Disclaimer: The views expressed by the author in this blog do not represent the opinion of the Millennium Cities Initiative, the Earth Institute at Columbia University or any of its professional consultants.
In Kenya, like with many developing counties, residents often lack access to specialized medical care. International Surgical Mission Support (ISMS), which strives to train medical professionals and provide free care to those in need, recognized a gap in the level of care available in Kenya and decided to send two teams to Nyanza Provincial General Hospital in the Millennium City of Kisumu, Kenya.
The Kenya mission was the 15th mission for ISMS’s main team, and was intended to provide care to cancer patients and burn victims. The mission was a result of a partnership between ISMS and the Millennium Cities Initiative, introduced by Amanda Powers, a Columbia surgical resident who completed a rotation in Kisumu last summer. MCI secured an agreement with the hospital and provided support on-the-ground to the team. ISMS put together two teams of surgical specialists and outfitted them with needed supplies and equipment.
The first team was led by me and consisted of one general surgeon, one general/thoracic surgeon, two plastic and reconstructive surgeons, two obstetrician gynecologists and an intensive care specialist, as well as anesthesia and nursing staff. The second team, which is scheduled to leave on April 27, will be led by Colleen Hekemian, and will comprise pediatric surgical specialists including general, orthopedic, ENT and plastic surgeons.
We left JFK Airport on Thursday February 10th at 6 p.m., followed by a layover in Amsterdam. We then boarded a flight to Nairobi, followed by another layover, then a short flight to Kisumu, arriving on Saturday at 3 p.m. We carried with us 67 pieces of luggage that contained all of the supplies we believed we would need for patient care in the pre-, intra- and post-operative periods. We also carried with us all of the machinery needed to set up four operating rooms and a six-bed Recovery Room/Intensive Care type-of unit. This equipment included portable anesthesia machines, cardiac monitors, electrocautery machines, skin grafting machines, bronchoscopes, flexible sigmoidoscopes and a LEEP machine.
Despite their exhaustion, the medical team members chose to personally unload their luggage from the truck to the Operating Room (OR) to ensure that all items arrived safely and were secured. Knowing that the real hard work still laid ahead, the team had an early dinner and went to sleep.
On Sunday morning, the team split into two groups. The first group included the OR nurses, the nurse anesthetists and RR nurses, and the second team included the physicians. The first team headed to the operating room where they refitted four of the existing operating rooms for the mission and properly prepared the RR for the type of cases expected. They also created a central supply area, ensuring that items were properly labeled and accessible at all times.
The second team headed to the floors to evaluate the in-patients who had already been admitted in preparation for surgery. Then we went to the clinic, where more than 300 patients were waiting to be evaluated. There was widespread variation of pathology – from extremely large benign tumors of the head and neck to benign and malignant tumors of internal organs and the reproductive system. Plastic surgical cases included many patients with either fresh burns or severe burn-related contractures and several congenital anomalies. After evaluating all of the patients, team members got together and prioritized the cases and created the OR schedule for the entire week. Knowing that additional patients in need of care would show up at the hospital throughout the week, we decided to leave some openings on the schedule, which has proven to be the appropriate thing to do, given our experience in other developing countries over the years.
Starting Monday and through the entire week, the daily routine consisted of arriving at the hospital at 7:30 a.m. and evaluating the patients who were scheduled for the first cases and instructing nurses on the material needed for each case. While the ORs were being set up and patients were being anesthetized, the physicians made their rounds on the post-operative cases, changed dressings and made recommendations as needed. The rounds were done in conjunction with the local doctors and nurses to help with the learning process. Our work days were very long, extending to late evening hours most of the days we were there.
The team performed 90 major surgical procedures – an impressive number – some of which required the combined expertise of more than one specialty. I expect the April mission will also perform a high number of surgeries, making a difference for younger patients in the Kisumu area.