Oct 12 2011
by Sina Iranmanesh
Vanderbilt Department of Surgery, Resident
No doubt, working at Kijabe is a once-in-a-lifetime experience. Upon setting foot on the dirt road leading to the hospital, I knew I would face many hurdles over the next four weeks as a general surgery resident. Over time, I appreciated subtle clues and changes in each patient’s physical exam to help guide the management of their care without relying on further information.
Lesson number two: I could no longer practice medicine ignoring the financial burden of my treatment plan. Practicing cost-conscious medicine was not just beneficial on a global sense, but specifically affected each family suffering from an economic crisis. Even worse, many treatment options (i.e., chemotherapy, radiation therapy, referrals to specialists) were physically or financially inaccessible by our patient population. For example, unlike women in the U.S. who had the option of a lumpectomy with radiation for breast cancer, our patients in Kijabe underwent a mastectomy because they could not afford radiation. I spent time counseling a young woman on her treatment options after removal of a large tumor from her thigh. I recommended radiation therapy to reduce the chance of the tumor returning, though she decided against it after discovering how much it would cost her. Such encounters were unfortunately fairly common.
In contrast to the philosophy of utilizing single-use, individually wrapped, and disposable equipment in Western operating rooms, Kijabe’s mantra of maximizing its very limited resources proved surprisingly effective. With the exception of our gloves, every piece of equipment used in the operating room (especially those labeled as ‘single-use’) had been routinely sterilized over and over again. I can only wonder what impact we can have on the US Healthcare Crisis if we learned a few lessons from Kijabe...
Kijabe is renowned for its level of care and medical education. As such, it is home to a number of visiting physicians of all levels of training. I felt fortunate to have encountered a number of these missionary physicians. My one-month commitment to work in an African hospital paled in comparison to individuals (and their families) who offered years of devotion. Working alongside such individuals was inspiring to say the least. I am grateful for the opportunity to experience medicine from a different angle, and the lessons I learned along the way.