Supplies shipped in to address the difficult task of providing healthcare in Kenya. Click here to view the entire photo gallery on KodakGallery.com.

For our next volunteer mission we may also incorporate some other volunteer activities (counseling, school building, and day care workers) for those that might be interested in coming along and are not qualified to work in a hospital.

If you are a doctor of any specialty, particularly an anesthesiologist, and are interested in possibly making the next trip with us, please e-mail me at bruce [at] knockfoundation.org or call 773.848.9551.

For more information on or to donate to Knock Foundation, Inc., please check out our website, www.knockfoundation.org.

Read Bruce’s posts, in order, that chronicle his trip to Kenya with Knock Foundation, and with support from United Therapies:

(Previous post: Development in Kenya: Hope Muddled with Heartbreak)

What most impressed me and, I think, the doctors is that although NPGH lacks even basic medical equipment and supplies (NPGH did not have a cystoscope (a basic piece found in any U.S. hospital or surgery center) and they specifically asked us to bring our own scrubs and surgical gloves), the Kenyan doctors, nurses and staff are no less committed to providing quality healthcare services than their American counterparts albeit with significantly more limited resources.

Indeed, the most significant obstacle to this seems to be the lack of basic medical equipment or outdated medical equipment (during one operation, the doctors used a circa 1950s Soviet piece of equipment used to electronically cauterize a bleeding wound) and, perhaps, more specialized training (most of the surgeons were general surgeons without specialized training).

For example, in the U.S. benign prostatic hyperplasia (enlarged prostate) is usually treated with a TURP (an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow), which is much less invasive then open surgery. Because of the lack of such equipment at NPGH, almost all such procedures are done as open surgical procedures that naturally have a much greater morbidity.

In some respects, it could be argued that the Kenyan doctors are every bit as skilled as their counterparts because the circumstances under which they operate call for much greater improvisation and technical skill because they cannot rely on technology to the extent their American counterparts can.

On our last day, I met with NPGH’s administrator, who expressed her great satisfaction with the doctors, their work ethic and professionalism and most importantly, how they conducted themselves and interacted with the staff which she said showed great respect for and humility towards their Kenyan counterparts. This contrasted markedly, she said, with a group of doctors that arrived the previous day and were demanding, condescending and so taxed NPGH limited personnel and equipment-related resources as to be not as helpful (or welcome) as one might otherwise expect.

There is little doubt that we acquitted ourselves well.

The trip was a great success and we have begun planning a return engagement, perhaps April 2012. We now have a much better idea as to what equipment and supplies we can bring which will, we hope, leave a lasting mark on the services NPGH will be able to provide.

Moreover, when the trip was to be two weeks, we had hoped to provide some educational training courses for the general surgeons and, perhaps, those surgical residents that might be interested in a urology specialty. This, we believe, would be the most significant thing that we can provide (in addition to equipment), as this person could pick up where the visiting doctors left off and then, rather than have visiting doctors clear a backlog of patients (which is essentially what we did), NPGH will be able to provide these services long after our departure.

(Previous post: The Notion of ‘Free’ Care )

I will not bore you by going into a day by day recitation of our activities but will, instead give you a general idea of what the days entailed as well as discuss a highlight, lowlight and provide you with my general impressions.

After Monday’s screenings, the remainder of the week was scheduled for surgery. NPGH had been kind to give us access to two of their six operating rooms (of which only four actually functioned).

The doctors would begin their day back at NPGH at 7:45 am where they would make rounds and see the patient’s they had operated on the previous day as well as talk with the patients that were scheduled for surgery that day. After making rounds, we would go to the doctor’s lounge and review the charts for the day’s patients and determine the proper order and who would be working on which patients (we had three doctors and 2 ORs which meant that two of our doctors would always be working together).

The doctors were ready to begin surgery by 9 am although, as in other parts of the world, time is an ephemeral notion in Kenya even with something as significant as surgery. Consequently, although informed that they were ready to begin surgery, the doctors might venture to the OR only to find the patient on a gurney in the hallway waiting to be taken into the OR to be prepped and anesthetized for surgery.

It was one of many significant cultural differences the doctors confronted. Throughout, the doctors acted with great humility understanding that even though they were volunteers providing much needed medical services, they were visitors in this country and at this hospital and acted accordingly. The doctors would typically perform surgeries from 9 am until 6 or 6:30, breaking with their Kenyan counterparts to share a lunch of ugali (cornmeal porridge) and beans. The next day the doctors would begin anew.

Without question one of the greatest moments came when we went into recovery on Thursday morning to check on the patients treated the previous day and the four-year-old girl that had a 5 kg (about 11 lb.) tumor removed from her stomach was sitting in bed crying. For the uninitiated, this might be cause for great concern not for the two doctors that spent six hours operating on her the previous day; her crying was almost as much a sign of recovery as a beating heart.

She continued to improve when we visited and examined her the next day while in the arms of her mother.

