"You give 100% of yourself, and then some more." Dr. Hellen Kihoro, PAACS Kijabe General Surgery Resident
Conversation with Dr. Hellen Kihoro about training, faith in medicine, specialization, dreams for Kenya.
DAVID: I'm David Shirk, director of Friends of Kijabe. And what is your name and what are you doing here at Kijabe Hospital?
HELLEN: My name is Hellen Gathoni Kihoro and I'm a second-year resident. I'm taking my residency in General Surgery.
DAVID: Excellent. And where did you come from? Why are you in Kijabe right now?
HELLEN: Wow, that's an interesting question. Probably a little background. I did my internship here. That was back in 2021, 2022. And then I always knew I wanted to do Gen Surg. So I applied. And here I am. So I applied the first time. I needed an little bit of experience and then I got in the second time. Yes.
DAVID: The reason we're doing these conversations, we're talking about building resident housing, but it's not about housing. It's about you guys, what you're learning and what you're able to do, you know, why you came to Kijabe, why what what you want to do after graduation and really, the call God has placed on your life, right? That's the big that's the reason why we're building housing is part of the entire picture of of your lives, right? So what was it that made made Kijabe special to you? And then why did you want to come back? Why did you want to do surgery training through PAACS?
HELLEN: Okay, so first and foremost, I don't come from very far from here. So even from the community, I've known that people seek medical attention here, but among other things, it's a Christian center, which for me is a big deal. I knew that this can be incorporated as part of my everyday activity, getting to do God's work through patients and the environment is very supportive. So that did not disappoint even when I did my internship here. So it went well and after that during my internship period I got to learn about PAACS as well. I knew they were residents but I didn't know how they used to get in. So that's the time when I knew about PAACS and yeah, I need something that I'd want to try out for. And thank God, here we are.
DAVID: That's awesome. And if you're not familiar, I'm sure most people watching this, PAACS is the Pan African Academy of Christian Surgeons. So, they are an education support body. They raise money, PAACS raises money for tuition, but they need other partners to help with infrastructure and equipment and the ancillary surgical things.
So, faith in medicine. What does it mean to you to be a Christian surgeon? How do you how do you see that in your interaction maybe with other people or your interaction with patients or you can answer however you would like to?
HELLEN: Okay. So, first as a Christian and as a doctor, having them incorporated in the same setting is golden. It's not every place that you get to do that where you can talk about your faith and communicate the same to patients at the same time, but then again still practicing Christlike behavior even to your patients. You don't have to preach to them directly, but by them you're extending your compassion, extending your patience with them, knowing that they at their worst when you're meeting them, then you're able to portray that behavior and one way or another, that's ministry in itself. It gets to get patients closer to God and it's just a matter of time and then they'll be like, "I don't know what's different with this person and I'd like to know what it is." So, getting to have that in the same setting means a lot. That is one. And then two being a Christian facility, we are not limited in that you cannot pray with your patients. You can be able to express and also minister to the patients real-time and also actively which is also a good thing especially seeing that most of our African community and even Kenya at large we have a lot of people of faith and our population here in Kenya is about 80% Christians, well as per what they say, but then that means at one point or another people have heard about God and they putting their faith in something. In their worst then it's good to hang on to some hope somewhere. I mean, God is there for us so it's good that we can communicate that in our day to day.
DAVID: That's awesome. And when you talk about that, like at their worst moments like or at their most challenging moments, like "where do you where do you go to like who do you trust in when you're trying to figure out who to trust in?" And in Kijabe, before surgery, the patient is on the table, you guys are going to stop, you're going to pray with them.
HELLEN: Yes, we are.
DAVID: And what I've learned as a photographer is a lot of times they're not asleep. I always have to check the behind the curtain now because many times you're doing local anesthetic. So, it's not just you're stopping and praying when you do a timeout, but if you're praying with the patients, they know.
HELLEN: Yeah. Even if it's general anesthesia, you pray with them before they go under. They get to participate in this. And I think at that point, even if you're not a Christian, even if you're a Muslim, they don't mind you seeking a higher power to support you through this. So, I mean, it's a plus.
DAVID: Can I ask you about learning? I want to ask about like learning in the surgical sense, but also in the spiritual sense. Like what does it look like as a younger trainee? I mean are you do you look to kind of your older or the people a year or two ahead of you? Do you look to faculty like how do you how do you learn spiritually and surgically? Okay. So I'll start with spiritually. So spiritually one I still maintain my circle even from my home church and all. But also, here we have people like-minded and people of the same faith. So, we have the surgeons, we have our residents that are ahead of us, and we even have residents that even after us and we all subscribe to the same faith so to speak.
