Joseph Schlesinger
Resident
Kijabe, Kenya
Vanderbilt International Anesthesia

joe schlesinger blog 1

We arrived safely in Nairobi and stayed at the Mennonite Guest House.  The next morning we ate breakfast with missionaries from all over the world in different stages of their calling around Africa.  Kijabe’s reputation is well known and they wished as well as we were picked up and driven to Kijabe via a road that had terrible slums juxtaposed with sweeping views of the Rift Valley. 

We toured the hospital and got settled in our lodging for the month and got sign-out from the ICU as one of us was on-call the first night.  It took adjusting to drugs and equipment that were foreign to us.  All of the patients did well overnight leading into our first day in the operating rooms, or “theatres,” as they are called.

The staff comprises one MD anesthesiologist and in our case, two anesthesia residents, missionary and local surgeons, surgery residents, KRNA (the Kenyan version of a CRNA), and anesthesia students.  Patients present with late-stage disease, terrible trauma, and for obstetric emergencies without previous prenatal care.  One could take care of a neonate with a tracheoesophageal fistula followed by a patient after a road traffic accident followed by a C-section.  The steep learning curve of anesthesia is addressed with intense didactics combined with a sick and varied patient population.  The KRNAs and students do a great job.  However, there is not insignificant morbidity.

I had the pleasure to oversee a few operating rooms, help the KRNAs and students perfect there neuraxial anesthesia techniques, discuss pharmacology and physiology, and teach them approaches to regional anesthesia that they have not seen before.  The way they gather around and pay attention exhibiting their willingness to learn is refreshing.

After the first day, we brought two heavy suitcases of medical supplies to the anesthesia workroom as most of the equipment is donated.  It caused me to step back and realize the amount of equipment we use in America and how we take many things for granted at our institution.

Everyone at Kijabe has been extremely welcoming and the missionary spirit of providing excellent medical care in the midst of educating the local medical staff is encouraging for the future.  All of this paired with the beautiful land, delicious food and chai, and local wildlife seen on our weekend hikes prepare us for a busy week next week in the operating theatre.

By Sage P. Whitmore, M.D.
Vanderbilt University Medical Center: Emergency Medicine
Georgetown, Guyana

I had plenty of time to contemplate all that I had seen during 12 hours of travel back home from a medical mission trip to Georgetown, Guyana. I had just spent three weeks working in the Accident & Emergency (A&E) department at Georgetown Public Hospital and using my training as an Emergency Medicine resident in the United States to help teach new ER doctors core material such as EKG reading, airway management, and the approach to shortness of breath and chest pain. I had not realized when I arrived how much of my time would be dedicated to sitting in the metaphorical trenches and caring directly for patients coming to the A&E. I was prepared for a foreign experience in a distant land, but instead I found myself right in my element.

The minute-to-minute practice of medicine was in Georgetown was very similar to what I was used to; see as many patients as possible, gather all the information you can, make a decision—often instinctual—to admit a patient or treat them at home. One important difference, however, is that in the United States it is easy to get caught up in which hospital has a trauma center, who has immediate cardiac catheterization capabilities, and how long it might take to get a specialized MRI or exotic blood test; these distinctions do not exist in Georgetown, and as a physician I got back to basics. In medical school what we really learn is how to interact with and assess a patient; how to sit, what to ask and how to listen, where to push and prod, how to translate the patient’s presentation into terms of anatomy and disease process, and how to offer comfort. These remain the most useful tools in a physician’s arsenal and are the foundation of all medical care no matter how many elaborate adjunctive capabilities you have at your disposal. 

When a concerned mother presented her coughing infant for evaluation, rather than immediately ordering an expensive antibody test for respiratory viruses, I got to be a doctor. Does the patient look ill, or does she look like a normal baby who happens to be coughing? How long had she been sick, did she have a fever, did she have any prior medical problems? What do her lungs sound like? While I was thinking about the possibilities, I used the moment to reassure the mother how well her baby looked, and her look of relief reminded me why my job can be so gratifying. Ultimately the baby checked out fine, required no testing, and the decision to discharge her was as practical as it was scientific—her mother was reliable, lived nearby, and would return if the situation worsened. In this case, practicing medicine meant relieving anxiety and educating a family member, at the cost of merely a few minutes of focused attention and interaction. 

