Community-Based Global Health Innovations with Dr. Wagaki Gicheru

• As a child, Gicheru was influenced by her parents' professions in healthcare. Her mother was among the first Kenyan nurses sent to the UK for advanced midwifery training before the country’s independence.

• She chose to specialize in anesthesia after seeing safety gaps during cesarean sections in a rural internship early in her career. 

• Gicheru decided to shift from clinical work to education at Kenya Medical Training College, expanding the non-physician anesthesia curriculum from one year to 18 months and increasing training sites.

• She is passionate about digital and simulation learning and spent five years building a simulation center in Kenya, launching it in 2020 with partner support and faculty training with the Havey Institute for Global Health at Northwestern University. 

• To compensate for lack of emergency care support across Kenya, Gicheru’s team trained over 11,000 boda-boda/motorcycle taxi drivers, in basic life support as key roadside responders. 

• She contributes success in partnership with Northwestern University in part to the mutual respect and understanding of each other’s strengths. 

• While many may think global health requires worldwide travel, Gicheru defines it as improving care across divides, even within borders.

• For those seeking a career in global health, she recommends looking local first and asking where needs are within a community, then seeking mentors to support continuous growth and learning.

[00:00:00] Dr. Rob Murphy: Welcome to the Explore Global Health podcast. I'm Dr. Rob Murphy, executive director of the Havey Institute for Global Health here at Northwestern University Feinberg School of Medicine. Making sure there are enough well-trained healthcare professionals to care for growing populations is a major challenge in global health today. Dr. Wagaki Gicheru has spent much of her career focused on that issue and transforming how healthcare workers are educated and prepared to serve their communities. She's an anesthesiologist, a medical educator and head of e-learning at the Kenya Medical Training College, an institution that trains the vast majority of Kenya's healthcare workforce. She recently served as the keynote speaker at our Global Health Education Day here at the Havey Institute at Northwestern University, where she talked about the importance of not only training more healthcare workers, but preparing them with the skills, technology and support they need to deliver excellent care where it is needed. We welcome Dr. Wagaki Gicheru to the show today to talk about her career journey, which has transformed how healthcare professionals in Kenya are educated. Welcome.

[00:01:12] Dr. Wagaki Gicheru: Thank you, Rob. I'm delighted.

[00:01:13] Dr. Rob Murphy: We're very happy to have you. My first question: What was your childhood like growing up in Kenya? And when did medicine first capture your imagination?

[00:01:22] Dr. Wagaki Gicheru: That's a very good question. I don't think I had an "aha" moment. It was sort of a transition into the space. I was brought up in a family where my mother was a nurse and my father was also in healthcare, though he was a nuclear physicist. So I got to see medicine through their eyes. But I think it was also that unwritten rule that if you did well in sciences, you did medicine. So I went through high school doing sciences and I thought, okay, I should probably do medicine. But I think it made sense to me when I went into medical school. So that was my journey.

[00:01:55] Dr. Rob Murphy: You shared that your mother was one of the first Kenyan nurses sent to the United Kingdom for advanced midwifery training before Kenya's independence. What was it like growing up with a trailblazer like her, and how did her example influence the kind of physician and person you wanted to become?

[00:02:12] Dr. Wagaki Gicheru: Thank you for that question. I think we take our parents for granted. We always see them through the lens of being a parent who is maybe not doing the things that you'd like them to do. It's only when you become older that you actually understand their career pathway. So I saw my mom as a nurse. I used to wear her uniform because she'd hang it behind the door, and I'd try on her cape and her hat, but I only got to know the journey that she took when I became a healthcare worker myself. Then I began to ask, oh, what was it like being a student from a poor family? They identify you as a top student and then you go on into high school, and then you do so well to be able to go to the university. And then she went on to be selected among the first nurses to be trained to come back to Kenya and either provide training or to lead the institutions when they were being turned over from the colonial government to the Kenyan government. So as I was growing up, I never saw her through that lens. I only saw it when I became a healthcare worker and started to think through my own journey and how I came to be a healthcare worker. I then asked the questions. 

[00:03:19] Dr. Rob Murphy: Well, it certainly made an impact in the end, that's for sure. You studied medicine and then later anesthesia at the University of Nairobi. Can you tell us why you went into anesthesia? I have to say, I don't interview too many anesthesiologists on this podcast. What was it about that specialty that appealed to you?