So, among other things we have a spiritual curriculum. I don't know if you know that we have a spiritual curriculum which we go through about every other week. It's a whole Bible study. So, we still get to grow together as surgeons, as residents plus our consultants together in the same space. And that's just one of the settings in which we do Bible study together. There are more settings in which we do Bible study together. I think we had a Bible study for the class our cohort that we got in with - well distance made it a whole big deal but there was that. And we still have a have other forums like women in surgery for PAACS women here. So, there's a lot of forums that we keep to keep getting to grow together all the time spiritually.
Also, in terms now of surgically, we have one our consultants and our senior residents like they're really, really good. They are patient with us and they help us learn and by and by you pick the same traits and so that you can be able to pass along the same to the other residents as well.
DAVID: There's something there's something you mentioned briefly in passing, but I think is probably really important. You said something about one of your Bible studies, but the distance makes it a challenge. What did you mean by that?
HELLEN: So, when we got here last year in our first year, we started a Bible study for the people in our class. But as you're well aware, some of us don't live in the campus, and that means we are scattered through and through. People come from different places, different distances, different directions if you may. And being in different programs also makes the schedules even harder. So, what we had tried to do was have our meetings happen on a weekday at around 5:00 p.m. Sometimes it will start a little late and it will run a little late. So sustainability in terms of ending time was becoming a problem because then if we end at 8:30, how are you going to get home? And even if you're driving, it's still a long way to go and you still have to travel and come back tomorrow morning, maybe you have rounds at 6:30, rounds at 6:00. So then by and by, we tried, we really tried, but by and by we'd get more people not attending.
DAVID: I think it's one of the biggest challenges is like you have consultants here. We have call rooms on campus but when people are scattered it makes it hard to be together. Were you here on Monday for the skills lab opening?
HELLEN: Yes, I was.
DAVID:
So we're on the other side of this wall from us. But I was thinking like "this is great. We have a surgical skills lab. Who can use it?" Because you're in theater, you're busy. It's such a challenge to come here. But if you're on campus, you can just come by anytime. So, so that's the goal is to have people close together, to have fellowship.
All right, so back to medicine. Do you have it do you have any favorite procedures? What do you what do you enjoy doing?
HELLEN: Wow.
DAVID: You're Gen Surg, but Gen Surg, you like to do something, right? Are you still too early?
HELLEN: Well, that's a good question. That's a very good question. Interestingly, for a long time I thought I'd like to do trauma surgery. I still love trauma surgery, by the way. I think the study trajectory is diverse, especially seeing that we don't have some of those sub specialties here in the country. But I've always thought it's a very good sub-specialty. It's something that I'd love to pursue. But also during my rotations, I think by and by I've come to enjoy urology. But that was like a two month rotation. I still think I enjoyed and it's not something it's not something to take lightly. It's probably something I might pursue. Who knows? Watch this space.
DAVID: Awesome. One of the things happening starting a urology fellowship.
HELLEN: So, for fellows. Yes. Not residents.
DAVID: Yes. But yes, but there's a pathway. So that is good. And so that's… actually that would be good to explain to everyone. So how does how does how does residency work? How long is it? What do you do as far as big overarching programs? And then if you want to specialize, how does it work?
HELLEN: Okay. So, I'll pick Gen Surg because that's where I am. So, in general surgery, it's a five-year program. The first two years are the basic years. So, everybody else, everybody who's doing surgery gets to do the first two years the same way. So, we also get exposure in some of the sub-specialties and some of the smaller rotations like ICU, physiotherapy, endoscopy, urology, OPD (Outpatient Department). We get to do all those in the first two years.
DAVID: You rotate in physio and OPD?
HELLEN: Yes, we do OPD. We have a resident clinic for sub for our specialty in OPD. Okay, for the specialty. So, like if you're on ortho rotation, then you would be an OPD. You have an OPD or rotation. You have an OPD gen surg rotation like that. Yes.
Then there's endoscopy. There's physio. Physio, most of the times the people who are doing orthopedics are the ones who rotate in physio. We rotate in endoscopy. And then there's ICU there's anesthesia. So, you get to do all those in the first two years and then from there you get to do your sub-specialties. So, I think next year there is peds surg, plastics, and head and neck and then you also get an elective term in year four and then, so by year three-four-five you're doing things that are completely now in your line.
