Habib Rafka Reflection

Habib Rafka is a College of Medicine student at MUSC. He was awarded a Center for Global Health Student & Trainee Travel Grant in early 2023 to pursue a project with Pan-African Academy of Christian Surgeons in Kenya. View more photos of Habib's time in Kenya in this Flickr photo gallery.

I was awarded the Center for Global Health Student Travel Grant to travel to Kenya for an on-site needs assessment trip with Mike Mallah, M.D., and project collaborators from Virginia Commonwealth University. Our project revolved around working with the Pan African Academy of Christian Surgeons (PAACS) on identifying problems and coming up with solutions for their surgical resident case-logging system. PAACS has surgical residency programs in 27 countries around Africa and have graduated more than 150 surgeons and there is more than 100 currently in residency through the organization.

The PAACS surgical case log is very old, and has many problems with compliance, functionality, usability, and synchronization among all of the PAACS hospitals. This leads to unreliable surgical case information and the inability to compare the surgical training in African programs to those in the United States and vice-versa. In-fact, the inspiration for this project came from Dr. Mallah and his African counterparts not being able to find how many appendectomies were done open vs laparoscopic while in Botswana.

Our trip started at the Brackenhurst Conference Center for the PAACS annual Basic Science Conference and Surgical Skills Workshop. There, we were able to present to a group of 23 African general surgery program directors and hold a discussion about the surgical case log. We got their perspective on the current case logging system and were able to get a good sense on what is wrong with it and think of ways to mitigate the problems. By the end of this discussion, 21 out of the 23 program directors agreed on the core problems and on what a surgical case log should look like for the African context. Additionally, we helped them carry out their surgical skills workshop for their residents and talked to various other people about the surgical case log.

After the Basic Science Conference, we started the site-visit part of our trip. The focus during these site-visits were to see how residents and faculty use the current case logging system and meet with them individually to get a better understanding on the problems and goals of the surgical case log from a resident-physician perspective. The first hospital we visited was Kijabe Hospital in Kenya. The program director, Dr. Richard Davis, showed us around the hospital and was able to connect us with the residents in his hospital. We talked to a total four residents there as well as their residency program coordinator, who is actually the person who uses the case logging system the most. We then had similar site visits at the Litein Hospital and Tenwek Hospital – talking to and gathering information from about 25 general surgery residents.

One thing that stood out to be tremendously during this trip was how everyone comes together to make sure people get the treatment they need. One poster that really highlights this shows different hospitals where children can get cleft lip or cleft palate surgery for free. Additionally, we learned that at Kijabe, there are a total of three funding sources that they can tap into if a patient cannot afford treatment, and they have been successful in covering all the cost for people who need it. This type of inclusion and compassion is something I think the US can learn from our partners in Kenya.

One thing that I was consistently reminded of when I was there was what works in one setting will probably not work in another setting. I am not even talking about “High income countries” and “low-middle income countries.” Even within LMIC’s, the amount of resources vary tremendously between different hospitals. And when it comes to creating something to be used in 27 different hospitals, all with their differing levels of resources, it is imperative to really understand the struggles and context of every single one of these setting so that you can accommodate everyone. The optimism that everyone had and passion they had for improving their surgical education infrastructure was contagious—and I am looking forward to the years of collaboration and bi-directional learning that comes from this work.