A conversation about Anesthesiology Residency training to start at Kijabe in early 2021.
David: [00:00:00] Good afternoon and good evening. We have no idea what time zone you guys will be in when you're watching this, but I am David Shirk. I'm director of Friends of Kijabe, and I'm sitting here with Greg Sund, our newest addition to the Kijabe team.
Greg: [00:00:17] We moved here from a small village, rural hospital in Burundi, where we have been for about five years.
David: [00:00:26] What was your training and background and specialty in the States before you started doing this Africa stuff?
Greg: [00:00:34] So I'm a board-certified anesthesiologist. I did a fellowship in cardiothoracic anesthesia and I was in private practice for several years before we moved to Burundi about five years ago. And during my time in private practice, I was doing annual trips to various places in Africa and kind of prayerfully trying to discern with my wife where God might be calling us to. And we ended up at this hospital in Burundi, which was a teaching hospital, and it was a place where I could not just do anesthesia, but also teach anaesthesia to medical students and nonphysicians.
David: [00:01:22] What was the terminology for them? Here we call them KRNA, Kenya Registered Nurse Anesthetist. Did you guys have a designation?
Greg: [00:01:29] So that's one of the problems, is that the training for nonphysician anaesthetists is variable from country to country. In Africa, there's no continent wide standard. And so in Burundi, they were anesthesia technicians and so they had a bit less training than the Kenyan nurse anesthetists have here. And unfortunately, it's different in every country. And unfortunately, there's still a lot of hospitals in sub-Saharan Africa where the anesthesia is being provided by underqualified and sometimes not even trained providers who are just there to fill in the gaps.
David: [00:02:13] And this was the case in Kijabe for a very long time. I want to get into Burundi, I want to hear more about that, because I actually don't know - I know you, and I know some of your colleagues, but I don't know much about the hospital and particularly the medical kind of situation that you guys were facing there before that.
Why does somebody who's a private practice anesthesiologist in America walk away from that and move to Africa?
Greg: [00:02:42] Yeah, well, ultimately, it was definitely a calling from the Lord that he laid on our hearts after doing frequent trips to Africa. I saw just the massive discrepancy in anesthesia care between what's going on in most of sub-Saharan Africa and what's going on and in the United States. And I was just really convicted that here I have the ability and the capacity to go to a place like Burundi or Kenya and teach anesthesia. And it was something that the Lord laid on my heart and thankfully on my wife's heart as well.
David: [00:03:23] That's awesome. And you guys came out...so you've been doing short travel trips and then you moved for a year in 2013?
Greg: [00:03:31] Yeah, it was twenty fourteen. We moved to Burundi for a year and we joined a multi-specialist team that had just settled there a few months earlier that I had met on one of these short-term trips to Tenwek hospital in Kenya in 2010. We heard they were moving there [Burundi]. They had three surgical specialists and the anesthesia care at the time was provided by one non-physician anesthetist with coverage by some, actually, non-trained, providers. Their community health worker, who normally gives vaccines, was taught how to give Ketamine to get people through surgeries and caesarean sections on at nights and on the weekends.
They asked me if we would come out for initially for a year to help work with this one non-physician anaesthetist to try to help increase her capacity for what she could do, and during our year there, we realized that there's actually, an anesthetist training program that sends students to this [Kibuye] hospital. They're actually medical students who had a required anesthesia in critical care rotation and there was no anesthesiologist to teach them. And so we felt like this is where we were called to be for longer than just one year. So we went back to the States to support raise for a year, and then to France for a year for language training, because it's a Francophone country, and then in twenty-seventeen we moved there and we've been there up until just a few months ago.
David: [00:05:12] We've had this KRNA program in Kijabe for about a decade [2007]. Officially. I think before that, unofficially. What what is the difference between anesthesiology training for a physician level anesthesiologist versus for nurse-level in Africa?
Greg: [00:05:34] In general, nonphysician anaesthetists are there to put the patients to sleep, to monitor them during surgery, to wake them up. Physician anesthesiologists are there to be consultants for more complicated cases, when complications arise at any time during the perioperative period.
