Samir Patel MD – 2020 (Kenya)

I’ve had the pleasure of spending two weeks with Dr. Benjamin Roberts and the entire ophthalmology team at Tenwek Mission Hospital in Bomet, Kenya. Since his arrival in 2006, Dr. Roberts has expanded Tenwek ophthalmology department into a tertiary eye referral center that is able to manage nearly any ocular pathology. Dr. Roberts is fellowship trained as a vitreoretinal surgeon, and Tenwek Mission Hospital is one of only a handful of referral centers in Eastern Africa that have the resources to treat retinal pathology. As an aspiring retina specialist, I was eager to learn about the practice patterns of a vitreoretinal surgeon in this environment.

On the edge of the Rift Valley, his clinic is filled with the latest gadgets including optical coherence tomography, fluorescein angiography, B-scan ultrasonography, digital fundus photography, laser indirect ophthalmoscopy, and pattern scanning lasers. His operating rooms are equipped with the latest technologies including the Alcon Constellation vitrectomy machines using 23g, 25g, and 27g systems and Zeiss microscopes.

All surgeries are performed using the Resight noncontact viewing system, and there is access to endolaser, perfluorocarbons, SF6, C3F8, and silicone oil during cases. In addition to retinal cases, the operating rooms are equipped for corneal cases including transplants and crosslinking, cataract surgery through phacoemulsification or MSICS, and glaucoma surgeries including glaucoma drainage implant devices and cyclophotocoagulation. Opened in 2018, the Tenwek Eye and Dental Center houses the clinic and operating rooms, and the physical environment is almost identical to what you would expect in the United States. By design, Dr. Roberts has labored under the conviction that every patient—whether in rural Kenya or back on his furloughs in Alabama—deserves the same excellent, intentional care.

I was most surprised by the level of pathology when patients presented to clinic. For example, the vast majority of patients with retinal detachments will never have access to a retina specialist and so they go untreated. The patients that do present to the clinic almost always have chronic detachments with proliferative vitreoretinopathy and a poor prognosis such that they require combined treatment modalities such as pars plana vitrectomy, scleral buckle, and silicone oil. In addition, I found that the clinic and operating rooms face unique challenges in working in an environment where nothing is thrown away or wasted. There is no option to buy another when something is broken or bring in on-site technical support. You are as much a surgeon as you are an engineer who can take apart and repair complex machines. Furthermore, having disposable supplies such as blades and vitrectomy cutters presents obstacles in that they are often used longer than they are designed for out of pure necessity. I have been amazed by the ingenuity of the staff to create novel solutions for these supplies such that do not compromise sterility or patient safety.

One of the long term goals of the hospital is to help local ophthalmologists assume management and care of their communities. The hospital serves as an educational site for trainees of all levels including medical students, interns, residents, consultants, and regional ophthalmologists hoping to specialize in retina care. Dr. Roberts and the entire ophthalmology department have created a unique niche within the global ophthalmology field, and I look forward to witnessing the continued expansion of its ophthalmic community.