Oral & MaxilloFacial Surgery
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
The Oral and MaxilloFacial Surgeon’s Role at Tenwek
There is not a full-time oral and maxillofacial surgeon (OMFS) serving Tenwek. The general surgeons are able to provide some treatments of head and neck disorders, but are unable to keep up with the demand or tackle the more challenging cases. The general dentist performs some of the needed dental alveolar surgery and trauma here, but not the more “complicated” cases.
The types of disorders the visiting OMFS may see include dental alveolar (removal of teeth, biopsies, pathology, and infections), cleft lips/palates, acute trauma and traumatic deformities, developmental disorders, and various types of infections and pathology. Ameloblastomas, ossifying fibromas, and large dentigerous cysts seem to be three of the more common ‘benign’ lesions of the jaws we see at Tenwek.
Malignant lesions of the mouth and head/neck are also frequently seen. Currently, an OMFS may be at Tenwek for only a couple of weeks each year and many patients in need of this type of care must go a year or more without treatment. Those fortunate enough to have the means, must travel to Nairobi for their care. As a result, patients often present with a more advanced stage and size of lesions than they would in the United States.
Anesthesia and Surgery Staff
Anesthesia is provided by a dedicated and well-experienced staff of Kenyan anesthetists. These practitioners are extremely well-versed in long and complex surgical cases. Visiting anesthesiologists may also provide anesthesia when serving at Tenwek. If and when indicated, the general surgeons will assist and/or work with the OMFS. The surgeons at Tenwek practice a much broader range of surgical care than those in the U.S., due to the need and their experience on the mission field. It can be advantageous to serve as a team of OMFS’s, OMFS/ENT, OMFS/Plastics, etc. The different backgrounds, as well as experience and training, often are complementary towards patients’ care.
Daily Schedule and Teaching Opportunities
The “typical” workday begins with morning rounds followed by conference/lecture/devotions – depending on the day. Surgeries begin at about 8:00 a.m. The visiting specialists are given preference in surgical scheduling while there for short periods of time. Consultations may be needed between surgeries or at the end of the day. Clinic patients are seen about two days per week. Although the OMFS is on-call at night, it is quite unusual to be called in. The surgical residents treat most emergencies and will involve the OMFS or consult with them the following day as appropriate.
One of the most gratifying aspects of serving at Tenwek is the opportunity to interact with and teach the general surgery residents in the PAACS program. A surgery resident is usually assigned to the oral surgeon so that he/she can be involved with and begin to appreciate the complexity of OMFS cases. Tenwek also has 16-18 first year interns in training each year whom the OMFS might interact with on rounds or morning report.
Other Important Information
The hospital has “gone digital” with an electronic HMIS for medical records as well as PACS for radiographs and CTs. Internet access is easily obtained and aids in communicating with “home” and there is a facile system to send CTs for review by your colleagues in the U.S.
East Africa’s largest eye/dental building recently opened at Tenwek. This incredible new facility provides clinic space, surgical suites and in-patient beds for dental, eye and oral surgery/ENT patients.
Our Future Goal
Our goal is to provide more continuous and predictable oral and maxillofacial surgical care at Tenwek with an oral and maxillofacial surgeon or a team rotating at least quarterly. We would also like to develop a team of oral surgeons willing to be available for consultation digitally to provide expertise and advice for the general surgeons at Tenwek.