By far the most difficult experience occurred on Wednesday when the doctors were in the OR working from 9 am to 9:30 pm. On this day, a physician performed surgery on a patient but could not get the patient fully stabilized after the procedure. The patient continued to suffer from bleeding and blockage when the doctor decided to bring him back to the OR, open him up in an attempt to get him stabilized. With the assistance of the other doctors and their Kenyan counterparts, the team worked well into the night to finally get the man stabilized.

He was sent to the ICU in stable condition with the prognosis cautiously optimistic.

The next morning when we visited the previous day’s patients, we learned that the patient died at about 5 am that day, most likely from hypothermia (the body temperature drops to a level where the body can no longer function). Had the patient been in the U.S., this could probably have been avoided through the use of blankets and a bear hugger but at NPGH where medical equipment/devices are rare it is unfortunate that seemingly avoidable deaths are far more common.

(Previous post: Publicizing the Development Work Leads to Great Demand)

Many of the patients had not only been suffering for months but in many instances years and this provided them with a welcome opportunity to be treated by a specialist (some still had catheters that had been inserted months earlier).

As they saw patients, the doctors wrote into the patient’s booklet, which is carried by the patient and not maintained by the hospital, the diagnosis and the proposed treatment. We were never quite sure how a patient that was to have surgery was to be scheduled and, in some respects, assumed that when the doctors showed up to perform surgery on one of the following days, the patients on the schedule would not be there.

To say that we did not understand NPGH’s processes is a bit of an understatement and, from an American’s perspective, it appeared more like organized chaos than anything else. Yet as the day passed our confidence in the nurses convinced us that not only would patients be scheduled as directed but that prescriptions would be filled and tests would be taken.

As in any hospital, it seems as though the nurses are most responsible for the “efficient” running of the institution and its processes and somehow, despite all appearances to the contrary, get the job done. Just the same, we were still pleasantly surprised when the patients that were scheduled for surgery did in fact show up.

I would be remiss if I didn’t discuss the notion of “free” medical care. At the beginning of the screenings, there was a great deal of displeasure voiced by many patients. Indeed, a mini riot was brewing. I soon discovered that the radio advertisements informed the patients that care would be free; in fact, this was not the case. Even though this was a provincial hospital serving all comers (those with money or insurance would likely go to a private hospital with more modern amenities and equipment), nothing was free.

Indeed, patients scheduled for surgery were required to bring the disposables used in surgery. For example, if a procedure called for 100 liters of fluid and sutures, the patient would have to show up with cases of saline solution and a box of sutures the day prior to the surgery. NPGH staff would carefully check off all the items the patient brought and if they were satisfied the patient would have the procedure the next day as originally scheduled.

Moreover, the patient would have to pay operating room costs – about 5,000 Kenyan Shillings, equivalent to about $65.

Once I found out about this I made it clear to the patients that the doctors were providing their services free of charge and NPGH agreed to waive all operating room costs (although not supplies) as long as our doctors were doing the surgeries. Although not fully placated this seemed to calm every down. As an aside, because of time and equipment constraints, we were not able to perform scheduled surgeries on about 12 patients that had originally been scheduled which meant that, if they were subsequently operated on by a local surgeon, they would be responsible for the operating room fees which many could not afford.

Feeling an ethical responsibility to these patients that we screened, scheduled for surgery and most of whom had bought their supplies (which they had to take home and could not store at NPGH lest they disappear), we agreed to pay the operating fees when they scheduled the subsequent surgeries.

I believe this brought us even more goodwill from already grateful NPGH staff and patients alike.

(Previous post: Development in Kenya: A First-Person Account)

In anticipation of our volunteer mission, radio stations in Kisumu and the outlaying areas ran commercials informing the public that a team of five urologists from the U.S. would be at NPGH performing “free” screenings and treatment from Monday, April 19 through Friday, April 30. Consequently, on Monday, April 17, a week before the doctors finally arrived, I was informed that as of 8:00 am, 30 people had shown up waiting for the screenings.

This is highly unusual given that people have to travel a great distance and take different modes of transportation which is time consuming; consequently, NPGH expected most to show up between 10 am and 11 am local time, which they did. NPGH staff notified the patients to come back the following week when it was hoped the doctors would make it.

The prospective patients did return the following week, in significant numbers.

As westerners, it is unusual that people would travel great distances and endure hardship for medical care, let alone the possibility of free medical care. In Africa this is not uncommon.

Healthcare, like other things we take for granted, is far more scarce in Africa. As an example, in the greater Chicago area there are approximately 200 urologists serving a population of about 7 million. In Nyanza Province, Kenya, which has a population of between 5.5 and 7 million people, there is only one urologist. And he works at a private hospital which, because it is fee for service, is limited to the general population that cannot afford the care or that does not have some form of insurance.

NPGH, the hospital, was built in the 1960s by the Soviets and has the charm and aesthetic beauty found in Soviet-style block housing complexes. To soften the otherwise-harsh appearance, at some point the hospital was painted pink, which only further highlights its age and worn appearance. Pink buildings do not wear well particularly in dusty and dirty environs.

