AMPATH Surgery

Palliative Care is defined by the WHO as “an approach that improves the quality of life of patients and their families facing life-threatening illness through early identification and impeccable assessment and pain treatment of pain and other problems, physical, psychological, and spiritual.” Even before palliative care was officially recognized as an official sub-specialty in 2006, the need for its services on a global scale has been overwhelming. From 2007 to 2018, palliative care has grown on the African continent from 14 institutions to over 70. While such growth is profound, the focus of palliative care is currently narrow and most often in medical oncology. Therefore, many other high-risk patient populations who suffer from high pain and symptom burdens, surgical patients in particular, are left unaddressed.

Surgical disease represents nearly 30% of the global disease burden, and spans 100% of disease sub-categories. Due to limitations in operating room availability, supplies and trained surgeons, even patients who are able to reach the hospital may not receive the care they require. Therefore, patients who are younger, have treatable conditions, and do not require complex surgeries still face high rates of mortality and suffering. It has been shown that early palliative care intervention in surgical patients can decrease complications, improve quality of life, reduce healthcare costs, and increase survival. However, the sheer numbers of patients in need overwhelm the budding, under-staffed and under-resourced palliative care teams present. Therefore, surgical patients are often not linked to palliative care until death is imminent. This leaves patients to not only face astounding health inequality, but they must also do so in the midst of great pain and suffering. 

At MTRH, palliative care is integral to the surgical care delivery.  Many diseases that could have a surgical cure, present late with metastatic disease.  90% of our surgical oncology care is palliative in nature. Rather than curative resection, we perform surgeries to bypass tumors so that patients can be comfortable.  AMPATH surgery has been working closely with the palliative care team to understand the need and deliver the appropriate care.  Your donation will support this effort.  

AMPATH's surgery team has been busy on many initiatives during the past few months! 

TEAM: (Trauma Evaluation and Management). This is a course for medical students. We have run a course for the medical students here at MTRH and just assisted with a course at Kenyatta University in Nairobi for their graduating 6th year medical students last week. Helen is spearheading a research project evaluating the course in these student populations. She has submitted an abstract to the Association for Surgical Education about our experience at MTRH, and we are waiting to hear if it has been accepted. We will be helping conduct another TEAM course at JKUAT (Jomo Kenyatta University of Agriculture and Technology) at the end of this month.

ATLS: We ran the first course in Eldoret and have continued to assist with courses in Nairobi. We will be presenting our experience with the first ATLS course at the COSECSA meeting in Kigali, Rwanda next month. Our next course in Eldoret will be in February while next week we will be traveling to Nairobi to help with their next course. We are designing a study to evaluate the ATLS experience in Kenya over the last 5 years.

Burns: We had a clinical burn care camp with the team from Eskenazi October 5-11. This included participation in the Burn Society of Kenya National Symposium which was held in Eldoret on October 5. The camp provided surgical care for 23 patients. Educational sessions were held for the surgeons, nurses, and therapists. Additionally, donations of surgical and wound care supplies were made by the team from Eskenazi. We have continued to have weekly multidisciplinary teleconference meetings with the Shoe 4 Africa Burn Team and the Eskenazi team to discuss the patients and follow-up on their care.

 The burn registry has also been initiated following the camp. So far we have enrolled 23 patients in the registry. 

 Trauma Registry: We have rolled out the prospective trauma registry trial at Shoe 4 Africa. We are also beginning to analyze the data from the prospective trial at the adult side of MTRH. We will be presenting an abstract from this data evaluating preventable risk factors in road traffic accidents (i.e. helmets, seatbelts) at the Academic Surgical Congress.

Surgical Oncology: We have begun collaborating with Tenwek Hospital in Bomet, Kenya during our weekly Tumor Board meetings. They are joining via teleconference and both sides are presenting patient cases for discussion. This has facilitated transfer of patients between the two hospitals to seek care provided at one facility and not the other. 

We have also developed standardized data collection forms for our sugical oncology clinic to help make the clinic run more efficiently and standardize the type of information we report on patients. This will help improve their care when they return for surgery as well as help us to collect research data in the future as well. 

Listrunner: We have implemented Listrunner, which is a HIPAA-compliant electronic inpatient census list software which can be used via web browser or mobile app. This allows for a secure method to keep track of our surgical inpatients. It also helps us to organize the list of patients to be presented at our weekly Surgical Oncology Tumor Board. So far it has been adopted by General Surgery, Pediatric Surgery, Burn/Plastic Surgery, and ENT. 

It's been a busy few months and we wish you all well as the holiday season approaches!