They are also, typically in Africa, the ones that will be a lot more involved in intensive care medicine, in post-operative pain management, and also in leading and teaching medical students, anaesthetists, students and other other health care specialists that that need some training in anesthesia, critical care and or resuscitation.
David: [00:06:31] What's what did ICU care look like in Burundi versus what it looks like somewhere like Kenya? I know Kenya, we're behind America, but you still walk in to [Kijabe] ICU and we've got real ventilators and usually good oxygen supply, right?
Greg: [00:06:49] Yeah, I think in the entire country of Burundi, there are about 12 ICU ventilators, unfortunately, none of them are at the hospital that I worked at. Those are all at the main university teaching hospital in the capital city. And when we arrived, there was no Intensive Care Unit. During my time there, we made a small step forward by designating four surgical beds that we were where we were able to do a little bit more intensive monitoring, nursing surveillance. But it was still a far cry from what you have at Kijabe, and what we're used to in the U.S.
David: [00:07:35] What would what you want to see if you were to think five, 10, 15, 20 years out? What would you like to see happen in our region, in East Africa? You could speak to Burundi or you can...I don't know how familiar you are with other countries? So answer however you want.
Greg: [00:07:57] I would say anesthesia care and critical care in general are very variable right now. And there are a lot of places where anesthesia is simply not safe. Mortality under surgery in sub-Saharan Africa, in general, is twice what it is in the US. And so there needs to be a great deal more invested in training nonphysician anaesthetists, which ultimately needs to be done by physician anesthetists. And that's kind of leading into why we decided to move to Kenya.
David: [00:08:34] Awesome.
David: [00:08:35] Mark Newton does some sessions here just on training. Training trainers, essentially. That's the that's the vision, right?
Greg: [00:08:43] If you're teaching people who are qualified to teach others, that's the Biblical model from the 2 Timothy Chapter 2 - "teach others who will be able to teach others who will be able to teach others."
Greg: [00:08:57] And so that's a big part of why we moved here. We saw that what we were doing, training nonphysician anesthesia providers in Burundi and medical students was good work and it was important, but it wasn't sustainable in the long term. And so in Burundi, for example, there are only seven physician anesthesiologists..
[00:09:20] I was the only one working outside the capital city. And so that leaves the vast majority of hospitals without any anesthesia consultants, without somebody who can manage critically-ill patients in an intensive care setting. And so ultimately, during our time in Burundi, I came to realize that Burundi was not alone. There are a lot of other East-African countries where this is the case.
[00:09:47] If you look at the numbers, there is a recommendation by the World Federation of Anesthesiologists to have a minimum five physician anesthesiologists per one-hundred-thousand population.
David: [00:10:06] How many people are in Burundi?
Greg: [00:10:08] So the number in Burundi came out to. . .it was about zero point zero one eight [0.018/100,000], I believe. It's better in Kenya [1.7/100,000], but it's still far from five per one-hundred-thousand. And so I came to realize over our time in Burundi that sub-Saharan Africa, while it does need more nonphysician anaesthetists, in order to to form and train more nonphysician anesthetists, we have to, at the same time, train physician anesthesiologists.
David: [00:10:41] So what has the groundwork looked like for building up to this training program starting?
Greg: [00:10:47] There started to be some discussions going on between a small group of us who are anaesthesiologists, who are missionaries in Africa in twenty-seventeen. Three years ago, and most of us had been exposed to or involved in helping to do some anesthesia training with surgeons under the PAACS, which is the Pan African Academy of Christian Surgeons. And so we already had some relational foundation with PAACS programs and the leadership of PAACS. We started talking together as a group about the need to start creating Anesthesiology Physician Anesthetist training program. It seemed to us logical to try to partner with PAACS. And so, last year at the PAACS board meeting in Chicago, a group of us went and presented the idea of starting an initial, anesthesiology residency program under the umbrella of PAACS to their board. It was received favorably and they agreed to allow us to start this initial program in January twenty-twenty-one here in Kijabe.
David: [00:12:06] Awesome.
David: [00:12:07] And what has to what has to fall in place for things to kick off in January? I assume there's a few things.
