​Valedictory Speech

By Tabitha Alexandria Njeri Nyanja, Master of Medicine, Class of 2014

Your Highness, Mr Rasool, members of the Board of Trustees, members of faculty, distinguished guests, ladies and gentlemen and my fellow graduates. 

Today I take great pleasure in representing the graduands from the Bachelor of Science in Nursing, Master of Medicine and Master of Education programmes. All represented here today are current and future leaders in their fields and have under the aegis of the Aga Khan University developed the skills, knowledge and attitude to be practitioners in their fields of practice and to become change agents to society’s benefit. It may have taken somewhere between one to four years to complete our degrees but some of us have aged much more than that. I hope you will agree with me that with all that learning and training now comes a tremendous responsibility. I know this now more than ever and I will share a story to explain why.

After my undergraduate studies, on my first day as an intern in the medical ward several years ago, I was called by the nurse to attend to a patient who was having a seizure. She was a young lady in her early 20’s with a family history of epilepsy. She had not been using any medication and had been referred to the national hospital for better care. When I got to her bed she was fitting uncontrollably and was not responding to the only drug we had in the ward, which was diazepam. We had run out of any other anti-seizure medication at the hospital pharmacy. My assessment was that she was now in status epilepticus (this is a state of continuous uncontrollable seizures) where the best option for her was to be admitted to the ICU and get anesthetized. I called the ICU and they had no extra breathing machines; we call these vents. I called my on-call resident doctor and he was sitting an exam. I called my consultant and after I informed him of the situation he said “What medication have you given? Did you call the ICU? Where is the resident?” I gave him my responses and then he said, “It seems as if you have covered all options.” “So what do I do?” I asked him.  “Daktari, do the best you can.” I kept thinking “Oh my goodness, I am only an intern. What does ‘do the best you can do’ mean?” Sadly, my patient did not survive. It was my first mortality. Now I fast-forward to several years later. I am in my first year of residency at the Aga Khan Hospital here in Dar es Salaam and I am the on-call doctor in the paediatric ward. The nurse on duty calls me and tells me there is a newborn who is not breathing. In medical terms we say that the child is in respiratory distress and this baby needed ventilator support. I called the ICU and they did not have a vent. Now I tell you these ICUs they never have a vent when you need it most. I informed my consultants and we called every hospital within the vicinity and none of them had a vent. By now I am at the entrance of the hospital ICU hoping that if they see my sick baby, they might let us in. But they cannot because they have no vent. So the nurse I was with and I manually bagged the baby all night. In the morning we got a ventilator.

Why these stories, you might wonder. Well first it is because as noble a profession as medicine is, being a doctor is not easy and yet even then you are expected to do the best you can. Before my residency I thought all I needed to do was save someone’s life to be a good doctor. Now four years later I know and understand that that is never going to be enough. It is not enough to see a patient and write a prescription, or clean a wound and patch it up. As clinicians we are spectators and servants to human survival. This is a difficult thing to do because we are ourselves human. We are called to become comfortable with the uncomfortable so that through us others are comforted, yet sometimes, due to no fault of our own things may not always be as they should. Machines may be faulty; drugs may run out; your attending may not be available; the ICU may be full. It is at these moments that we must question why this has happened? What can I do? How can I change the way things are?

It begins with a choice, the choice to acknowledge the past, to appreciate your present and to change your future. To do so I have realized one must never stop learning, never stop asking questions. We must use every challenge that we face, and they are many, as an opportunity for progress and development. How, you may ask. Where opportunities exist, engage in further studies and research to influence how people think, to advance science in service of humanity so that we can advocate for those in need and underserved. We must appreciate that this knowledge is useless if it is not shared; therefore, we must take every opportunity to impart it. 

My fellow graduates the future is ours and it is ours now. You could chose to wait on things to happen, you could chose to watch things happen or you could chose to be the one who makes things happen. Will you be the hammer or the nail? To accomplish this we must realise we need each other. In order to progress we must work with those who share the stake in what we are doing or have a perspective to contribute across disciplines, across sectors, across borders. Imagine the human body without a limb or with an eye missing. Sure enough you can function but how optimal would you be? Yes, we shape our own destiny but we are nurtured and moulded by those who have sat here before us. As a great scientist and teacher Isaac Newton said , “If I have seen further, it is because I stood on the shoulders of giants.” To lead one must be led. To teach one must be taught. To nurture one must have been nurtured. It takes a lot of humility to acknowledge how helpless we are without each other, how dependent we are on each other. 

My fellow graduands I would like for every one of you gathered here to reflect back to the first day you walked into an academic institution. Did you imagine you could be where you are today those “x” number of decades ago? Did your teacher who taught you how to say the letter “A” know you would be seated in this hall being conferred with a degree through which the power to read and to teach is given you? Somebody somewhere believed in you. That alone inspired you to be who you are today. It is now your turn to go out and return that favour. So when you go out to teach, to nurse, to treat your patients remember what Martin  Luther King said to do it like “Shakespeare wrote poetry”, “like Handel and Beethoven wrote music”. In other words be the best teacher, be the best nurse, be the best doctor that there ever was. And as you ready yourselves for the brand new realities that lie ahead, take full advantage of the education that you have been privileged to receive here at the Aga Khan University. It has been a journey and as we forge on let us never forget the people who made it easier, these are the people we have to thank and whom we will cherish for giving us direction and purpose. The professors and faculty members who dedicatedly taught us and supported us, our classmates who challenged us, our friends who tugged us on, our parents and family who unconditionally supported and cheered us on and the special ones who dried our tears. 

Finally the calibre of teaching the effectiveness of the Aga Khan University in leadership have earned my enormous respect and admiration and secured in my mind its reputation as one of the leading universities in east, central and southern Africa. And as of the class of 2015 you too deserve respect and admiration. You have excelled and clearly succeeded in this demanding academic environment. As I look out from this podium I know that for decades to come you will save lives and teach great people building on what you have learnt and accomplished here. 

I am now supposed to say farewell to this great institution; the people who maintain it; those who supported me by leading and urging us forward. But I hate good byes, but instead I will say, see you soon! And with that I wish you all in the words of Confucius, “Wherever you go, go with all your heart”. 

Thank you! ​

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