One early morning, a young man was brought in by his family members for confusion and shortness of breath. Sitting in a wheelchair, he was having difficulty concentrating on my questions and panting as if he had just finished a marathon. Virtually any cause of confusion and shortness of breath can be diagnosed for the price of a couple CT scans, a blood gas analysis, full panel of labs, possibly a cardiology consult and stress test, maybe an ultrasound or MRI. If resources were unlimited, one could simply check all the boxes on an order sheet at home if so inclined. Instead, we started with the basics—looking and listening. This shortness of breath had not started suddenly. He had no pain. He was not blue from lack of oxygen. He looked very dehydrated. Despite his rapid rate of breathing, his lungs sounded clear and he was not sucking in at the ribs or working hard to breath through fluid or inflammation in the airways. In medical school we learned about “Kussmaul” respirations, a pattern of deep breathing meant to get rid of acids in the blood, usually from undiagnosed diabetes. We did have a glucose meter on hand, and it turned out his blood sugar was critically elevated, proving the diagnosis. The treatment is simple, and he improved over several hours with IV fluids and insulin. In this case, practicing medicine meant a thorough history and physical examination, and the cost of one glucose check and widely available basic medications.

In a blur of activity, orderlies whipped into the A&E with a woman found unconscious at home. She was limp, unresponsive, snoring and gurgling through her oral secretions. In this situation, protecting the patient’s airway with a breathing tube is essential to prevent secretions from draining into the lungs and getting infected. There is no fancy test required, but getting the tube in place can be difficult and can require specialized equipment. At my home institution, a cutting edge machine with a fiberoptic camera at the tip and a high definition screen can be used to look around the patient’s tongue and place the breathing tube through the vocal cords. In this A&E we had one basic device, and with it the resident was having difficulty passing the tube as the patient’s oxygen dropped lower and lower. Even in this extreme case, going back to the basics proved life saving. As we learn in our airway courses, what saves lives initially is not placing a breathing tube, but rather simply ventilating the patient with a bag and a facemask, by holding the jaw just so. Employing this technique brought the patient’s oxygen back up and gave us time to change the patient’s position, the size of the breathing tube, the height and angle of the bed, and optimize the conditions for the procedure. When the situation had calmed down, we took a slow, deliberate look for the vocal cords and passed the tube successfully.

I came away from these clinical scenarios with a new appreciation for basic medicine. In the era of whole body CT scans, unlimited lab analysis, and myriad medical gadgets, the fall back is always our own eyes, ears, and hands. Forming a therapeutic bond with a patient, asking the right questions, searching for the right clues, combining instinct and basic life support skills, and caring for patients with compassion are principals that know no borders. 

By Sage P. Whitmore, M.D.
Vanderbilt University Medical Center: Emergency Medicine
Georgetown, Guyana

As I was packing for my first international medical trip to Guyana, South America, my wandering mind conjured image after image of third-world medicine based on popular notions and dramatic stories I have heard over the years. I imagined a row of soiled cots where emaciated children without IV access spent their final hours. I pictured a sweltering tent full of tuberculosis patients collectively coughing up blood; or a bathroom-sized emergency department packed with fever-stricken, jaundiced, indigenous peoples dying of AIDS, malaria, and other ailments while overwhelmed healthcare workers looked the other way out of emotional self-preservation because they had nothing to offer. As described to me by some physicians who had been there in recent years, some of these were features specific to the hospital I was heading to in the capital city of Georgetown.

I am delighted to tell you how antiquated and cynical my preconceived notions had been.

On my very first day in the Accident and Emergency Department (A&E), my first patient did not have AIDS or malaria or tuberculosis; he had hypertension and diabetes, and came in for chest pain. I have seen this exact patient many times in my own tertiary hospital in the States! I caught myself thinking perhaps my view of international medicine was a bit narrow. But, I thought, we probably wouldn’t have the equipment to diagnose him, and even then certainly we would have no treatment to offer. Wrong again. A junior resident from the brand new graduate training program in Emergency Medicine appeared beside me and handed me an EKG. “Inferior wall MI (heart attack). He’s gotten fluids, aspirin, oxygen, and morphine. Holding the nitro. We’re waiting for his portable chest x-ray so we can start heparin, and the admitting team is on their way down to evaluate him for streptokinase (clot busting medication).” Incredible! His care was nearly equivalent to that in thousands of small hospitals across the United States.

