When We Come To It

We are all back in the United States. It is somewhat hard to comprehend the this trip – almost 3 years in planning – has come to an end. As expected the experience was unforgettable and yet so different from our expectations. What is next?

First thing is a debriefing with the orthopedic chair at KCMC. We had a great trip and met some long-term colleagues. Many of the residents there yearn for more learning, instruction, and skills. We continue to communicate with them on WhatsApp with orthopedic questions and reliving inside jokes from our visit. But there is room for improvement. The OR schedule is slow and flawed. Al of us were disappointed in our total case load. Some of this is economics but there is also a lack of organization and planning from our host department. How can we maximize the time spent of visiting sub-specialists at KCMC. The travel to Africa is long and arduous, next visits have to provide more time for the traveling specialist to provide hands-on training.

Second, how does the KCMC program plan to improve training for the increasing load of residents. There is 1 OR for nearly 50 residents. Simple math shows that the graduating residents are not going to see/do enough cases to be prepared for their medical practice. Overall case volume at KCMC seems to be falling. Is this just a small snapshot in time or is there a migration of medical care away from the government run hospital? Again, the local staff have to take a strong role in leadership here. What is the plan for appropriate training moving forward.

I do not think these concerns are unique to our site. As a volunteer, can we balance the desire to work and teach efficiently with the constraints of the resource limited environment. How do we hold the local program accountable for “self-inflicted” problems such as implant organization, self-accountability, training program expectations? Can we critique without sounding over-bearing or condescending?

I think the debriefing will be important as we look to the desire of both sides to continue our relationship unchanged or remodel the structure.

That all being said, the memories and experiences of our month will be carried with us forever. It has raised, again, my appreciation for healthcare in the States especially the structure and attention to training of future physicians. It has driven home the need for continued involvement to work toward a stronger global health environment. It has created friendships – both in and out of the hospital – that I will cherish forever. A special thank you to my travel companions – you made the trip and the moments!