Last September at the Kenyatta National Hospital in Nairobi, Kenya, residents in orthopedic surgery and neurosurgery got a sense of what their U.S. counterparts experience. Virginia Mason complex spine fellow Vijay Yanamadala, MD, traded information with the young doctors as part of his volunteer surgery work at the massive 3,000-bed hospital. Creating a learning environment with the residents – some inspired to further their education in the U.S. – was an important cohort in the week-long mission.
Virginia Mason neurosurgeon Jean-Christophe Leveque, MD, who also volunteered in Nairobi, works through the NuVasive Spine Foundation, a nonprofit organization providing surgery and advanced training to disadvantaged communities in Africa. Dr. Leveque praises the shift he sees in the medical missions from simply performing a series of surgeries to partnering with the resident surgeons for training opportunities.
“When you interact with the residents on the surgical cases, not only are they getting instruction from the experienced surgeons, but they do the follow-up care with patients and keep in touch with us on their progress,” says Dr. Leveque.
Of the 18 surgical cases completed during the mission, the majority were to correct spine deformities caused by long-term tuberculosis (TB) infection. If the infection spreads from the lungs to the spine, a severe form of arthritis can develop. Eventual collapse of the vertebrae can lead to deformities, nerve damage and paralysis. Spinal TB is an ongoing threat in underdeveloped countries, where access to anti-TB drugs and public health care is scarce.
Despite having nearly 10 times the beds of Virginia Mason Hospital, Kenyatta National Hospital is challenged to serve all patients, with hundreds doubling up in single beds or sleeping on the floor. The power can be fickle, as can the running water: scrubbing before surgery was sometimes a dousing with an alcohol-based solution. Yet there were surprising things Virginia Mason shared with this hospital across the world.
“We asked the hospital’s chief quality officer what kind of quality improvement projects they were working on,” remembers Dr. Yanamadala. “She said ‘5S kaizen.’ Even in a resource poor environment, their priority was an efficient, productive hospital. I realized there is no setting where these principles can’t apply.”
Only about 12 neurosurgeons and 60 orthopedic surgeons practice in Kenya, serving a population of 64 million. There are no complex spine fellowships because there’s no one to teach them. Missions like the one Dr. Leveque and Dr. Yanamadala completed are first steps toward growing programs to advance patient care around the world.
“There is no way we can treat all the patients who need surgery the week we are there,” says Dr. Yanamadala. “But we can help train and inspire new doctors to continue the work going forward.”
A version of this story previously appeared on Virginia Mason’s internal news site.