DAVID: Yeah. Okay. This is a big question. This is a big one. No, no, don't be scared. What do you see as the biggest health challenges in Kenya? Obviously, you became a surgeon to solve a problem. What is the big problem that you see yourself as part of solving?
Hellen: One, access and two, quality compassionate care.
A lot of people are getting mismanaged and probably not getting treated with the compassion that comes with it. For most patients, hospital is not a good experience. And while it still shouldn't be a good experience that you seek, then it shouldn't be any worse than it is. So, in terms of offering quality with compassion, I think that's the biggest niche especially that PAACS is trying to cultivate and it's doing a very good job at. Yeah.
DAVID: Can you give me an example like of what that might look like for a patient?
HELLEN: Okay. I'll give I'll give an example of like - maybe a patient comes in maybe is a referral from a peripheral facility and maybe what they they're bringing as a referral note, one is not comprehensive, two is ill-informed like maybe not even accurate and then that means of course going back to the drawing board and starting afresh. But also, now this patient is not only sick they are also frustrated. They've been at it for a while. If it's a cancer, it's probably something that's grown bigger than it was before. So, they require a lot of patience and compassion.
So, while they may even project some of that to you, you also want to try and remain levelheaded and, you know, be the bigger person in this conversation. So you still handle them. Not "no you can't make you can't say these things to me I'm not the one who made you come in late" but "You know, we are here now, what can we do? How can we help in a timely fashion and give you the best of the care that you need, at this point in time?"
It's a good thing that you can be able to pause and do that but also it's also something you see everyone doing so it becomes easy for you to adopt.
DAVID: When we do our compassionate meetings, I feel like that's the case very often. It always starts like this person went to the local like clinic or dispensary and then went to this facility and then went to this facility and then they've used all their money and then they come to Kijabe and they're stressed and struggling.
HELLEN: Yes. They're tired. The family is tired. Everyone is tired.
DAVID: So, we want that to improve. But then also, I guess the good side of it is when they do get here, you can give them hope and you really can encourage them like you're not going on from here.
HELLEN: Like we will fix you. We will support you. You give them 100% of yourself and then some more.
DAVID: Ooh I like this.
What are your dreams? What are your dreams for you and for your community and for Kenya? For me and my community and the country at large.
HELLEN: Oh wow. That everybody gets quality healthcare.
Quality and access are still the biggest things. I come from a central region and while you think that's supposed to be we are supposed to be like the people who get better access but we still like many kilometers away from a good facility and while at it a quality facility I think to here is like maybe 25 kilometers on average and to some of the public facilities that we have, you know, like some of the health centers and the dispensaries, they don't even operate at night.
DAVID: And you know, 25 kilometers for people that's like in America, that's like 11 or 12 miles. But how long would it take to make that trip?
HELLEN: It's a long trip. It's at least an hour. So, this is Kijabe. That is two hours. Two hours to go 11 miles.
Yeah, because then, even finding transport is an issue. Especially to this place by the way… but that's even a good case scenario. There are people in other regions that totally don't have access.
I've been in a place where a patient gets involved in in trauma like a gunshot wound somewhere and they get you six hours later and they had the best of like ambulances but they didn't have a facility close to them. So even if they have all the resources access, I mean, it's already bad enough. So we're still not there yet in terms of reaching everyone and it will be prudent to just reach them with the quality and the best of the care that you can. Yeah.
DAVID: Yes. I love this. Your dream is my dream.
There's a couple terms that come to mind when I think of that. One is localization: having good care close to where people are.
And then, having good referral networks to get people from where they can go to where they need to go in a timely manner.
Then connecting what happens at a community health level to what you guys are doing. We're a referral hospital in Kijabe. You're a surgeon. you're talking about being a specialized surgeon. How do people how do how do people get to you at the right time?
And how does information get to those local providers to know, "Hey, there's resources available."
So, I'm hoping there's a couple of things that will happen. One, I think Kenya is just improving, I think, globally.
But then two, Kijabe is expanding and expanding, and so I hope we can put some of our clinics close to where people are. We have graduates closer to where people are, and I hope that can make a big difference.
HELLEN: Sure. Sure. More and more training, more and more people out there, quality care and people who are aware of the referral systems who can recognize, "I am limited in this way. I don't have this infrastructure. I don't have this and there's a place where I can refer this patient." So yeah, that knowledge may sound as basic but it's not.
DAVID: Thank you. This is amazing.