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Book Review: After Kilimanjaro

Tuesday, February 4, 2020  
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Book Review: After Kilimanjaro by Gayle Woodson, MD, FACS

After Kilimanjaro describes the journey of Sarah Whitaker, a fourth year surgery resident from Philadelphia, as she starts a new chapter of her life studying maternal mortality in Tanzania. Sarah begins somewhat unsure of herself,what she is looking for, or why she is undertaking an obstetrics research fellowship as a surgeon. One thing is clear: she needs to do something different. Over the course of the first three years of her surgery residency, Sarah had become burned out. She often finds her thoughts wandering back to a patient she tried desperately to save in the Philadelphia ED, who ultimately did not survive. Sarah, as the reader comes to appreciate, allows herself to care deeply. She invests herself entirely in each endeavor, giving her full self to patient encounters and personal relationships. While this makes her a better physician and partner, it also makes her vulnerable to burnout and heartbreak when her efforts are not reflected in the outcome.

Sarah initially applied for the prestigious Stanford Foundation research fellowship because her fiancé made plans to do a year of malaria research in Tanzania. Wanting to accompany David, she applied for a grant to study the prevention of eclampsia related deaths. David had suggested she come along with him as support, and use her free time to explore the country. Sarah was ready to go along with him, but applied for research funding so that she would not be sitting idle. Ironically, when David's funding fell through and he was presented with the same opportunity to follow Sarah on her year research project, he decided to stay stateside. So, Sarah embarked alone, to a foreign country, to study a disease outside of her specialty.

After arriving in Tanzania, Sarah quickly falls into place in the community. As a reader, it is easy to appreciate how Sarah found her place so effortlessly. Above all else, she is invested. To better understand the field of obstetrics, Sarah attends the medical student OB-GYN lectures, a move no other OB research fellow had made. Sarah spends time with the clinic coordinator learning Swahili, and puts forth effort to understand the respectful phrasings. She spends extra time outside of research scrubbing in to general surgeries and teaching medical students. Perhaps most influential for her, she finds her tribe. She falls into a group of local doctors who help her get settled in a new house, explore a new country, and pursue her passion.

Many of the pregnant women from distant villages only travel to the hospital when they have developed full eclampsia symptoms. Sarah becomes frustrated that even if she did everything right, the disease was often so advanced by the time the women arrive at the hospital, little could be done to save them. She finds her big inspiration when a pregnant woman comes to her clinic with pre-eclampsia, referred to the hospital by a traditional birth attendant (TBA), or local midwife, who had measured the woman's blood pressure in the village. Sarah knew if she was going to make an impact and prevent maternal mortality, she would need to work closely with the TBAs in their community and educate them on recognizing which women should be referred to the hospital. As with everything else, Sarah completely immerses herself in the project; she develops a curriculum for the TBAs and moves to a rural village to begin the course. While she knows this is an unconventional and somewhat dangerous move, nothing could prepare Sarah for the trials this will create.

After Kilimanjaro is clearly written by a surgeon; Gayle Woodson's writing is deliberate and vividly descriptive. She writes about the characters and African landscape with such appreciation that the reader cannot help but feel as if they had truly experienced the culture and the friendships. While discussing physician burnout and maternal mortality can be heavy topics, the novel is a quick read that leaves the audience feeling uplifted and inspired. In addition to being a novelist, Dr. Woodson is an otolaryngologist and active member of AWS. In 2010, she was awarded the AWS Foundation Olga Jonasson Distinguished Member Award. Each year, she and her husband spend time teaching at a hospital in Tanzania.

Shan Lansing is a third-year medical student at The Ohio State University College of Medicine. Originally from southern Oregon, she attended Oregon State University where she earned a dual Bachelors in Chemistry and Biohealth Sciences. She continued at Oregon State University for a Masters in Analytical Chemistry. Her current research interests include increasing surgical patient engagement in care and communication after discharge to improve quality outcomes. Ultimately, Shan seeks to pursue a career in rural general surgery, aiming to provide compressive surgical care for an underserved community. In her free time, she enjoys running, cooking, and cross-stitching. Shan can be found on Twitter @ShanSLansing.