Big heart, small world

Big heart, small world

Adrienne Schlatter’s road to becoming a physician took a detour to an HIV clinic in Kenya
Rowan University

Following her third year at RowanSOM, San Francisco native and UC-Berkeley graduate Adrienne Schlatter put her dream of becoming a physician on hold to pursue something larger than her ambition. She took a leave of absence to work for a year in a Kenyan clinic for children with HIV.

By her own description, Adrienne was a “non-traditional” medical student. She started her undergraduate career at a community college before attending UC-Berkeley, where she majored in molecular and cellular biology with a minor in LGBT studies. Following her graduation from Berkeley, Adrienne began working at a research lab that developed ways to make biofuel from genetically engineered microbes. A year later, she embarked on her first solo international trip, crossing several continents along the way.

“I spent some time where my mom grew up in Chile, and then I went to Peru,” she recalls. “Afterwards, I went to India for three months and volunteered at the Mother Teresa of Calcutta Center and followed that with two weeks of hiking in the mountains of Nepal.”

That trip gave rise to “Big Heart Small World," the aptly titled blog Schlatter keeps about her travels and her twin ambitions to see more of the world and to do more for the people in it.

Her inspirations, she says, are her mother, a nurse, and her father, an artist.

“Growing up in the Bay Area, there are so many clinics and services available, soup kitchens and people helping out all the time,” she said. “My parents always got me involved in community service activities, like cleaning up the beach or walking dogs at the SPCA. I made scarves for local shelters. My family saw these opportunities as a way to gain some level of happiness. So, I always gravitated toward those things and having my parents as role models for that inspired me.”

Big Heart Small World, Aug. 5, 2015: “I fell in love with traveling at the same time as I learned I was accepted to medical school. I began to merge my two passions, health care and traveling. I spent a summer volunteering in the Sacred Valley of Peru and every break I get I jump on a plane to discover someplace new.”

As an undergrad, she had volunteered at the Berkeley free clinic. There, she was introduced to osteopathic medicine by students from a nearby osteopathic medical school. They inspired her to apply to osteopathic medical schools, including the Rowan University School of Osteopathic Medicine

“A lot of the people who came to the clinic had chronic pain,” she recalls. “They were on their feet all day or sitting on hard concrete and most of them didn’t have access to health care. The students would perform osteopathic manipulation on the clients and help them feel less pain. It was really interesting to see what the students were able to do with their hands, especially in that setting where you don’t have many resources.”

Providing health care in an environment of scarce resources was an experience Schlatter would later repeat on another continent.

‘Who else will help?’

For her first two years of medical school, Schlatter was sure that she wanted to be a pediatrician. But, in her third year, she began to waver because she “pretty much loved everything” she experienced as part of her clinical rotations. At a time when medical students traditionally decide on the medical discipline they want to specialize in, she was torn between her first love, pediatrics, and family medicine, where she would be able to work with both children and adults.

“I always knew I wanted to take a year off, so, around December of my third year, I started looking for different fellowship opportunities abroad,” she says.

She interviewed with a few organizations and was accepted into a fellowship program with AMPATH-Kenya, a consortium of U.S. and Canadian universities working with the Kenyan Ministry of Health. Originally created in response to the HIV pandemic in Africa, AMPATH now provides a holistic approach that includes primary and specialty care along with chronic disease management.

While the human interaction that medicine offered drew Schlatter to her career choice, it was her compassion that led her to Africa for what she called “a once in a lifetime opportunity.”

Why apply for such a fellowship? Schlatter’s answer is simple—but profound.

“If not me,” she says, “who else will help?”

Upendo Ward

In Kenya, Schlatter was assigned to a pediatric HIV clinic in Eldoret, the country’s fifth largest city located about an eight-hour drive north of Nairobi.

UNAIDS estimates there are 1.5 million people living with HIV in Kenya, including 98,000 children 14 years or younger. However, some organizations believe that the number of infected children could be much higher. Despite significant progress over the past two decades, myths still surround HIV in that country.

