting and culture in person has been so important to her training and future plans.

How did you become interested in studying health disparities?

I attended Rice University for undergrad where my love for poverty, justice, health disparities, and patient advocacy blossomed. The notion that one's zip code has a greater effect on your health than your genes was shocking and something that I was eager to understand.

Since coming to medical school, I have sought out opportunities to expand my knowledge by joining the Global Health and Disparities Path of Excellence, through which I have attended expert lectures and conducted a research project to investigate racial variations in presentation and management of chronic pelvic pain.

I also pursued my passion for health disparities by becoming the clinic coordinator for the Delonis Shelter, Diversity and Health Equity Day sub-committee chair, Admissions representative for the Black Medical Association, and curriculum chair for Healthcare Education and Access Liaisons.

Why did you want to do an international rotation?

As my passion grew, my need to expand my understanding beyond the classroom grew as well. As a proud Nigerian and first generation American, I knew that I wanted to complete an abroad rotation in Africa. I was desperate to apply context to the topics I learned in the classroom and to witness firsthand how health care is provided in low-resource settings. During my third year, I reached out to Dr. Timothy Johnson to organize a clinical rotation and to Dr. Sarah Rominski to organize a research project. I traveled to Ghana in June and was able to experience an entirely different culture for six weeks.

What did you do on your international rotation?

I rotated through the OBGYN Department at Komfo Anokye Teaching Hospital in Kumasi, Ghana, and conducted a research project on contraceptive choice at various family planning clinic sites in the area. During my stay, I resided at a student hostel on the main medical campus and found myself surrounded by bright future physicians. Within the clinical environment, I learned about health care dissemination in underdeveloped settings, natural child births, breech extractions, the role of the family in Obstetrics, midwifery services, and advanced stages of gynecological diseases. Through my research, I encountered firsthand the stigma around family planning and contraception and the challenges associated with conducting international research projects.

How has Michigan been a good fit for you?

Selecting the right medical school was a tough decision. I was looking for a program that would challenge me and shape me into an incredible patient-centered OBGYN. The pass-fail preclinical curriculum allowed me to focus on my learning for the sake of learning, as opposed to simply working for a high score. Additionally, the curricular structure encouraged peer support and collaboration as everyone had the opportunity to succeed. I am a visual learner who enjoys watching lectures multiple times, so having the flexibility to stream lectures remotely allowed me to take ownership of my education. The curricular flexibility also extended into our quizzing schedule. I was able to prioritize myself and find my ideal work-life balance by taking quizzes when I felt ready.

I was also searching for a medical school that valued research, health disparities, and international work. Michigan surpassed all of my expectations and turned out to be an excellent fit for my medical school education.

What did you do when you were not in the clinic or at the hospital in Ghana?

During my time abroad, I utilized my free time to soak up the Ghanaian culture. I had opportunities to attend multiple trips to national parks and tourist attractions. I visited Cape Coast with other students from University of Michigan graduate schools and completed the Canopy Walk at the Kakum National Park, traversing the tree tops 100 feet in the air. At the Cape Coast Castle, the largest slave trade destination in the Gold Coast of West Africa, I expanded my knowledge on slavery and was moved by the historic conditions. The international student host organized a trip to Mole National Park where I explored the safari via walking and Jeep safari tours. I met baboons, elephants, and warthogs outside my front door!

What are some insights you have gained as the result of your rotation in Ghana?

Increased cultural awareness was the most valuable insight that I gained while abroad. It was fascinating to hear the opinions that peers, physicians, and Ghanaian men and women had about family planning and contraception. I was often met with shocked looks when I revealed my involvement in a study on contraceptive choice. Additionally, witnessing firsthand the limited knowledge that female patients had about their health care reinforced my passion for patient advocacy and women's rights. Going abroad was the perfect way to ignite my future career in women's health. I feel more invigorated and determined to advocate for my future patients and to provide personalized health care in which they are equal members of the team.

I was intrigued by the lack of equipment and the level of medical care that was being provided in an underdeveloped setting. When you enter the labor ward you immediately notice the number of patients and the absence of IV poles and beeping monitors. Fetal heart rates are monitored intermittently using a pinard as opposed to a continuous external fetal monitoring system. Vitals signs are similarly monitored intermittently, and all the information is charted by hand onto a paper patograph. There is reliance on skills that are no longer used in the United States due to the presence of medical equipment.

How have these shaped you as a physician in training?

This experience will help to shape me into a more knowledgeable and well-rounded physician. As someone who has sought out opportunities to learn about health care disparities and global health care, having an international experience was a crucial part of my journey as a learner and future patient advocate. Thus far, my education has been limited to the classroom and various domestic fieldwork opportunities, but in order to truly grasp the complexities of global health care, cultural awareness, and my role as a future physician, I needed to travel abroad and experience global health care firsthand. Working in an underdeveloped setting with medication shortage and limited medical equipment reinforced my interest in health disparities and international medicine. During residency, I hope to continue my global work and seek out opportunities to provide health care internationally.

How did you find time for extracurricular activities in medical school?

We all have different passions in addition to medicine, so we have to find ways to prioritize the things that make us happy. Staying organized is essential to finding the balance between curricular and extracurricular activities.

What were you looking forward to most in your M4 year?

There are many aspects of fourth year that I was eager to experience. The year represents an opportunity to truly personalize my education, enrolling in rotations that help to inform me as a future OBGYN, such as radiology and surgical ICU. Additionally, an opportunity to be a sub-intern was a huge appeal. Not only are you practicing medicine in the specialty that you intend to pursue, but you now have the clinical knowledge, skills, and passion to significantly contribute to your team. I will never forget how I felt when I was assigned as first call on an admitted patient or when I took ownership of the antepartum service. In addition to increased clinical responsibility and autonomy, fourth year has also granted me the flexibility to go abroad, which was my dream prior to starting medical school.

How prepared do you feel for the residency interview trail?

I am nervous but excited to embark on the infamous interview trail and jet set across the United States. Overall, I feel well prepared and know that my confidence level will only increase with all the resources that Michigan offers medical students. The OBGYN Department has a well-established FROG program (Future Resident of Obstetrics and Gynecology), which pairs each applicant with a resident. They organize personal statement workshops and coordinate mock interviews. My first residency interview will be here at Michigan Medicine, which will not only count as a real interview, but also serve as an opportunity to receive feedback. Additionally, the school now offers each student two mock interviews at the UM University Career Center. With all of these measures in place, I am confident that I will be well prepared to hit the interview trail.

What would you say to a prospective student who is considering the University of Michigan Medical School for their medical education?

Apply! Michigan has truly become my second home. From the supportive community to the top notch clinical environment, I am so thankful to have received my medical education at the University of Michigan Medical School.