Travel Report Kenya 2009
Saturday 15th of February
I lost track of the number, but this could be my 11th visit to Kenya for cleft operations.
The participants are my colleague, maxillofacial surgeon Joel Defrancq (9th time), anesthesiology nurses Henk and Yvonne Geerlings (3rd Time), first-timer Jan Vanhove, an almost-maxillofacial surgeon, and me. In the second week Ellen Defrancq will join us (1st time). She’s the daughter of Joel and a last year medical student with a great interest in maxillofacial surgery.
Furthermore my children Anne and Pino and another daughter of Joel, Lore, are on the trip. They are enjoying the spring holidays and will be doing a scuba diving course on the south-coast of Mombasa.
The plan is to work three days of the first week in Nazareth Hospital near Nairobi. Afterwards, we’ll rest over a long weekend on the coast. During the second week we’ll work for another five days in the Consolata Hospital in Nyeri. This hospital covers a very large region. We have always had a rather large amount of work there.
We will catch the night flight. Apart from a defective video system to Anne and Pino´s dismay, the trip is uneventful.
Sunday 16th of February
On arrival we find out that since our last visit the airport of Nairobi has invested in cameras to enable the customs take pictures of all the visitors. Moreover, they have placed signs that indicate which line is for Kenyans, which is for visa holders and which is for the remaining travelers. Not every change means advancement. In consequence our waiting time is more than an hour. By the way, in the end it appears that you can use any line. In Kenya, rules are no more than guidelines. My idea…
Outside, the chauffeur that has been sent by the sisters of Nazareth Hospital is waiting patiently, holding a sign that reads, “Dr Bat”. In former years the nurses came themselves. But that’s the result if you start doing things regularly. It’s not special anymore.
As always we stay in a house in the hospital area. For Kenyan standards this is an enormous luxury. It reminds us a bit of our student times. First, we nap for an hour or two. Then the same chauffeur from this morning brings us to Village Market, a shopping centre for expats and the Kenyan upper class. Each year have an ice cream there from The Italian and fetch some Camembert and Tusker bear at the supermarket.
In the evening we meet the patients for the next three days, 20 in total. Unfortunately, one patient is too small; one clearly suffering malnutrition and one doesn’t really look healthy and moreover has a heart murmur. The mal-nurtured and the unhealthy child are sent to a pediatrician. To the mother of the too small child, it is explained that she needs to come back next year. We come here each year in February/ March and will operate on her child then. She has to cry. Next year is so far. Will her child still be alive? Honestly speaking, we also have our doubts about that. The mother says her child has difficulty in drinking and this you can see. But to operate now would most likely lead to death.
Monday 17th
Today we performed five surgeries on two tables. Joel works alone and Jan sits at my table. He’s very happy. In Leuven, where he’s in training, the professor changes the design on the lip so often that in the end Jan is completely lost. Joel and I have a very systematic way of working, partly because of the book about cleft lip surgeries that we made. I like to explain what I’m doing and why and once in a while let him do some small things. Our technique for closing palates has been changed bit by bit over the last two years. With our new method, it’s possible to close the lip and palate in one operation in the somewhat older children. We do it in such a way so that there isn’t so much scarring that the growth of the upper jaw is inhibited. Today, I have two of such big operations which last four hours each. The satisfaction is high, because basically these two children from a surgical point of view are ready in a single operation.
Tuesday 18th
How progress can mean decline:
In the past few years we’ve been very active to improve our technique for closing the palate. Consequently, we now use a method in which a flap from the inside of the cheeks is being transposed to the palate. By doing this you’re capable of closing the palate and even make it longer without causing too much scarring. This is very important for good, understandable speech in which the soft palate needs to close the nose from behind for some sounds. However, now the palates are so long that some children, in the first days after surgery, can hardly breathe because of swelling. In western countries these children are kept asleep and are ventilated. Here they don’t have the equipment for that. So today we had to reanimate a child that we operated on yesterday. We have now left a tube from the nose to the throat to ensure an airway. We now do this in all patients as a means of prevention. Here in Kenya, you need to improvise, which is not without risk.
Wednesday 19th
Today we operated on another six patients: a total of 16 so far. Sister Sarah comes in the evening with one of the other sisters to give all of us a safari shirt as a present. As usual, it’s accompanied by a request: If we can help her to get an EKG machine. I tell her that in the basement of Agave Clinic there probably will be a used machine. I’ll have it checked and sent to her.
Tomorrow morning we leave early for the airport to have a short holiday with my children on the coast.
Tuesday 24th
As we knew from telephone contact with Consolata Nyeri Hospital that this year there wouldn’t be so many patients, we only go there today instead of Sunday. The problem is that we didn’t come last year because of political riots. In fact, afterwards everybody considered the project as stopped definitively. In addition, our contact person, ENT Patrick Nduduri, has left to work in a hospital in Nairobi. According to the new ENT, Patrick told them that we would only be coming in November, leaving them little time to prepare. Upon arrival it appears there are 11 patients, of which only eight are healthy and strong enough to undergo surgery.
Wednesday and Thursday 25th and 26th
Without any notable problems the eight patients are operated on. We do notice however that the operation theatre hasn’t improved at all in the last 2 years. Doors are stuck, sockets are hanging out of the wall, and it’s a dirty mess. It’s been said that they’re going to build new theatres. It’s about time for that.
Friday 27th
In order to have a good number of patients again next year, I’ll have to invest time and energy in organization. In the morning I see Father John, the new director of the hospital in Nyeri. We agree now that next year we’ll come to Kenya for operations in the 1st and 2nd week of March. He’ll get in contact with the regional manager for healthcare to make sure that through his canals all the hospitals in the region will know we’re coming. Dan Mbuti, the ENT, will see the patients beforehand and will make an operation list.
My colleagues leave for Nakuru National Park, which is at a two hours driving distance from Nyeri. It’s situated around a lake with millions of water birds, mainly flamingoes and pelicans. I once heard that our own prince Bernard (of Orange) was the founder of that park.
I myself get a lift from a radiologist from Nairobi. He works temporarily in Nyeri to explain the new CT scan to the local personnel.
In Nairobi I have an appointment in the evening with Patrick Nduduri. He was the ENT in Nyeri and we’ve been able to cooperate with him perfectly for six years. He now leads the hearing centre of the Lions Hospital nearby Nairobi and would like us to come there yearly and operate cleft patients as well. I meet the director of that hospital, Mr. Samson, also director of the biggest transportation company of Kenya. In 2002, Mr. Samson, an influential man, was governor of the Lions Club for East-Africa. He says Patrick spoke highly of us and that we’re most welcome to the Lions Hospital for cleft operations.
Saturday 28th
Finally I can check e-mails again and I visit a museum. In the evening my friends arrive from Nakuru. Tomorrow morning we’ll fly back to Amsterdam.
Our visit hasn’t brought what we hoped for in terms of the amount of patients, but we’ve still been able to help 24 children and probably have created a foundation again for many more years of very useful work in Nairobi and Nyeri.
Bart van de Ven
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