Greg: [00:12:16] Thankfully we have now three board certified physician anesthesiologists that will be serving here myself, Dr. Roger Barnette and Dr. Mark Newton. Both of them have been here already previously for several years. So that's the first piece. And we can check that one off. The second piece is we do need funding to support this program. To train each resident costs about twenty-five-thousand dollars a year per resident.
Greg: [00:12:53] Our plan is to start with two residents and build up from there. And so we are currently in the support raising phase of this.
David: [00:13:03] How long is the program? Is it three years?
Greg: [00:13:05] Yes. So, all of our, anesthesiology residents will have done one a one year internship that might be done in Kijabe. It might be done elsewhere. But once they're once they've completed that, it will be three years of anesthesia and critical care training also.
David: [00:13:26] That means total sort of three years. So seventy-five-thousand dollars per resident to get through the entire program.
Greg: [00:13:36] The other thing you know, once that piece falls into place, the next thing we need to do is recruit our first two residents. The announcement that we would be starting this program was just sent out three weeks ago. Within a week we had over one hundred inquiries and within a week later, we had over 30 applications already submitted. We're currently, the the anesthesiology council under PAACS, is currently in the process of going through those applications,to find who will be our first two residents.
David: [00:14:15] It's exciting. Yeah, it is really, really cool. It's been a dream long, long coming.
David: [00:14:22] And then the other side of this, I assume that these guys will do have a bond service bond similar to how the surgeons do so, where the surgeons, if they come under PAACS, they're obligated to work the same number of years at a Christian Mission Hospital. Is that the same?
Greg: [00:14:41] So that's our plan. And that's the model.
Greg: [00:14:45] A big reason for that is because typically it is the rural areas that are that are underserved, both in terms of surgeons and anesthesiologists. And so, we're really looking to to recruit and train people who are going to go to those hard places and live in those rural areas where, you know, unfortunately, their salaries might not be as high as they would be in the city. And, their lifestyle is going to be very different. So, it's definitely a calling from the Lord, because they're going to have to give up a lot of the lifestyle that they might have in the bigger cities.
Greg: [00:15:23] So that is our plan, to recruit residents who are who want to do that, are willing to serve in rural mission hospitals after their training is done.
David: [00:15:37] It might be worth explaining, because I'm sure some people will not be familiar with terms like missionary. If somebody is not familiar with how the structure works, missionary might sound like an odd or archaic word. But but it's important to set up like what the need is because it gives a framework for what somebody like you or Roger Barnette or Mark Newton, how your life looks logistically, and why we need people to help with this training program.
So what does it mean to be a missionary and how does that process work for you being here?
Greg: [00:16:24] Wow, that's a that's a big question.
David: [00:16:27] I mean, more practically than theologically, it's somebody who is sent by God. I felt a you talked a little about that in the beginning, as a spiritual call from God. This is your purpose. This is what you feel like you're being led toward in your life.
But then what does that what does it look like practically after that?
Greg: [00:16:49] I think those of us who are doing this feel called to to go to places where we can minister to the needs of people, both physically and spiritually. And so, you know, we're not just here to teach anesthesia. I'm not just here to teach anaesthesia, but also to to to disciple and to try and deepen my students, my residents, and hopefully my patients, to the understanding of who Jesus is, what he's done for me and and and the world, and point them to the hope that we have in him.
Greg: [00:17:28] Logistically speaking, those of us who are missionaries working in medicine outside of the U.S., typically that means that we give up our salaries and we have to live off the support of others. So for all of us, we have a team of supporters in the U.S. Who give some give once a year, some give monthly, to meet all of our the expenses that that we have our living expenses and that allow us to be here and do this work. So for a lot of us that's going to be churches in the US or individual families. But that's really the only way that we can be here and continue to do this work.
Greg: [00:18:17] Then that financial support goes through our mission agency. We are here under mission agencies who also care for us, who keep an eye on us, who help us logistically with all the particularities that come with living in rural Africa, which we can't be here doing what we're doing without them either.
