Uzwena Health — transcript

High-Quality Healthcare Is Not a Luxury. Prof. Nancy Kunyiha Is Proving It | Uzwena Health. Ep. 55

This transcript is generated automatically by YouTube and has not been checked by a person. It misspells names and mishears words, particularly around Kenyan English and company names, so read it as a guide to the conversation rather than a quotable record. Each timestamp opens the video at that moment.

0:05 Greetings ladies and gentlemen and welcome to episode 55 of the African blue podcast. Today we are very privileged to have a good friend of mine Dr. Nancy Kunha a consultant endocrinologist. I think I got that right and who and proprietor of health. Dr. Nancy welcome to the podcast.
Thank you. Thank you very much Leonard and thank you for the invite. Uh I think this is unique because after a while of uh not doing we got to 50 episodes without hosting any doctors and now we're doing doctors back to back. So must be a sign. So welcome. It's great to have you on.
So Nancy before we get into your field or or your your venture, your entrepreneurial venture. Let's let's speak about Dr. Nancy as you as a doctor. what it's always interesting to find out what's the inspiration behind going a going into a line

0:58
and um I've had many instances in my life where I've met people who want to be doctors um because it's society globally it's the epidome you know you're told it's maybe because it's the most difficult so but many people who think they want to be doctors and don't really become doctors or have several friends who've started and then quit
so I always like to ask doctors who are practicing h practitioners of medicine what inspired them because you have stayed the course and you are a doctor you're a professional you have specialized
so maybe you can tell us about your early days and what inspired you to become a doctor
I think um it's a number of things I enjoy connecting with people so I think there's there's the inherent person that you are

1:50
yes
um and there's a bit environment. So I think I I grew up in a space where my mother interestingly had friends who had health challenges
and it was interesting watching her host them on weekends. Um I remember a lady who was very crippled and slowed down our going to school on Mondays cuz of how long it took to get into the car. Okay.
When I look back in retrospect, I think now her care would have been better and she probably would have lived a longer life. So I think from my early days was um just thinking through how do you alleviate suffering or make the lives of people with conditions especially chronic ones
more comfortable
and and give them is it dignity and improve their journey. So my mom did that in her own way hosting them and opening her home to them.

2:42
Okay. So for example using this one who used to come she would give her I would assume a ride to work.
Yes. a ride from work on Fridays
and then she'd come home, spend the weekend with us. So, you kind of learn to interact with someone who's crippled, who can't hold things,
who takes an inordinate amount of time to go to a bathroom, you know, things you don't think about. um and and seeing her deteriorate lung problems and just watching that journey I think as a as a younger child influence a lot of how I would want to make a difference um from a medical or caring I think initially it was caring thinking about how to care for people okay
rather than medicine itself
okay
now that we've we've reinvanced that inspiration so how does that journey look like for you

3:32
where do you study? Uh how is the battle? You know, we used to be told to chase good grades so that we can become doctors. So, how was that journey for you growing up?
Yeah, medicine. I started out in um my primary school just I enjoyed a lot of the subjects and I think a lot of doctors are not just pure scientists.
Yes.
So, I enjoy art. I actually enjoy decor and uh and the art side. So, and I enjoyed my sports through primary. So, there was both science and art for me. I wouldn't say I was a pure scientist. Yes.
Actually, I enjoyed my drama. Um went on into Alliance.
Um where that formed just a different side, a more competitive edge to academics.
Unfortunately, I had to lose my tennis. I used to play tennis for the country actually.

4:24
Oh, wow. Um so I lost sport and that was I think I lost certain sport cuz I continued to swim
but it was the first time seeing that academics um
it's a choice you choose.
So I think high school defined that for me in a very big way and it wasn't a good loss.
Yes.
It was a bit of a traumatic loss. [laughter] It was a painful loss
because you enjoying your tennis.
Yes. And I wondered why do you have to go to a boarding school to do this? You can thrive in. So I struggled a bit with that.
Um and then went on into uni, University of Nairobi. Medicine is a long program. I think whenever I tell young people and even parents of children who want them to do medicine, I think it should come from a core. There's gifting, but there's what the individual wants to do. So it's really important to be able to stay out that it's it's something you're passionate about.

