What Sen. Bill Frist has been doing lately:
Issues: Foreign Policy · Global Health
February 9, 2007 Operating in Rural Kenya
Seven a.m. in a beautiful, green region of Kenya with rolling hills … time for surgery. Little did I know what would unfold that day. But I was happy to be back in the operating room. We left the mission home on the hospital property of Dr. Mike and Pam Chupp to head up the hill to the operating room suites.
On arrival we were told by another surgeon, “Change of plans … we have an emergency life-or-death case.” A 22 year old Kipsigis tribesman had come in having been shot in the head with an arrow. The arrow (see pictures), still present but firmly lodged deeply in the man’s skull, entered posteriorly at the base of the neck and penetrated about 7 inches toward his nose. It would prove to be a full and fulfilling day.
We changed into our scrubs in the newly constructed operating pavilion in rural Kenya and said hello to Kibet (who we had examined last night) just before he was put to sleep for his surgery. (All pictures taken are with the permission of the patients). We would do his case first as the emergency patient was being prepared for surgery by another surgical team. A last look at the x-rays (see picture) and then out to the scrub sink to wash our hands for 10 minutes … no different than in the US.
Kibet was explored through a left thoracotomy (chest incision). There were a lot of adhesions surrounding the lung that had to be taken down sharply. The large mass inside the young boy’s chest was isolated and entered, with tuberculosis pus spilling into the chest cavity. The infected, crumbling, mushy bone of the spine was excised and a bone graft taken from the boy’s hip was inserted after extensive debridement of the infected wound. The healthy bone graft was wedged into position to replace the necrotic bone, with a few bits of rib inserted to fill the surrounding area. He was placed in a full chest cast to ensure stability. I had never seen Pott’s disease so extensive, literally eating away the spine with the abscess mass pushing on the boy’s spine which explained his paralysis. But today’s successful decompression should allow Kibet to walk again. It will take a couple of months for full recovery. But later in the day when we visited him in the recovery room he was smiling without pain. (See pictures)
Tenwek Hospital has a fascinating story that tells much about the history and importance of the medical mission field in Africa. It started ever so modestly in 1937 as a medical dispensary and was staffed by two nurses until the prophetic arrival of medical missionary Dr. Ernie Steury in 1959. Dr Steury, who died in 2002, IS Tenwek Hospital. He created the hospital's motto, “We treat. Jesus heals.”
Tenwek has grown over the years to 270 beds seeing thousands of patients each year from throughout western Kenya. World Medical Mission got their big start in 1979 here when Dr. Dick Furman and Franklin Graham visited the facility, were told by the venerable Dr. Steury that there was an urgent need for more doctors, and right then and there Franklin Graham promised that they WOULD find doctors who would come and serve short term missions there to assist the full-time mission surgeons. An idea was born. A promise made. An idea fulfilled when a few days later Dick and Franklin, while still in Nairobi, received a call from a doctor who said he wanted to serve in Africa … and they said they knew the perfect place! And indeed, word spread and their promise to provide doctors to supplement the care at Tenwek has been fulfilled over the last 25 years … most of the surgeons we operated with today were volunteers with WMM (as well as the two medical students I met from my own Quillen Medical School in East Tennessee, Lauren Chipman (with her husband Steven) and Chris Dill). In fact this year 30 doctors and med students from WMM served at Tenwek.
Well … I’ve removed knives from the heart, treated on more occasions than I’d like gun shot wounds to the chest, but I have NEVER seen a patient shot in the head with an arrow (Apparently there was a tribal dispute over some land. Until today. (It’s a long way from the floor of the U.S. Senate.)
I have included some pictures of Kisma which tell the whole story of the operation. As you can see the arrow was removed successfully without hemorrhage, although the position of the arrow, with the broad penetrating arrow head, made the surgical exposure very difficult.
I rotated to the next room where Dr. Carol Spears was the chief surgeon on a sigmoid volvulus, or a twisting of the far end of the colon which leads to obstruction of the bowels, and death of that portion of the colon. Another success! (See picture)
We bounced out of the operating room n the early afternoon and went to the endoscopy suite where Dr.Chupp and Dr. Spears placed an esophageal stent for cancer (pictures) in 47 year old, Somalian Ali Hussein G. The stent holds open the 9 cm area of the esophagus that had obstructed and prevented the patient from eating for days on end. He will go home later today … eating. Dr. Russ White is the thoracic surgeon here at Tenwek and he has discovered and extraordinarily high incidence of carcinoma of the esophagus in the Kalengi tribal people … we don’t know why, but with more research will be able to figure it out.
Two years ago the room that is now the endoscopy suite was the main OR. But in August the new operating room pavilion had opened up. Life works in change ways. Ten years ago I had brought Dr. David Charles, a neurologist to Tenwek with me from Washington for a visit; he returned as a medical doctor with WMM several years later with his wife Julia, an architect, who helped design the fantastic OR pavilion we operate in today.
Back to the OR for a left colectomy for colon cancer (picture) and then to the wards for rounds. The need in Africa for medical services is great. It is not unusual to see two patients to a bed – sometimes three (see picture). On rounds we met the 38 Year old Kenyan who had an abdominal aortic aneurysm repaired by Dr. Chupp and visiting surgical resident Rona Norelius from New York (picture). We examined the African who had multiple perforations of his jejunum secondary to tuberculosis (TB is rampant with the high incidence of HIV – they go hand in hand); he is recuperating nicely.
Probably 80 per cent of the medical ward is HIV positive – yes 80 percent. Probably 60 percent of the surgery patients are HIV positive and approximately 40 % of the new mothers are HIV positive. We have much more work to do on HIV … I am covering that elsewhere over this month, but I do need to thank President
Bush for his unprecedented leadership in supplying much more funding than anyone in the world to fight this condition. Testing for HIV is much more acceptable today than last year when I was in Kenya; that is progress.
Karyn spend the day on rounds with us, meeting with the mission families, touring the Umora (“Unity”) Orphanage in an adjacent village Silibet. She especially loved the orphanage, home to 23 young children (picture).
I have gone on too long on the surgery, but the one to one connections are what compassion is all about. Though I am here a lot, I never cease to be overwhelmed by the kind and generous hearts that I see each time I operate at mission hospitals in Africa. This connectedness I believe can be used as a currency for peace around the world.
Written by Bill Frist, M.D.
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