361-bed Christian Mission Hospital
Hospital staff: 800+
Births/year: approx. 3,000
Hospital-wide HMIS and radiology PACS system
Full-time missionary staff includes physicians in:
General and Orthopedic Surgery
These are exciting times for the practice of nephrology at Tenwek. The specialty is undergoing a major transition — from conservative management to the provision of dialysis as a hospital service. Building modifications are underway for a hemodialysis unit adjacent to the main hospital building. Fresinius has a presence in Kenya, and staff is being trained. The standard of care is evolving, and you can be a part of it.
Kidneys fail in Africa for familiar reasons: hypertension, diabetes, nephrotic syndrome, and obstructive uropathy. Since the mission hospital lacks tertiary pathology services and Nairobi is inaccessible to many of our patients, the majority of stage 3 and 4 patients are managed without biopsy. A knowledge of statistics and discernment of the risk/benefit ratio are what we can offer our patients. Patients on high-dose steroids are followed in clinic. Urologic interventions are currently limited, and provided by general surgery. We see a significant amount of HIV-associated nephropathy, and are able to offer effective treatment for this as well.
Daily Responsibilities of a Visiting Nephrologist
As a nephrologist you are comfortable with the inpatient care of sick adult patients, and this will be the backbone of your service at Tenwek. Tenwek is a teaching hospital, and ward rounds with the Kenyan MO and CO trainees will be a daily opportunity to share your knowledge and multiply the impact of your skill as a clinician. Your interns will take first call and you can expect to provide night coverage as a consultant every third or fourth night during your visit. There is a sizable outpatient clinic in the afternoons, and your consultative skills will find application there as well.
There is already some outpatient dialysis in the community facilities around Tenwek. The Kenyan national health service does not currently fund the program to KDOQI standards of adequacy, but the availability of even limited treatment represents hope for end stage patients. The challenges are many. Most of the long-term hospital staff are generalists, skilled in the medicine of limited resources but unfamiliar with the unique problems of ESRD patients in the context of dialysis. Training and teaching represent a major opportunity. Too many patients have catheters, and surgical or interventional radiology support is needed. And only half of our patients have coverage under the national health service. How will we sort all of this out? Proverbs 3:5-6. Trust in the Lord with all your heart….
Grow in Faith
In the States, we are taught not to impose our own value system on our patients. Too often this is accomplished through spiritual silence. At Tenwek you will hear the nursing service sing a hymn in the morning, you will pray at the bedside for the outcome of your patients, you will grow in your walk with the Lord.