Care Challenges in Kenya
By Natasha Pyykko, CRNA
I was fortunate enough to serve on a medical mission trip with Kenya Relief in July, providing critical anesthesia services to patients who would otherwise go without. Access to basic healthcare, surgery, and safe anesthesia care is scarce throughout the developing world. Kenya Relief, founded by Alabama nurse anesthetist Steve James, assembles teams of surgeons, anesthesia professionals, and operating room staff to deliver surgical and anesthesia services to the people of Migori, Kenya.
My experience in Kenya was immensely challenging and even life-changing. It helped me grow as an anesthesia professional, as I had to practice outside of my comfort zone without the equipment I’m accustomed to having. The facility – the Brase Clinic and Vision Center – consisted of a small clinic, two double-suite operating rooms, and a makeshift recovery room. Our selection of pharmacological agents was minimal, and some medications were past their expiration dates. The only available muscle relaxant was succinylcholine, and we had minimal analgesic agents. Our vital sign monitors worked sporadically and the power supply to the clinic was unreliable, so we had frequent power outages.
Our team consisted of four ENT surgeons, one general surgeon, one plastic surgeon, five nurse anesthetists, one anesthesiologist, and 14 other professionals in various roles. The days were long and hot. We started our surgical days at 6:30 a.m. and ended between 7 and 9 p.m. We evaluated over 300 hundred patients and performed more than 80 surgeries. Most of the operations were for large masses and goiters.
These were some of the most difficult airways I have seen! We had minimal airway equipment and pharmacologic agents. We had to be creative in the induction and maintenance of anesthesia, and we even did a few awake intubations. We were able to successfully and safely anesthetize every patient. There was nothing like this in my anesthesia training.
We were fortunate to have a few translators. Kenya’s main language is Swahili, but there are over 25 other local tribal languages. There were times where we had three or four people translating into different languages to allow us to communicate with our patients. We worked together and accomplished our goal of providing care for the people of Migori, even with the language barrier, long hours, and suboptimal working conditions.
I was so inspired by how strong the people of Kenya are. Many of them traveled hundreds of kilometers, walking for two or three days on foot to come to the clinic. We did preoperative evaluations for all the surgical patients on one day, and then did several days of surgery. The patients would wait, sometimes camping outside, for days to have their surgery. Not once did any of them complain. They would welcome us each morning by singing as we entered the clinic. They were so thankful for our services.
Doing a mission trip like this really puts things into perspective – not just anesthesia care but life in general. I am so fortunate to live in Los Angeles and work at UCLA. I have access to the highest quality medical care at my fingertips. I work with top-of-the-line physicians, nurses, equipment, and monitors, and have every pharmacologic agent I could ever want for my patients. With one phone call I can consult with a cardiologist or a critical care physician. Providing anesthesia care with Kenya Relief truly helped me grow as an anesthesia professional and as a person.
Kenya Relief has served over 1,000 patients with the help of over 300 medical and surgical missionaries this year alone. The organization hopes to expand the Brase Clinic and Vision Center into a 300-bed inpatient hospital, with the help of volunteers and generous donors.