5:19
Um so med school was a long journey for us. There was strikes in between at UN. So it was further lengthened by a year of strike
but again another opportunity.
So that moved it from what from six to
five to six to six and a half almost
years and then um there's for us there's internship and then it's thinking about specialization. So for us there's medicine internal medicine so you specialize and then endocrinology now is a sub specialtity which deals now with hormones diabetes. Um my journey has been interesting because I had family in between. Um so I started my personal journey of family also rather young.
Yes.
So
still in uni or
just in my final year.
Yes. Okay. So it was blending how those blend into career I think has made my journey a little different than the conventional finish and then start children. So it's been longer

6:20
because it meant um some of the programs like my diabetes was a longer program. I did like a sandwich program with Cardiff and South Africa. Um but it's been a fulfilling journey when I when I look back and and here I am
and then went on into Aakhan. Aakhan has been the place I have worked after completing training
and I I did 20 years there.
Wow.
Both and predominantly in post-graduate medical education um supporting um the program. I went into some leadership roles there also. So a big part of my actual practice has been in a university teaching environment.
So I have blended both clinical care which I think is my core strength and and mentorship and education.
So you you you'd be a good person for us to speak about I I think maybe we can touch briefly on the state of education

7:19
of of of medicine in Kenya because you're a graduate of University of Nairobi. have been through the challenges and then you worked in a university teaching hospital for the bulk of your career.
So you did participate in education. If I was to ask you what is the state of um medical education in Kenya, how would you respond?
I think the first thing is I it's very hard not to compare. So when we started out in the '9s, we had very small classes. So like our cohort was 90.
Mhm. And there were like two medical schools. So actually medicine like you say was quite there were very few people doing it. Very few people doing it in the country.
So you have the privilege of more onetoone. So medicine does have there's the academic side to it and the

8:11
didactic we call it didactic but there's also the apprentichip. So what has I think changed over time that I've seen over the years is just the numbers. the sheer number
the sheer numbers and the capacity to keep up with how you build apprenticeship with large numbers.
So, and I think that's that's where the challenge is especially with very big classes and big cohorts. Um, and that impacts quality and outcome just how refined you are. Yeah.
So when you spend 50 hours in the hands of a guru in a particular area and you're going to the wards and you're being you're with him and you're being it's hours and hours and and that's what medicine is expertise just the the doing and the doing it becomes second nature

9:02
the seeing the cases the understanding when I listen to a chest this is what I hear. So that's what sometimes I think um is is lacking for um some of the younger trainees. Not of any fault of their own. I think it's just the systems and and I think that's the the broader challenge for
has policy been left behind. Would you say we had the crisis
uh last year with the lack of spaces or the government and
especially for Yeah.
to send out the newly graduated uh doctors because in a Kenyan context you have to practice first, right? Yes.
For you
you become
your certificate to be licensed. So again, yeah, like you're saying, it's policy and planning.
So when Yeah, it's it's they're looking ahead to all these numbers, where will we take them? How do we how do we absorb them in the system? Because the need is there. I mean, the country has grown. We have 55 million Kenyans now. So when you go out there is almost sometimes even a lack of specialists. When I think our speciality a few years ago there were 12 14 of us

10:14
10 years ago before I [clears throat] I took over the diabetes society. So there is room for doctors to specialize and grow but we are not keeping up with the the need. So
I think that when you think about it, yes, there's need in Kenya, but when I've started to look at things from an Africa continentwide perspective because I think we need to find continental solutions.
Solutions. Yeah.
The need is even greater.
Yeah. So
but but that said there there are things that I think we have um a larger number of colleges now when I think back. So the number of
of colleges providing medical degrees has grown. I think the challenge then is keeping up the quality
and getting enough specialists again to to maintain those different areas. So there are graduates coming out of Maseno um there are good good colleges. Moy Moy has been older. Moy was there. It was been one of the best teaching referral hospitals. So it's how do you even keep up with training fellowships which like happen at Aakhan and send out people then to train um the students in the different places?

11:24
If you were the one how would you uh keep up with that? I think it's it's a tall order um for a number of reasons because you find a lot of the specialists by nature of I think devolution theoretically could help that because it would mean specialists then are stationed in different
counties. Yes, every county has every specialist
and then there must be equity for them that if I'm there must be incentive for a young doctor to go and live in a particular county and grow practice. Mhm.
And and that's both social and medical. Yeah. That their children can get
and their life Yeah. children can go to good schools, you know. So it's not just about medicine and the earning of money. It's actually thinking across the counties on equity of social

12:14
social potential. Interesting you bring that up because it is and and as you are speaking to it particularly their social aspect it's actually when you speak to expatriots who come and settle in Nairobi or in Kenya that's exactly what they speak about you know they speak about why Nairobi is a great destination to come and be an expatriate
is because you have your choice of schools you have your choice of health care you have your choice of social speaking to the same thing with regards growth of the of the healthcare sector.
Yeah. [snorts]
I mean that you that's that's that's quite quite an interesting take. So let's come back to you. So you
um speak a bit about your journey in Aakhan. Yeah.

