Getting an Education at the Hospital

My first night taking call as a missionary surgeon and teacher of PAACS residents at Tenwek Hospital in Kenya was filled with teaching moments...for both the residents I shared the call with, and for me.  As usual for my call nights, my drift off to sleep at about 10:45pm was abruptly halted when I was summoned to the hospital's casualty (emergency room) by the second year resident on call.  My family and I have been slowly regaining our energy and sleep patterns since moving here one week ago, but I wasn't about to gain any ground this night.  Dr. Kanyi informed me he had three patients to present.  My first of three patients was a 3 year old with deep partial thickness burns to the forearms.  Dr. Kanyi had already dressed her wounds, tucked her in to the Peds ward, and directed my attention to the two other patients awaiting me.  He presented the history and physical of both patients in a clear and concise fashion and I was impressed.  Both patients had sustained blunt abdominal trauma (a boy hit with a stick 4 days ago, and a 30 year old male hit by a plank of wood being carried on a motorbike two days ago.)  The resident wanted to take both to the OR, but I wasn't going to be so hasty.  I was skeptical of his assessment and decision making and wanted to examine the patients myself.  After laying eyes on each patient I quickly realized Dr. Kanyi had been spot on. Both examined with peritonitis and off to the theatre we went.  I asked when the OR would be ready, and he responded with "I had already informed them of these cases, and they are ready now."  Nice!! Both patients required small bowel resections, and we walked our way through the cases together.  I shared tips with him that I had gleaned from my practice, and I relied on him to ensure our hand sewn anastamosis was solid.  I didn't reveal to him that the last hand sewn small bowel anastamosis I had done was as a fourth year resident on my pediatric surgery rotation. His surgical skills were on par with U.S. residents I had taught in the states.  My first impression...these residents must be getting a good training.  So far I had witnessed excellent patient evaluation, decision making, and operative technique...from a second year resident.

After operating all night, both Dr. Kanyl and I were fatigued, but I was impressed with his enthusiasm and vigor as he continued to work the next day, and double scrub a distal gastrectomy I did for a gastric outlet obstruction. He didn't have to scrub in and help, but he did.  I thought to myself, "Perhaps this work ethic and exposure to good cases are a few of the reasons for his early competence." 

Before I arrived at Tenwek, I was excited to participate in the education of PAACS residents.  After one week of surgery at Tenwek, my excitement has risen, as I have witnessed excellent comradary, caring attitudes, and a passion for learning the art and science of surgery.  I look forward to getting to know each on a personal level and not only teaching them surgery, but about how to grow in their love for Christ and understand our purpose here on earth.  I'm sure I will learn from them just the same. 

To round out the weekend, my cases were as follows:  resection of a huge lipoma in a guys neck that extended down to his carotid sheath (everything in Africa is bigger...the pathology, the animals, the mosquitoes), antrectomy with BII reconstruction for gastric outlet obstruction (take out part of the stomach because it is blocked), suprapubic catheter placement on two patients in a row, both with pelvic fractures and urethral transection (google it), a craniectomy for a depressed skull fracture, declining GCS and a blown pupil (take off part of the skull because the brain underneath got whacked), exploratory laparotomy for small bowel obstruction (cut scar tissue blocking the intestine), repair of an incarcerated inguinal hernia in an eight month old, another ex lap, and an EGD with removal of a not one, but two key rings in the esophagus of a 2 year old.
Glad I have the help of residents!