General Surgery
Medical Specialties
The General Surgery Department Tenwek Hospital has a long legacy of providing high quality surgical care to people from western Kenya and beyond. For decades, the hospital has been the referral center for complex surgical cases in the region. The breadth of routine and emergency surgeries that faculty and residents provide is wide and can range from the general to complex oncology cases and vascular procedures. Surgeons also provide some specialty services such as basic urology and ENT procedures.
Most patients come from the surrounding area in western Kenya. However, it is not uncommon to have patients referred from Nairobi and even from the coastal areas of Kenya. The local tribe is the Kipsigis tribe, which is a warm and hospitable culture and makes care for these patients rewarding.
The area is relatively rural and patients often present late in their disease course. They are frequently quite ill upon arrival and require engaged surgeons to be able to steer them through a difficult course. Tenwek sees a lot of trauma ranging from typical blunt trauma sustained in road traffic accidents to arrow wounds from local fighting. Tenwek physicians also frequently manage complex oncology cases with locally advanced tumors making surgery in these patients difficult. The most common laparoscopic cases are laparoscopic cholecystectomies and laparoscopic Heller myotomies for achalasia.
Nutritional issues further compound recovery and complications from surgery. However, Tenwek patients are relatively young and with minimal comorbidities they often experience amazing recoveries.
Caring for surgical patients at Tenwek can be challenging – but it is an amazing place to be a surgeon. Surgeons who participate in a short-term medical mission trip provide valuable service in three critical areas: caring for patients, teaching residents, and providing a respite for long-term surgeons.
Daily Responsibilities of a Visiting Surgeon
A typical day begins at 7 a.m. with either rounds that include residents, visiting medical students, and interns; or a teaching conference, depending upon the day of the week.
A daily devotional and prayer are observed before patient rounds. Visiting staff are guided and oriented by long-term staff and residents. Surgeons help cover the weekly clinic and usually perform two to four surgeries on theater days. The non-call days end around 5 p.m., with often busy call-nights continuing beyond.
During a two-week visit, a surgeon might cover four or five calls, including a weekend.
Department Staff
The General Surgery Department is staffed by several full-time missionary general surgeons, including expatriate surgeons and Kenyan surgeons who have graduated from Tenwek’s residency program. General Surgery residents also provide supervised surgical care.
There is one Kenyan anesthesiologist on staff. Most of the anesthesia care is provided by anesthetists. Tenwek is a clinical training site for the Anesthesia Nurse training program sponsored by Kijabe Hospital.
Surgery Equipment
Tenwek’s operating rooms are equipped with much of the basic equipment available in US hospitals. This includes endoscopic towers, portable C-ARM fluro X-ray units, laparoscopic equipment, and portable ultrasound machines for line placement. There is limited Transesophageal ECHO capability. A Microscope is used for some neurosurgical procedures.
Tenwek Residency Program
The Tenwek General Surgery Residency program started in 2007 and is credentialed by the Pan-African Academy of Christian Surgeons (PAACS) and the College of Surgeons of East, Central , and Southern Africa (COSECSA). As of 2020, the program has graduated 15 general surgeons, all of whom have become board certified surgeons through COSECSA.
Tenwek’s residency program is similar to the American model of training. It is five years in duration and clinically heavy. Residents must learn to operate on a wide variety of surgical conditions so that they can provide surgical care in the under-resourced setting of East Africa.
Residents are very didactically oriented and study hard to pass certification tests. They are very teachable and welcome tips and other insights from visiting surgeons.
In addition, because this is a Christian faith-based program, there is also a spiritual curriculum which residents participate in. Following graduation, residents are encouraged to see their profession as a ministry and to invest in others through patient care, leadership, and discipleship. Almost all of Tenwek’s graduates are doing this and some have started surgical training programs at other hospitals. We are grateful to see God building his Kingdom through our graduates!
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