13:00
Um the need we have established there's a strong need in in K. Did you at all practice? You had to practice in in a government hospital. Oh yes. Where did you practice?
Kinata. Kinata actually did. So my training and also internship there.
Okay.
So yes.
And how was that journey at Kenyata?
Kenyata a lot of good happens in Kenyata
considering the volume.
Mhm.
I mean when you think of the sheer numbers you can't actually even compare it to to private practice in a sense. M
um I think one of the discouraging things for me at that early age was sometimes the lack of access to certain things that are life-saving.
All right,
that should be equitable. And that for me was was very difficult. It it was a a difficult environment to practice in

13:55
um when you have someone dying because the system sometimes does not allow for them to purchase something they need
and yet they could have lived through it. So those are some indelible you know those memories one or two that that that that remind you kids coming in late it's health seeking behavior. So when I was in pediatrics, children who die of diarrhea and not because of the diarrhea itself, it's how late they've come in because their mother
brought in by their mother didn't have money to come in
because she was waiting
looking for the money someone to come in. you get. So, so medicine is is beyond sometimes you think about it as treating
but the social determinance of health more and more um are such a powerful predictor of how people do and their outcomes you know with with different medical conditions and how healthy we are as a country.

14:49
I think you you raised some critical things to think about because I have a non-medical example of exactly what you mentioned. Um, I being in the restaurant business when I was running my own restaurant. I got taken into the I was a guest of the county in the jails because of refusing to bribe some public health officials.
Yes. And I remember being with a lady um if you have been I don't know if you have been but if you have been to those county jails there's a it's somewhere down
thankfully I've not you've not been so [laughter] you not to go so it's somewhere down there and um I remember being with this lady and she asked me she tells me you don't look like you're here
you don't belong here you know so how are you here so I told her my story

15:38
and she she mentioned something that I've never forgotten and it really
got me thinking So I told her what happened and the guys came and they were shaking me down for a kickback and I wouldn't and so
they they put in the back of the truck and I find myself here.
Then she says,
"You're really fortunate that you have the luxury to make that choice."
Oh.
And I was like, "Oh, okay." It was not the response I was. So I asked her, "What do you mean?" M
she says if I don't pay my daily bribe my kids don't eat.
Mhm.
So me I paid to survive.
And I was like whoa. Even I had never looked at it like that. I was just like oh you know sometimes I I feel that middle class Kenya we sit and we pontificate about don't pay bribes bribe. But now she broke it down to such simplicity. She says, "I would love to do

16:42
what
to have a choice, but even you that choice of not bribing is a privilege."
Wow.
And I [clears throat] never seemed like that when and when you speaking about your diarrhea story and the ch children, I I equate the two to be the same.
This is not this is a this is a problem of circumstance.
They would do better
but they can't. Yeah.
And even choice. I mean choice where you at at a particular time, privilege. How did that frame your your that was early that was before you even so how did that frame the doctor you became?
I think it it has always and and when I think about even my practice now
there's a very big part of it that looks at the dignity of the individual wherever you're coming from. Um personalized care so that you're understanding where the individual comes from. It's a very big part of of care. So, you're not blanket throwing things at people because we come from the same country but such diverse

17:45
yes
very diverse um experiences.
Um so it framed my is it also the depth of my compassion
so that when you see individuals with medical issues sometimes it's easy to box them.
Yes. like why didn't you bring your child earlier?
Why are you in this?
You are here because you do this.
Why didn't you eat better?
Why didn't you eat better?
Yeah.
And I I think understanding individuals um in a wider context than just the medical that you are seeing I think changes approach and potentially improves outcomes
because you get to the heart of the matter. So I I think that that has changed how I listen to patients and how I attempt to provide care.
Okay.
Yeah.
Okay. Now we were just about to start talking about your time at Aakhan

18:40
and how that journey was. You did mention that you you you specialized by doing
a dual
what do you call it?
Program.
Dual program. First of all tell us for the sake of the lab.
Yeah. No, no, no. It was just more program.
Um when traditionally one of the challenges in medicine has been
how to train like when you have family
when you don't have training programs here.
Mhm. [clears throat]
So traditionally you'd go abroad for 3 years
to do that
and you go
leave your family. So that actually hampers a lot of people specializing because one the resource may not be there.
Yes.
Two depending on your family circumstance not everyone can leave children or a husband. Yeah.