My very next patient was brought in on a gurney in full cardiac arrest for unknown reasons. Far from looking the other way, a team of three physicians including myself and four nurses started CPR, provided oxygen and ventilation, established two IVs, started fluids, checked his blood sugar, attached a cardiac monitor, gave epinephrine and sodium bicarbonate, and attempted defibrillation before finally pronouncing him dead. This was fully consistent with my own training.

Time and time again, I was surprised and humbled by the world-class care being delivered in this developing nation, from the availability of a neurosurgery consultation for head trauma, to blood cultures and antibiotics for septic shock, to the text book intubation of a comatose stroke patient (there was an available ventilator in the ICU), to the use of an “asthma room” for wheezing asthmatics receiving inhaled medications, oral steroids, and intravenous magnesium just like we would do back home. To be sure, this is not always the case, and there are countless places in the developing world with no medical resources at all, but the quality of care delivered in this public hospital in one of the poorest western nations is remarkable. I believe this is a great example of the success and power of international health efforts.

In Georgetown, an American team of Emergency Medicine residents and faculty, of which I am a member, are staying in a compound called Project Dawn, an international collaboration which houses teams of physicians and healthcare workers from the United States, Canada, Scotland, India, and many other countries around the world year-round. Like ours, these teams spend intensive time in the city helping provide direct patient care, teaching at the bedside, and setting up infrastructure and training programs. This, combined with the ambition of the local physicians who have trained in Guyana as well as places like Canada, the US, Cuba, India, and Europe, is a recipe for excellent patient care.

I am particularly proud of my home institution, Vanderbilt University and its Department of Emergency Medicine, and our involvement here. Within the last few years, we have had the privilege of assisting the Georgetown Public Hospital Corporation create a self-sufficient Emergency Medicine residency program to train new classes of emergency physicians who are specially trained in resuscitation and acute care of a wide variety of problems, from cardiac arrest to broken bones to childbirth to infections and trauma. As we’ve seen in the US, this training benefits patients by relieving the surgeons and family practitioners who typically cover emergency rooms but may not be well versed in the care of medical problems outside their usual scope of practice.

As my American colleagues and I led a didactic conference last week with the new residents, I witnessed with awe the geographical boundaries and disparities of health care dissolve. Together we interpreted the mysterious subtleties of EKGs, discussed strategies for resuscitation of shock, airway management, differentiating types of bleeds around the brain on CT scan. The local residents brought their own real-life cases for a conference, calling on each other to think though work-up and treatment of various life-threatening conditions. These residents would be as at home in our conference room in Tennessee as we are in theirs.

The far-reaching positive impact of international health efforts are all around me, and it is truly remarkable. Of course, none of this is possible without the enthusiasm and dedication of a well-educated and well-trained Guyanese health care force. I feel very honored to be part of something so inspirational, and I urge readers to continue to support international health efforts, as the gains from these investments are tangible and quite amazing to behold.

Matt Landman
Resident
Kijabe, Kenya
Vanderbilt International Anesthesia

matt landman and erik

(Photo: Matt Hansen and Kenyan Colleague)

I've probably done more than 30 appendectomies so far during my general surgical residency. For all the times I've taken care of someone with appendicitis, rarely, if ever, has the thought that they might die from the illness crossed my mind.  Indeed, some of these patients were quite sick; but once they presented to medical attention, we could get them through their illness.  Many of these patients were young which help in their recovery. 

My first week in Kenya changed my history with this nearly ubiquitous American surgical disease.  We took care of a 20 year old male who presented to an outside facility with appendicitis of about two weeks duration.  While he didn't have a CT scan to review, I'm sure his appendix was perforated.  He, appropriately, underwent an open appendectomy by these physicians. Unfortunately, he required another operation shortly thereafter necessitating resection of the right side of his colon (the part of the colon to which the appendix is attached).   He was discharged from that hospital and presented to Kijabe Hospital with stool leaking from his wound.  The connection of his intestine had completely broken down, likely result of weeks of malnutrition and intra-abdominal infection.  We performed additional operations to resect the damaged colon but the insult was too great.  He died during my second weekend in Kijabe. 

There I was, presented with a 20 year old, previously healthy man who died of an illness I’d not ever known in my short professional career to be fatal (although I think it's important to note that there is still a generation of American surgeons who certainly understand death secondary to appendicitis).  Admittedly, appendicitis is much less common in Kenya, but nevertheless, his death was a tangible reminder to me of how the lack of medical resources and access to healthcare can truly affect patient outcomes.   I’m not sure what kept this young man from presenting to medical attention sooner, it was probably a combination of lack of financial resources, poor access to care and cultural limitations, but had he presented earlier, he would have likely survived.

