Tenwek Vitals
361-bed Christian Mission Hospital
Hospital staff: 800+
Inpatients/year: 15,000+
Outpatients/year: 220,000+
Surgeries/year: 6,000
Births/year: approx. 3,000
Hospital-wide HMIS and radiology PACS system
Full-time missionary staff includes physicians in:
General and Orthopedic Surgery
Family Practice
Internal Medicine
Neurosurgery
Pediatrics
Pediatric Surgery
OB/GYN
Ophthalmology
Gastroenterology
The Department of Obstetrics and Gynecology (OBGYN) is a growing service at Tenwek Hospital. OBGYN physicians primarily serve high-risk obstetrics patients and other complicated OBGYN medical and surgical conditions.
OBGYN has the feel of a busy public hospital. The busiest part of the service is obstetrics. The Maternity Unit, which includes a NICU/ newborn nursery, is the largest single department in the hospital. Moms and babies make up approximately 100 beds. The Unit is very busy with low risk mothers arriving for delivery who have had prenatal care at the Tenwek maternity clinics and also women without prenatal care. There were 4,951 admissions to the unit, with 3,273 deliveries in 2018. Women in cesarean section rate at 22%, with increased numbers of both in 2019 by about 10-15%. Women in labor are managed by Kenyan nurse-midwives, with doctors providing constant support if complications arise.
The Ob/Gyn Physician’s Role at Tenwek
There is an OB operating room in Maternity and available OR space in the Main “Theatre.” When on call, the visiting physician will perform or supervise this surgery. There is a maternal-child health clinic where prenatal care is provided Monday through Friday. Complicated pregnancies are referred to the obstetrics team while normal pregnancies are generally cared for by MCH nurses and clinical officers. The Tenwek OB service provides care for many complicated patients.
The Obstetric service includes many high-risk antepartum patients with the diagnosis of chronic hypertension, preeclampsia, preterm labor, preterm premature rupture of the membranes, rheumatic heart disease, and diabetes, as well as frequent patients with severe HELLP syndrome, many complicated by IUGR. HIV affects about 5% of the patients.
The Gynecologic service also is busy. Gyn clinic is held on Wednesdays, and elective Gyn surgical cases are done in the Main Theatre Tuesdays and Thursdays. Surgery for fibroids (hysterectomy and myomectomy) are the most common Gyn elective cases. Nonelective cases include pelvic masses, ectopics, D&Cs for hemorrhage and complicated pelvic abscesses. Advanced gynecologic cancers are frequently encountered, particularly cervical, uterine and ovarian.
Department Equipment
The unique challenges of providing care in a resource-poor country makes treatment much more difficult. Tenwek is one of the few hospitals in Kenya that provides electronic fetal monitoring. This is a tertiary center by Kenyan standards, with a CT scanner and NICU with ventilator capability. However, nothing is easy or straightforward. You have to be flexible, innovative, and creative.
Five new fetal monitors were delivered by Dr. Phil Greig, FOT’s Champion for OB/Gyn. The maternity unit and the radiology department have ultrasound machines, including a vaginal probe transducer. Ultrasound expertise is needed to teach the ultrasound techs and provide Ob and Gyn ultrasound diagnostic evaluations on a daily basis.
Department Staff
The OB/Gyn team is comprised of:
- Long-term and visiting OB/Gyn consultants (specialists)
- A medical officer (general practitioner)
- A physician assistant specializing in reproductive healthcare
- Medical officer interns completing their clinical training
- Physician assistant (clinical officer) interns.
- 1-2 medical students
In addition, most of the year, a first or second year surgical resident is rotating on the service. Family Practice residents also come in three-month rotations.
This is the only training they will receive in women’s health so they need intense and comprehensive training during their clinical rotation. Visiting OB/Gyns will work with long term staff and will be involved in many aspects of care and teaching of our students, interns and residents. These young staff are so enthusiastic and eager to learn; this is one of the most rewarding parts of service at Tenwek.
Daily morning rounds are done on all the patients, along with prayer with each.
Department Residency
Tenwek has received approval from PAACS to begin residency training in the OB/Gyn specialty. The development of curriculum and training modules is underway. Tenwek hopes to recruit international OB/Gyn faculty who can provide teaching at Tenwek for a minimum of two weeks per year and possible telemedicine consultation.
We invite you to come and experience the adventure of practicing and teaching all aspects of Obstetrics and Gynecology in Africa. You will be changed forever.