19:22
Or parents if you're caregiving to go and train.
So I was privileged to have a a program that was between Cardiff and South Africa. It prolonged it but you are able to travel come back.
The program existed or you
it existed and it it no longer exists now actually because it was funded. It was I guess a more expensive kind of program but it had actually been developed for this region. M
so we were one of the first people to be privileged to have that that um so we have other models now um but that has been one problem for specializations and why we need in-house training and fellowships in Kenya there's a there's a body now called exacop the east Africa central southern and central Africa now that are training within our local institutions so people are able to get their fellowships

20:13
okay
within
okay
so it means they can train you can still earn a salary because remember for many of these when you're training away
it means loss of income. So
because you're not earning
if you're a man how do you
if if you have a family how how do you provide?
So there are all those aspects to medicine too. So it's not all a bed of roses. Sometimes people think doctors have an easy
easy easy time
and they are really long courses. So it's years and years. You're talking 10 11 15 years of your life of training.
Okay. So you you start working and then you now go into specializ while you're at
Aaka. Yes. Yes.
Okay. And how was that? You're studying, you're working.

20:57
You're you're a mother, your kids are growing.
I think uh one um the importance of a supportive uh spouse.
Yeah.
I think is everything. And family. So I think that's one advantage here of community. Family around. So I I think that was a very has been a very big part of growth in career.
Yeah.
The work environment also Aakhan is I think he's very good at at at mentoring and providing opportunities for growth even within. Yes.
So you you're kind of getting the best of all both worlds. You're practicing um you're studying. You can travel for your exams and your courses. So um I think I was privileged in that sense. And again it's it's something not everyone has but we were able to do that. I I in Aakhan I went on to run the program the internal medicine program.

21:50
Um so that gave me quite a wealth of experience in an early program because they had just started their post-graduate program.
Okay.
Um and that that was a big leadership growth space.
Yes.
And and mentorship and it's a small program. So you get this very personalized one.
What does small look like in this context?
Small looks like our first cohort was two.
Oh wow.
That's what I mean.
Two students.
Yeah.
Okay.
Then four.
Okay.
Then six.
So they don't take very big numbers.
But what happens when you're talking about apprenticeship? They they come out
beautiful. Beautiful is the only way to actually descri so so well trained. And then that ripple effect then can potentially um go on especially for those now who have been able to go out

22:41
outside of Nairobi you know because most specialists are centered here.
Yeah.
Yeah.
So um one of the things that um I think I admire and intrigues me about medicine is the way it is
inherently a teaching profession.
Yes. I mean teaching is built
into the way global medicine runs. You know what you're speaking about is like a global
standard. You know if if you if you practice you will teach you will have students shadowing you and that's very interesting. Um
so you by virtue of the duration of time you did at Aakhan you did witness the growth and development of the Aakhan University as a medical training institution. M
what was your your take on that because it started first with I think the postgraduate program started first and then just recently they introduced an undergraduate program. So

23:37
how did you view that experience?
So it was wonderful to be part of the life of that. I think again as the uh pioneers or people who are there early we got the privilege of very good educational training
okay
at the beginning you know like one-on-one again because it's a small faculty starting with a small program so the privilege of of how to teach and learn and you you talk about a very important point cuz medicine even now in my 50s you still have to learn you keep learning always.
So it changes and things that were thought to be very true
um 20 years ago change and and science means that we grow and learn. So when you talk about entrepreneurial journeys and and medicine,

24:25
they are very similar because there has to be an openness to grow
to learn and to shift even your thinking
on something that was you know fundamental. So [snorts] um Aakhan provided that environment um it provided a space that has everything you kind of need technologically and then colleagues who are very well trained also.
So it's a it's a almost a a very it's a a wonderful environment to to work in because you've got all these specialists around you. You're not kind of just managing patients on your own. And so the collegiality also was a very big big aspect of um enjoying practice
and being the given the size of the hospital a wide diversity of specialities
uh practiced within the gagan ecosystem

25:20
and they're within [clears throat] they are phone call away I mean it's it's fantastic you know
does that extend to regional
or it's it's more a Kenya affair because aakan is more in Tanzania Tanzania Yes. So it's it's growing in those areas. I would say this is the hub.
Um but the largest number of specialities and training is of course in Nairobi.
Yeah. So it's
and and just to understand a bit of the the how the university hospital works is are all the satellite hospitals also considered university hospitals like Kisumu Aakhan Hospital Kisumu Aakhan Hospital Mombasa or is it the university hospital is the main one in Nairobi? The university hospital is the main one because the faculty

26:10
in terms of Kisumu and Mombasa
run remember um this the hospital started as a hospital then the university came in
okay
yeah after that
okay
so I think more and more there's this interconnectivity happening
students going across okay
and now um so that that is a a growth area that we've seen over the years Yeah,
I admire I admire um I admire how medicine teaching has evolved in Kenya
because um you still have a good balance like you said there they are great private uh teaching hospitals. Um I think Aakhan was the first was it in the in because before that you knew if you are studying medicine in Kenya you're going to a public university you're going to university of Nairobi you're going to

