Traverse City Record-Eagle

April 20, 2013

Munson reaches out to provide support in Kenya


---- — TRAVERSE CITY — Some 7,800 miles separate Munson Medical Center and a private hospital in Chogoria, Kenya.

A new international option in Munson’s family practice residency training program aims to bridge that distance.

The first team of three doctors — a supervising faculty member and two residents — left for Chogoria PCEA Hospital in mid-February and returned in late March. The plan is to send medical teams two or three times a year on six-week trips to work side by side with Chogoria medical staff, said Dr. David Klee, a faculty member in Munson Healthcare’s Family Practice Residency program.

“There are just five family practitioners in all of Kenya,” said Klee, a lead physician in developing Munson’s new international option.

Funding for Munson’s program comes from the Northwest Michigan Osteopathic Endowment Fund, Michigan State University and Rotary International. The Munson program builds off a similar physician rotation program created a few years ago by Munson cardiologist David MacIntosh for the foundation and MSU, Klee said.

Chogoria lies 145 miles north of Nairobi near the base of Mount Kenya. Founded by a Scottish missionary in 1922, it is now a private hospital with 312 beds located in a gated compound. It has an occupancy rate of 50 to 80 percent.The two hospitals are about the same size in terms of bed numbers, Klee said.

Physically, Munson is much larger and has more doctors — about 100. Chogoria has 12.

Chogoria hospital staff members have created their own residency program, which starts in 2014. Munson doctors were not involved in that project, but will help guide the curriculum, Klee said.

Chogoria physician Nelson Lolos spent a month at Munson last year. Anthony Tata, another Chogoria doctor, will spend a month later this year at Munson.

Munson’s three-year residency program provides training to 18 resident physicians — six each in first-, second- and third-year classes. Residency is a stage of graduate medical training.

Practicing family medicine in an international setting provides important benefits to a resident’s education, said Dr. J. William Rawlin, director of the residency program focusing on rural health and working with limited resources away from medical centers.

“Working in Africa gives about the strongest possible experience for working in conditions with limited resources,” he added. “It really forces the resident to learn how to use their history and physical exam skills to diagnose and treat patients. They get the opportunity to improve their ability to care for patients of a different culture and also work with health care providers of a different culture.”

They also will be exposed to many disease processes that they otherwise would not see, he added.

Klee said Munson's new international residency program has several goals, among them:

• Work jointly with Chogoria physicians and nurses to develop standardized physician “order sets,” or written set of evidence-based medical practices on how to treat specific illnesses to ensure that no necessary treatment is forgotten.

• Give the physicians a global experience and a world view of medicine.

• Provide residents with a closer look at tropical illnesses.

“The infectious disease element is more prevalent in Kenya with complications of tuberculosis, AIDS and malaria," said Klee, who has worked in Liberia, Tanzania and Malawi hospitals. Other common and serious health programs are malnutrition and pneumonia.

Munson and Chogoria physicians already have developed standardized “order sets” for pneumonia, head injuries and post-partum hemorrhages in surgery as well as diabetic ketoacidosis in kids, Klee said.

Dr. Robert Milanes spent a month at Chogoria Hospital in November-December 2012. He described his trip as “life-changing." He did a hospital needs assessment as part of his senior residency program and also worked in Chogoria’s adult inpatient and pediatric wards.

“They take care of a lot of sick people,” he said. “You learn a different type of medicine. It’s not that they don’t have anything. It’s just different from what we are used to. And it works, as primitive as it looks.”

For instance, the hospital incubator is a wooden box with a light bulb in it and a glass of water to keep air in the box moist. It was made in 1922.

Milanes also had an opportunity to work with tropical disease cases and treatments. Tuberculosis cases are rare at Munson, he said. Chogoria handles 10 to 12 a day as well as many HIV/AIDS and babies born with HIV/AIDS cases.

“I felt almost that I gained more than I gave,” he said. "Over here I can read a CT scan or an ultrasound, but they don’t have those there and you have to base your findings and diagnosis on a physical exam.”

What was the most important thing he learned?

“The strength of people and the human spirit,” he replied. “And as hokey as it may sound, ‘With great strength comes great responsibility.’ The reason I became a doctor was to help those in need. It feels like a social contract.”