This, and other, experiences in Kijabe changed my view of global health.  It’s so much more than just doing operations or treating patients in a hospital or clinic.  Where the real efforts are being made and continue to be made is in creating a system in which patients get open access and timely care for both acute and chronic disease.  Surely, as long as there is poverty, this will be difficult.   However, if healthcare professionals of the caliber I interacted with in Kijabe continue to commit time and resources to a needy people, the outlook continues to look bright.   

 


By: Bill Frist

Politico
December 15, 2011 12:03 AM EST

While Congress remains deadlocked in fiscal debates, American families are holding their own budget negotiations. How much can we spend this year on gifts for the children, home projects or even food for the holidays? Congress and families alike are tightening their belts, cutting costs and planning ahead.

This week, Congress is to vote on a drastic reduction of foreign assistance. While most Americans shy away from the language of foreign aid, polls show that despite continuing economic problems, more than half all Americans support funding for health, including education and emergency relief, in developing nations.

On World AIDS Day, President Barack Obama, joined by former Presidents George W. Bush and Bill Clinton, spoke about the global commitment to end HIV/AIDS by 2015 and recommitted the U.S. effort to do so. He announced new targets to combat the pandemic — including providing anti-retroviral drugs to more than 1.5 million pregnant women with HIV over the next two years.

Obama received a sustained standing ovation when he announced his administration has set a goal to get six million people with HIV on anti-retroviral treatment by the end of 2013.

These are worthy targets to celebrate. But to achieve it, we must have the support of Congress. Continued investment in the fight to end global AIDS is more than an investment in the lives of families and communities in developing nations — it is an investment in security, diplomacy and our moral image worldwide. It uses health as a currency for peace.

Millions of lives are at stake — literally. Under the current budget cuts, more than.4 million people will likely lack mosquito nets, a cheap way to prevent malaria. More than 900,000 children will lack access to vaccinations for measles, tetanus and pertussis. These numbers are staggering, but real.

Yet, as with any good investment, there is need for accountability, transparency and results. The Millennium Challenge Corporation is a good example of promoting aid effectiveness from “input to impact.” There is mutual responsibility for both donor and recipient to achieve the goals agreed on — an expectation that the recipient take ownership, as a partner, of both the aid and its implementation. Washington should and does require seeing results in practice.

For example, one of the best investments is providing access to clean, safe water. Every $1 invested in safe drinking water and sanitation, according to the U.N. Development Program, produces an $8 return in costs averted and productivity gained. Children are healthier, girls can go back to school and women can begin to work again.

A Millennium Challenge Account compact funding package for El Salvador now invests nearly $24 million to provide access to potable water systems and sanitation services to benefit 90,000 people in the country’s poorest region. This money creates healthier and more economically sound communities with something as basic as clean water.

More than 68 percent of Americans in a recent holiday poll said that because of the economy, we should be committed to charity this year more than ever before. With Americans reaching deep into their pockets to fill the coffers of red-hatted Santas on street corners or offering plates at houses of worship, Congress should follow their constituents’ leadership as they consider foreign assistance this week.

This holiday season, let’s recommit to investing in global health and development in the parts of the world that need our assistance the most. Foreign aid is less than 1 percent of our national budget, so cutting it would have a miniscule effect on our deficit reduction.

But it means the world to a mother whose child’s life we will save.

For the hope of greater peace on earth, investments in health and security could be the best bargain in town.

Former Sen. Bill Frist, a doctor, served as Senate majority leader. He is the chairman of Hope Through Healing Hands, a nonprofit charity that promotes using health as a currency for peace.

An Impatient Optimist

Dec 01 2011

An Impatient Optimist's View of HIV
by SENATOR WILLIAM H FRIST MD

Impatient Optimists: The Bill and Melinda Gates Foundation
 
In 1981, I was a surgeon in training at Massachusetts General Hospital in Boston. I still remember the day we learned about a strange, new, deadly infection that presented on the West Coast. A little over a year later, we learned it was caused by a virus transmitted in the blood, a vital fact for a doctor performing surgery every day.

As I watched the epidemic grow from a handful of cases to a few hundred to several million, I also witnessed the cases grow in biblical proportions in less developed nations, namely across Africa. While I served in the Senate, I volunteered on annual mission trips to do surgery in villages ravaged by civil war. In these forgotten corners of the world, I witnessed how HIV was hollowing out societies.

