W.I.R.E.

Reflections on My WIRE Experience

By Sarah Kuchar, MD

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This past month, I was fortunate enough to spend two weeks serving at Tenwek Hospital in Bomet, Kenya as part of the Wills International Resident Experience (WIRE). Tenwek Hospital is a Protestant missionary hospital in southwestern Kenya and is the largest in the area, providing care to approximately 600,000 people within a 20-mile radius and serving as a major referral center for the region. I spent my two weeks under the guidance of Dr. Ben Roberts, a retina-trained ophthalmologist who has served at Tenwek for the past 7 years and Dr. Michael Chen, a cornea specialist who will be serving at Tenwek for the next 2 years. Dr. Roberts has been kind enough to host Wills residents for the past 3 years, generously providing one of the most rewarding educational experiences of the residency.

I arrived at Tenwek and was met by Dr. Roberts and his wife, Jenny Roberts, in Nairobi. Together we made the 4-hour journey to Bomet and arrived on the hospital grounds by mid-day Sunday. Tenwek hospital has a steady stream of visiting physicians that come from all around the country in all different subspecialties. As a visiting physician you say in the Guesthouse where you enjoy a lovely spacious room, complete with a coffee maker, that is a mere 100 yards from the hospital. Every night a delicious meal is prepared by Livingston, a man who has served at Tenwek for over 30 years, and all of the visiting physicians get to dine together, sharing stories from the day.

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On Monday I was introduced to the ophthalmology team. Dr. Roberts and his staff are truly among the most welcoming, gracious and kind people that I have ever come across. There is a true sense of team among the staff and a shared commitment to delivering the best care possible to the people of Kenya. Monday is one of the main clinic days. Together, with Dr. Roberts and the staff, we spent the day seeing patient after patient until we had gotten through the seemingly endless line of people. As Dr Roberts says, the sign of a good Monday is when the hallway where patients wait is covered in mud by the end of the day!

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Patients travel from all over the region; some have traveled up to 6 hours to be seen! We work in one room with 5 slit lamps set up, which provides for a very nice sense of camaraderie. There was a retina specialist to my right and a cornea specialist to my left, which made for some very efficient referrals! The goal of these very busy clinic days, where over 100 patients are examined, is to treat problems that can be managed medically and admit patients requiring surgery. On that first Monday we admitted close to 30 patients, all of who required cataract, retina, glaucoma or trauma-related surgery. We documented all of this on the brand new EMR system set up by a few months earlier by Patrick Rapuano!

The rest of the week was devoted to the OR where we began at 7:30 and work until around 5 or 6 taking on case after case. The Kenyans, however, have a healthy understanding of work life balance and so even on the busiest OR days there was always time for a mid-morning chai tea and mandazi break (the Kenyan equivalent to a donut). Additionally, the entire hospital makes an effort to observe a lunch break at 1:30. At this time, physicians and hospital staff have the chance to return home to enjoy lunch with their families. As a visiting physician, I was invited to a different missionary’s home each day for a home-cooked lunch. We would return in the afternoon and continue with cases. In between, we would see post-operative patients and check in on clinic, which is always open and staffed throughout the week by Kenyans who have been trained by Dr. Roberts and are superb clinical ophthalmologists.

In my two weeks at Tenwek I assisted with and performed a lot of surgery and saw remarkable pathology. Access to care is very limited and as a result patients are often forced to wait until their problems are very advanced. The work that Dr. Roberts and his team do each and every day is truly life changing for their patients. It was rare to see a cataract that was not at least count fingers vision. Cataract surgery for one patient whom I was fortunate enough to meet meant that she was able to leave her home alone fro the first time in months. My experience operating in Kenya opened my eyes to the entirely unique set of obstacles faced when delivering healthcare in the developing world. Resources are scare and precious and nothing is wasted! You think about every step and how you can conserve. What struck me, however, was that excellent care was never compromised. Dr. Roberts and his team use what is available and make it work.

I learned more in two weeks then I ever could have imagined. I worked with and treated some of the most gracious, intelligent and appreciative people that I have some across in my training. This experience has solidified my commitment to international work throughout my career. I was so proud to represent Wills Eye. We have had physicians donate their time, expertise and supplies and on my final day each and every one of the team at Tenwek made sure I returned and expressed their gratitude for all the Wills has done for Tenwek. I am in awe of the work being done at Tenwek and look forward to continuing to give back. I want to thank Dr. Haller, Mr. Bilson and the Wills Alumni Society for giving me this opportunity through WIRE. Asante sana! (Swahili for ‘thank you very much!’)