PAACS Article...and Our Future

Approximately 80% of graduating surgery residents today pursues fellowship training after residency.  I chose to do a fellowship, just not a traditional one.  Instead of learning robotic thyroid surgery through the axilla (armpit), or how to do an EVAR (endovascular aneurysm repair), I have served at Tenwek Hospital in Kenya with the World Medical Mission Post Residency Program and learned how to do surgery in the developing world.  My two years here working with seasoned missionaries and PAACS residents has taught me a lot.  I became a true “general surgeon,” learning how to do operations never taught to me in my surgery residency.  I learned how to teach and conduct myself in another culture, how to be concerned with cost and practice medicine on a budget, and about how mission hospitals are constantly balancing patient cost and their institution’s financial sustainability. 

While at Tenwek, I also learned more about PAACS.  I learned a few practical things like how the finances work, what COSESCA stands for, and what the resident’s academic requirements are.  I learned many spiritual lessons and the value of dedicated Bible study time with the residents.  Overall, I learned that we are training a generation of Christian surgeons that are going to bring about a surgical revolution to the continent of Africa.  My fellowship experience has been worthwhile. 

Surgery Residents Jack and Tony and I at Tenwek

At the PAACS conference in Brackenhurst this year I also learned an aspect about PAACS that I believe was an unintended consequence.  Before PAACS existed, there were missionary surgeons at various mission hospitals throughout Africa all practicing with minimal collaboration.  They all shared similar vision yet had similar struggles.  The creation of PAACS not only set up the structure to train residents, but it also brought missionary surgeons around Africa together.  The PAACS organization and meetings like Brackenhurst brings over 30 surgeons together and gives them the ability to collaborate, have camaraderie, provide emotional support, and pray together. 

PAACS faculty from across Africa at Brackenhurst conference 2015

First and Second year PAACS surgery residents from across Africa. February 2015

Participating in the meeting this year and helping out at Tenwek brought to my attention that many of these surgeons are struggling.  They are doing the work of several people, juggling a full surgical practice with residency program director responsibilities, hospital administration responsibilities, mission agency duties and family life.  Many surgeons stated they had too many hats to wear and not enough heads.  Burnout was close at hand, but the love of the ministry and the PAACS residents kept them going, one day at a time.

Hearing all these program reports and prayer requests made me feel excited that I will be graduating from “fellowship” soon and could help alleviate the burden.  I had been researching future locations of service, but in Brackenhurst I really began networking with people to figure out where to go.  Where are the greatest needs?  Where would my family fit in?  After many lunch and dinner conversations I suddenly I found myself feeling like I need to be everywhere, helping all these programs.  But the reality is that I can’t.  I can only be one surgeon.  There are 14 active PAACS programs at 10 sites, and by my assessment, approximately 10 more surgeons are needed to fill these programs with full time faculty.    Ten more surgeons would share the responsibilities with the existing PAACS faculty and allow the PAACS training sites to be sustainable.  And, this need only considers the existing programs.  There are also approximately 10 hospitals located in countries with atrocious access to surgical care that need to start up PAACS programs but lack the necessary 2 full time faculty to start the program.  One example is in Burundi at Kibuye Hope Hospital where Dr. Jason Fader would like to start a PAACS program.  I spent three weeks with him this year and really felt a pull to join him with the hopes of starting a new surgery residency program.  There are so many places where full time missionary surgeons are needed. 

Leading Valentine, a third year surgery resident, through an operation.

As I pray for wisdom and insight to where God is calling our family to go next, I sit and wonder, where is everyone else?  Why are so many missionary surgeons looking to me to be the cavalry coming at a time of need?  What is preventing other people from coming and joining what God is doing?  He is doing something amazing as PAACS is growing and on target to train 140 surgeons in Africa by 2020.  The PAACS budget is increasing, the number of administrative people is growing, and the number of residents is increasing.  In order for PAACS to continue to train quality Christian surgeons, the number of faculty must increase as well. 

As I prayerfully consider what my future holds, I find myself at one of those critical points in the decision tree of life.  What hospital do we serve at next?  Do I help start a new PAACS program in an area desperate for well trained Christian surgeons?  Or, do I provide reinforcements to an already existing program that needs more faculty?  No matter what, I want to serve God with the gifts and abilities He has entrusted to me.  It is also my prayer that He would be stirring the hearts of more surgeons in the first world and convicting them that there is an opportunity to get on board with the work He is doing in the rest of the world.