Drawing on these firsthand experiences, as the Senate Majority Leader I encouraged and supported both the PEPFAR program and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The Global Fund, a multilateral institution with the U.S. as the leading contributor, leverages $2 for every single dollar given, all to combat this trilogy of diseases that disproportionately attack children and young adults in the poorest nations on the planet.

The remarkable news is that millions of lives have been saved by these investments. Thanks to the Global Fund, over 3.2 million people living with HIV are on lifesaving treatment.

I am proud to have been part of a government whose leadership, acting on behalf of the American people, has led the world and literally saved the lives of millions of people globally.  

In 2008, I co-chaired the ONE Campaign’s ONE Vote ’08 Campaign. We brought a delegation of Republicans and Democrats to Rwanda to see firsthand the good work being done by the funding of the Global Fund, PEPFAR, and the President’s Malaria Initiative.

In Eastern Rwanda we visited the inspiring Rwinkwavu Clinic, run by Dr. Paul Farmer’s Partners in Health. With 110 beds and eight health centers, this clinic provides essential medicines, supplies, and equipment and recruits, trains, and retains staff to ensure a sustainable infrastructure for the future.

But without Global Fund funding, the Rwinkwavu Clinic could not provide health care services to the people of Rwanda. This is true for so many organizations and clinics worldwide.

And it’s unfortunate that even though we see investments pay off, lives saved, and economies grow, the Global Fund was forced to cancel its round 11 funding. This means clinics like Rwinkawvu will only be able to support those currently on HIV treatment and not add any new patients. This is alarming because in low-income countries half of people living with HIV are not receiving treatment.

At a time when our own economy is faltering, and our national debt is growing unacceptably, we have to tighten our belts. To do so, we need to decide where we make smart investments and where we do not.

The fact is that the American people spend less than one-quarter of 1% of our federal budget on global health and fighting global epidemics like HIV, tuberculosis, and malaria. With this little sliver of the pie, the Global Fund’s return on investment means more sustainable economies, less global instability, and healthier families. For less than a penny to the dollar spent on all foreign aid, we are investing in the lives of children, mothers, and our own national security.

On the horizon is excellent news for HIV. New evidence suggests male circumcision, microbicides, and quicker AIDS treatment will markedly decrease the disease. Combined with known prevention methods like condoms and nevirapine, we are on the right track to substantially halt the growth of HIV/AIDS.

I’m an optimist, an impatient optimist. We will win the war on HIV, tuberculosis, and malaria.  Our investments have worked. The end is in sight. We just have to be smart enough to continue to invest wisely, using health as a currency for peace around the world.
By BONO
New York Times

I’LL tell you the worst part about it, for me.

It was the look in their eyes when the nurses gave them the diagnosis — H.I.V.-positive — then said there was no treatment. I saw no anger in their expression. No protest. If anything, just a sort of acquiescence.

The anger came from the nurses, who knew there really was a treatment — just not for poor people in poor countries. They saw the absurdity in the fact that an accident of geography would deny their patients the two little pills a day that could save their lives.

This was less than a decade ago. And all of us who witnessed these dedicated African workers issuing death sentence after death sentence still feel fury and shame. AIDS set off an almost existential crisis in the West. It forced us to ask ourselves the big, uncomfortable questions, like whether capitalism, which invented the global village and kept it well stocked with stuff, could also create global solutions. Whether we were interested in charity... or justice.

The wanton loss of so many lives in Africa offended the very idea of America: the idea that everyone is created equal and that your destiny is your own to make. By the late 1990s, AIDS campaigners in the United States and around the world teamed up with scientists and doctors to insist that someone — anyone — put the fire out. The odds against this were as extreme as the numbers: in 2002, two million people were dying of AIDS and more than three million were newly infected with H.I.V. Around 50,000 people in the sub-Saharan region had access to treatment.

Yet today, here we are, talking seriously about the “end” of this global epidemic. There are now 6.6 million people on life-saving AIDS medicine. But still too many are being infected. New research proves that early antiretroviral treatment, especially for pregnant women, in combination with male circumcision, will slash the rate of new H.I.V. cases by up to 60 percent. This is the tipping point we have been campaigning for. We’re nearly there.

How did we get here? America led. I mean really led.

The United States performed the greatest act of heroism since it jumped into World War II. When the history books are written, they will show that millions of people owe their lives to the Yankee tax dollar, to just a fraction of an aid budget that is itself less than 1 percent of the federal budget.