David: [00:18:42] I think this is helpful for people to understand the framework and complexity because we've talked about several organizations, and I don't want anybody's heads to get muddled over by this. But it's just important to know that it takes multiple organizations to make these things happen. So, they have their different roles. Your mission agency is Serge. But we've got PAACS, who's the overseeing body for the for these [training] programs. And we've got COSECSA, the College of Surgeons of East, Central, and Southern Africa, who's the accrediting body for the thing. And then we've got the little organization out of all of them, Friends of Kijabe, which is our nonprofit just dedicated to Kijabe Hospital.
David: [00:19:31] You have a great question of "Why, David, why are you doing this? What's your role in this process? Why would funds come to Friends of Kijabe instead of PAACS?"
David: [00:19:42] The short answer is ultimately funds are going to both. But Friends of Kijabe, we have connections with people who pass through here over time. And Kijabe Hospital has been around for 100 years.
I think we're...2020...we just turned one-hundred and five [105] in May. So there's just a deep, deep network of people who care. And ultimately, this is why I think Kijabe is a cool place, is because we get to be part of these training programs that affect not just this one place, but affect the entire region.
So for me personally, my role is just to help you guys amplify your message with the people we already have connected. And so that's our hope with Friends of Kijabe - essentially as money comes into Friends of Kijabe, a portion goes to PAACS for the education resources and a portion ends up at Kijabe Hospital. And we will just, really, follow the Anesthesia Council's instructions on where to write the check. The biggest involvement of Friends of Kijabe, though, is the storytelling and connecting donors and just helping, hopefully, in that process.
Greg: [00:21:03] Yeah, we're really grateful for friends of Kijabe. As I mentioned, the need to raise twenty-five thousand dollars a year per resident to us is a big part of this. And we are, as an Anesthesia Council, not really equipped to to do that. And so we were really grateful David and Friends of Kijabe agreed to help us with that with that arm of this program, as these guys are amazing.
David: [00:21:34] You know, I spent a lot of time with Roger Barnette over the years, a lot of time with Mark Newton, and what they do for our countries, Kenya and Burundi, and for these parts of the region, and for our world, these guys are amazing.
For you [listening] as potential volunteers, once the world returns to normal, you will be really, really valuable. I know there's some people probably watching this. Joleen has been here. Usually, every summer she will come over for a month. I believe Liz Drum has been here before. Matt Kynes, we're hoping to get him here for a longer term basis, but he's been here, pretty regularly, teaching. And I know Roger Barnette has had some folks over from Temple and Mark Newton has brought folks from Vanderbilt. Those connections are also really, really, really important.
So if you're watching [or listening to] this, I know for some of you it may be possible on a regular schedule, and for some of you and may be less frequent, but it is a huge, huge, huge help for the people doing this [anesthesiology] on a daily basis, to either give them an extra hand, or give them a week or two off, where they can recover and get back into the fray. So definitely, as if you're watching this, keep that [a volunteer visit] in the back of your mind.
David: [00:22:54] Also, how you can participate? There's really three ways of really participating. You know, there's the financial component, there's the volunteer component, and then there's making connections with with colleagues that you may have around the States or around the world.
Anything you would add to that?
Greg: [00:23:19] No, I would second everything you just said. And yeah, I would encourage any anesthesiologist out there who's watching this, to come see for yourself. Kijabe is a really special place. A big part of the reason why we're able to start this program is because Kijabe is a place where we do get short-term volunteers who come and help and teach and give the long term folks a break. And it also is great because it gives the students a different perspective, because everybody who comes has something different to teach different areas of expertise, different experiences to share. And and all that, I think, is what's going to make this program so rich.
David: [00:24:04] For me, this is really exciting because I've come in with my wife, Arianna, a pediatric emergency medicine doctor. We've been in Kijabe almost seven years now. When we came, we would hear legends, honestly, about these people who started these programs and how they came to be. So for me, just looking at this, this is just amazing. This is something that one hundred years from now, people are going to look back on and think, "Wow, this started there in this specific place with these people."
Greg: [00:24:41] Thank you, David. Appreciate all that time and all your help. So it's exciting.
David: [00:24:46] And so for all you guys out there who might be watching [or listening to] this, thank you in advance for however you are able to join us in making this making this dream of better quality, more accessible, more affordable health care a reality for people everywhere in the world. So thank you. Thank you.
