Prof. Ezekiel Wafula Masibo.
We sat down with retired Professor Ezekiel Wafula Masibo as he narrated his joyful journey as a paeditrician for more than 40 years at the Department of Paediatrics and Child Health. Get more details in the below interview.
With more than 40 years working in the Department of Paediatrics, how has your teaching journey been, and what have been your motivations plus inspirations that have kept you going?
That is a loaded question, but I think it springs from the very beginning when I joined the field of medicine and particularly paediatrics because I enjoyed it. I loved it. For me, it was a dream of my life, and being able to help a child who is sick recover was a very gratifying fulfillment and being able to transfer the same skills to those around me was also a big encouragement as it were.
When I joined the Department the Paediatrics, the environment at the time, medicine was like a vocation; a calling as it were. It was not a job. In the beginning, I never thought a time would come when I would sell my services in private practice, I thought that was below the quality. Helping a child who is unwell to become batter, was a mission, as a calling.
My teachers and all those who were training us at that time were very kind. It was unusual not to feel driven for the sake of the patient, everything was for the welfare of the patient. When you succeed, or if you have done your best, that was the reward, the fulfillment. Monitoring among other things was not very major, the most important thing was whether we have solved the problem.
In the graduations, as a student came on, one of the things that I enjoyed most is that, as you pursue the calling, as you work the best you can, your skills also improved. One of the things I found useful, is that there are two ways we try to impart knowledge especially to those people below. Some people use intimidation and fear, others use an encouraging environment that is enjoyable to be able to spread the knowledge. I have desired to try to come up with new tips and help students learn knowledge, without instilling fear of consequences if people do not know this is that. It has been a nice journey. Even at the time of retirement, I was still willing to continue teaching, but the age has said "you don't continue" and I discovered recently that the age is right.
The other motivation has been being able to understand disease processes deeper and deeper to be able to solve them. Teaching has been my passion, after finishing my masters training as a pediatrician, I was posted to The Coast General Hospital as a provincial pediatrician, I knew I was going there for a short while and come back to teach. Over the years, when I have been encouraging students, a student who seems not to grasp things as expected, overtime they grasp, they improve and move on quite quickly. One of the fulfilments is that some of those who are not very knowledgeable, who are struggling, over the years get even better in subspecialties. I have many of my students, who know much more in various areas because they have subspecialized and it's a joy to keep referring patients to them.
The question of transferring skills and knowledge is one, the other bit is the profession and the perspective aspect. Many of the students come in with intimidation and fear, but as you begin interacting with them, they get confidence and understand that they can do it, it is within their power. This is also very fulfilling.
I remember one time I was on a ward round and because it had become a way of doing things, we wanted students to be responsible and work hard, and be able to be good at their work. I asked a student to come to where I was, but from what I heard she had hidden and she was crying, because just didn't want to go there. Whoever consultant was there apparently was a bit difficult. Later on, she confessed that that's the section or field where she wanted to be. What am saying is that there are times when you do something correctly, it may cause a bit of a mountain, but with time you realize that that is the mountain that you needed to get to where you wanted to go.
The last one is research, which I started doing later in my career. Researching to try to address issues in your practice is very encouraging. Because then you find new answers, new things, not by other people but by yourself.
Besides, because of my faith as a Christian, one of the encouraging things is knowing that am fulfilling what God has created me to do in that area, concerning the people am dealing with, those below me or higher. You do not get discouraged; problems are not blocking but stepping stones.
I have desired to encourage students to pick a specialty they like. What I tell them is that "do not go to where there is money, go to the one where you feel inclined towards, where you seem to have an easy stay, and take it if you think your lifestyle later will resonate well with it. Because some specialties may be very busy, for instance, critical care, newborn care may also be very busy. Some a bit more relaxed and you can do other things. When students come to me, I ask, what do you see your lifetime later will be like, and on that basis, I advise them.
You also look at the areas, where there is not much crowding, and you may have more space to do more than where everybody else is. The sub-specialization is good because you go into deeper knowledge in that sub-specialty. However, as a pediatrician you need to know enough of general pediatrics, which is quite a lot so that you do not sacrifice your pediatrics to the other specialists.
Many times, the people who do sub-specializations of any kind, concentrate a lot on that and tend to know every little of other areas out of that sub-specialty. In these sub-specializations, also try to go beyond paediatrics, but if the sub-specialization is being reduced to what a pediatrician does it means you are not adding a lot of value. Function more than a paediatrician in your specialty, such that you are almost getting to the edge, doing innovations among other things. If you end up a paediatrician in the media doing pediatrics, not exercising your role as a sub-specialized, highly trained pediatrician.
