Posts Tagged ‘Global Health’

Guitar Brain Surgery

Photo Credit: Today Show

Many years ago, when I was engaged in hand-to-hand combat with the ferocious winters of Montreal, I was introduced (virtually) to a speaker who shared these thought-provoking words “What makes you angry? It is a clue to something you were purposed to address.” The words have echoed in my mind since then, especially when I see something upsetting. And that happened this week.

I was watching a run of the mill news story featuring German Chancellor, Angela Merkel, holding a town hall meeting in which a young immigrant girl, living in Germany, expressed her desire to continue her studies in Germany. The problem? She was a refugee from Lebanon, now facing deportation. As she spoke of how painful it was to watch her friends go on to study when she could not, she cried. Merkel’s response:

When you stand in front of me and you are a very nice person, but you know . . . there are thousands and thousands [of people] and if we say you can all come and you can all come from Africa… We can’t manage that.”

Immigration is a loaded topic and there are reasonable arguments both for being lenient and selective in policy. What got to me is that the simple desire of this girl to study where she lived was being held hostage to a policy and to the limitations of her home country. It reminded me of my experience at a Kenyan hospital earlier this year when a mother presented her child with a spinal birth defect at 9 months instead of the recommended 48 hours which caused lower limb paralysis and incontinence. Why not earlier? Cost. The mother could not afford it. It is frustrating when people do not have access to basic education and health. But what is more upsetting is when we settle for sensible answers and say things like “There are not enough resources to go around.” or “We can’t take everybody.” Where is the creativity? Where is the resolve that says this is unacceptable and sensible answers are not enough?

It was not sensible to suggest fighting malaria with a fence that shoots out lasers to kill mosquitoes . . . a “Phototonic Fence” is almost ready for market.

It was not sensible to have a patient play guitar during brain surgery, but that’s how a neurosurgeon recently conducted an operation to ensure the patient’s brain function was not being compromised.

It was not sensible to suggest that the nation with the highest percentage of its population engaged in mobile banking would emerge from sub-saharan Africa . . . today, that nation is Kenya.

It was not sensible to suggest that internet service can be provided to a rural community without electricity. The creative thinkers at Mawingu Networks are doing just that using solar energy and “television white space,” unused television frequencies.

No one is saying these problems are easy, but we won’t solve them by conventional thinking. This could be reduced to another “thinking outside the box” message but this imperative goes deeper. I think we all harbor real doubts about whether some problems can ever be solved, but if we see something isn’t right, it should drive us to do something about it regardless.  The creative knowledge is there and our access to each others’ thoughts is unprecedented.

You’d be amazed what you can find.

Consider a silly experiment that I carried out this week. First, let me say that I am always astounded when I look up something on Google at how many people have asked the question before, even when it’s quite obscure. So I decided to make up a highly ridiculous search request, just to see if the question had been asked.

I typed in the question “Do onions make good pillows?” I did not find a hit with that exact question, but someone did ask whether he should sleep with an onion in his armpit. Why??? Apparently, in some regions of South Asia, it’s a trick to cause a fever for kids to get out of school. I have no idea if this works and have no (immediate) plans to test it. But if it is true, how was that discovered?? Minds are churning every day and we have access to these minds.

It bothers me when we settle and use words like “reasonable”, “realistic” and yes, “sensible”. This is not arguing for rebellion for rebellion’s sake, or self-indulgent attention seeking. And, of course, there is a place for planning and counting the cost. But, there are real heart wrenching issues we face today that are costing lives and hope that can only be confronted successfully if we’ll take the risk. Spectacular success begins with the willingness to fail, spectacularly.

Let’s stop being sensible.

Kijabe OR

Even though I grew up in Kenya and made the drive often, there has always been something about the Great Rift Valley that inspires a sense of awe each time I see it. Perhaps, it is the sheer expanse of this structure that never ceases to inspire. Not too far beyond this impressive natural landscape, down a steep hill and a winding road whose potholes must be dodged with the lightning quick reflexes of a professional gamer lies AIC Kijabe Hospital. The last time I was in the town of Kijabe was for a camp as a teenager. At that time, a few friends and I imitated the classic 90’s R&B group Boys II Men. I was the bass that would randomly start speaking in the middle of the song saying things like “Girl, you know we belong together” But where were we? Ah, yes . . . Kijabe Hospital. I had just arrived for a month long rotation with the Pediatric Neurosurgery Department and could not wait . . .