NPGH is the largest hospital in the province and serves as the feeder hospital for the local hospitals in the province; the cases that cannot be handled at the local hospitals, including the most difficult, are referred to NPGH.

As mentioned above, Monday was to be a clinic day where the doctors screened the patients and scheduled those that required surgery for surgery either on Tuesday, Wednesday, Thursday or Friday. The doctors began screening in the morning when the waiting “room” (an outdoor seating area), was already full with a disproportionate number of older men.

As the three doctors (the third arrived that morning at 8 am and immediately came to NPGH to participate in the day’s festivities) began the screenings, a nurse assisted each doctor with language or NPGH process issues. Additionally, two surgical residents accompanied each doctor so that they could observe and learn from the doctors.

Pleasantly surprising the nurses, the doctors worked through lunch and finished the screenings at about 4:30 pm (the surgical residents left for lunch promptly at 12 and never returned). Both nurses and patients commented on how respectful the doctors were and were appreciative that the doctors took the time to talk them and listen to their problems.

(Previous post: How Knock Foundation Partnered with United Urology Centers on Development Work in Africa)

The logistics in arranging such a trip are daunting; in short, we had to (among other things) (i) find a hospital willing to put up with us, (ii) pick dates and help arrange air, hotel and ground transport in a country half a world away, (iii) solicit physician volunteers and inform them as to the details of the trip and what they could expect (which we ourselves did not really know), (iv) get them licensed in Kenya, (v) collect and ship supplies ahead of time, and (vi) ensure that their time on the ground would be well spent.

Assisting me in these efforts (actually, she did much of the work and I mostly assisted her by pestering her with emails), was Beldina Opiyo-Omolo, the MCI Public Health Specialist in Kisumu, Kenya. To say that Beldina is an absolute force of nature is a gross understatement. Without her efforts and her dynamic personality, it’s hard to imagine this trip ever getting off the ground.

After spending two weeks with her, I’m more convinced than ever that she is the future of Kenya and could change the face of that country singlehandedly. As I did, those to that know her respect her intellect, drive and ability and, as a result, take the mission of MCI very seriously.

I arrived in Kisumu, Kenya on Monday, April 19, fewer than 24 hours after I was originally supposed to arrive and a full six days before the first two of my five doctors eventually arrived. This was not as originally planned but Eyjafjallajökull put months of painstaking planning in jeopardy and required creative thinking by me, the five doctor volunteers, our travel agent Sherry Widman, Beldina, and the administration of Nyanza Provincial General Hospital (NPGH) in Kisumu.

Eventually, three of the doctors made it but the trip was cut short to one week rather than the originally planned two.

In the summer of 2009, acting through a non-profit I founded with four others, Knock Foundation, Inc., I approached the Earth Institute at Columbia University on its Millennium Cities Initiative (MCI) about possibly working together. I had received a master’s degree from Columbia University’s School of International and Public Affairs and thought they might have some ideas as to how we could work together, which they did.

Knock’s vision is similar to that of MCI’s albeit significantly smaller in scale: to build a grassroots organization that initiates and actively affects positive change in the developing world. By working closely with affected communities, Knock develops comprehensive, self-sustaining and holistic practices designed to alleviate poverty and its attendant problems.

Our work stems from an abiding belief that to reach one’s full potential, every human being must have the opportunity to pursue an education, practice healthy living, and exist in a clean environment.

MCI is the urban counterpart to the Millennium Villages Project and an outgrowth of the national-level policy work carried out by the United Nations Millennium Project. MCI’s core mission is to help selected cities across sub-Saharan Africa complete an urban transformation — one essential to attaining the Millennium Development Goals eight fundamental and quantifiable targets agreed to by 192 countries — aimed at cutting in half extreme poverty and creating the conditions for sustainable economic development.

One of these targets relates to improving the delivery of quality healthcare.

Given my role with United Urology Centers, LLC and its relationship with more than 400 practicing urologists in the U.S., I thought this could provide a good opportunity. I approached the Company’s managers about “sponsoring” a trip of our urologists and they both agreed immediately. Although for healthcare regulatory reasons the Company was precluded from providing any financial assistance to the doctors for the trip (other than providing medical supplies and logistical support), the managers’ have always recognized the Company’s obligation to not only provide the highest caliber healthcare services available but also, to be good corporate citizens.

In the past, this obligation has been put into practice in not only providing free or significantly discounted care when circumstances warranted but also modifying company practices to be more “green” and environmentally sensitive. The latest and perhaps most committed demonstration of their dedication to good corporate citizenship, supporting a trip of our urologists overseas to provide much-needed medical care.

A series of future posts will chronicle those efforts. Both the Knock Foundation and United Urology Centers are proud to have been involved in this important project that addresses a problem that confronts not only Africa, but the entire global community as well.