Orthopedic Surgery

Introduction & General Information

Aerial viewTenwek Hospital is a 300-bed Christian Mission Hospital located in the rural highlands of Kenya, 150 miles NW of Nairobi. It was founded by American nurses in the 1950s and its first physician, Dr. Ernest Steury, arrived in 1959. (The book, Miracle at Tenwek, tells his inspiring life story.)

Today, Tenwek serves 600,000 Kipsigis people in the region and receives referrals from throughout Kenya and surrounding East African countries. Learn more at the Tenwek Hospital website.

Tenwek-ResidentsTenwek is a major training center with residencies for African physicians in Family Practice and General and Orthopedic surgery through the Pan-African Academy of Christian Surgeons (PAACS). About sixteen interns do their first year of training at Tenwek each year; approximately 22-25 residents serve at Tenwek in Surgery, Orthopedics, and Family Practice. There is a large Nursing School on campus as well as a Chaplaincy School. Tenwek has a large, active Community Health department impacting a wide geographic area and serving as a model program for developing countries.

 

Orthopedic Surgery Department at Tenwek

Tenwek Hospital has for decades taken care of a high volume of orthopedic surgical patients. In the early years, general surgeons performed the majority of the procedures with an occasional visiting orthopedist helping out and bringing implants and equipment. The last decade has seen significant growth in the Orthopedic Department.

In 2009, Drs. Dan Galat from the USA and Geoffrey Koech from Kenya (more commonly known as Dr. Kiprono) joined the Tenwek staff as orthopedic surgery consultants. In 2013, the first Pan African Academy of Christian Surgeons (PAACS) orthopedic residency program started at Tenwek to train East African physicians to be capable, compassionate, and missions-minded orthopedic surgeons. Currently there are eight orthopedic residents at Tenwek and the first “graduating class” of two residents will be in December 2018. In 2016 Dr. Dylan Nugent arrived at Tenwek full time. He and Dr. Kiprono (seen in photo) currently form the backbone of the Orthopedic consulting staff.

Trauma patients make up the majority of orthopedic admissions to Tenwek Hospital. There also are many patients with musculoskeletal infections and tumors. Participation in sports is becoming more common in Kenya and arthroscopic procedures are increasing in number. Hand and wrist trauma from panga (machete) altercations are common and visiting staff with upper extremity expertise are very welcome. Congenital and acquired deformities are common and frequently reconstructed. Post-infectious and degenerative arthritis has always been prevalent in the patient population but now adult reconstructive procedures are performed weekly. Spine procedures are performed by Dr. Will Copeland, a neurosurgeon.

Equipment

The operating theatre at Tenwek has two rooms open for orthopedic procedures each day and a third room two days a week. Anesthesia is provided by capable nurse anesthetists. There are two C-Arms used primarily by ortho. An aging fracture table is in one of the rooms. Implants come from a variety of sources.

The SIGN nail  has been valuable resource for stabilizing femoral, tibial, and humeral fractures and also is used for ankle arthrodesis. There is a limited supply of reconstructive femoral nails and peri-articular plates with locking screws. The plates and screws used routinely are sourced from India vendors.

Total joint components are American-made by DePuy or Smith-Nephew. Radiographs are digital and viewed on a hospital wide PACS system.  Tenwek has a CT scanner on site. MRIs are currently obtained at outside facilities.

The Role of the Visiting Orthopedist at Tenwek

Visiting orthopedic surgeons or residents have as their “main job” to represent the Lord Jesus Christ as His ambassador to all those they come in contact with. The Tenwek motto, We Treat, Jesus Heals is lived out each day in the orthopedic surgery department. Many visiting surgeons may have as their main goal to operate as much as possible. While many patients would no doubt benefit from the visitor’s surgical talents, the bigger goal is teaching the Tenwek orthopedic residents the clinical and surgical skills that would equip them for a lifetime of service and witness to thousands of patients. Visiting staff mentoring residents in orthopedic training and in their relationship with Jesus is vitally important to the mission of the hospital.

Rounds usually begin at 7:00 am and surgery starts about 9:00. Three or four cases are done in each room each day. There are breaks for chai tea and lunch that can be both welcome and frustrating if there is much to be done. Tenwek has an HMIS so the residents and interns do the “paperwork” on-line. Visiting staff are welcome to make clinical entries but most find it is not necessary to learn a new HMIS system.  The day usually ends at about 5:30 pm. Call is usually every third night and it is backup for a senior and junior resident.  The visiting consultant may get a call or two at night but it is unusual to operate. The residents are capable of washing out open fractures and placing external fixation devices without the consultant present.

There is Ortho Clinic daily with approximately 80 patients seen. The visitors are encouraged to take their turn in clinic, supervising a team of a resident, intern, clinical officers, and physical therapists. Usually a visiting orthopedist will go from room-to-room and answer questions.

Visitors also are able to involve themselves in areas outside of medicine and spouses can find numerous opportunities for meaningful service. Showing hospitality to other visitors, long-term missionaries, and Kenyan acquaintances provides encouragement and adds to the short-term missions experience. There are numerous churches in the area that welcome visitors and give the occasion to develop fast friendships with those in the community. The Tenwek countryside is beautiful and there are many dirt roads and paths to explore. Something is always happening around Tenwek. One needs only show up to be blessed in some way. Spouses are welcome and usually have no trouble serving and keeping busy in new and exciting ways.

 

 

 

Travel and Housing

Most physicians who serve at Tenwek do so under the auspices of World Medical Mission, a branch of Samaritan’s Purse (SP) It is a long journey to Kenya but once there, SP has staff who meet you at the airport and arrange a night at a guesthouse in Nairobi if necessary.

Tenwek Guesthouse
SP drivers will drive you four hours to Tenwek through the Rift Valley and center of Maasai land. There is a comfortable guesthouse on campus with private apartments. There is also a  common area and cooking staff (or you can cook yourself). Tenwek is in a rural mountainous area surrounded by small farms and tea plantations. It is a family-friendly environment and a safe area. Elevation is 6,000 ft so although you are near the equator the climate is moderate and changes with the rhythm of “dry” and “rainy” seasons.

 

African Safari Opportunity

masai-mara

 

The world famous Maasai Mara game preserve is just two hours south of Tenwek. Many visitors work with the hospital staff to arrange a short visit to “The Mara.” Hospital volunteers receive significantly discounted rates for this is a once-in-a-lifetime experience. Learn more about the Fairmont Mara Safari Club in this video.

 

 

 

Where do I go from here?

If you are interested in serving at Tenwek or being part of our Orthopedic Surgery team, please contact Keith Braun (knkjjk@cox.net) or Dayna Wright who oversees volunteer physicians for Tenwek at World Medical Missions (dwright@samaritan.org /828-278-1168).

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