Innovation

Innovation rarely occurs in the academic medical centers here, in contrast to the US. For example, there are CT surgeons at MRTH, however they do mainly pericardial windows and biopsies, or so I hear, but they do not do valve replacements or cardiac surgeries. More invasive, skilled, and even new procedures occur at private hospitals. According to Chandler, this same situation occurs in Uganda, however, the reason there is because many of the US trained doctors return to Ugnada and work exclusively at private hospitals. I am not sure if this is the case here but it could be. There is such a great need for valve replacement surgery in Kenya, even just in Eldoret, that clearly if these surgeries were offered (and could be afforded) there would be no lack of patients. We just had a 15 year old girl die a couple days ago from rheumatic heart disease who could have lived if she had a valve replacement (or two).

One thing I have been struck by is how smart and up to date all the doctors at MRTH are. Clearly it is not an issue of skill or love of teaching that stops innovation from occurring here. It must be an issue of money. Whereas in the states doctors take pay cuts when they work in academics rather than private practice, there is a significant amount of prestige that comes with academic centers and research grants provide the money needed to conduct innovative research. That is what is lacking here. There are research projects going on, for example studies on cryptococcal meningitis, but there don’t seem to be any surgical or procedural studies.