David: [00:00:00] Good afternoon and good evening. We have no idea what time zone you guys will be in when you're watching this, but I am David Shirk. I'm director of Friends of Kijabe, and I'm sitting here with Greg Sund, our newest addition to the Kijabe team.
Greg: [00:00:17] We moved here from a small village, rural hospital in Burundi, where we have been for about five years.
David: [00:00:26] What was your training and background and specialty in the States before you started doing this Africa stuff?
Greg: [00:00:34] So I'm a board-certified anesthesiologist. I did a fellowship in cardiothoracic anesthesia and I was in private practice for several years before we moved to Burundi about five years ago. And during my time in private practice, I was doing annual trips to various places in Africa and kind of prayerfully trying to discern with my wife where God might be calling us to. And we ended up at this hospital in Burundi, which was a teaching hospital, and it was a place where I could not just do anesthesia, but also teach anaesthesia to medical students and nonphysicians.
David: [00:01:22] What was the terminology for them? Here we call them KRNA, Kenya Registered Nurse Anesthetist. Did you guys have a designation?
Greg: [00:01:29] So that's one of the problems, is that the training for nonphysician anaesthetists is variable from country to country. In Africa, there's no continent wide standard. And so in Burundi, they were anesthesia technicians and so they had a bit less training than the Kenyan nurse anesthetists have here. And unfortunately, it's different in every country. And unfortunately, there's still a lot of hospitals in sub-Saharan Africa where the anesthesia is being provided by underqualified and sometimes not even trained providers who are just there to fill in the gaps.
David: [00:02:13] And this was the case in Kijabe for a very long time. I want to get into Burundi, I want to hear more about that, because I actually don't know - I know you, and I know some of your colleagues, but I don't know much about the hospital and particularly the medical kind of situation that you guys were facing there before that.
Why does somebody who's a private practice anesthesiologist in America walk away from that and move to Africa?
Greg: [00:02:42] Yeah, well, ultimately, it was definitely a calling from the Lord that he laid on our hearts after doing frequent trips to Africa. I saw just the massive discrepancy in anesthesia care between what's going on in most of sub-Saharan Africa and what's going on and in the United States. And I was just really convicted that here I have the ability and the capacity to go to a place like Burundi or Kenya and teach anesthesia. And it was something that the Lord laid on my heart and thankfully on my wife's heart as well.
David: [00:03:23] That's awesome. And you guys came out...so you've been doing short travel trips and then you moved for a year in 2013?
Greg: [00:03:31] Yeah, it was twenty fourteen. We moved to Burundi for a year and we joined a multi-specialist team that had just settled there a few months earlier that I had met on one of these short-term trips to Tenwek hospital in Kenya in 2010. We heard they were moving there [Burundi]. They had three surgical specialists and the anesthesia care at the time was provided by one non-physician anesthetist with coverage by some, actually, non-trained, providers. Their community health worker, who normally gives vaccines, was taught how to give Ketamine to get people through surgeries and caesarean sections on at nights and on the weekends.
They asked me if we would come out for initially for a year to help work with this one non-physician anaesthetist to try to help increase her capacity for what she could do, and during our year there, we realized that there's actually, an anesthetist training program that sends students to this [Kibuye] hospital. They're actually medical students who had a required anesthesia in critical care rotation and there was no anesthesiologist to teach them. And so we felt like this is where we were called to be for longer than just one year. So we went back to the States to support raise for a year, and then to France for a year for language training, because it's a Francophone country, and then in twenty-seventeen we moved there and we've been there up until just a few months ago.
David: [00:05:12] We've had this KRNA program in Kijabe for about a decade [2007]. Officially. I think before that, unofficially. What what is the difference between anesthesiology training for a physician level anesthesiologist versus for nurse-level in Africa?
Greg: [00:05:34] In general, nonphysician anaesthetists are there to put the patients to sleep, to monitor them during surgery, to wake them up. Physician anesthesiologists are there to be consultants for more complicated cases, when complications arise at any time during the perioperative period.