27:06
or and and and now Kinata and Maseno have already
I think if I'm not wrong they might be starting some medical program.
Yeah. So it's it's really interesting to to see because all that is for the the benefit. I sometimes find that the miss not missing link I would say the slow link
is policy and planning like you brought up earlier catching up
up with
with that because the the
innovation is there
is there people are doing things you know the Gakan ecosystem decides day decide you
executed a brilliant plan we watched the hospital grow from nothing into this big thing that is
and where we thought about it initially with the arts and teaching you know when you think about yeah another

27:58
and you know now you hear kinata teaching and referral hospital referred to a lot and so it's really good to see that
there's been growth
I I I actually I've seen it somewhat uh in hospitality training um
but I think Utali we started with only Utali but now USA has a strong program and Maseno has a program and so on and the other even Kinata University has a program
but I think
in terms of robustness and planning and training
I I have my doubts if all are equal I mean some are way superior and it takes time
and the gap is is quite big. Yeah.
Yeah. So you you achieve a I would say um could I say call it comfort or you arrive you know you you've you've practiced you're in a st very stable environment yeah

28:59
I would assume by the time you're heading um Aakana happy we see doctors practice well into their yeah you know into their 70s and some even into their 80s
but uh you then uh decide that health is the way to go. M
so maybe just walk us through what um first what is health
and what informed that thinking to say okay let me leave this relative structure comfort and security that I have built
over 20 plus years
and go and set up what was calling you and what made you say okay I want to go this way and and pursue
it was a number of things I think Um, one of them is when you've done something for very many years and you you start seeing generations of people coming through.
Okay.

29:55
Um, and you you wonder whether your your your personal growth and stretch. There's a place internally that um starts asking do you need to grow? Do you need to go a bit more in other areas?
And what does that growth look like? And I like calling it growth and transition rather than exiting and I see it kind of um it's it's just part of journeys. It's yeah it's part of
so for me it was we had probably done four five cohorts. So you see the students who were the first ones now leading leading units the ones who Yeah. And so 2004 the first graduants are actually the leaders and when you're on a table you almost start feeling okay now they they're ready to
they've got this
they've got this they can run this and I think the questions become what about the next season what what will you be doing and how so I think those questions came u midlife

30:59
yeah 50 halftime
yes
um and then I also read a very interesting book that informed um have you read 4,000 weeks No, I haven't.
Oliver Buckman.
And if you live to 72,
you live 4,000 weeks.
Okay.
Okay. So, I realize I'm 2,500 plus weeks. Just like, hey, 1,000 and something. Just the average age in the ' 70s.
And thinking about what is it you're doing? And how do you also prepare for transition? Because
structures, whether they are corporate structures or employment structures, people must transition. We must actually give room for younger people to grow.
Yeah.
And that's a very deep fundamental thing. I think if we don't give, it's part of generosity.
Yes.

31:45
But you also see the crisis of those in the institutions of those that don't.
Yes.
You know, when you have and you're saying, hey,
I was looking at something the other day and I was like, you know, everyone's skirting around the issue, but the issue is that the leader stayed too long.
Too long.
Yeah. Yeah.
And and generationally you have to give way.
Yeah.
So there's time and then when your kids are growing you realize you've got adults now.
So so this where do I fit into this whole cycle of life that just that bigger story of medicine.
Um and then you think about pace also because the pace you're at 20 years ago is not the pace now.
And and how how do I practice in a space that allows for where I'm at? [snorts] So when I was birthed from that um it's not very different from what I was doing but part of it was um it's it's a smaller outfit of course but it's thinking about a health practice that was um person centered. you're able to give individualized care because we manage chronic care

32:57
and chronic care means it's a lifelong journey or with people actually 20 years 30 years into their death.
Yes.
And thinking how do you accompany people and their families on that journey? So it's providing care for the individual and also a focus on the family. So when I'm thinking about diabetes, can I screen the family also? How do I prevent the family members of this individual? And we have an environment that allows me actually to have the luxury to look at family members.
Our our hashtag is uh our our key line, our tagline is live every day.
And part of that is the overwhelming sense that chronic conditions give if you're thinking about the long term. So a lot of our patients are scared of diialysis of [snorts] amputations of you know dying suddenly and yet if we're able to live well today do what we need to do today it makes all of life it makes your life journey

33:57
just in small bites a step at a time so a lot of um I think preventative care and what we do chronic care has a lot to do with how you approach today
and if you approach that well then life it kind of it's a ripple effect.
Yes.
So it was a space where I also my vision is also just shifting mindsets from dispondency because in developing nations sometimes we just like we are it's so dismal
you get diabetes that's it's too expensive we going to you just hear very many negative stories. So how am I in a space I can speak beyond prescription beyond into these spaces and into the the individual and their communities.
Yeah.
Okay.
So that's health.
Oh wow. So it is but if you were to summarize it into a sentence.