For me, a fan and a pest of America, it’s a tale of strange bedfellows: the gay community, evangelicals and scruffy student activists in a weird sort of harmony; military men calling AIDS in Africa a national security issue; the likes of Nancy Pelosi, Barbara Lee and John Kerry in lock step with Bill Frist and Rick Santorum; Jesse Helms, teary-eyed, arriving by walker to pledge support from the right; the big man, Patrick Leahy, offering to punch out a cranky Congressional appropriator; Jeffrey Sachs, George Soros and Bill Gates, backing the Global Fund to Fight AIDS, Tuberculosis and Malaria; Rupert Murdoch (yes, him) offering the covers of the News Corporation.

Also: a conservative president, George W. Bush, leading the largest ever response to the pandemic; the same Mr. Bush banging his desk when I complained that the drugs weren’t getting there fast enough, me apologizing to Mr. Bush when they did; Bill Clinton, arm-twisting drug companies to drop their prices; Hillary Rodham Clinton, making it policy to eradicate the transmission of H.I.V. from mother to child; President Obama, who is expected to make a game changing announcement this World AIDS Day to finish what his predecessors started — the beginning of the end of AIDS.

And then there were the everyday, every-stripe Americans. Like a tattooed trucker I met off I-80 in Iowa who, when he heard how many African truck drivers were infected with H.I.V., told me he’d go and drive the pills there himself.

Thanks to them, America led. Really led.

This was smart power. Genius, really. In 2007, 8 out of the 10 countries in the world that viewed the United States most fondly were African. And it can’t be a bad thing for America to have friends on a continent that is close to half Muslim and that, by 2025, will surpass China in population.

Activists are a funny lot. When the world suddenly starts marching in step with us, we just point out with (self-)righteous indignation all that remains to be done. But on this World AIDS Day I would like you to stop and consider what America has achieved in this war to defend lives lived far away and sacred principles held closer to home.

The moonshot, I know, is a tired metaphor; I’ve exhausted it myself. But America’s boldest leap of faith is worth recalling. And the thing is, as I see it, the Eagle hasn’t landed yet. Budget cuts ... partisan divisions ... these put the outcome in jeopardy just as the science falls into place. To get this far and not plant your flag would be one of the greatest accidental evils of this recession.

Bono is the lead singer of the band U2 and a founder of the advocacy group ONE and the (Product)RED campaign.

Matt Landman
Resident
Kijabe, Kenya
Vanderbilt International Surgery

matt landman kijabe 1

(Photo: Matt Landman at left)

It’s now been one full week since my arrival in Kijabe, Kenya.  Simply speaking, to understand everything I’ve seen and experienced in the past week will take months of careful thought and reflection.   I’ve seen the shackling consequences of poverty, the natural history of surgical disease more advanced than I’d ever seen before, a lack of medical resources, and the list goes on; but, overshadowing all of this, I’ve seen the good several committed people can do at one place in time to positively affect patients and their families for a lifetime. 

My first full day in the hospital was spent in the general surgery clinic.  I use the description “general surgery” but in reality, if forced to label it back at my home institution in the U.S. it would be better described as the general surgery - urologic surgery- otolaryngology -surgical oncology -endocrine surgery -thoracic surgery –vascular surgery-wound care-palliative care clinic. 

I never imagined a more unique conglomeration of surgical diseases coming through the door in a single day.  While the pathology was interesting (and inspiring to hit the books to expand my surgical knowledge) I was most struck by what each procedure meant for the patient—particularly the financial toll.  Instead of flashing an insurance card and putting down a small copayment, each patient (and many times their family) was required to produce a down payment for the recommended procedure.  If they required a cholecystectomy it would be x-amount of Kenyan shillings.  If they required a colonoscopy it would be y-shillings.  Quite foreign to me (and most in the US) was the readily available price tag, if you will, for each procedure (I should note that the payment system was different for emergency cases).  That price tag allowed me to clearly see the financial sacrifice, relatively extreme in some cases, made by patients and their families to improve (or simply maintain) their health. 

I often wonder what would happen to Americans if we were put in a similar situation.  Would we still spend most of our healthcare dollars at the end of life?  Would we be doing radical resections with small chances of cure?  Would emergency rooms still be overcrowded?  What would I give up in order to pay for me or my family’s medical care?  While I’m not sure of the answers, I know that many Americans, as I’ve seen these Kenyans do countless times this week, would step back and evaluate their priorities and healthcare need. 