They are also, typically in Africa, the ones that will be a lot more involved in intensive care medicine, in post-operative pain management, and also in leading and teaching medical students, anaesthetists, students and other other health care specialists that that need some training in anesthesia, critical care and or resuscitation.
David: [00:06:31] What's what did ICU care look like in Burundi versus what it looks like somewhere like Kenya? I know Kenya, we're behind America, but you still walk in to [Kijabe] ICU and we've got real ventilators and usually good oxygen supply, right?
Greg: [00:06:49] Yeah, I think in the entire country of Burundi, there are about 12 ICU ventilators, unfortunately, none of them are at the hospital that I worked at. Those are all at the main university teaching hospital in the capital city. And when we arrived, there was no Intensive Care Unit. During my time there, we made a small step forward by designating four surgical beds that we were where we were able to do a little bit more intensive monitoring, nursing surveillance. But it was still a far cry from what you have at Kijabe, and what we're used to in the U.S.
David: [00:07:35] What would what you want to see if you were to think five, 10, 15, 20 years out? What would you like to see happen in our region, in East Africa? You could speak to Burundi or you can...I don't know how familiar you are with other countries? So answer however you want.
Greg: [00:07:57] I would say anesthesia care and critical care in general are very variable right now. And there are a lot of places where anesthesia is simply not safe. Mortality under surgery in sub-Saharan Africa, in general, is twice what it is in the US. And so there needs to be a great deal more invested in training nonphysician anaesthetists, which ultimately needs to be done by physician anesthetists. And that's kind of leading into why we decided to move to Kenya.
David: [00:08:34] Awesome.
David: [00:08:35] Mark Newton does some sessions here just on training. Training trainers, essentially. That's the that's the vision, right?
Greg: [00:08:43] If you're teaching people who are qualified to teach others, that's the Biblical model from the 2 Timothy Chapter 2 - "teach others who will be able to teach others who will be able to teach others."
Greg: [00:08:57] And so that's a big part of why we moved here. We saw that what we were doing, training nonphysician anesthesia providers in Burundi and medical students was good work and it was important, but it wasn't sustainable in the long term. And so in Burundi, for example, there are only seven physician anesthesiologists..
[00:09:20] I was the only one working outside the capital city. And so that leaves the vast majority of hospitals without any anesthesia consultants, without somebody who can manage critically-ill patients in an intensive care setting. And so ultimately, during our time in Burundi, I came to realize that Burundi was not alone. There are a lot of other East-African countries where this is the case.
[00:09:47] If you look at the numbers, there is a recommendation by the World Federation of Anesthesiologists to have a minimum five physician anesthesiologists per one-hundred-thousand population.
David: [00:10:06] How many people are in Burundi?
Greg: [00:10:08] So the number in Burundi came out to. . .it was about zero point zero one eight [0.018/100,000], I believe. It's better in Kenya [1.7/100,000], but it's still far from five per one-hundred-thousand. And so I came to realize over our time in Burundi that sub-Saharan Africa, while it does need more nonphysician anaesthetists, in order to to form and train more nonphysician anesthetists, we have to, at the same time, train physician anesthesiologists.
David: [00:10:41] So what has the groundwork looked like for building up to this training program starting?
Greg: [00:10:47] There started to be some discussions going on between a small group of us who are anaesthesiologists, who are missionaries in Africa in twenty-seventeen. Three years ago, and most of us had been exposed to or involved in helping to do some anesthesia training with surgeons under the PAACS, which is the Pan African Academy of Christian Surgeons. And so we already had some relational foundation with PAACS programs and the leadership of PAACS. We started talking together as a group about the need to start creating Anesthesiology Physician Anesthetist training program. It seemed to us logical to try to partner with PAACS. And so, last year at the PAACS board meeting in Chicago, a group of us went and presented the idea of starting an initial, anesthesiology residency program under the umbrella of PAACS to their board. It was received favorably and they agreed to allow us to start this initial program in January twenty-twenty-one here in Kijabe.
David: [00:12:06] Awesome.
David: [00:12:07] And what has to what has to fall in place for things to kick off in January? I assume there's a few things.