34:52
Yeah.
What is health? health is a practice that has um multiple specialtities housed in one place that take care of persons with metabolic conditions. So from obesity to diabetes and any other related conditions. Okay.
And so what is also a bit different is we it's not just about the specialist. You've got diabetes nurse educators, the nutritionists, we've got exercise physiologists who come in. So you're able to give um is it a more multid-disiplinary approach than the conventional come and see Nancy and fill out.
Okay.
So let's let's speak a bit about ecosystems because we haven't
and in setting up this as you have described it you did not just have your specialization you had to build an ecosystem. Yeah. So maybe let's speak towards the development of that talent, the availability of that talent

35:53
and because there's some I would call them signature elements to Zena that you want to be known for.
How was that journey of you who's been in a very structured employed space now coming to do that and now having to put together this team that will help you execute the vision that you have.
Okay.
Yeah. I think first I'll tell you the first the initial part was was scary and difficult.
Yeah.
And um I think in the first few months I was actually shocked by how much how much detail and how much was needed to build an ecosystem.
And I think you don't realize sometimes when you're is it when you're in corporate and in employment how much is done for you?
Yes. Now I'm saying that I was at the other given to you IT systems are not working. You call someone say and you tell the patient the IT system what's happening. So um let me when I go back I think about even first finding a practice space because I I've always wanted to practice in a space that you can see green and um and again serendipity uh God's provision or whatever even finding a space was took months [clears throat]

37:12
that you can afford that you're not going to spend sleepless nights over rent and we found an old flat which we renovated so we didn't even go the conventional way on space.
Yeah.
Um and that helped balance cost as well as the the a nice, you know, a nice environment.
I used local a friend who does design and she did a beautiful design. So again, that makes you realize that we've got so much
talent
talent in creating spaces and so that the space can be a space of peace of it's it's not just a medical practice space. So we spent quite a bit of detail on the space
and then in terms of systems I think Mushai my husband is in business so he helped me a lot with the systems and part of it was um setting up right

38:03
and I think I would tell any entrepreneur starting out just first of all do your homework on kaju what is needed
cuz sometimes you think I'm bringing my skill in I'll just see patients
then you realize the number of licenses needed
you realize is um it how how do you set up a good IT system? So I wanted to go paperless initially. So that means again you look for systems and again we found a very good local locally developed system um QFA
um so setting up those particular aspects especially for the health data management how to think about confidentiality things that the the hospital did for you now you're the one who has to do those data protection um and look at all that get all the licenses is in place. Think about water. Think about

38:57
power
taps running.
How will they always be running?
Backup power if there's you know.
Yeah.
So there was a lot of that that was new for me and very difficult. Actually the first three months I felt like I think I've jumped into a space I will I make this will I be able to do it? So you ask I think uh it teaches you humility. Ask for help. And it might sound like a dumb question but what is this? I'm a doctor but I I would sit sometimes through meetings and I don't understand what these guys are talking about the lingo.
So it was like learning a new language.
Yes.
A very new language. And then Kame Kame who happens to be your sister.
Yes.
Took on my accounts and audit and everything.

39:40
And it was very interesting learning about compliance. You do it personally but now when you've got a few employees it's another
it teams.
Yeah.
Getting teams compliant early. So, so those were jumping in and learning to separate Nancy from the business
that identity. It's a very interesting thing. Not just the monetary just outcomes here are the business and Nancy is here. So, learning to see myself as I am enough. This is a business. I'm doing my best and and it will run as it will. So, I'm still working through that.
Yeah. Um so that that was an interesting one. And finally for the for the people I work with, I've got an excellent team was going through
who to speak to recruitment. And some of them I would say was just God's provision or you know how you meet someone and talk to this person and then there were other people who just caught on the vision. They're just like I'm coming with you.

40:42
I'm sold. Oh, from where you were?
From where I was.
Yeah. That's that but that's a
and and they just came.
No, no, no. That one I'll [laughter] tell you they didn't just
they didn't just come.
That speaks to your leadership.
So they and and and
the way you led them where you are is what made them come
and have the faith that so there were people who
So it speaks to your good leadership and I always tell guys you you you can't call yourself a good leader if you don't have followers.
Yeah.
They have to be followers who are following you.
Yeah. Yeah. So our team was also encompassed by people who who just took the leap to come.
Okay.
And um then comes the responsibility of that. And I think for entrepreneurial journeys is I think you realize the weight of it

41:33
the just the sheer weight of people need to be paid at the end of the month. it's your responsibility these homes from people who clean to
the highly you know more trained staff and um yeah so that was a new journey so that's how it it came together I think um in a nutshell
listening to you now I would say the questions you asked yourself when you are leaving have been answered right in terms of stretching yourself
getting into new environment new challenges learning new things changing adapting.
I would say based on your your your journey of of of setting up that you have achieved that
that aspect
that aspect of growth of growth and stretch. Yeah.
And and Leonard there's a there's a notion I think another thing I struggled with was my age.

