Vanderbilt International Anesthesia
(Photo: Matt Hansen and Kenyan Colleague)
I've probably done more than 30 appendectomies so far during my general surgical residency. For all the times I've taken care of someone with appendicitis, rarely, if ever, has the thought that they might die from the illness crossed my mind. Indeed, some of these patients were quite sick; but once they presented to medical attention, we could get them through their illness. Many of these patients were young which help in their recovery.
My first week in Kenya changed my history with this nearly ubiquitous American surgical disease. We took care of a 20 year old male who presented to an outside facility with appendicitis of about two weeks duration. While he didn't have a CT scan to review, I'm sure his appendix was perforated. He, appropriately, underwent an open appendectomy by these physicians. Unfortunately, he required another operation shortly thereafter necessitating resection of the right side of his colon (the part of the colon to which the appendix is attached). He was discharged from that hospital and presented to Kijabe Hospital with stool leaking from his wound. The connection of his intestine had completely broken down, likely result of weeks of malnutrition and intra-abdominal infection. We performed additional operations to resect the damaged colon but the insult was too great. He died during my second weekend in Kijabe.
There I was, presented with a 20 year old, previously healthy man who died of an illness I’d not ever known in my short professional career to be fatal (although I think it's important to note that there is still a generation of American surgeons who certainly understand death secondary to appendicitis). Admittedly, appendicitis is much less common in Kenya, but nevertheless, his death was a tangible reminder to me of how the lack of medical resources and access to healthcare can truly affect patient outcomes. I’m not sure what kept this young man from presenting to medical attention sooner, it was probably a combination of lack of financial resources, poor access to care and cultural limitations, but had he presented earlier, he would have likely survived.
This, and other, experiences in Kijabe changed my view of global health. It’s so much more than just doing operations or treating patients in a hospital or clinic. Where the real efforts are being made and continue to be made is in creating a system in which patients get open access and timely care for both acute and chronic disease. Surely, as long as there is poverty, this will be difficult. However, if healthcare professionals of the caliber I interacted with in Kijabe continue to commit time and resources to a needy people, the outlook continues to look bright.