Greg: [00:12:16] Thankfully we have now three board certified physician anesthesiologists that will be serving here myself, Dr. Roger Barnette and Dr. Mark Newton. Both of them have been here already previously for several years. So that's the first piece. And we can check that one off. The second piece is we do need funding to support this program. To train each resident costs about twenty-five-thousand dollars a year per resident.
Greg: [00:12:53] Our plan is to start with two residents and build up from there. And so we are currently in the support raising phase of this.
David: [00:13:03] How long is the program? Is it three years?
Greg: [00:13:05] Yes. So, all of our, anesthesiology residents will have done one a one year internship that might be done in Kijabe. It might be done elsewhere. But once they're once they've completed that, it will be three years of anesthesia and critical care training also.
David: [00:13:26] That means total sort of three years. So seventy-five-thousand dollars per resident to get through the entire program.
Greg: [00:13:36] The other thing you know, once that piece falls into place, the next thing we need to do is recruit our first two residents. The announcement that we would be starting this program was just sent out three weeks ago. Within a week we had over one hundred inquiries and within a week later, we had over 30 applications already submitted. We're currently, the the anesthesiology council under PAACS, is currently in the process of going through those applications,to find who will be our first two residents.
David: [00:14:15] It's exciting. Yeah, it is really, really cool. It's been a dream long, long coming.
David: [00:14:22] And then the other side of this, I assume that these guys will do have a bond service bond similar to how the surgeons do so, where the surgeons, if they come under PAACS, they're obligated to work the same number of years at a Christian Mission Hospital. Is that the same?
Greg: [00:14:41] So that's our plan. And that's the model.
Greg: [00:14:45] A big reason for that is because typically it is the rural areas that are that are underserved, both in terms of surgeons and anesthesiologists. And so, we're really looking to to recruit and train people who are going to go to those hard places and live in those rural areas where, you know, unfortunately, their salaries might not be as high as they would be in the city. And, their lifestyle is going to be very different. So, it's definitely a calling from the Lord, because they're going to have to give up a lot of the lifestyle that they might have in the bigger cities.
Greg: [00:15:23] So that is our plan, to recruit residents who are who want to do that, are willing to serve in rural mission hospitals after their training is done.
David: [00:15:37] It might be worth explaining, because I'm sure some people will not be familiar with terms like missionary. If somebody is not familiar with how the structure works, missionary might sound like an odd or archaic word. But but it's important to set up like what the need is because it gives a framework for what somebody like you or Roger Barnette or Mark Newton, how your life looks logistically, and why we need people to help with this training program.
So what does it mean to be a missionary and how does that process work for you being here?
Greg: [00:16:24] Wow, that's a that's a big question.
David: [00:16:27] I mean, more practically than theologically, it's somebody who is sent by God. I felt a you talked a little about that in the beginning, as a spiritual call from God. This is your purpose. This is what you feel like you're being led toward in your life.
But then what does that what does it look like practically after that?
Greg: [00:16:49] I think those of us who are doing this feel called to to go to places where we can minister to the needs of people, both physically and spiritually. And so, you know, we're not just here to teach anesthesia. I'm not just here to teach anaesthesia, but also to to to disciple and to try and deepen my students, my residents, and hopefully my patients, to the understanding of who Jesus is, what he's done for me and and and the world, and point them to the hope that we have in him.
Greg: [00:17:28] Logistically speaking, those of us who are missionaries working in medicine outside of the U.S., typically that means that we give up our salaries and we have to live off the support of others. So for all of us, we have a team of supporters in the U.S. Who give some give once a year, some give monthly, to meet all of our the expenses that that we have our living expenses and that allow us to be here and do this work. So for a lot of us that's going to be churches in the US or individual families. But that's really the only way that we can be here and continue to do this work.
Greg: [00:18:17] Then that financial support goes through our mission agency. We are here under mission agencies who also care for us, who keep an eye on us, who help us logistically with all the particularities that come with living in rural Africa, which we can't be here doing what we're doing without them either.
