Written by Deepika Parmar, MD, PGY-2 at Kaiser Permanente Oakland Pediatrics Program while on Global Health…
Posted by Irene Mason, MD (a third year Ob/Gyn resident from Kaiser Permanente, Santa Clara serving a global health elective at The Matibabu Foundation in Ugenya, Kenya).
I spent 2 weeks at the Siaya District Hospital in western Kenya through the Matibabu Foundation. Although Matibabu does not strictly work at the hospital, they were able to set up a surgical rotation for us. I went with Dr. Philip Miller, a recently retired Kaiser Ob/Gyn physician.
Upon arrival in Nairobi, we had an orientation to the Matibabu Foundation with Dan Ogola, a co-founder, and learned about the beginnings of the Foundation as well as the vision for its future.
Having made our way to Kisumu and beyond into the rural areas of western Kenya, we were embraced by the Matibabu clinic staff and given a tour of their facilities. One of their nurses, Celestine, was gracious enough to be our liaison during our time at the district hospital.
Upon our arrival to the hospital, we were given a tour of the operating theatre, the outpatient clinics, the female wards as well as the ancillary services. Several patients had been lined up for us as surgical candidates and were already admitted to the wards. We reviewed their records, examined them and discussed the indications for their surgeries.
The following day and into the first week we proceeded to perform hysterectomies. For 80% of these women, the indication for surgery was very large uterine fibroids which caused excessive bleeding and pelvic pain. The other 20% consisted of large ovarian tumors and uterine prolapse. We were consulted on 1 young lady who had HIV as well as advanced cervical cancer (manifesting as vaginal bleeding) for which she needed multiple blood transfusions. We made our recommendations for treatment, which did not include our performing a hysterectomy. We did not feel that we had the back-up in the event of massive blood loss or the need for an intensive care unit. We also performed one minor procedure- removal of a cervical polyp which was likely benign.
During any down time we had in-between cases, we consulted on other women who also had large uterine fibroids for which we set up surgery for the following week. I also had the opportunity to help conduct the GYN clinic. There we saw women for their postoperative visit, chronic pelvic pain, pelvic inflammatory disease and uterine fibroids.
Our preoperative work-up for these women would be a complete blood count, an ultrasound if needed and a good history and physical exam. We noticed that most women were chronically anemic, although asymptomatic, likely from years of malaria infection. Very few women needed blood transfusions. Only 2 of our 10 patients needed blood transfusions. We followed our patients in the postoperative period and managed their hospital care and eventual discharge.
I found the other surgeons and OR staff to be very helpful. I have great respect for these healthcare workers as they have many obstacles to overcome as they attempt to provide the best care they can for these patients.
Overall, I had a fabulous experience. The keys my good experience are: 1) having an open mind about what healthcare is like in a developing nation 2) only doing what is within your means with the tools you have- which is often much less than you are used to in the U.S. 3) creating good working relationships with the local staff 4) being prepared in terms of bringing many of the surgical supplies you may need 5) remaining positive about your experience.