By Nicholas Carter, FGHL
This month at AIC Kijabe Hospital in Kenya boils down to a joyous encounter with a medical center in the developing world where patients find reliable access to quality surgical services. Here, to a large degree, patients are spared the immense burden of death and misery associated with the myriad of conditions that can be cured or palliated by surgical procedures. Every short-term visitor will view Kijabe through the lens of prior experiences, and I reflect back to 10 months spent in Haiti as a medical student, where preventable deaths were a daily routine. I have seen here in Kijabe a model for expanding access to surgery with tremendous effect for patients and their families.
To be sure, there are patients who suffer at this hospital, as is true for any medical facility. Yet the patients who died during my time here faced conditions that would be devastating in any health system – metastatic esophageal cancer, massive chest wall trauma. AIC Kijabe has even established a palliative service to provide specialized compassionate care for those with terminal diagnoses. If we could expand access to this kind of health care on a national, continental, or global scale, the world would be a much more just and merciful place – closer indeed to the Kingdom of God.
The leaders at Kijabe are working to achieve just that. Perhaps the most marvelous accomplishment of AIC Kijabe is the number of medical providers trained here to go forth into the world to serve (I think it is only fair to count the visiting Vanderbilt residents, myself included, amongst those trainees). For virtually every position in the hospital, there are students who are learning the craft, with the expectation that they will use their privilege to help treat those in need.
Among four weeks worth of highlights, my greatest pleasure has been operating with the surgery residents sponsored by the Pan-African Academy of Christian Surgeons (PAACS). In recent days, I have had the privilege of working across the table with Kenyan residents during an exploratory laparotomy for perforated appendicitis, cranial burr hole for subdural hematoma, and several cesarean sections for obstructed labor. Each of these patients was suffering considerably when the Kijabe surgical teams decided to operate, and each has emerged from the theater with an excellent outcome. This is a credit to the skill, intellect, and training of the PAACS surgical residents here at Kijabe.
During daily conferences, the Kijabe residents recite classic surgery textbooks almost by memory. When time counts, such as when a trauma patient presents with tension pneumothorax, they place emergent chest tubes as swiftly as any Vanderbilt resident. Their breadth of practice expands well beyond what is expected of a general surgeon in the United States; they are knowledgeable and experienced in management of urologic and neurosurgical conditions that cause tremendous morbidity if left untreated. They are well-trained by any standard – which is good, since they will face great challenges.
These trainees are the beginning of the answer to the vast disparities in access to surgical care. They come from Kenya, Sudan, the Democratic Republic of Congo, and a variety of other nations with their own idealistic calls to service. Our role as global health enthusiasts should be to stand alongside them, to assist when we can in their training, and to help build the infrastructure that will allow them to do their work effectively. If we are not standing in solidarity with them, we should get out of their way.