Serving on the medical front lines in Kenya

Alumna Sarah Ashley, who volunteers as an oversight physician in a Nairobi emergency room, knows she will be needed as the COVID-19 pandemic gets worse

Sarah Ashley (Cowell '08, health sciences)

On March 24, as the number of COVID-19 cases grew in Africa, the last international flight left Kenya.

Sarah Ashley, a 2008 Cowell College graduate in health sciences and an emergency medicine physician from California, was not on it.

The 31-year-old former global health and leadership fellow at the University of North Carolina and a surgeon with the U.S. Army Reserve 450th Civil Affairs Battalion, had decided to stay. Not only because Ashley volunteers as an oversight physician in the emergency room at Nairobi’s busy Kenyatta National Hospital and is helping set up the country’s first emergency medicine residency to train more ER doctors, but also because she is part of a team working to find ways to stretch the limited number of personal protective gear for the hospital’s doctors and nurses, and she knows she will be needed as the pandemic gets worse. 

“It seems the place for me to be right now,” Ashley said in a telephone call from her home in Nairobi. “Now, it’s just waiting to see what happens and anticipate what we can, and plan as much as we can.”

Ashley’s former Army Reserve battalion commander, Lt. Col. Sue Gannon, said Ashley has what you hope to expect from anyone who wears a uniform: a sense of selfless service.

“What is remarkable is that Sarah is working as a volunteer there in Kenya and she stayed," said Gannon. "You can’t quantify her dedication to service any more than that. That is her calling.”

Ashley grew up in the wine-growing city of Templeton, Calif., the daughter of two teachers. Homeschooled beginning in the sixth grade, she graduated from Cuesta Community College at 14, got her bachelor’s degree from UC Santa Cruz at 19, and went to medical school at UC Davis.

During Ashley’s first year of medical school, she traveled to Kenya as part of an HIV-AIDS project. The next year, she came back to ride along with Nairobi’s emergency medical technicians, who worked in a fragmented and chaotic ambulance system. At that time, a small community of EMTs served as the sole emergency medical responders for a city of 4 million people, despite the fact there was no functioning emergency number, no centralized dispatch center, no official recognition of EMTs as a profession, and no public funding for ambulances. (The system is slowly changing.) 

Ashley said she was struck, not only by those technicians’ passion for helping others in the face of so many obstacles, but also by the need for an emergency medical residency program in a country where there is only one physician in that discipline. 

“Emergency medicine has really become the safety net for society,” explained Dr. Justin Myers, associate director of the Office of Global Health Education at the University of North Carolina and Ashley’s fellowship director. People come in all hours of the day and night with a variety of conditions that an ER doctor is trained to identify and treat. And, with the growth of urban areas in Kenya, more people are going to emergency rooms, which means the need for trained emergency medicine doctors becomes more necessary.

“Dr. Ashley is working hard alongside some very dedicated Kenyan physicians to establish an emergency medicine training program for doctors,” Myers said.

Ashley said she also fell in love with Nairobi, a crowded city of mostly young people where almost everyone has a side hustle and the smell of food cooking is enough of an invitation to join someone for dinner. 

“What drives me?” she asked in response to a question. “I guess a few things: One is I get to interact with people in a meaningful way in the ER. I get a chance to spend short but really intense moments with people facing the scariest times in their lives. It is very powerful and it humbles me. 

“I also am very curious. I love getting to explore things and figure things out. No matter how much you study and what you learned in your residency and fellowship, it’s just never enough. There is always something to learn.”

And learn, she does. According to Ashley, who also taught at one of Nairobi’s medical schools until it was shuttered by the pandemic, Kenyatta National Hospital gets some of the city’s toughest cases. Death is a regular occurrence.

It excites her to be able to save people, but she also grieves quietly for those she loses. It’s a process, she said, of feeling sad for the death but also repeatedly going over each detail of what happened in order to be prepared for the next time a similar case shows up. 

Ashley said she believes Kenya may be ready to face the COVID-19 pandemic, having prepared with protective equipment and airport screening since the 2018–2019 Ebola outbreak in the Democratic Republic of the Congo. There have also been outbreaks of cholera and tuberculosis, a disease that is four to five times more infectious than COVID-19 and is one of the top 10 causes of death in the country. So far, the government has set up screening protocols, ordered a strict curfew, and established a 120-bed infectious disease unit at Mbagathi Hospital in Nairobi, which is housing confirmed and suspected cases of COVID-19, Ashley said. She also believes that because the city has a relatively young population (life expectancy in the country is 66 years) complications from the virus may be less severe. Still, there are worries.

If hospitals are overwhelmed with COVID-19 cases, it will be harder to treat people with things like heart attacks, strokes, and injuries from auto accidents, she said. There is also the very real fear of infection among medical personnel, which is why Ashley is on a team at the hospital trying to find ways to safely re-use personal protective gear. She also worries about the livelihoods of the people of her city, many of whom already live on a few dollars a day and who would be financially ruined by a full lockdown.

“We’re going to have to see what happens,” Ashley said.

Those who know Ashley described her as hard-working and humble with a deep sense of altruism. Ask her, and she said she is inspired by people like those given the honorific “Righteous Among Nations,” who didn’t focus on themselves during WWII but instead risked their lives to save Jews from the Holocaust. 

“After (Ashley) finished her fellowship,” said Dr. Myers, “she sacrificed getting a big fancy job in the U.S. and is working full time with our partners in Kenya to establish emergency medicine there.

“It is a thankless and difficult job, but Dr. Ashley is driven by her high ideals of compassion, justice, and selfless service. She is truly a remarkable and talented physician, and her altruism will undoubtedly change the world for the better.”