[00:03:38] Dr. Wagaki Gicheru: When I went for my internship, I went to a rural town. I spent a lot of time in the labor ward and in the obstetric unit and, as a result of that, also spent a lot of time doing cesarean sections. As we were doing those cesarean sections, the thing that I saw lagging behind was the anesthesia provision. The surgery was emphasized for us as interns and medical officers—we had to learn surgical skills—but nobody told us anything about how to make sure the patient is safe and pain-free. I found that was a major gap. So that was how I developed my interest in anesthesia.

[00:04:15] Dr. Rob Murphy: Many physicians spend their entire careers caring for individual patients. But you eventually shifted toward educating thousands of healthcare professionals. Was there a defining moment when you realized your greatest impact might come from teaching rather than practicing medicine alone?

[00:04:32] Dr. Wagaki Gicheru: Yes. Even when I was a medical officer, I spent a lot of time teaching. I just didn't know that was something innately in me. Regarding the teaching aspect, I just thought every clinician teaches somebody, because you're always being mentored and you're mentoring somebody else. Then somebody asked me, "Would you be interested in working at Kenya Medical Training College?" And I thought, "Oh, I've not thought of entering education." My approach to it was that I would go there, but I'd still be a clinician who is mentoring others, not really thinking about the education bit of it. I have now learned that health professions education is something that we as clinicians really need to understand so that we can do it right. I think that happens with most clinicians who are then asked to teach—we just teach based on what we have been trained to do, which is to mentor and to tell others what you know. We've never really known that there's a pedagogy to health professions education. So I've learned as I've gone along.

[00:05:33] Dr. Rob Murphy: Well, I could see why you are our lead speaker at Global Health Education Day here at Northwestern. It all fits together. Today, Kenya Medical Training College educates an extraordinary share of Kenya's healthcare workforce. When you joined the institution more than two decades ago, what was your vision then, and how has your role evolved?

[00:05:53] Dr. Wagaki Gicheru: My vision was very small. I was only thinking about emergency care and anesthesia. So that's how I plugged in. I spent a lot of time teaching basic life support and advanced life support for staff and lecturers. I was doing faculty training only for emergency skills. I also did a lot of curriculum review for anesthesia. When I joined, the anesthesia program was one year for nonphysician anesthesia providers. I looked at the curriculum and I thought, no, there are some gaps and a need to increase the training and increase the sites, so we moved it from one year to 18 months. And we increased the number of sites providing that nonphysician training. So I started off just doing what I knew. As I progressed, I started to learn other skills, which included the use of digital technology, and so then I switched to training faculty to do that.

[00:06:52] Dr. Rob Murphy: Let's drill down into that area a little more. You are now the head of e-learning and coordinator of KMTC's simulation laboratory. How did simulation become such a passion for you, and what difference have you seen it make in how clinicians learn and ultimately care for patients?

[00:07:10] Dr. Wagaki Gicheru: My pathway toward simulation has only been five years. I started off by being exposed to it while doing basic and advanced life support, where there was a little bit of simulation. But I did not understand how to use it in a wider context until I got exposed to it. I met a group of people who were doing simulation, and I joined their program and learned how to do it. Later, I went on to do training at a local university within Nairobi and learned the pedagogy of it. Then I found a partner who was willing to set up a simulation center for us at KMTC. During COVID, we spent many months casting a vision of what that could be like, locating an ideal place, setting it up and finally launching it in 2020. It's been a slow, steady path toward having a center that we can utilize. I've also attended trainings offered by Northwestern. We work very closely with the Havey Institute for Global Health through Dr. Colleen Fant and Professor Ashti. We've done a lot of faculty training. They've come to Nairobi and we've gone to Kisumu to train anesthesia providers in the use of simulation.

[00:08:24] Dr. Rob Murphy: Yeah, Dr. Ashti Doobay-Persaud is co-head of our global education center. Dr. Fant is the co-director of the Global Pediatric Center—two very important people at the Havey Institute. You are also passionate about community-based innovations. One you have shared that I find incredibly innovative is the recognition that motorcycle taxi drivers, or boda-boda drivers, are often the first people to respond to road accidents. You and your colleagues at KMTC decided to train more than 11,000 of these drivers in basic life support and first response. I think this is just an incredible initiative. Could you tell me more about this?