Besides, allow the paediatricians to do paediatrics' in your subspecialties as much as is possible. Pick up from where they do not know and move that way. If you take over, then actually you are disenfranchising paediatrics. Paediatrics is very wide, allow pediatricians to go as far as they can. Paediatricians, please do everything, and allow the subspecialists to add to your function, to add to what you have done. There is no competition, it’s an additional element, the sub-specialists work with the general paediatrician to make the care of children better.
Having been the oldest member of faculty at the department, and knowing that you have even overseen the training of many younger faculty members at the department, how do you describe the atmosphere?
This is a good question. One thing I want to mention here is that the department of paediatrics is unique. It is like a family. I have enjoyed working in it because they are a tremendous team and the people who have done sub-specialties have done a good job and add a lot of value. They are also very respectful, and very good in their sub-specializations. Over the years, there are things that you pick up, but we all complement one another. Even those who have gone for a short time and come back after their sub-specialties, together with those who are general paediatricians that have been around for a longer time, creates a level of sharing both skills and experience which makes things much better. This mix has been wonderful.
One of the things that I have found that if you are a general paediatrician, you may not be at par with the new ideas and knowledge which underlie some of the diseases and practices. When sub-specialists come you are opened to these areas, and you are enhanced, you know things better and better. The blend is amazing.
One of the things I encourage paediatricians and other medical doctors is that never look at your skills as a reason for showing off, it's a service. The more you have, the more responsibility you have towards other people and many more. Am glad to say that the team in the department of paediatrics is more of sharing and blending. It has been beautiful, you have an issue and hardly see what to make of it, and you consult some of your colleagues who are sub-specialized, who happen to be my previous students, they add-in and give solutions to the problems. Medicine is a flow of learning, you never come to the edge until you go. You are always learning new things.
And to talk about what has been your passion for a big part of your life up to now paediatrics tells us about the role of general paediatricians in the world of Paediatric health.
Over the years you become a leader. And as a leader, you help in so many ways. I have been involved in public health issues for some time now. Earlier on I did some bit of work on pneumonia, so when it came to adoption of the IMCI (Integrated Management of Childhood Illnesses) guidelines, to be able to simplify ways of taking care of children because the people in the field are simple, I was one of the initial people that were involved in this. I was involved in directing many of the courses here and in other places. And to eradicate polio, I was crafted in a committee at the national level, where I have been the chairman since 2001, we have been at it and we are nearly coming to the end of it. We were with Prof. Bwibo who was the chairman of one of the committees and I was chair of the other, recently Prof. Bwibo was replaced by Prof. Were. So, I have been involved in this area for some time. And lately, I have been chairing a committee looking at the side effects following immunization and work is in progress. We have also been involved in resource initiatives, immunizations, and have been in many other committees doing one thing or another.
When a course in MSc infectious disease was started outside the department, I was involved to address the paediatrics and child health component in infectious disease. And before then, there was a postgraduate diploma in research methodology, where I was the foreman for many years. And other areas in leadership not only in pediatrics.
Furthermore, I discovered this when still very young in practice, as a doctor you are a leader of the team. You take charge of the leadership. As a paediatrician you also take charge. So that whatever issue pertains health care of children in your area, it is all your responsibility. If someone is not doing their job, you find out and find solutions. I have done this all along. From the level of the ward, county, province, and national level.
Before I became a paediatrician, while doing my postgraduate degree, I did a rotation in Coast General Hospital. While there I was told kernicterus due to neonatal hyperbilirubinemia was not a problem at the coast because that total bilirubin levels for neonates never go above 6mg/dl even though the feet of the babies were yellow. This sounded very strange. So, I obtained some blood samples and I brought them to our laboratory in Kenyatta National Hospital only to realize that a sample that had measured 6mg/dl in the coast general had a level of above 30mg/dl in the KNH laboratory. So, we had to rectify the calibration of the machine in Coast general. So, I went back, and we rectified.
Before I completed my postgraduate, Nyeri was reporting that many of the children who were admitted with diarrhea had poor outcomes, many ending up with convulsions, and some even died. So, they asked Prof. Bwibo at the time, to see what needed to be done, so Prof. Odhiambo and I were sent to see what was happening. What we found is that the ORS at the time, being prepared by a laboratory assistant, was prepared with too much salt. So, the children were dehydrated, and with this iatrogenic hypernatremia, they worsened and died. When we took the blood samples, these children were loaded with salt. But no one had noticed this. When we changed this, the outcomes were much better. At the time, the one who was one of the administrators who used to be a classmate in undergraduate mentioned to me that he was very happy that we had not gone alongside the protocols.
