Jambo from Kenya! After barely escaping a rare Nashville snow storm and back to back 8 hour flights, we arrived safely in Nairobi (well, two of the three of us at least; our final companion missed a connection and made it the next morning.) Despite having been here once before, the drive down the hill into Kijabe was just as breathtaking. This idyllic oasis, this “place of the wind” nestled on the mountainside overlooking the ever-widening Great Rift Valley, remains as aesthetically beautiful as ever. With our comfortable guest house and nightly dinners waiting in the fridge, it is easy to lose sight of the reality of ever-present scarcity that exists all around. Yet as familiar faces welcomed me back to the operating theaters on Monday morning, I was reminded why AIC Kijabe Hospital – built from nothing over the past century – remains such a remarkable place. On our second morning in the ORs, one of the surgeons approached us hurriedly and said, “Dr. Jon, please go to the emergency ward, there has been a mass casualty.”
Two matatus – minibuses that serve as the primary form of transportation for the vast majority of the Kenyans – had collided, leaving dozens injured. Unfortunately, this is by no means a rare occurrence in Kenya. In fact, as many were quick to point out, the road between Nairobi and Naivasha (which runs right past Kijabe) is considered one of the most dangerous roads in all of Africa. Overall, Kenya holds the ominous distinction of having some of the most dangerous roads in the entire world. And Kenya is not alone in this reality.
In 2015 WHO released a report showing that road trauma had cracked the top 10 for causes of mortality in both low- and lower-middle income countries. It had risen to number 8 in upper-middle income countries (of note, it was not in the top 10 for high-income countries). Research suggests that road traffic injuries will jump all the way to number three in causes of mortality globally by 2020. And yet the real tragedy will be the mortality disparity, as it is projected that 90% of global road trauma deaths will occur in low- and middle-income countries.1
By the time we arrived in the emergency ward in Kijabe, the mass casualty protocol had already been implemented. A physician team leader and nursing team leader were wearing yellow vests and had already begun triaging patients into three areas. We split up, serving as extra hands to complete primary trauma surveys, perform FAST exams, and assess patients who may have been in need of emergent surgical intervention. The two ORs that were between cases remained on hold, with staff setting up for any emergent cases. Surgeons came to the ER to assist in triage. In the end, seven patients came to the OR throughout that afternoon and the next day for various fractures or major lacerations; all did well. The system worked. The patients who arrived at Kijabe defied the WHO prognostication because the system worked. It is up to all of us to continue the capacity-building that will allow what we saw this week at Kijabe to expand across East Africa and the rest of the developing world.
1. Hofman, K, et. al. Am J Public Health 2005. 95: 13-17.