Local-Specific Surgery in Action

A conversation with Dr. Derrick Lin about his recent trip to KenyaDSCF4850-L

On Friday, we had the opportunity to sit down with Dr. Lin, an otolaryngologist at Mass. Eye and Ear, and learn about his recent trip to Kenya. In September, Dr. Lin spent three days training ENT surgeons and residents from across Africa in a condensed but comprehensive course. Dr. Lin was invited to participate in the training by Dr. James Netterville of Vanderbilt School of Medicine who, after conducting several mission trips to Nigeria, began to question the sustainability of the traditional mission trip model and decided to shift his focus to medical education. The training in Nairobi this September was Dr. Netterville’s first experience under the new education model and Dr. Lin’s first humanitarian experience in Africa.

About the Training

The ENT training focused primarily on head and neck cancers. The first day of the training was dedicated to a series of lectures, the second day revolved around cadaver dissection, and the third day focused exclusively on live surgeries. Participants travelled from across Africa for the training, from countried like Zimbabwe, Uganda, and the Congo, for a total of over 25 participants. The Kenya ENT Society sponsored the training which was held at Kenyatta National Hospital, and, during the second day, the group also had access to Nairobi’s state-of-the-art cadaver lab. Pre- and post- training surveys were conducted to get a sense of what attendees wanted to learn and whether they felt the training was successful.

Determining Surgical Focus

On the first day of training, Dr. Netterville asked attendees what they wanted to learn over the next few days. Somewhat surprisingly the primary concern of these doctors was laryngeal cancer. They explained that often patients come in with T3 or T4 laryngeal cancer and wait times for radiation are typically 3-4 months. Attendees wanted to learn how to conduct partial laryngeal surgery on T1 laryngeal cancer patients to prevent patients from reaching later, harder-to-treat stages.  Given the limited equipment and tools available to most African surgeons, surgical education strategy was modified to better suit local resources. As a result, the three-day training focused primarily on open partial laryngeal surgeries. Although open laryngectomies would typically not be performed in the U.S. today, it became obvious that open surgery is the most practical approach given the equipment available to the majority of African surgeons.

Main Takeaways

Dr. Lin (far right) on the final day of training.

Dr. Lin (far right) on the final day of training.

Dr. Lin highlighted two key lessons learned from his experience in Kenya:

One, these residents and surgeons want to learn. On the final day of the training, there were several patients cued up for surgery, far too many to get through during a training intended to end at 5pm. Dr. Lin told his group that they were welcome to head home at 5pm, that he would get through the rest of his patients on his own, but not a single person left. Dr. Lin was both impressed and moved by his group’s desire to learn and observe as many surgeries as possible. Overall, the attendees expressed a strong desire to improve their abilities and provide better care for the communities they serve. Dr. Lin noted that the African surgeons clearly demonstrated incredible passion and book knowledge. However, faculty mentorship and hands-on surgical skills seemed to be the missing links in their training; this is part of the reason why courses like Dr. Netterville’s are so important.

Two, Dr. Lin emphasized that medical education must be tailored to the resources available. He explained the power that Dr. Netterville has in his ability to bridge the gap between new high-tech surgery and low-tech operations, like open laryngectomies, that were popular in the Western world 30-40 years ago. Although Dr. Lin hopes that one day African and American surgeons will have access to the same cutting-edge technologies, he recognizes that, at the moment, African surgeons want to learn how best to save lives given the environments in which they currently work.

Hopes for Future Trainings

Dr. Lin hopes that, for next year’s training, American residents will also be able to attend; he believes it is important for residents to learn not only how to be good surgeons, but also how to be good teachers. He is excited to learn more about where African ENT surgeons believe the burden of disease lies and how we can best target training programs to the specific challenges of the region. Dr. Lin, like the Office of Global Surgery and Health, also hopes to see more collaboration between Vanderbilt University and Mass. Eye and Ear as these institutions continue to address the gaps in medical education and the needs of surgeons in the developing world.

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