Most of the time we do not follow protocols. Don't be limited by structures, if you find danger for children, cross the protocols if you need to and solve the problems, let somebody else sort out the protocols because this is a life issue.
And for the doctors who consider a career in Paediatrics, what advice would you share about the field?
Paediatrics is a very unusual specialization. It is very broad, from birth to 18 years. It is a field where children are changing in size, perception, physiology, susceptibility, and environment. The newborn has no language, the teenager has language which others do not understand. The newborn has a body no one understands, the same with the teenager, and in between it is a continuum. Paediatrics is a field like no other, it involves the father, mother, and children, and what the parents do together influences the wellbeing of the children. It is not only the story of damage from the disease process but what the environment is doing to the child to make them that way. So, a proper story may reveal that the problem is not with the child, but the nature around him/her. This field is a good one, very fulfilling, and if one chooses it, it is a very good choice.
And if some would desire, general paediatrics is very good as well and very enjoyable. To know the whole of everything as it were. Not to discourage those who want to go into subspecialties, it is also fulfilling, the only thing is you may not have time for anything out of the sub-specialty to do anything else.
One of the things I encourage doctors, do not to be in a hurry to make conclusions that are not backed by science. For example, in the recent period, cow's milk is blamed for everything under the sun, a rash, abdominal pain, among other things. Yet milk is a very good source of calcium that the child requires, and most of the advice made to parents has no scientific evidence. Let us be knowledgeable so that when we make conclusions, they are backed by scientific evidence.
For those who have yet to make a choice, choose pediatrics, you will not regret it.
What message would you pass on to your residents in the department of paediatrics?
Please I encourage you, you have chosen, nobody has chosen for you therefore do not allow anybody to discourage you. You have wonderful people around you who are good, who can help you along the way, but they do not have to because you have made the choice. Make sure you get the training from whoever, from whatever. There are times when those who were training were very arrogant, very intolerant, and very callous, but this does not change anything, the fact that you have chosen that's part of the process. It would be lovely if people around you are good, encouraging, urging you on, but that is beside the point, the point is that do not be discouraged.
And when you have finished, make it a calling. Do not make it an income ship or a business, be a paediatrician it is fulfilling. Running for money, you are likely to take short cuts and may compromise the time of the investigative analysis due to the patient. Stay in paediatrics; Paediatrics is very fulfilling.
We always talk about good paediatrics in western countries, why can't it be also good here. We are the same people; we even have more patients. Most of the time we don't apply, we don't get a good story, we don't do a good examination, we investigate even when it is not necessary, and even after investigating, we don't interpret these appropriately. But if we did all well, we would go a long way.
And lastly please consult when you do not know, consult. You are not stupid. If someone thinks you are stupid, just move on and continue what you are doing. When you consult, you are adding on what you already know.
Is there a message you want to share with the whole team in Paediatrics including the Faculty?
This department has been unique all along. I think I did what I thought I could do. I do not think I was the best; everyone can do what I have done. My message is, let us build the department to the heights the department needs to go. Some challenges are beyond us, but these we can manage to overcome; through commitment, teamwork, harnessing all our resources, by respecting each one of us at various levels, each one of us has a part to play. I have learned a lot from students, we can all learn from each other.
The future is very bright. God will help us, but a lot is really on us, as we get ourselves committed, we will do it. The health care that was started in this country was started by missionaries, they were few, they had the drive, the care was very good, we look back with pride, but we are now much more, we can do the same, we can elevate health care. Let us not blame other people, let us take whatever it is in our fields and lift the standards. And with God, we shall save everyone, and the department is a good footing, good leadership, and the faculty there is very good.
Do you have any last message you want to share before we end?
I know right now, we have challenges in health care, one of the things I would like to think about whenever we have had strikes, of course, there are grievances and concerns. but what I always wonder about is where does my patient stand. It is not simply to walk off. Strikes are a difficulty for me to handle and knowing where the calling is. People have grievances, but this must be put into consideration as well.
As I retire, I am still in and out, I will still come to the clinic in Kenyatta National Hospital, I supervise student's research and am very open to research, whether in a lecture or guidance. Am more relaxed now than I was before.
Prof. Ezekiel Wafula has been a lecturer at the University of Nairobi, Department of Paediatrics for more than 40 years. Those who have passed through his hands will always recall his fatherly figure, his humility, and eagerness to teach. His great work within the department of paediatrics has inspired this initiative. As residents within the department of paediatrics, we have witnessed his work face to face, and it was a great privilege to have worked with him. His work has impacted many and will remain to do so for many years. We wish him a blessed retirement period.
Authors: Dr. Allan Kayiza and Dr. Chifor Theresia Mfu
Edited by: Dennis Omido
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