The knowledge of these costs has another effect.  Physicians are forced to understand their healthcare consumption.   I certainly have been more cognizant here of what each laboratory test, imaging procedure or recommended operation would mean for my patients and have tapered my practice and recommendations to be cost-conscious while maintaining medical effectiveness.   Seeing the results of our operations and care here, I’m confronted with excellent results that don’t necessarily correspond to the amount spent on each case. 

It’s been a week and I’ve learned quite a bit, both medically and professionally.  I look forward to the coming weeks for more experiences in which I can look back and evaluate my role in this place and in surgery as a whole globally and in the U.S.

 

The Tennessean

by Bill Frist

Russian-U.S. relations are complicated and, at times, trying. But since we share a commitment to improve the health of our citizens, there is much we can learn through dialogue and collaboration. And there is no better place to do so than Tennessee, the heart of health-service delivery innovation.

Even at the height of the Cold War, U.S. and Russian scientists collaborated closely to eradicate polio and smallpox. Similar collaboration can lead to mutual benefit for today’s shared challenges, chronic disease and obesity, with a byproduct of improved diplomacy. Collaborations on health-service delivery in Tennessee between Russian and U.S. doctors are a powerful example of health diplomacy and a valuable currency for trust and understanding.

Russia has more doctors, health-care workers and hospitals than most countries, but standards remain variable. Prime Minister Vladimir Putin has committed $16 billion over two years to bolster working conditions, training, and national electronic health records with a promise to trim bureaucracy.

The Washington-based Open World Leadership Center invited 30 health professionals from Kirov State, Russia, to come to the U. S., specifically to Tennessee, to study and explore financing, organization and delivery of health infrastructure and services.

The Russian delegation spent a day in Washington to better understand how health policy is formulated at the federal level and to visit the National Institutes of Health. They then came to Tennessee for a week, spending time in Memphis, focusing on research, and in Knoxville, focusing on rural health delivery.

The visit culminated in Nashville, where they observed firsthand our $70 billion global health-care industry. Hosts Nashville Health Care Council and Hope Through Healing Hands welcomed the travelers to the “Silicon Valley” of health care.

Industry leaders citywide opened their doors with sessions on medical simulation at Vanderbilt and HIV research by Meharry. The group also received an inside look at the public health sector’s progress on making communities healthier from state Health Commissioner Dr. John Dreyzehner, Nashville Mayor Karl Dean and Metro Public Health Director Dr. Bill Paul. The day concluded with global disease-management leader Healthways, and focused on the company’s work to improve well-being through prevention.

Most valuable, however, was the opportunity to hear what the delegates found most applicable to their home. Among them were the development of IT for unified e-records, logistics for emergency services, and the great benefit of community volunteerism.

As the U.S. and Russia attempt to address growing health demands, we have much to learn from each other. Collaboration, using health as a currency for peace, will mean healthier societies, better diplomacy and improved bilateral relationships between our nations.

Sen. William H. Frist is a nationally recognized heart and lung transplant surgeon and former majority leader in the U.S. Senate.

Nashville Business Journal
by Chris Silva, Staff Reporter

Former Tennessee Sen. Bill Frist was at the Hermitage Hotel this morning with about 30 Russian physicians and a cadre of Nashville’s health care and business leaders to promote global unity and attempt to solve public health and behavioral issues that lead to chronic diseases.

Frist said Russia faces many of the same health care dilemmas as Middle Tennessee.

“We do have the best health service infrastructure here in Middle Tennessee, so why not share it with the global community – a oneness of mankind?” said Frist, who prompted Sen. Lamar Alexander to send a request to Open World Leadership Center to host the health exchange. “Out of our commitment to global health, democracy, being the best in the health service delivery and using health as a currency for peace, we had the conference today. It will be a foundation for future exchanges.”

The Russian visitors started out with a tour of Vanderbilt University Medical Center this morning and listened to a presentation from an expert from Meharry Medical College on HIV/AIDS research.

Ralph Schulz, president of the Nashville Area Chamber of Commerce, was on hand, as was Mayor Karl Dean.

“I am concerned most about this issue of obesity,” Dean said. “It’s going to be a battle that will be won or lost in the Southeast.”

Today’s events were hosted by the Nashville Health Care Council and Hope Through Healing Hands.

Subscribe to our newsletter to recieve the latest updates.