42:25
So there were people who are just like you can't start
at that age. that age.
Yeah.
And and one of the things I've learned is to face the the possibility of failure and think about, okay, if it fails, I tried.
I went in there and I engaged.
And um I think we have a societal thing that's very strong about age. It's an agism of you can't agism.
Yeah.
So, I've been thinking a lot about what defines that, what makes people say you can't do certain things at certain times. So that's yeah,
let allow me to share with you a lesson that I've actually learned from doing this podcast.
Um
the this being our 50 fifth episode, it there's something it has given me.
Yeah.

43:12
And it has given me a very positive outlook on Kenya.
Not to say that um I belittle our challenges as a nation, not at all. But it has helped me recognize that in the midst of all the fear, shame around us,
there are many people who are just doing
and they they they don't sit down and lament, how tough the market is, how can you are harassing you. They just wake up and say these the cards have been dealt and with these cards I will do.
Yeah.
And I have taken from Martin. I can give Martin Kiaria his props. is one of my guests on my podcast
and he he he he gave me a quote on the podcast and it's a quote that I've taken when he says that uh he says God gave him the ability to do

44:13
and he does and he's completely divorced himself from outcomes
because outcomes are tend to be what
either hold back people the fear of the outcome if If I do this, I will fail.
Says, but if you have the ability to see this thing that can be and the value it can offer the society, I think you're obligated to try.
Age notwithstanding, you know. So, um, and because of the diversity of the guests that we've had, we've had young guests who are battling the same challenges.
It's interesting, isn't it? Yeah.
Yeah. But having to learn K and and E teams and all that and and all the systems and that same. So I think that speaks to this Kenya of ours or this Africa of ours that we can we can do

44:59
that we can grow and we and I I think another thing for me was that our gifts you you have your gifts. So we can is it execute or leave out our gifts just in any space. M
so what changes or what I think changed for me was the space and many times we think oh you're exiting here going here it's we box out
like this doesn't connect to that in any way
and yet in real life it is you living out your gifts in different spheres your family your work spaces and your work space could be in a one continent and in another continent another time
and seeing them as flowing together rather than distinct
yes
spaces
so you're whole M
you know I think it removes that crisis of you left blanos

45:50
and now you're here you know you're just one person
being
being
wow interesting so where are we now with health
now we've just done 24 months so we are very very young
congratulations [laughter]
and now I'm learning to celebrate
every milestone
every milestone
um I think we've got a team and systems that are running well
um I think now is thinking about um how do you grow because I think one of the challenges with medicine is
um there's the care of the individual how do you scale how do you scale the things we do and how much do we want to scale asking those questions
yes
I'm currently on a course with the grassa Michelle it's a women's leadership course and thinking through those fundamental questions of where you want to be

46:44
so we have a rhythm. We have a clientele that are coming back because for us retention of course is a big one
important. Yeah.
And we have younger colleagues who I hope are growing and in the facility because part of my big thing is training and mentorship and I think Leonard when people do well they must move.
Yes.
I think that's another
allow them to grow
and to transition. So it's it's keeping up the educational portfolio even in a small in a small is it environment.
Yes.
So yeah that is was when are growing I I think growing in our strides. One of the things that was new for me was thinking about social media cuz as medicine we don't
we don't advertise.
Yes.

47:35
You know we don't go out there.
So when you start a practice how do you get people to know? A lot of it has still been word of mouth and putting out educational content. We are also trying to do some some group uh training and events on the premises every quarter.
Um
and just trying to be innovative. I think I enjoy that.
Try this. See if it works. What's the reach? Collaborate.
So it's learning learning new skills. I think those are new skills in certain senses.
Yeah. I think a part of it what I find to to to with social media is do what you're comfortable with. If it's teaching, see how those pocketsize lessons, you know, and that could be the thing that makes people
look at your brand in a

48:25
different way and and know your audience.
You know, there was this push of do this, you must make this, you must do that.
You don't have to do everything to everyone. Yeah. Yeah. Maybe uh we can talk a bit about the research landscape. Yes.
Because research is critical
to your space. I think research is critical period
uh in any industry but more so in medicine because advancement
of medicineare is uh works hand in hand in research.
First of all, what's your take on where we are
um holistically as a country and specifically to your craft?
Okay. Yeah,
I think um having worked at Aakhan and in an academic environment, I would say very good research being done because there actually people with research portfolios even among medical doctors. Okay.

