All My Friends Are Dead: Why African Doctors Must Lead Healthcare Change | Dr. Kamatamu Amanda Mbonye

About a year ago, I was seated in the back row of a conference, one I had finally gained enough confidence to attend. Out of hundreds in the room, only one other person looked like me. We smiled and locked eyes as the committee shared their "groundbreaking" clinical guidelines.

But these guidelines ignored a major group of people—arguably the most affected people. Our people.

As I sat, a feeling of injustice rose in me. And despite my deep insecurity, I stood up, raised my hand, and asked the committee—in probably many more words than this: "What about us—the Africans?"

The committee chair looked at me and said—in probably more words than this: "We recognize that more needs to be done." And then he just moved on.

But I couldn't move on. I couldn't sit comfortably. Why did he say it so casually? Why wasn't more already done?

And from that moment, I could see it clearly: We are the ones.

We are the ones with one of the youngest populations in the world. We are the ones carrying rising pressures—in our lives, in our blood. We are the ones with health systems that were never designed for us. We are the ones trading land for medical services.

But we are also the doctors, the healers, the educators of our generation. We are the ones caring for our families, our communities, our nations. We are the ones explaining to them when we have reached the limits of care, telling them we are sorry—"There is nothing more that can be done."

But Why Us? Why Me?

I am my parents' child, born into a medical legacy. Growing up, I felt I had to prove myself worthy of their name—waiting for the right time, the right skills, the right credentials to return home, to do work that could stand on its own.

But sometimes the "right time" doesn't come with another degree or more letters at the end of your name. Sometimes, the right time comes with great loss. A friend who died suddenly. Family members who left too soon. A phone call for support. And words of comfort that you were never really prepared to give.

A few months after that conference, I prepared to travel home to start my sabbatical. My decision to move back home was driven by a heavy heart and deep hunger to make change. I couldn't just move on.

What I Found at Home

And what I found at home opened my eyes to a world I needed to see.

Walking down the aisles of the general cardiology wards, I heard attendants negotiating with their nurse about how many days of antibiotics they really needed to buy, because the last invoice they received was the last one they could afford.

A dialysis line that had stayed in way too long, but it was the last affordable lifeline this young man had to survive.

It was frustrating. It was not what I was used to. It wasn't in the guidelines.

But amongst the frustration, I also saw pockets of hope, pockets of innovation, pockets of resilience.

At home, I was part of conversations and interventions that were driving change and transforming the lives of our communities.

A surgically opened valve that allowed a young girl to return to school. A stent that saved the life of a young man with a young family. A pacemaker that kept a grandfather on the farm he loved. Proof that change was already in motion and we were driving it.

Healer and Educator

As doctors, we wear two hats—healer and educator.

As much as I resented the biases of Western medicine towards Africa's health issues, I acknowledge that my training abroad put me in a unique and privileged position. One that I never take lightly.

I seized the opportunity to combine my two worlds and helped lead a health partnership that would enable the sustainable growth of specialized cardiovascular services at home.

Where the guidelines saw limitations, I saw opportunity.

As a continent, our health systems are overwhelmed, and many of the health issues are due to conditions that can be prevented through education and through lifestyle change.

In my role as an educator, I founded a wellness clinic that is driving a movement to encourage our communities to take ownership of their health and develop more positive lifestyles—because the systems we live in are not sufficient to support us. We are the ones that need to make the change.

Our Problems Are Uniquely Ours

Our problems are not unique. For centuries, Western medicine has neglected not just Africa's health issues but women's health issues and the health issues of many other minority groups.

Our problems are not unique, but they are uniquely ours.

Hearing "there's not enough data" about heart disease in Africa is not enough. Hearing "they're Black, so their blood pressure is difficult to treat" is not enough. Watching governments chase funding for the "fashionable" health issues while ignoring the conditions killing our youth—is not enough.

Taking Centre Stage

A mentor once told me: "There is no shame in taking centre stage when it's for a greater purpose."

For a long time, and to some extent even now, I've wanted to work quietly in the background. Not to draw attention. But I've learned that sometimes it is important to stand up and raise your hand. Not just for yourself, but for others.

So right now, I stand here with more confidence, more clarity, and a lot more people who look like me! The ones affected the most. The ones with the solutions.

So how will we use our voice, our platforms, and our privilege to make a difference?