Pediatric Resident Carries the Authority Health Teaching Health Center Mission Abroad

When Dr. Alyssa Motzel was looking for a pediatric residency program, she wanted an experience in which she would treat all children. Through her training at Authority Health in Detroit, “I’m seeing the world of medicine, not just a pocket of medicine.” Literally.

Earlier in 2023, Dr. Motzel, together with recently-graduated Authority Health resident Dr. Sarah Harris-Kober and residents from Vanderbilt and Georgetown universities, completed a six-week clinical rotation in Mutomo, Kenya, through the Catholic Medical Mission Board. While medical care is a constant aspect of the experience, Dr. Motzel and her colleagues were there to teach and create a sustainable value for Kenyan clinicians. She provided three lectures per week, taught operating room procedures, provided laboratory training, and worked in the orthopedic, HIV, and tuberculosis clinics. She also participated in cancer support groups and went on field service trips throughout the country with Red Cross and UNICEF, helping provide vaccines and support for a measles outbreak.

Dr. Motzel experienced the “challenges and possibilities of caring for people with medical problems complicated by the social determinants of health.” Her challenge was similar to that working with children living in high-poverty areas of Detroit, except exponentially every social determinant was complex, from food and housing insecurity to transportation. These exacerbated the medical problems she faced.

She knew about the importance of understanding the circumstances that affected someone from becoming healthy, but “I didn’t understand the gravity” of how it applied to the impoverished region of Kenya. “Everything I learned at Authority health really matters. This is meeting people where they are.”

In addition to their clinical residency requirements, Authority Health residents complete special training in population health, trauma informed care, and antiracism/social justice.

An essential lesson learned through the Kenyan experience was the importance to lead with humility, Dr. Motzel says. “That is important when going into an unfamiliar community. It doesn’t have anything to do with medicine or patient care. I’ve found that making a true relationship with people – outside of being a doctor – to being a visitor, being part of their lives and being interested in their lives matters. You have to get to know them as people instead of subjects you’re trying to help. You’re a guest in their lives.”

Her indoctrination to the complexity of this clinical rotation “came fast and furious,” she says. “As soon as I walked into the hospital on the first day I realized: no windows, no doors. Everything is open to the outside. My first conversation was with a patient whose child had been sick for a month.” They couldn’t get to a physician any sooner. Her patients presented a variety of health problems compromised by abject rural poverty.

Dr. Motzel did considerable work in acute health care settings, treating over 400 children, as well as providing 100 hours of community service and education for nurses and physicians. In addition to testing her ability to analyze the impact of social determinants, her Kenyan rotation enhanced her residency training by learning to provide medical care with few resources, becoming sensitized to community dynamics affecting the health of her patients, and making worldwide health connections and extending the mission and work of Authority Health.

Global health has been part of her passion for a long time. During her undergraduate years, she participated in a mission trip to Nicaragua. She was looking for a residency training opportunity that offered an experience in global health. When she heard that Authority Health offered the medical mission to Kenya she was even more excited about selecting this training site.

“I wanted to go. I knew it was going to be a transformative opportunity to go to a community that was out of the comfort zone that I was used to, pushing me to the limit… If I can learn how to practice medicine in a very low resource area place like Mutomo, Kenya, when I came back to Detroit, I’d be that much better of a physician.”

Upon her return, Dr. Motzel has provided formal and informal insight on the Kenyan experience to her fellow residents. “I’m a senior resident now. From that experience, I’m able to teach from that perspective, to empower them to think about (medical care) in different ways.” For example, she is far more acutely aware of the appropriate use of resources – financial and material – after working in an environment of relative scarcity.

The next step in Dr. Motzel’s career is pursuing a fellowship in endocrinology. As with Authority Health, she is looking for a fellowship program that will allow her to do global health work in addition to her fellowship responsibilities. She feels that the Kenyan experience has confirmed her lifetime goal of pursuing medical missions abroad with her husband, who is completing an orthopedic residency.

Dr. Motzel and Dr. Chaya Pittman-Hunt, director of the Authority Health Pediatric Residency Program, presented the Kenyan rotation to the Authority Health GME Teaching Health Center Board of Directors in November. “We are creating an experience for residents that is more longitudinal,” Dr. Hunt explained. Spending several weeks in a region not only offers more extensive training, but it also gives a greater opportunity for the resident to provide patient care to Kenyans and train Kenyans who seek training in the field of healthcare or medicine.

Loretta Bush, president and CEO of Authority Health, noted that Dr. Motzel embodies the spirit of the Authority Health mission. “You represent the heart of Authority Health,” she said. “Many times, the administrative staff doesn’t have a chance to interact with residents and are hopeful that they understand the mission and vision of Authority Health. You represented it beautifully. It’s in your DNA.

“The patients you will touch and the communities you will touch will be better for your experience. You get it. I’m confident that you will carry this with you. I look forward to how you are going to change lives in the future.”

An intense experience like the Kenyan rotation often has a significant impact on the character and career development of physicians. For Dr. Motzel, it was a reminder that she may have specialized in pediatrics; she is first and foremost, a physician.

“In the U.S., everyone is hung up on specialties,” she says. “Being in Kenya made me a better physician because it reminded me to be a doctor. It doesn’t matter where you went to school, you’re showing up for work and you’re a doctor trying to help patients. It changed me to remember that no matter where I’m at, I’m a physician first. I will take that wherever I go.”