By Jon Niconchuk
Since its inception over a century ago, AIC Kijabe Hospital has transformed into a national (and even international) center of clinical excellence. And yet the mission of the hospital does not end with clinical excellence alone. As the institution has matured, its goals have expanded beyond care delivery to care systems development and medical education. Over the course of our time here we have worked alongside medicine residents, obstetric residents, general surgery residents, neurosurgery residents, plastic surgery residents, and anesthesia residents and fellows from not only Kenya, but all of Africa (including Cameroon, Somalia, South Sudan, Ethiopia, Gabon, and Rwanda just to name a few) – training at Kijabe and planning to return to either their county or country equipped to provide high quality care.
Despite once being known as the “neglected stepchild of global heath,” surgery (and anesthesia) in Africa has an ever-brightening future. I can say without exaggeration that AIC Kijabe Hospital is playing a major role in improving the future of healthcare delivery – especially surgery and anesthesia care delivery – for an entire continent. Yet so much work remains. One of the KRNA students told that in her home hospital in El Dorat, only 1 of the 40 anesthesia providers has been trained in ACLS. The pediatric anesthesia fellow currently training in Kijabe will return to her native Rwanda as the only pediatric anesthesiologist. While the United States has over 20 anesthesiologists per 100,000 people, much of sub-Saharan Africa has only 11 (or even 0) per 100,000. Kijabe hopes to change that. Twenty years ago, Kijabe had two operating theatres – today it has eight. A training program that began over a decade ago with a class of 5 KRNA students has expanded to roughly 16 students per year, training over 18 months. For the first time, Ethiopian anesthesia residents have begun rotating at Kijabe, in addition to pediatric anesthesia fellows from across Africa.
More recently, the leadership of the anesthesia training program at Kijabe, led by some of the very first graduates of the program under the mentorship of Dr. Mark Newton, has expanded the reach of the training program even further. Every Wednesday and Thursday morning at 0700 sharp, a teleconference is set up between Kijabe, Kisumu (in western Kenya), Somalia, and South Sudan. This week, the Wednesday lecture covered anesthesia care of burn patients, and the Thursday case conference reviewed the anesthetic management of a 12-year-old boy with a skull base fracture (see photo below).
On the remaining mornings, we have been giving lectures to the KRNA students. Throughout the day we continue to teach both the KRNA students and Ethiopian residents, in addition to serving as examiners for the senior KRNA students’ final assessments. We work with junior KRNA students on the basics – properly setting up the room, checking the anesthesia machine, and learning how to understand the monitors. We cover more advanced topics with the senior KRNA students and KRNAs, and have been able to teach regional techniques and review more complex topics with the visiting residents (see below photos of Dr. Meyer teaching ultrasound-guided TAP blocks to two of the Ethiopian residents).
With physician burnout in the United States at an all-time high and the realities of the U.S. healthcare system often leading to job dissatisfaction, it is easy to become cynical, even while in training. Here in Kijabe, it is hard to be cynical. Every provider we help train will have a tangible impact on reducing maternal mortality, decreasing morbidity from road trauma, and setting a new standard for anesthetic and surgical care for all of Africa. The residents and KRNAs who graduate from AIC Kijabe will not only be well-trained clinicians, but also leaders in their hospitals and clinics. They will show their communities what is possible. They will be the ones to make health care equity a reality.