Kenya Initiative

After 27 hours of travel (New Haven to JFK Airport to Amsterdam to Nairobi to Nanyuki) and one flat tire at the airport, John Colberg and Campbell Bryson have arrived in Kenya! Thanks to the assistance of their driver, Kennedy, after a 3.5 hour ride from Nairobi Colberg and Bryson arrived safe and sound at their hotel in Nanyuki at 1:00 a.m. Sunday morning.

Today is the first day where Colberg and Bryson will see patients at the Nanyuki Teaching and Referral Hospital, so we are all looking forward to their next update. For reference, Kenya is 7 hours ahead of us in Connecticut.

Dr. Campbell Bryson reports that Day Two was "a great day." Drs. Colberg and Bryson visited Nanyuki Teaching and Referral Hospital, and spoke with a few administrators and received an overview of the hospital: the physicians who work there and the type of patients they see. Dr. Bryson also noted, "We also learned a lot about the Kenyan healthcare system as a whole; we then took a tour of the grounds and saw the wards, the clinic facilities, the separate 3-bed emergency department, the OR prep areas, and then we had a chance to meet the patients we will operate on. After physically evaluating a few patients, we decided that surgery wasn’t indicated for them at this time, but the rest were then admitted to the wards for preoperative evaluation before surgery. The hospital is a very different environment to back home, probably better to show through pictures."

The town nearby had a mall with a large grocery store and a KFC. Nanyuki sits basically on the equator so it gets dark very early - by 7:00 p.m. it’s black out!

Day Three ended up being Labour Day in Kenya so the Nanyuki Hospital operating room was closed. Taking advantage of this free time, Drs. Colberg and Bryson went on safari. Dr. Bryson share this about their day:

"Today was Labour Day in Kenya, so we took the advantage of the closed OR at the hospital for a safari day! We were picked up before dawn by our driver George and traveled to Ol Pejeta Conservancy, a 90,000 square foot non-profit wildlife conservation area. The car the drove through the vast area, sticking to dirt tracks as our guide. The huge area includes grassplains, thick forest-like areas, and rivers. We were able to see many, many animals freely roaming - hundreds of zebra, buffalo, wild hogs, and gazelle were the mainstays. We also saw elephants, including one who was just meters from us near the road. We also saw one lone female lion stalking a gazelle, though no great drama happened. There were a few enclosed areas fenced off to keep predators out. Here we saw the last two surviving North African White Rhinos, both female. The lone male died of natural causes last month and got a lot of press. We also were able to get out of the car and feed an old blind black rhino, and some chimpanzees.

The guides taught a lot about the conservation effort, and the need for more money and resources to keep the animals thriving and also to keep away poachers. We saw a small cemetery showing headstones for all the rhinos who died in captivity, nearly all from poaching, which was a grim reminder. We had a delicious lunch at a restaurant right in the middle of the park. For obvious reasons, exotic meats weren’t included. We then left the park and traveled to another area on Mount Kenya called “the orphanage,” which was really closer to a large animal petting zoo composed of lynx, ostriches, llamas, giant tortoises, two pygmy hippos, a leopard in the trees, and monkeys. It was very interactive with a lot of the animals roaming free. Definitely scary to have a 7-8 foot ostrich come right at you looking for food. After exploring the orphanage we headed home, it was about an 11 hour trip all included, so we were both tired. Tomorrow we will go to the hospital for the first day of operating."

From Dr. Campbell Bryson: "Today was the first operative day for us. We planned to start around 9:00 a.m., but an ENT case ran long and then a prolonged extubation pushed us back to an 11:00 a.m. start. Given the shortened day, we did three cases - two pediatric (an orchiopexy and a communicating hydrocelectomy) and one adult (an evacuation of a large clot in a scrotum after a previous hydrocelectomy one month ago).

There were many differences in the OR in Nanyuki compared to Yale. Notably, there is an obvious push towards conservation. Almost everything is reused or recycled. Nothing disposable like suture is put on the table until specifically asked for. The economic approach to operating is evident in the garbage - there is almost none. I think there is certainly something to be said about how much waste can be found in our system, which puts a lot of emphasis on disposable or one-time-use-only surgical items. The Kenyan doctors were very curious about how we approach our surgeries, and they lent us their surgical intern, Liz, to come join our cases scrubbed in, while they stayed unscrubbed. She did a great job, and though she confessed she is really going into anesthesia, she was engaged, bright (and very, very helpful in navigating the system!).

Following the cases, Dr. Colberg did a presentation to about 20 physicians from the local area, first giving an overview of Yale Urology and our scope of practice, and then he gave a talk about the current status of prostate cancer, with an emphasis on the controversy of the PSA screening test. The physicians had a range of backgrounds including family medicine, surgery and OBGyn among others, and they had thoughtful comments and questions. Overall, there was a strong mood of collegiality and hope for building our partnership going forward."

Day five brought to light the challenges that remote hospitals often face - a lack of manpower and supplies to accommodate non-critical cases alongside emergency cases. Unfortunately the emergencies that came in took precedence over the cases scheduled for Drs. Colberg and Bryson, but they made the best of the day, learning more about the region, its history and culture, and they got in time to prep for an equally important portion of their trip: the Grand Rounds presentations to local physicians scheduled for day six.

From Dr. Campbell Bryson: "Today, we had a few setbacks in the OR. Our cases were bumped to accommodate a few surgical emergencies, and then there were equipment and power issues which made opening up a second OR unfeasible. Unfortunately for us, it was decided the two cases we had scheduled for today would be postponed. They were both non-urgent scrotal cases and they will get covered next week, but it was still a disappointment. In light of this, we were able to call up George who took us for a long drive around Mt. Kenya (which is the highest mountain in Kenya, and second highest in Africa next to Mt. Kilimanjaro). While we weren't in the OR, we continued immerse ourselves in the local culture and gain more insight into their beliefs and lifestyle, which can be put to use when meeting with patients and physicians in future trips. George grew up around the area and had a lot of knowledge to share on the region's history and way of life.

Upon returning to the hotel, I started to put some finishing touches on a Grand Rounds presentation I will be giving to physicians tomorrow morning. Being able to share our experience and knowledge with the physicians here has been tremendous, and with our upcoming presentations, we'll be able to talk about cases and what we learned and share that with the group."

The inaugural trip to Nanyuki, Kenya has come to a close, and Drs. Colberg and Bryson spent their final day with the full staff of the hospital. After nearly one week of acclimating to a different part of the world, learning about the Kenyan healthcare system, and sharing as much of their knowledge and skills as possible with the Nanyuki staff, Drs. Colberg and Bryson are making their long journey back to the U.S. We all look forward to learning from their experience and applying this information to the next trip, which is expected to take place this fall.

From Dr. Campbell Bryson: "Today was the last day in Kenya. At the hospital this morning, I gave a talk on urological trauma to the full staff: doctors, residents, nurses, students and administrators. It was their CME event for the week. After it was done, the group thanked us for coming to visit them, and then we had a debriefing with Dr. Njuguna and Sammy Kilonzo to discuss our trip. Both our teams are looking forward to future trips. After saying our goodbyes, we started our long trip back home (we’re in the Nairobi Airport now). Kennedy’s brother John drove us from Nanyuki to Nairobi. We expect to arrive back in NYC around 1:00 p.m. EST time tomorrow (Saturday)."