“The fear of death was used to promote a campaign in the 1990s to defeat HIV and a lot of those myths still persist in the schools,” Schlatter says. “There were other myths about how HIV was transmitted. So, a lot of kids with HIV weren’t allowed to eat at the same table or use the same restrooms as non-infected children.”

In Kenya, along with projects that targeted the stigma encountered by children with HIV, the difficulties some parents had when disclosing the realities of HIV to their infected children, Schlatter provided patient care to very sick children in a hospital with only limited resources to help.   

Big Heart Small World, Tuesday, Feb. 9, 2016: “Yesterday I began my pediatric ward week at Moi Teaching and Referral Hospital in Eldoret, one of the largest public hospitals in Kenya…The first day was rough, we had a lot of very sick patients. Slowly we went through the patients deliberating over what our assessments and plans would be…I went home exhausted. In the morning I arrived on the pediatric floor. I was notified that two of our patients had passed away overnight. I felt terrible, but this was not an uncommon occurrence in the Kenyan healthcare system.”

For people who are familiar with health care in Western countries, it’s difficult to imagine what that care is like in a country like Kenya. When, a year after her return from Kenya, Schlatter is asked to describe her experience, the memories and images are still fresh for her.

“Imagine a room that is not very big, that’s crammed with beds and, maybe, 40 or 50 people,” she says. “There’s not much privacy and there are some pretty sick kids. Here in the United States, those same kids would be in a pediatric ICU. They would be on ventilators, on monitors. But, there, there are no ventilators. No monitors. They barely have oxygen tanks and the ones they have will often have three different supply lines coming off them. That means there is not even enough oxygen being delivered to these kids.”

Big Heart Small World, Tuesday, Feb. 9, 2016: “Death is all too familiar in the wards in Kenya, but not for me…One of the Kenyan medical students and I took the most urgent case. A baby boy who was having trouble breathing…We laid the baby down to examine him. His pupils were nonreactive, his breathing shallow, and his body limp…We started resuscitation. I tried to get a seal over the baby’s face, the bag was so large and the baby so small.

“My hands were shaking as I held the bag mask…The mother was crying on the bed next to me. Five minutes went by, then ten, then fifteen. Finally I looked up at the doctor across from me. We knew it was futile at this point.

“I realized that I needed to end the resuscitation measures that I had initiated, but it was so hard. As a medical student my goal is to preserve life. I did not want to pull the mask from the baby’s face or tell the team to stop. But at the same time, it’s Kenya and even if we did get a pulse and we could ventilate properly, there are no ventilators to maintain breathing and no ICU beds available.”

“In Kenya, they see kids pass away every day, but, for me, it was new,” she says. “So writing about it in the blog helped me to get my emotions on the screen and share them with people around the world.”

Big Heart Small World, Wednesday, Feb. 10, 2016: “Upendo Ward:  Upendo means love in Swahili. It's a fitting name for the ward…Illnesses such as pneumonia and anemia that can be treated successfully elsewhere lead to death because we lack oxygen and enough blood. Every day we see children suffering or dying due to congenital heart diseases that are treated at birth in the states…I asked the intern yesterday, after we finished seeing a patient with a congenital heart disease, ‘What will we do next?’ He shrugged and replied, ‘Nothing." In reality we do a lot with what we have, and if all else fails, we just provide love. Isn't that the most powerful medicine anyways?’”

Schlatter continues to write in her blog, which she says helps her to decompress and to feel connected when she feels alone while traveling, here or in another country.

Among the many lessons she’s learned from her travels, one stands out.

“I think it is ‘follow your heart,’ she says. “Just dedicate yourself to always try to be compassionate and try to help people as much as you can. Even if it’s just a little bit of time – once a week or a couple of hours a week – if you could serve others in some way, it will make you happy, too.”

Now that Commencment is over, Schlatter is returning to the West Coast to begin a pediatric residency at the University of Southern California’s Los Angeles County Hospital. Inspired by Dr. Martin Finkel and Dr. Esther Deblinger at Rowan’s CARES Institute, she hopes to follow up her residency training with a fellowship that will qualify her to work with children who have experienced abuse, violence or neglect.