I walked into the ward and was immediately struck by the fact that all the mothers and their children were in the same large room in contrast to the largely private rooms I had encountered in Pediatric Neurosurgery rotations in the States. My first thought was how difficult it must be to not have that privacy, but the longer I stayed in Kijabe I began to question that position. I think a moment that captured that reevaluation was when I walked into the ward one day and heard a mother singing to her child in full hearing of the room. What effect did that have on the other mothers? How much easier was it for these mothers to talk and support each other–without walls? Privacy makes a difference, of course, and a private room certainly brings certain conveniences but what do we sacrifice in community to obtain these conveniences? When does privacy become isolation?

Kijabe’s Pediatric Neurosurgery ward primarily consists of children with one or both of two common conditions here: hydrocephalus or spina bifida. Both of these conditions can have devastating neurological consequences if not appropriately treated so the work being done by the neurosurgeons in Kijabe is important and life altering. I had the privilege of scrubbing in on multiple surgeries including shunt placement, ETV (Endoscopic Third Ventriculostomy), Chiari decompression and myelomeningocele repairs. I was impressed by the technological capabilities of the operating rooms in Kijabe. Unfortunately, a fair number of patients present late, largely for financial reasons, when damage has already been done, highlighting the need for certain systemic changes.

In the process, I got to join an outstanding team. Our attending was Dr. Humphrey Okechi who has worked closely with Dr. Leland Albright of the University of Wisconsin, the Neurosurgeon who established the program in Kijabe. Also part of the team were an Ethiopian Fellow, Addis, (and by “Fellow” I am referring to his medical title, not a variation on “dude”!), a visiting senior resident from USC, Eisha, and a Kenyan resident, Peter, from the University of Nairobi. A wonderful senior nurse, chaplain, social worker and other dedicated workers, also supported us.

It is hard to capture the atmospherics of how welcoming it was in Kijabe but let me offer one example. Consider one simple gesture, the handshake. In America, you typically only shake someone’s hand the first time you meet him or her. But in working with this Kenya team, there would be handshakes all around every morning among the team. This simple point of contact provided acknowledgement and a sense of camaraderie that set the tone for the day.

Aside from the OR, my other responsibility was to conduct research on the cost effectiveness of Neurosurgical care in Kijabe. This led to many insightful conversations with mothers of affected children. Aside from expected costs, there were some challenging cultural scenarios they raised, such as being disowned in some cases by husbands whose relatives felt the distorted features of hydrocephalus were an indictment of the mother. It was difficult to hear of the financial struggles faced by many mothers in obtaining neurosurgical care for their children and how far many had to travel to Kijabe, one of only two places in the country to get dedicated pediatric neurosurgical care. But this information also emboldened me further to produce this research as part of an effort to ultimately enhance local capabilities in Neurosurgery.

The interesting and ultimately poignant contradiction in Kijabe was the juxtaposition between taxing neurosurgical cases and a certain lightness in how the staff faced their days. Of course, this lightness did not mean trivializing the high stakes of the patients’ conditions, but rather a refreshing ability to not carry this angst around. One moment, we were in the operating room performing a delicate decompression surgery and two hours later we’re on the soccer field (“football pitch” for any Kenyan readers!). We would play with talented local players and hospital staff many of whom spoke Kikuyu, so my Swahili did not help me with on the field strategizing. After managing to not be entirely useless on the field the first day, I did manage to translate one thing they said . . . “Pass the ball to Obama!”

Several seeds were sown on this trip. The first is the even stronger urge I have to contribute in Pediatric Neurosurgical care in Kijabe and beyond. The second is the need to disseminate the research that will help contribute to this effort. These two seeds will take time to grow. But the third seed can sprout today. It emerges from the ease with which I saw so many people in Kijabe able to experience the present moment despite challenges. And by that, I do not mean to suggest the patronizing sentiment that “those people just seemed so happy!” Many of the parents I spoke to did show signs of strain on their faces as they talked about their struggles taking care of sick children. But it was only in that moment, and their struggles were only part of their stories. Of course, faith was a key component as well; AIC Kijabe is a mission hospital. It all adds up to way of living that challenged me to bring some Kijabe back to the US. Giving people in your team handshakes everyday may seem a little weird here, but the idea behind it is surely worthwhile, the simple power of acknowledgment.

The Team, the team, the team . . .