UM Surgical Team in Kenya: A Medical Mission Blog
This is a blog written by members of a University of Maryland surgical team on a medical mission trip in Kenya. Led by head and neck surgeons Jeffrey Wolf, MD and Rodney Taylor, MD, MPH, the team of doctors, nurses and surgical technicians traveled to Kenya on January 29 to spend the next 10 days consulting with and performing surgery on dozens of patients with head and neck cancer, thyroid disease and other health problems who have no access to much-needed surgical care.
The team members, who pay their own travel expenses and are donating their services, are working in a clinic operated by a nonprofit organization, Kenya Relief.
Written by Cindy Kiamko, operating room nurse
This day was a bit of mixed emotions. The team was excited to reach the finish line, knowing that we were able to do what we came for. Imagining the look on our patients' faces when they see themselves for the first time after the surgery, there is this sense of pride that we have achieved our mission! Or some part of it, at least.
On the other hand, we could not help but feel badly for patients who had travelled far and wide for a chance at undergoing a life-changing operation only to be cancelled for medical reasons. One was aborted because of ST depression, but she was otherwise stable. Another was a difficult intubation that the team decided not to pursue to avoid post-op complications. Three came back positive with HCG (human chorionic gonadotropin, which is produced during pregnancy). To see their devastated faces as they were informed that we couldn't move forward with the operation was saddening.
Then there was exhaustion. Operating from sunrise to sunset three days in a row was not without challenges. Aside from the physical and mental weariness, there were the issues of limited resources and increasing heat as the day broke. The surgeons also had quite a few tough cases. We were told our team did the bigger goiters. Yet we managed to perform a total of 38 surgeries!
After another hard day's work, a fancy dinner was waiting for us at the Brittney House, where we stayed. A home-cooked meal prepared by the locals! We only wished we got to spend more time with the orphans who are housed within the Kenya Relief compound.
In the short time we had with them, you could see they had so much fun as much as we did! Time with them was definitely one of the highlights during this trip. Some of us even got letters from the kids.
Leaving the compound, we could not wait to explore the beauty of Kenya, but more importantly, to go home to our families and friends with a renewed outlook.
Written by Andrea Hebert, MD, fourth year resident
We awoke on day two of our surgical mission still physically exhausted from our first day of surgery, but eager to start the day. For some of us, the effects of jetlag were still prevalent. However, we knew that while we slept in beds, patients were either sleeping outside the clinic or on the bare floors.
Our first patient was an older woman with a massive bilateral thyroid goiter. She didn't know her age and had no known medical history. Her signature was her thumbprint. Upon induction, our anesthesiologist noted concern with her electrocardiogram. After careful discussion with the anesthesiologist and the founder of Kenya Relief, we opted to postpone the surgery until she could have a cardiac evaluation. I had to break the news to the patient after she regained consciousness. Breaking the news was difficult, as she and I both knew that being seen by a cardiologist would be nearly impossible. With a heavy heart, I wished her good luck through the translator and started our next case, a young gentleman with a large neck mass present since birth.
He came to us wearing a turtleneck in 80 degree heat. The mass was approximately 20 cm by 20 cm and encompassed the entire left side of his neck. Based on the limited information we had from our history and physical examination of the patient, we deduced that the mass was likely a benign lesion, most likely a lymphatic malformation versus lipoma. We excised the mass in its entirety, and upon gross examination, it was clearly a lipoma. While closing, we talked with the other members of the team and remarked on how we hoped to make a difference in this young man's life. How he would no longer need to hide his neck under clothing or scarves.
We finished the day relatively early, after a broken sterilization machine left us without clean instruments. After two days of working under the supervision of two attending physicians, I had assisted in performing seven thyroidectomies. With each procedure, I improved my surgical skills and increased my confidence. While I was able to provide these patients with surgical treatment, they provided me with an invaluable learning experience.
February 4, 2015
Our first day of surgery in Migori, Kenya, will always be memorable! Certainly, one of our saving graces is that we worked together as a well-oiled machine. The team assembled from the University of Maryland—six surgeons, three nurses and five anesthesia providers—have all worked together previously, and it showed. We worked with an efficiency and purpose that was amazing.
The Kenya Relief staff was astounded by the sheer number of surgical procedures we were able to accomplish. In fact, our team did more surgeries than any head and neck team had ever done since the inception of Kenya Relief. We saw patients with advanced surgical disease that we, experienced as we are, almost never see in the United States. The thyroid goiters (thyroid gland enlargement) were enormous, and patients enthusiastically lined up to finally have surgery that would improve their quality of life. Very large goiters are endemic in this part of the world, where the diet does not provide adequate iodine intake for normal thyroid physiology. When goiters get as large as they had for the Kenyan patients, they can cause such problems as difficulty swallowing, sleeping and even breathing.
We arrived at the hospital at 6:30 a.m. sharp and operated and evaluated non-operative patients until 9 p.m. It is hard to appreciate how difficult it is to do complex surgery in poor lighting and extreme heat until you experience it. The conditions truly tested our fortitude and focus, and I am proud to say that each member of this team more than rose to the occasion. Although we were physically exhausted in a way that few of us can remember feeling, we were all energized and renewed by knowing the impact that we could have. I can't remember working in an environment where every member of the team was so selfless. At the end of the night, the only daunting thought we had was whether we could muster sufficient energy to do it all again the next day and then the next day!
Written by Jeffrey Wolf, MD
February 2, 2015
Our team of surgeons departed Baltimore, Maryland, on the evening of Thursday, January 29. We arrived in Nairobi, Kenya, at night on Friday, January 30. After a quick hotel stay in Nairobi, the team departed for Migori, where we will be spending the duration of our trip. This slow, eight- hour, gluteal-torturing drive was highlighted by the beautiful Great Rift Valley.
We arrived in Migori (Place of Mosquitos) on Saturday evening. After a pleasant tour of the facility, we got a good night’s sleep and attempted to overcome our jetlag.
On Sunday, we started seeing preoperative patients to determine who we would be able to help during our time here. Of the first 20 people to walk in the door, we immediately scheduled surgeries for 15 people: 12 patients with very large thyroid goiters; one patient with a tumor on the parotid gland (the largest salivary gland); one with a neck mass; and a patient with a nasal cavity tumor. The clinic charges $8 US for surgery.
We also saw an unfortunate young woman with a new tonsil cancer. We struggled with this patient, who we can’t operate on because the clinic does not have resources to handle the postoperative case after we leave.
We are waking bright and early tomorrow, as we plan to operate sunrise to sunset.