The proposed global health trip is part of a long-standing annual surgical mission to Malindi, Kenya spearheaded by Dr. James Netterville and the Vanderbilt Department of Otolaryngology – Head and Neck Surgery. The overarching goal of this endeavor is to provide durable and sustainable treatment of head and neck cancer as well as other otolaryngologic conditions to underserved communities in Malindi. This will be accomplished through both direct clinical care as well as through education of local head and neck surgeons.
A carefully selected team of residents, fellows and attending surgeons from Vanderbilt University, the Ohio State University, and Indiana University will work with local attending surgeons and trainees to perform both major and minor operations for patients in Malindi. In addition to excellent clinical care, active training of medical students, residents and fellows from Kenya and surrounding countries remain central to the mission of the trip. This element is critical to generating a sustainable long-term impact on this community. Ultimately, our goal is to establish a head and neck surgical oncology fellowship based in Malindi in the coming years.
My role as a head and neck surgery fellow is to assist surgical procedures and teach trainees in the operating room. I aim to contribute to the educational program of local surgical trainees while there and also assist with laying the groundwork for establishing a head and neck fellowship. Furthermore, I will be engaging in the peri-operative management of patients, primarily in the post-surgical setting.
The population we aim to serve on this global health mission includes both the patients of Malindi, Kenya as well as the local head and neck surgeons. The decision to proceed with this location was a joint decision between Vanderbilt and local providers as Malindi has a dearth of otolaryngology care. Similar to Malindi, Kijabe is another city in Kenya that has been the focus of numerous past mission trips from Vanderbilt. With these efforts, Kijabe now has a head and neck surgical oncology fellowship as well as established otolaryngology care that is led by local providers. In a similar vein, we hope to replicate this success in Malindi and have been traveling here annually now for over 7 years.
The patients of Malindi have varied head and neck pathologies including malignant tumors of the head and neck, thyroid disease, as well as other benign neoplasms. Given the lack of consistent otolaryngology care, there is a significant clinical need in this patient population. We aim to provide the education and resources to work towards establishing a robust framework from which local otolaryngology surgeons may provide expert surgical care to their communities.
From a direct clinical impact standpoint, our goal is to provide world-class care to local patients in need of intervention. We anticipate performing at least 60 major operations that are greater than 3 hours in length or require an inpatient admission post-operatively. In addition to this, we plan to perform an additional 100 or more minor operations. At the same time, our goal is to educate local Kenyan residents and attending surgeons in order to maintain continuity of high-level care to the local community long after we depart.
In addition to providing surgical treatment of head and neck pathologies, we plan to also expand educational programs in hearing screening in the pediatric population. This program will allow for implementation of basic hearing tests in schools and doctor’s offices to improve early detection of childhood hearing loss.
Another program that will be enacted during this trip will be a formalized ultrasound curriculum for Kenyan surgeons. This will allow for the development of both diagnostic and procedural skills using a platform that provides critical clinical information at low cost. Additional workshops could subsequently be organized by Kenyan providers to continue expanding ultrasound skills and we anticipate that this will continue to provide significant value to local communities. We have successfully applied for and acquired funding for 5 ultrasound machines to be used on this year’s mission trip.
The experiences from this trip will not only benefit the patients and Kenyan trainees but also all participants. This global health mission will provide valuable insights into how to provide sustainable care abroad and hopefully serve as a model for future ventures. Lastly, this trip will be an important building block towards shaping a future head and neck surgical oncology fellowship based in Malindi.
This was a truly exceptional mission trip with the primary focus on training local surgeons to approach complex head and neck tumors (both benign and malignant). The longitudinal relationship that has developed between the US surgeons/institutions and the local Kenyan surgeons has laid the groundwork for future growth with the ultimate goal to establish a head and neck surgical fellowship. Aside from just the large number of patients that were directly impacted by the surgeries, education of medical students, residents and fellows occurred throughout the trip.
From clinic screenings to outpatient clinic procedures, the medical student cohort played an instrumental role in both providing direct patient care as well as creating a streamlined schedule for the rest of the team. Furthermore, both Kenyan and US residents collaborated daily in pre-operative optimization and workup as well as in post-operative care. During the operations themselves, the Kenyan residents and attendings were able to learn and improve skills in complex ablative and reconstructive surgery with guidance from US surgeons.
In addition to this, morning didactics were lead by US surgeons on high yield topics pertaining to anatomical dissection as well as management of specific head and neck pathologies. These were often cases that were on the schedule for that specific day. This allowed for back and forth discussions and was very well received.
In the end, the trip was successful from both an education and clinical impact standpoint. The primary goal of this longitudinal trip is to establish infrastructure for Kenyan surgeons to grow in their skills to be able to manage these complex head and neck tumors. I believe we were able to generate a significant positive impact during our time there. I look forward to the continued development of the local Kenyan surgeons and future establishment of a head and neck fellowship in the region.
Lastly, this was also a very impactful trip for me. It was eye-opening to manage and run a surgical mission in a resource poor environment. It was both humbling and inspiring, and I look forward to continue doing work like this in the future.
