First Kenyan Surgery Resident Participates in Educational Exchange

Although Kenyan surgical registrar (resident) Dr. Beryl Munda often found herself completely lost in the Indianapolis campus hospitals, her AMPATH educational exchange experience convinced her she was in exactly the right place professionally.

“Every rotation was amazing,” said Dr. Munda. During her four weeks in Indiana, she rotated in trauma, robotic surgery, general surgery, plastic surgery/burns, hepatobiliary and breast reconstruction. “My expectations were high, but they were met and exceeded. I’ve learned so much,” she continued. “I’m like a kid in a candy shop and now I want to do them all (surgical specialties).”

Dr. Beryl Munda

Dr. Munda is the first Kenyan surgery resident to complete a surgery rotation at Indiana University (IU) since the start of the AMPATH partnership between IU and Moi University and Moi Teaching and Referral Hospital (MTRH) in Kenya more than three decades ago.

“I've had an outpouring of kindness from everywhere. The attendings, the residents, everyone has just been extremely kind and warm and welcoming,” Dr. Munda said. “I feel like I'm changed as a person, and also as a physician, as a medical care provider. I have the desire to do more. I have the desire to make myself a better person in terms of my work, and also just generally as a human being,” she continued.

The physicians providing training and experiences throughout her rotations had a profound impact on Dr. Munda. “I've worked with many doctors who are experts in their fields and are good at what they do, and they also they just carry themselves with a lot of grace and dignity,” she added.

During her trauma rotation, the speed with which accident victims made it from the accident to the operating room and the multidisciplinary approach to care impressed Dr. Munda. She noted the contributions of occupational therapy, physiotherapy and psychiatry in helping patients transition from the hospital to rehab to home. “The whole holistic approach to patient care is something that I felt is important, and it's something that we could focus on.”

The fact that robotic surgery happens without ever touching the patient was another revelation for Dr. Munda. “I think I bragged about that to everyone back home,” she laughed.

The rotation in the plastic surgery burn unit impressed upon Dr. Munda the impact that surgery can have on patients. “Burn patients go through the most,” she reflected. “When you can fix someone’s outside, you have such a huge impact on them.” She noted that there are many burn patients in Kenya, but not as much attention is paid to scars which can have a lifelong impact. The development of a specialized burn unit is underway at MTRH. “That will be an amazing thing. It's going to touch a lot of lives,” she added.

During the hepatobiliary rotation at University Hospital Dr. Munda scrubbed in on two Whipple procedures which are less common in Kenya. At Methodist Hospital, the rotation exposed her to a variety of flap surgeries used in breast reconstruction. “Surgery in a place that has all of the resources is just the most interesting thing. I could do that all day,” she enthused.

Dr. Beryl Munda worked with Dr. Julia Cook Beresford and Dr. Brian Christie from the Indiana University School of Medicine Department of Surgery division of plastic surgery.

Dr. Munda said she was left speechless watching Dr. Gayle Gordillo, chief of the division of plastic surgery at IU School of Medicine, demonstrate the use of antibiotic beads after surgery. “She has written papers on it and that is another thing I have admired. As much as people are doing all of these great things, they are also documenting them to find new and better ways to take care of patients. The practice of medicine is very wide, and every person’s contribution matters. Even the smallest things are a big deal, and you are contributing to making someone else’s life different or better or easier,” she continued.

Dr. Munda also emphasized that the relationships built through the AMPATH bilateral exchange impact the delivery of care in both the U.S. and Kenya. She cited the relationship she has created with Dr. Manisha Bhatia, an IU surgery resident who spent a year in Kenya as a research fellow. “The beauty of it is that we can have a discussion based on the fact that she's already been there, and I've been here and then we can have a whole discussion based on our experiences,” said Dr. Munda. “It also helps us as future surgeons. Now that we built linkages, I can call to have a consult. I feel with medicine being globalized, this is just us moving an inch closer to giving the same level and standard of care at different places. I think it’s an amazing thing,” she continued.

In addition to her experiences in the hospital, Dr. Munda (center) also experienced events such as the Indiana State Fair (shown with visiting Moi University medical students).

Dr. Munda noted several differences between patient interactions in Kenya and Indiana. In Kenya, patients go into the doctor’s room, while in the U.S., doctors go into the patient’s room. She also thought patients in Indiana are more aware and interested in what is going on and want to take a more active role in their care.

She also saw differences between the way resident education was delivered and appreciated the relaxed interaction between residents and attendings and the opportunity to discuss cases and challenges with peers and receive feedback. Although patient rounds started early at 5:30 a.m., those were some of Dr. Munda’s favorite experiences.

When Dr. Munda returned to Kenya, she had a thesis and exams to complete and then planned to return to Kericho County to care for people in her home community. Like many physicians pursuing post-graduate training in Kenya, she is bonded to her county and will provide care for a set number of years in exchange for the county’s support of her advanced medical education. She then hopes to apply for a fellowship in breast or plastic surgery. “As a future surgeon, I look forward to the opportunity to inspire others and teach,” she said.

Outside of the hospital, Dr. Munda enjoyed sampling the variety of foods and desserts the U.S. has. “Oh my God, you have like a million flavors of ice cream,” she exclaimed. “But I really don’t get the cheese thing; it’s everywhere!”

During her time in Indianapolis, she was also able to fulfill a lifelong desire to attend an art exhibition by attending the Monet exhibit at The Lume at Newfields (Indianapolis Museum of Art). “You feel like the artwork has been brought to life and it was so beautiful.”

“America is indeed the land of opportunity,” Dr. Munda observed. In addition to working with physicians from all around the world, her daily commute had her meeting Uber drivers from Venezuela, Mexico, Sudan and Nigeria among other places. “Another thing I have learned is that people like to talk! And I like to talk, so have heard all different kinds of stories,” she said.

“I just want to express my deepest gratitude for this opportunity,” concluded Dr. Munda. “It’s had such a huge impact on me. I’m hoping that as I’ve been honored to be here and avail this opportunity, that I’ll be able to reflect it in my work.”