Third-year pathology resident Kali Tu is focused on making a difference to improve health. She recently returned from a two-week elective residency training rotation in Malindi, Kenya, where she provided medical care to approximately 400 rural residents with little or no access to health-care services.
Malindi is a coastal town located on the Indian Ocean about halfway between Mombasa and Somalia In Africa. A two-hour flight from Nairobi, Malindi and the surrounding region have a population of about 200,000 residents.
The trip to Malindi was the second for Tu, who joined a team of 26 American physicians, nurses, anesthesiologists, and medical and high-school students. The trip was organized by Vanderbilt University ear, nose and throat surgeons and the Caris Foundation, a Texas nonprofit group that arranges medical care for treatable conditions for individuals in developing nations. The foundation worked with the two main hospitals in Malindi -- Tawfiq, a Muslim-mission hospital, and the public hospital, called the District Hospital -- and invited local residents with visible head, neck and facial disorders for evaluation and treatment by the team.
During the trip, surgeons operated on more than 200 patients, and Tu would travel between both hospitals on a daily basis as needed to examine patients and diagnose tumors and margins. The experience broadened her horizons, advanced her training and exposed her to another culture and health-care system.
"The experience was an incredible educational opportunity," said Tu, who joined the Department of Pathology and Laboratory Medicine's residency training program in 2010 in her second year of training. "I gained a lot of experience in performing fine-needle aspirations, assessing cell specimens and communicating with other physicians. It also was extremely fulfilling to work directly with patients and surgeons in an area with low resources."
At the hospitals the medical team had access to a total of three operating rooms, each of which had two tables for treating patients side-by-side. Surgeons worked eight to 10 hours a day, with Tu conducting a fine-needle aspiration clinic to diagnose tumors. Between Tu and the other pathologist on the team, they examined as many as five patients a day in clinic, all patients pre-operatively and all the surgical specimens.
"There are no pathologists in Malindi, so the nearest specialist comes from Mombasa, which is two hours away," said Tu. Medical equipment also is in short supply, so Tu and colleague Jeffrey Mueller, a pathologist from the University of Chicago, brought along a donated cyrostat to perform intra-operative frozen section diagnoses.
"There is still a lot of superstition in rural Africa, and many people believe tumors are related to curses. In addition, because few people have the resources to pay for medicine or treatment, most of the tumors we diagnosed were found in extremely advanced stages. That is something we would rarely see in the states," she said.
The Department of Pathology and Laboratory Medicine allows residents to take four months of electives during their four years of training and often provides supplies for medical missions. For Tu's trip, the department provided pathology slides, gloves and formalin, and the VA Northern California Healthcare System provided formalin biopsy containers.
"Training in underdeveloped or underserved areas around the world provides important 'real-world' experience," said Rajen Ramsamooj, professor of pathology and laboratory medicine and residency training director. "Trainees must rely on their own skills and problem-solving in an environment that lacks assays, auxillary tests and other technology that's readily available in the United States. It's a great learning experience."
"Kali's interest reflects the growing interest in global health among pathologists and clinical laboratorians nationally," said Lydia Howell, professor and chair of the department. "We are increasingly a global community, so the health of the world's citizens affects everyone. In addition, with 70 percent of all medical decisions based on laboratory testing, pathologists have considerable impact in reducing health disparities globally -- and locally -- by making essential lab services available to those in need and ensuring that these services are efficient and effective. These challenges will be even greater for the next generation of U.S. pathologists due to pressure for health-care reform."
"The cases are very difficult, and it can be a challenging environment," said Tu. "It is similar to what we do here, but the environment is certainly not as comfortable. We don't realize how nice it is to have air conditioning, and how problematic it is just to put on gloves in the humidity we experienced. Sometimes the power would go out, or there would be no water and we would have to buy jugs of water to wash our hands."
The experience expanded Tu's understanding of cultural diversity, she said. "Almost all the patients ask for their tissue back when we're finished with it, so we only take a small section. The belief is that if their tissue falls into the wrong hands, someone could put a curse on it," Tu explained.
While patients were initially suspicious of health-care providers, eventually the relief provided by the medical team changed many hearts and minds, Tu said.
"In my experience, all of the families were extremely grateful," she said. "They would come in with big bowls of watermelon or dates, bananas and other produce to thank us for treating their family members."
"We are proud that Kali is bringing her expertise to help those who have so much less than most Americans, and that she is gaining a unique perspective that will make her an outstanding pathologist, regardless of where she brings her skills," said Howell.