Address by Chief Guest
Mwenda Ntarangwi, Secretary and CEO, Commission for University Education
President Firoz Rasul
Members of the Board of Trustees of the Aga Khan University
Provost Carl Amrhein
Vice Provost Kweku Bentil
Deans, Faculty and Staff of the University
Members of Government
Members of the Diplomatic Corps
Parents, Partners, Supporters, Distinguished Guests
And most importantly, Graduands. Good morning/Afternoon!
It is indeed a great honor to be part of this graduation ceremony on this Valentine’s Day. Let me start by wishing you all a happy Valentine’s Day.
Given the theme of the day maybe I should anchor my remarks on the subject of love - love for your work, love for your profession, love for your patients, students and colleagues, and love for your community, country and the world (of course love for your family is a given).
I will start my remarks with two scenarios that I witnessed a number of years ago, which I hope will help frame what I want to share with you graduates, faculty, and administrators as you strive to best serve this great nation.
Almost 21 years ago my wife and I went to a doctor’s office for a routine ultrasound examination. She was carrying our first child and as inexperienced parents we were eager to follow the laid down processes. After the examination, I started chatting with the doctor and at some point asked him how the ultrasound works. Instead of feeding my curiosity he looked at me squarely and told me it was “complicated” (meaning I couldn’t understand). I guess I must have violated the unspoken relationship expected between a specialist and a non-specialist. I felt a little intellectually assaulted and not being one to go down without a fight I asked, “does it not work like the bat through what we call echo location?” He looked at me quite surprised then smiled.
In another time and place I was assisting a fellow anthropologist gather data on some Chinese clinics offering services in Nairobi. I was surprised during my visit to some of the facilities to see that consultations carried out with the service providers did not accord the clients privacy while they explained the problem that led them to seek assistance. Individuals kept going in and out of the consultation room as the client explained the source of pain or discomfort. Even the consultation room door was open and those sitting and waiting to be served could hear every word of the conversation. I was further surprised in the same study to learn that some service providers did not give their clients the conventional full dose of antibiotics because they assumed Africans were strong enough to fight infection in fewer days.
What do these two stories have in common?
They show us that in each of these human encounters there are underlying assumptions that shape the interaction. The Ultrasound doctor had made certain assumptions about an inquisitive client. The Chinese Clinic service provider had made assumptions about the clients who sought their services. These stories also give us a hint at how those interactions were constructed—clearly not to the advantage or benefit of those seeking services. Indeed, the main players in the stories seemed to assume that the ones seeking information or service had no agency (that is they lacked the capacity to act independently and make their own decisions and choices). They assumed that these individuals fitted into neat boxes called “patients” meant to just receive professional information. They could not ask questions or contradict the professional. The professionals wielded power—the power of knowledge.
To you Graduands:
We are here today to witness 85 of you be conferred with degrees, diplomas and certificates for the respective programs you have qualified; 65 from programs in the medical services sector. Given the focus on excellence at this institution I am sure you have been given the technical skills necessary to offer best services upon graduation. It is my hope that besides your technical skills you also have gained skills that will assist you avoid performing the “assumptions” game. I hope you have had a chance to interact with the Institute for Human Development that seeks to foster interdisciplinary and collaborative work. If you have not, let me remind you that your success as a health services provider will need more than technical skills. Healing is a consequence of many factors: the medicine dispensed, the patient’s adherence to required instructions for taking the medicine, and the patient’s unique physiological, physical, economic and social conditions, and identities, among others. What this means is that your work is not just an exercise in providing a one-sided set of instructions to a patient with no agency. The patient is as much a part of the healing as the technical services you will offer. You will also be called upon to share a lot of the knowledge you have gained in this University with your patients and their caregivers.
It is not unusual for us in this country to completely avoid sharing information with patients or those we assume cannot grasp the complex knowledge of our fields of expertise. But is it really the patients who cannot grasp the information or are the practitioners not able to explain it well enough to be understood? In the process of sharing information with your patients, you may also find yourself spending a significant amount of your time providing much-needed education and psychosocial support especially regarding one of the biggest medical challenges of our time--cancer. Many of us are still trying to come to terms with this monster. You can play a small part in alleviating our shock and fear by sharing the news in a more humane and caring way. Break the news to us slowly and kindly.
And to those of you graduating with degrees in education, please note that you too have a similar task of treating your students with care and respect. Your students are humans who bring a lot to your classroom. As you prepare to teach them ask yourself what the students already know so that you can build and stretch that prior knowledge. Consider acting more like a coach who helps students discover the joy of learning and research as you also share your own knowledge and experiences. Remember we are living in a world of multiple sources of information some good and others not so good. You as a professional can help the students discern the difference. After all they will be the ones giving you professional services after completing their studies. And since I am sure you want the best services, you would also want to prepare them well.
To you Fellow Academics and Faculty:
You have a role to not only offer the best training for your students but you also need to train them to be able to understand the basics of the science behind the work they do so that in turn they can help their patients make informed decisions about their health and healing. Don't tell them its complicated. If you understand it well enough you should be able to make someone else understand it too. They in turn can help their patients become important participants in their healthcare services.
To you leaders of this Institution:
One of the areas of focus in national development currently is affordable health care for Kenyans. While it may seem like affordability has to do with direct costs, may I suggest we can also reduce costs with an emphasis on patient-centered care. The scenarios I have given above boil down to ensuring that the patient is treated with dignity and respect. If we treat a patient as an individual whose knowledge and practices contribute to better health management then we can reduce some of the challenges facing us in the health sector. With proper follow through of prescribed health care solutions including taking prescription drugs in accordance with the doctor’s instructions, adherence to preventative health habits, psychosocial support, and encouraging patients to gather important data about their overall health, your work as healthcare providers might be well enhanced and lead to savings.
From where I seat in my daily work I invite you and others in the sector to ask ourselves what the key competencies, training and accreditation mechanisms of health professionals are necessary to offer patient-centered care. A good place to start is an interdisciplinary and multi-sectoral approach that will enable recognition of the social determinants of health and ways to equip students as well as those already in service with the requisite skills for such practice. Already the Aga Khan University has taken important steps towards attaining this goal with its establishment of the East African Institute and Institute for Human Development. These two Institutes will play a key role in shaping not only the kind of training that students receive here at Aga Khan University but will broaden the conversation and training of health care providers across the region. I can imagine from such work a trained cohort of health care professionals who:
Recognize and honor the agency of the patient, where such recognition would result in the first encounter with a patient starting with a recording of the patient’s health information (such as family history of illness, diet, working conditions, past ailments, etc.). Such a practice is often not available or requested for in some of the consultations where the patient is assumed to be passive and/or unknowledgeable. To capture good patient health history there is need for sensitizing the target population about such expectations and affirming that their knowledge aids in their own recovery and sustained health. With your numerous community centers around the country as well as your more than three thousand strong alumni base in East Africa alone, such a sensitization task can be rolled out widely.
Health care professionals who constantly engage with local community members to share with them key information to help improve health-seeking behavior.
Health care professionals who are always updating their skills to better deal with the constantly changing sector and put in place mechanisms to respond to the now growing phenomenon of self-treatment in this era of Web MD.
In conclusion let me take this opportunity to thank His Highness the Aga Khan for his enduring commitment to expanding access to high-quality tertiary education. And
graduands thank you for making this day a special one. We celebrate you. Go out and serve with diligence. Go out and do us all proud.
CONGRATULATIONS! Thank you.