AMPATH Surgery

As Connie gets ready to head back to Eldoret for Year 2 with a new addition to the family, we're pleased to share an exciting update about the AMPATH Surgery program. 

Kyle Carpenter, a General Surgery Resident at the IU School of Medicine, has received a prestigious Fulbright Scholarship that will enhance AMPATH's surgery work - particularly for burn patients. He's headed to Eldoret this month and will stay for a year, working to create the foundation for specialized burn care in Kenya . Here's more information about Kyle's work and motivation.

We look forward to hearing from him this year and how his work will improve surgical care for burn victims in Kenya! And we're grateful for your support to make work like this possible. 

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"Morning rounds can be somewhat mundane as a surgery resident in the burn unit, but this specific day stood out in late January as the director of the burn unit at Eskenazi Hospital in Indianapolis informed us of a special transfer from Johannesburg, South Africa.   I was intrigued due to my passion for global surgery, but as the story unfolded it highlighted the amazing fortitude of this specific patient and emphasized the need for improved surgical care in Kenya. He was a Kenyan-born British bush pilot who worked for a conservation group, patrolling for elephant poachers in Tsavo national park. On duty one morning early January, a strong wind overturned his plane, causing it to crash and catch on fire. He suffered severe burns from the fire and there was no one nearby. Despite his injuries, he self-extricated from the wreckage and trekked five miles, despite the potential dangers of nearby wild animals, until he was met by another human. From there he was transported by air to a hospital in Nairobi. However, due to limited infrastructure to manage his critical condition from the severe burns, the patient was transferred to Johannesburg. Yet again, he was now being transferred to our care.

While his bravery and courage are commendable, the reality is that most patients in western Kenya do not have access to the resources or connections that made it possible for our patient to receive care in South Africa and at Indiana University. My career goal is to improve access to surgical care in underserved parts of the world, such as western Kenya.

This patient was not my first exposure to the difficulties of providing care for victims of burn injuries in Kenya. As a fourth-year medical student, I had the opportunity to participate in a month-long rotation on the pediatric surgery service at African Inland Church (AIC) Kijabe Hospital in Kenya, a small missionary hospital that serves as a private referral hospital for its region. There, I learned first-hand the frequency and significance of these injuries and the challenges faced by surgeons caring for burn patients in a resource-limited setting. These challenges, along with the rest of my experiences in Kijabe, solidified my passion for a career in global surgery.

I have been pursuing a career in global health since medical school. I was quickly attracted to my school’s robust global health programs. I completed a track of global health electives throughout my four years. Through the National School of Tropical Medicine, I earned a Diploma in Tropical Medicine. The focus of my capstone project was on the burden of road traffic injuries in low- and middle-income countries (LMICs). Choosing to complete an Ethics track of electives as well, I focused my ethics research on global surgery. I devised an ethical framework for measuring competent surgical performance. This tool can be used to determine whether surgeons working in humanitarian and/or global health settings may ethically perform procedures outside the scope of their formal training. Since starting my surgical residency at Indiana University, I have participated in an interdisciplinary global health residency forum along with residents from several different medical specialties. I now have the fortune of serving as my department’s first global surgery research scholar. These experiences have prepared me to meet the challenges of a career in academic global surgery.

Burn injuries in Sub-Saharan Africa account for significant morbidity and mortality. The World Health Organization (WHO) estimates that the worldwide annual death toll due to burns is over 265,000, with burns in LMICs accounting for over 95% of all annual burn deaths.8 An estimated 43,000 people die of burns in Africa every year. In Kenya, burn injuries are associated with significantly higher rates of mortality when compared to other traumatic injuries and they are the leading cause of traumatic injury in patients under the age of 5.This is consistent with other data in Africa, where children die three times as often from burns compared to the world. 

There is a shortage of burn care providers in Sub-Saharan Africa, and in Kenya specifically. Many countries have one or two burn specialists, if any. These providers tend to be located at national referral hospitals in urban centers. Most patients in rural areas of these countries have no access to specialized burn care.

In general, the objective of this study is to better understand the burden of burn injuries in western Kenya as well as the implementation of a validated burn registry at Moi Teaching and Referral Hospital, the national referral hospital in western Kenya.

 Specific Aim #1: To evaluate the capacity and protocols in place for providing care to burn patients at Moi Teaching and Referral Hospital through an objective review of their infrastructure and workflow.

Specific Aim #2: To retrospectively review charts from patients treated for burn injuries over a six-month period from Moi Teaching and Referral Hospital in Eldoret, Kenya, using a validated burn registry data collection form.

Specific Aim #3: To prospectively collect burn injury data over a six month period from Moi Teaching and Referral Hospital using a validated burn registry data collection form. Analysis of this data will help to better understand the burden of burn injuries in western Kenya as well as the challenges and applications of implementing a burn registry in these facilities.

By developing and implementing a burn registry, collection of burn information will be formalized into a validated model. Conducting such a study is a necessary first step in improving the care of west Kenyans injured by burns. Ultimately we hope this study serves as the foundation for creation of a national referral center for specialized burn care at MTRH."

- Kyle Carpenter