In my previous post, I focused on the trainees here at Kijabe. Now I want to reflect a little on the nuts and bolts of surgical training as a method for addressing disparities in access to essential care.

What does it take to train a safe and effective surgeon? If you reduce it all the way down, trainees need clinical experience, didactics, and mentorship. The entire enterprise relies on a professional culture of discipline that enforces the expectation that surgical trainees push themselves. There is no point in sugar-coating it – surgical residency is, and must be, a grind.

Nick Carter operating at Kijabe AIC Hospital in Kenya

Keeping the entire juggernaut together requires real leadership. The long-term general surgeons at Kijabe, Drs. Bird, Davis, and Barasa, are engaged on a daily basis with maintaining the rigor of the residency. Every morning starts early with ward rounds and then an hour-long conference. This conference can feature a particular journal article, a chapter from Schwartz’s classic surgical textbook, or a discussion of notable cases from over the weekend, usually presented by one of the PAACS residents. The subject matter varies considerably, but all sessions are interactive and force trainees to demonstrate and expand upon their foundation of knowledge.

After conference, residents disperse to the operating rooms or outpatient clinic to pursue the practical experience they will depend on once they leave Kijabe. The clinical setting is where much of the real teaching occurs, as the attending surgeons offer guidance through hundreds of daily interactions with trainees. There is a tremendous amount to learn, from subtleties of operative technique to management of complications. After a full day, we round again on our patients in the hospital. A few residents will spend the overnight shift seeing consults.

The surgical day is pretty much always the same – from day to day, in Kijabe or Nashville. The routine provides a framework to tackle the immense variations seen in surgical disease and therapies. There are no shortcuts to progressing as a surgical trainee. Surgeons from prior generations woke up before dawn every morning to read (and many still do). Their mentors offered no mercy from critiques of their operative skills or decision-making. The attending surgeons at Kijabe work hard to maintain this expectation of excellence.

Many lives depend upon our ability to address surgical disparities which deny basic care to much of the world’s population. There is real urgency. Yet the hurry to address these disparities creates a temptation towards shortcuts that are counterproductive. As an extreme example, I have heard U.S. surgeons suggest using Da Vinci robots with an internet connection to perform procedures in Haiti. I think the robot would break on the tarmac in Port-au- Prince.

In contrast, the faculty at Kijabe has rejected shortcuts and is engaged in training the next generation of surgeons for East Africa. This work is strenuous but eminently worthy. Isn’t this how progress will be made? After all, what shall we say the Kingdom of God is like? It is like a mustard seed, and when it grows it puts out great branches.