49:22
So the university allows then for you can be a clinician educator, you can be a researcher and there's dedicated time for that. um excellent studies being done at post-graduate level because whenever people are training that's another space that people can can can learn or delve into new areas and write up.
Yeah.
Uh so the university is doing well. I think last year they had the biggest number of grants they've had previously.
Okay. um a lot of untapped potential and in our space for diabetes and endocrine I think is registries
you know [clears throat] just centralized systems that allow to pull in data okay
so that's I think where the biggest fragmentation has come so we have lots of pockets of information

50:06
so where do in other markets where do these registries sit
um
are they national registries academic or
ideally they're national registries that then feed into academic dialogue or or you interrogate that.
So that is one area and that's the role societies play. Um we have different societies the diabetes study group, Kenya cardiac society, the renal society and now actually a lot of the area I mean is looking at cardioretabolic
it's just not metabolic. You're thinking about working together the heart and kidney.
Okay.
So there's a lot of work going on.
Yeah. thinking about pathways and uh [clears throat] how to
to is it create care models that can translate down to the county.

50:59
Okay.
It's very easy up here to be
talking about exotic things. Yes.
But we it needs to translate down.
Okay. So the research gap I think is um not in the in the skill and the the manpower per se but in our field is getting the registry so that we can understand what is relevant to us when we have certain data from the west is it relevant to us is this how we tailor make which medications do we use which preventative measures work better what's our phenotypes
um those are the kind of questions okay
yeah Okay. [snorts] And on the back of that, let's let's speak a bit because you brought in the counties. Let's speak on one side about counties going down. How do you
um
healthcare particularly from a specialization practice perspective?

51:52
It's largely Nairobi based.
Yeah. So how do you take this trickle this down
and also how do you encourage a regional collaboration because I think there would be benefits for that wouldn't there
there's a lot going on on education for primary healthcare you you'd be surprised okay
lots of educational forums I think every week there's uh cardior metabolic forum
that are free they are online this changed in covid so I think co actually opened up the education space tremendously. So in terms of individual nursing and clinical officers who are our
they actually manage a lot of the patients on the ground. There's been a big I think reduction of
the gap. Okay. Um we have guidelines. Kenya is one of the few African countries that actually has a diabetes guideline into its second edition.

52:45
Nice.
So what it is is thinking about how is each county at a similar place. If you if you got sick in a particular county, do you get the same care or similar to what you'd get in Nairobi at base? Maybe not at specialist care.
And then the important thing is the referral system. So for a lot of these metabolic conditions that we handle at US or in in tertiary care, we see a lot of complication. People come late. So they've been languishing in the system,
you know. So it's referral early, mitigate complications and again back to my tagline of every day what what you do every day matters
and um if we can reduce those gaps then the it's a whole economic it's a ecosystem if you're spending more on diialysis we all poorer

53:39
okay
so let's prevent this
fair enough
so the county and devolution I think in principle is not a bad thing the It's it's then delivered and the equity across now different counties is is again when we talk about policy and
Yes. Yes. and and execution.
Execution. Yeah.
Yeah.
Wow. Nancy, what a fabulous conversation. You I' I've learned a lot as I do on this podcast. But I'll now give you a chance to just speak to the audience and tell them where can they find health um social media handles location uh telephone numbers etc. so that interested audience members in reaching out to you can do so and and speak.
Yeah.
Yeah.
So health is based um at 95A Limuru Road.

54:33
So not far out.
We're on the first floor. Um our telephone numbers are 07118118. So easy numbers. 07118118. We on LinkedIn. We have a website ww.zenna.health. Um and you can find us on those platforms if you [clears throat] just uh Google. So welcome for anything metabolic both not just to treat but a lot of metabolic conditions are preventable. So there's genetics but how can we journey with you also to prevent these conditions and if you get them how do we help you to live every day and have um positive outcomes so you live out your your life in good health.
Excellent.
Yeah.
I particularly have to say this. I I particularly like um you've touched on um something that I consider crucial and I wish we could hear more of which is dignity. M

55:31
I think if you build any business regardless of what it is and dignity is a key tenant of what you intend to do I think you have a recipe for success.
So I wish you all the best with
Thanks Leonard and thank you thank you very much and thank you for this uh yeah time for dialogue
ladies and gentlemen that was episode 55 of the African do podcast where we featured Dr. Nancy Kuna of Health and had a fabulous conversation. Once again, this is the African Do podcast where we feature excellent Africans executing excellently. Thank you very much and see you in the next episode.