Author: jtoews

i was able to do the final global health rotation of my medical education at kijabe hospital in kenya for 2 weeks of volunteering and teaching! kijabe hospital is growing, medium-sized rural mission hospital on the edge of the great rift valley about 1 hour north of nairobi, and has developed a reputation as one of kenya’s best hospitals. i spent 3 months volunteering at this hospital back in college, so it was a special experience to be able to return now, 10 years later, as a pediatric emergency medicine fellow. there have been amazing strides made in the medical education offerings at the hospital, and it is now has numerous training programs, including a surgery residency, nursing program, clinical officer (kenyan equivalent of physician assistant) and medical officer (kenyan equivalent of medical internship) programs, and more! impressively, it is also one of a few teaching sites for a new pediatric emergency medicine (pem) and critical care fellowship program, which is the first and only program of its type in africa!

i spent some time with the kenyan pem/critical care fellow rotating at the hospital that month, as well as a lot of time supervising and teaching the clinical officers and medical officers in the emergency department and the 10-bed pediatric intensive care unit. they loved learning and loved my lectures, which was great! i was able to give a number of lectures on burn management, pediatric advanced life support, pediatric abdominal emergencies, seizure management and more. and i was able to lead rounds in the intensive care unit, and did a number of nights as the pediatric attending on call.

as one might expect, rural kenya remains a very resource limited setting, though kijabe hospital has many more resources than almost anywhere else in sub-saharan africa. their 3 pediatric ventilators provide an almost unheard-of abundance for a hospital in the region, yet they are still not enough for the number of patients who need a ventilator, which is always tough. through donations, the hospital is able to cover inpatient medical costs for many families who cannot afford care, which most hospitals do not do. the pathology in rural kenya is much more advanced than in the west, and patients often present very late in the disease course.

it was also fascinating to learn about differences in medical management in africa compared to the west, and not just those one might expect due to resource limitations. for example, a mainstay of treatment in the west for sepsis, an overwhelming blood infection, is aggressive resuscitation with fluids. however, a landmark, large, blinded randomized controlled study in east africa (the feast trial) revealed that aggressive fluid resuscitation is associated with worse outcomes in this setting, so fluid resuscitation is used very judiciously throughout africa, which is a complete paradigm shift from what had been considered sacrosanct in sepsis treatment for decades. the evidence-based treatment for severe acute malnutrition is also notably different in africa than in the west (where admittedly it is very rarely seen). in any case, for my pem fellowship senior lecture after i got home i talked about these differences for 1 hour as i think they are very fascinating!

the pediatric emergency medicine / critical care fellowship at kijabe is run by an inspirational american-trained pem named dr. ariana shirk, who has served at kijabe hospital for almost a decade. i truly appreciate her willingness to let me come out on short notice, and even provide me (and my wife ann for the second week) housing in a nice little guesthouse. i learned a lot from her. she is a true hero, and it is mindblowing to consider how many children’s lives have been saved either directly by her, or exponentially more-so by the countless providers she has trained over the years, who are now working throughout kenya and further afield in africa.

one funny story: we needed a portable xray on a patient. it was taking forever and we had called the xray tech multiple times, but they were saying the machine was too heavy for them to push it up some ramps to get to the icu. so i decided to go get it myself. it was a portable xray machine from about the 1950s, and did seem to weigh about 1 ton, and the wheels on it seemed very stiff. i struggled to push it up multiple ramps and down multiple hallways, finally arriving at the icu about 15 minutes later, sweating profusely. everyone started laughing, because apparently i had pushed this thing through the entire hospital without removing the brake. once that was off, it rolled easily!

medical education is definitely one of the best ways to go in terms of having a profound and sustainable impact in global health. i felt honored to have this opportunity to be involved at kijabe hospital and look forward to the next trip!