Serving Kenya’s underserved

Editor’s Note: In this installment of Sight Lines, J.C. Noreika, MD, MBA, talks with Thomas Ebner, MD, a community-based surgeon from Medina, OH, who, in his retirement after a fulfilling career of more than 30 years, brings his expertise, care, and compassion to the underserved of Kenya. Though Dr. Ebner’s expertise is in general orthopedic practice, his passion for volunteerism is universal among many professionals in the greater medical community, including ophthalmology. Dr. Ebner shares the challenges and insights he has gained in his second career.

Sight Lines By J.C. Noreika, MD, MBA 

Dr. Noreika: In 2004, before you retired from practice, you spent several weeks in Sri Lanka in a camp for people who were displaced by the tsunami. Tell us about your experience there.     

Dr. Ebner: We went about 2 months after the tsunami. Much of the orthopedic-trauma cases had been taken care of already, so we volunteered in a displaced-person camp in the eastern part of the island, where the tsunami hit.

We couldn’t believe the destruction along the beach, which is where much of the population in that area lived. They were fishermen. 

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For 300 yards in, everything was demolished. We met some people who had lost their families. It was just heart-wrenching.

We staffed a medical tent to treat any problems people had. It was primary care, but they appreciated having physicians to take care of them. It was very rewarding.

Dr. Noreika: You began volunteering in Kenya in 2010. How does one get involved in something like that?

Dr. Ebner: I had an interest in volunteering in the Third World in orthopedics for a number of years.

There is a service group called Samaritan’s Purse in North Carolina that is run by Franklin Graham, who is Billy Graham’s son. 

I had contributed to them because they donate a lot of time and money and supplies to Third World hospitals. They accept used equipment from U.S. hospitals and doctors’ offices, refurbish them, and send them to these hospitals. 

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I called them and said I was a donor interested in volunteering, and they said they always need orthopedic surgeons. I had read in their literature about Tenwek Hospital, in Bomet, Kenya. I told them I would be interested in going there. They put me in touch with the full-time missionary orthopedic surgeon there, and he happened to be from Mansfield, OH, which is very close to us.  

He was working by himself at that time and welcomed help. So I first went over there in 2010, and now have gone eight times. I usually go once or twice a year. Since my wife, Joyce, died [of Lou Gehrig’s disease in 2004] and I’m retired, it’s very easy for me to get away.

If something comes up where one of the main orthopedic surgeons is going to be away for a while, then people like me cover for them. It’s an ongoing hospital and it needs to be kept staffed.

Discussion (cont.)

Dr. Noreika: How long are you usually there?

Dr. Ebner: I usually go for 4 weeks, but I have stayed as long as 6 weeks. They appreciate volunteers who can come for at least 2 weeks. Some people volunteer much longer, 3 to 6 months.

Dr. Noreika: What is that part of Kenya like?

Dr. Ebner: It’s in the Kenyan Highlands, which is at about 6,000 to 7,000 feet elevation. It’s right on the equator, so the weather is the same year-round. They get quite a bit of rain so it’s a very fertile area with many small farms.

Kenya itself is a very big country. It has about 45 million people. Most live in the area where the hospital is, and in Nairobi, the capital city of about 4 million people.

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The people in the Highlands are amazing. They are hard workers. They have small farms, probably three to five acres, on which they mostly grow tea and corn. They have some small animals-goats or cows for their consumption and chickens for eggs.

They do not make a lot of money. They do not have insurance. They are pretty much on their own in that respect.  

Dr. Noreika: Do you need a work visa to serve as a physician in Kenya?

Dr. Ebner: You have to get a Kenyan license, which is basically a formality if you have an American license. You do have to get a visa and they have started tacking on a fee of about $100 when you leave.

Dr. Noreika: Do you travel on your own dime?

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Dr. Ebner: Yes. The hospital does not have any money to provide transportation.

They have a wonderful living facility, but it’s about $20 a day for room and board. 

Even the missionary doctors, who are full-time volunteers, arrange for their own finances. 

The hospital’s overhead is primarily administrative and nursing. They have to be somewhat competitive with the government hospitals to keep these employees.

Discussion (cont.)

Dr. Noreika: Are the patients charged for their care? Is there an insurance system?

Dr. Ebner: Insurance is minimally existent. The people who have insurance are usually government employees.

Insurance is relatively inexpensive, about $15 a month, but small farmers living on a shoestring can’t afford it. I didn’t realize how important the insurance industry was to practicing medicine in the United States until I went to Kenya.

Tenwek Hospital has been able to do fairly well, but it does charge patients. The amount is minimal compared with what you have in the United States, but it’s still a cost.

It’s always kind of a shock to me that people have to pay in order to be treated, especially since I see a lot of trauma cases, and no one plans on having a trauma.

People will come into the emergency room with a broken hip and if they can’t pay for care, they are sent home until they can. I thought that was cold-hearted until I realized that the hospital has to pay its overhead. Patients do not pay a lot but the economic fact is that the hospital has to do this to survive.

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I saw a study once that said in Kenya there were about 18 missionary hospitals and only two or three of them charged people for their health care. The rest were financed by U.S. donors.

Almost all the ones who didn’t charge patients went out of business. The ones that were able to make a go of it were the ones that did charge people.

Medical financing was something I never had to deal with in the United States and it’s hard, but you can see why it has to be done.

Dr. Noreika: Is English the primary language in Kenya?

Dr. Ebner: In business it is, but most of the people there do not speak English. They speak either their native language or Swahili, which is kind of a common language up and down the East coast of Africa.

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English is spoken in the hospital by most of the doctors and nurses.

Our patients can have maybe four or five different languages from their different tribes. Every tribe has its own language. So I rely upon the nurses or the doctors to translate. I am always amazed at how many languages the staff can speak.

Discussion (cont.)

Dr. Noreika: Walk us through a typical day. When you’re in Kenya and the sun is coming up-and I presume they still have some roosters that crow-what do you do and when does it end?     

Dr. Ebner: I usually get up around 5 a.m., and yes, there are a lot of roosters and chickens. I work out, get something to eat, and get ready for the day.

We usually start rounds at 7 a.m. and then surgery starts around 8 a.m., although you have to get used to African time, which isn’t the same as American time. Things usually start around the time they say, but they never put starting times on the surgery board. It’s supposed to be 8 a.m., but maybe it will be 9 a.m. 

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Since it is a mission hospital, they often have spiritual conferences before the day starts. But then we usually work until around 5 or 6 p.m., depending on when we get done. But we never really get everything done. Things run over into the next day. That’s the way it goes. 

On Saturdays and Sundays we only see emergencies. Most orthopedics cases are trauma-such as long-bone fractures, femurs, tibias, upper extremities, pelvises, sometimes spines. Some of the mission doctors will occasionally do elective surgery-such as a total hip or total knee-but I don’t.

I am on call about twice a week. They call people like me ‘consultants.’ In the states, we call them ‘attendings.’