FGHL Beth HelmlinkIt seems to me that global surgery, or really any work in a resource-poor country, requires a different type of intelligence to be successful. Indeed, it requires ingenuity, the ability to think outside the box at nearly every level to make do with the resources available. This has been demonstrated to me over and over again for the last four weeks here in Kijabe, Kenya.

An example of a minor tweak was demonstrated to me one day while banding hemorrhoids. The rubber bands we were using were old and brittle and kept breaking as we loaded them onto the gun. I asked one of the Kenyan senior residents who happened to walk into the room if she had ever encountered that problem. Her response: “Oh yeah, definitely. Those rubber bands are no good. Just cut up a Foley catheter into thin rings.”

Of course. It made sense, but certainly, I had not thought of that. Other examples include using a sterile glove as a retrievement device during a lap chole and homemade wound vacs out of gauze, ioban and feeding tubes. 

But these small creative solutions give way to completely unique patient care plans. As a surgical oncologist in training, my interests lie in the care of cancer patients. I had the opportunity to see many patients with breast cancer during clinic days. Due to resource limitations, my typical approach to a new patient with breast cancer was thrown out the window.

With early cancer in the US, I’d consider breast conservation surgery and adjuvant radiation. Radiation here is possible in theory but not in practice due to cost, long wait times and distance to travel. Thus, modified radical mastectomy becomes the treatment of choice. In patients with advanced cancer, which is unfortunately the more frequent presentation, my workup in the U.S. would include CT chest and abdomen to evaluate for metastatic disease. CT is expensive here, but you garner the same information with liver ultrasound and chest XR. Again, there are little tweaks to make things work.

This has far-reaching implications for the design and implementation of effective cancer treatment protocols for patients in resource-limited areas. Protocols designed for the U.S. population will not work here nor are protocols suitable for use in Kenya applicable in the U.S. Furthermore, protocols designed for Kenya may not work for Malawi etc. As a future global surgical oncologist, the lessons learned this month in creative thinking will certainly be utilized as I work to design region-specific cancer treatment plans.