David: [00:18:42] I think this is helpful for people to understand the framework and complexity because we've talked about several organizations, and I don't want anybody's heads to get muddled over by this. But it's just important to know that it takes multiple organizations to make these things happen. So, they have their different roles. Your mission agency is Serge. But we've got PAACS, who's the overseeing body for the for these [training] programs. And we've got COSECSA, the College of Surgeons of East, Central, and Southern Africa, who's the accrediting body for the thing. And then we've got the little organization out of all of them, Friends of Kijabe, which is our nonprofit just dedicated to Kijabe Hospital.
David: [00:19:31] You have a great question of "Why, David, why are you doing this? What's your role in this process? Why would funds come to Friends of Kijabe instead of PAACS?"
David: [00:19:42] The short answer is ultimately funds are going to both. But Friends of Kijabe, we have connections with people who pass through here over time. And Kijabe Hospital has been around for 100 years.
I think we're...2020...we just turned one-hundred and five [105] in May. So there's just a deep, deep network of people who care. And ultimately, this is why I think Kijabe is a cool place, is because we get to be part of these training programs that affect not just this one place, but affect the entire region.
So for me personally, my role is just to help you guys amplify your message with the people we already have connected. And so that's our hope with Friends of Kijabe - essentially as money comes into Friends of Kijabe, a portion goes to PAACS for the education resources and a portion ends up at Kijabe Hospital. And we will just, really, follow the Anesthesia Council's instructions on where to write the check. The biggest involvement of Friends of Kijabe, though, is the storytelling and connecting donors and just helping, hopefully, in that process.
Greg: [00:21:03] Yeah, we're really grateful for friends of Kijabe. As I mentioned, the need to raise twenty-five thousand dollars a year per resident to us is a big part of this. And we are, as an Anesthesia Council, not really equipped to to do that. And so we were really grateful David and Friends of Kijabe agreed to help us with that with that arm of this program, as these guys are amazing.
David: [00:21:34] You know, I spent a lot of time with Roger Barnette over the years, a lot of time with Mark Newton, and what they do for our countries, Kenya and Burundi, and for these parts of the region, and for our world, these guys are amazing.
For you [listening] as potential volunteers, once the world returns to normal, you will be really, really valuable. I know there's some people probably watching this. Joleen has been here. Usually, every summer she will come over for a month. I believe Liz Drum has been here before. Matt Kynes, we're hoping to get him here for a longer term basis, but he's been here, pretty regularly, teaching. And I know Roger Barnette has had some folks over from Temple and Mark Newton has brought folks from Vanderbilt. Those connections are also really, really, really important.
So if you're watching [or listening to] this, I know for some of you it may be possible on a regular schedule, and for some of you and may be less frequent, but it is a huge, huge, huge help for the people doing this [anesthesiology] on a daily basis, to either give them an extra hand, or give them a week or two off, where they can recover and get back into the fray. So definitely, as if you're watching this, keep that [a volunteer visit] in the back of your mind.
David: [00:22:54] Also, how you can participate? There's really three ways of really participating. You know, there's the financial component, there's the volunteer component, and then there's making connections with with colleagues that you may have around the States or around the world.
Anything you would add to that?
Greg: [00:23:19] No, I would second everything you just said. And yeah, I would encourage any anesthesiologist out there who's watching this, to come see for yourself. Kijabe is a really special place. A big part of the reason why we're able to start this program is because Kijabe is a place where we do get short-term volunteers who come and help and teach and give the long term folks a break. And it also is great because it gives the students a different perspective, because everybody who comes has something different to teach different areas of expertise, different experiences to share. And and all that, I think, is what's going to make this program so rich.
David: [00:24:04] For me, this is really exciting because I've come in with my wife, Arianna, a pediatric emergency medicine doctor. We've been in Kijabe almost seven years now. When we came, we would hear legends, honestly, about these people who started these programs and how they came to be. So for me, just looking at this, this is just amazing. This is something that one hundred years from now, people are going to look back on and think, "Wow, this started there in this specific place with these people."
Greg: [00:24:41] Thank you, David. Appreciate all that time and all your help. So it's exciting.
David: [00:24:46] And so for all you guys out there who might be watching [or listening to] this, thank you in advance for however you are able to join us in making this making this dream of better quality, more accessible, more affordable health care a reality for people everywhere in the world. So thank you. Thank you.