[00:09:09] Dr. Wagaki Gicheru: It was an interesting journey to that point. We were trying to think about how we can engage in terms of emergency care in Kenya, but as an institution, we realized we are not in service provision because we are a training institution; we don't have a hospital. We don't own ambulances, so we can't provide the service aspect of emergency care. But we're good at training. So when we looked at the strategic plan for the country, we thought where we could plug in with training that would make a significant impact. We thought pre-hospital care. Then we thought, possibly bystanders, because in Kenya we don't have a very good network of ambulances. You have to call a specific ambulance to pick someone who needs to be rescued wherever they are. There's no 911 that you can call. Most of the time we respond as citizens to an accident or a crisis. So we thought, on the roadside, who are the people who respond the most? And we finally came to the conclusion that while other motorists respond, you can always find a boda because they've got associations and they park close to bus stops and markets. That's how we came down to that bystander. In Kenya, they are our first responders.

[00:10:32] Dr. Rob Murphy: That's incredible. What an innovative program. You've developed many partnerships around the world with institutions like Northwestern. Tell me about your work with our institute and what makes for truly equitable partnerships from your perspective.

[00:10:48] Dr. Wagaki Gicheru: I first met colleagues from Northwestern in 2023. They had partnered with a university in Kenya called Maseno University and were doing a conference on health professions education, so I was invited to come. When I saw the poster, I registered and thought I'd go and do a presentation. That was my first time to interact with Northwestern colleagues. What I found as we continued to collaborate is that the collaboration is based on mutual respect. It's also based on a mutual understanding of each other's role in global health and recognizing the part each partner plays. I've found that they have created an environment where health professional educators can come together and share ideas. At the conferences, there's probably no single major innovation, but I have found that it's a place where I can learn what someone else is doing and they can learn what I am doing, and together we can partner to create this community of practice. I think it's provided a safe space where people can learn and share ideas.

[00:11:59] Dr. Rob Murphy: It sounds like a win-win situation to me.

[00:12:01] Dr. Wagaki Gicheru: Yes, exactly.

[00:12:03] Dr. Rob Murphy: As you look at your work today, what research or educational initiatives are you most excited about?

[00:12:09] Dr. Wagaki Gicheru: In education, I think there is potential for growth in our institution that we've not tapped into yet. Healthcare has moved on to using digital technologies and even AI, but health professions education has lagged behind. As we have grappled with how to make our healthcare workers ready for the market, which is using technology, we've had to rethink how we teach so they also begin to learn how to use technology. In our country, people use phones a lot, but as they're training, we don't have very high computer literacy. Some do computer studies in high school, but you can see it's just at a basic level. Yet the workplace requires more—you have to be able to type and use spreadsheets. So there's a gap around digital literacy. I'm passionate about getting faculty and students ready for that market.

[00:13:08] Dr. Rob Murphy: Many people think of global health as traveling abroad or working internationally. What does global health actually mean to you and why do you think so many people are already doing it without even realizing it?

[00:13:20] Dr. Wagaki Gicheru: That's a very good question. When someone asks me if I do global health, I hesitate because of the notion that it means I've gone somewhere else to do something. It's about providing solutions for people across different divides. In our country, health is devolved, which means healthcare is different depending on where you are within Kenya. That means it is a global health space. Even as we do our education, we have to do it in the context of the campus—are you in northern Kenya or at the coast? What you are exposed to in terms of healthcare provision will be very different. So we have to provide solutions and enable our faculty and students to learn in a way that meets local healthcare needs within the communities where they are living and training. I think global health is doing health in diverse settings across whichever divides exist, whether socioeconomic or geographical, even within a border.

[00:14:32] Dr. Rob Murphy: That's a very astute interpretation of global health, and I agree with you 100%. One last question: What advice do you have for young people embarking on a career in global health?

[00:14:48] Dr. Wagaki Gicheru: I would say just open your eyes, especially in the healthcare space. See what needs exist in your local community. Some people are drawn to pediatric populations. Answer that question: What draws me? What moves me? From there, spend your time in that area learning more. You will begin to see things that trouble or interest you, and then you begin to walk in that direction. I think also find someone who's in global health to mentor you. They help you ask questions that are important and give you an opportunity to learn. So find someone in that space as well.

[00:15:36] Dr. Rob Murphy: People interested in global health are meeting lots of people like you to get their perspectives, and I think it's incredibly helpful. Dr. Wagaki, thank you very much for joining me today. I really appreciate you taking the time to help us with our journey here.

[00:15:55] Dr. Wagaki Gicheru: Thank you for having me on this show.

[00:15:56] Dr. Rob Murphy: Follow us on Apple Podcasts or wherever you listen to hear the latest episodes and join our community dedicated to making a lasting positive impact on global health.