Nov 28 2011
Vanderbilt International Surgery
(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.