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Thursday, March 28, 2013 - Munson-Kenya Ties Continue to Strengthen


Munson Family Practice Resident Robert Milanes, left, poses with medical staff from P.C.E.A.
Hospital in Chogoria Kenya. Below, right, a typical hospital ward.

Munson-Kenya Ties Continue to Strengthen
Family practice residents, faculty spend time at Kenyan hospital

Munson Family Practice Resident Robert Milanes, M.D., spent time late last year working at hospitals in Kenya and Morocco.

Watching tonsils taken out as a security guard kept a young patient’s head immobile was a good reminder of how different international medicine can be from what is experienced in the U.S.

“It’s good to go and see how fortunate we have it here,” he said. “They have limited resources and are asked to do patient care. They are very resourceful.”

Munson Family Practice Residency Program Director J. William Rawlin, D.O., said spending time in an international setting provides important benefits for a resident’s education.

“First, they are exposed to many disease processes that they otherwise will not see,” he said. “They get the opportunity to improve their ability to care for patients of a different culture, and also work with health care providers of a different culture. Our residency at Munson Medical Center has the mission to train residents for working in rural areas. In many rural areas, access to services or technology may be limited. Working in Africa gives about the strongest possible experience for working in conditions with limited resources. It really forces the resident to learn how to use their history and physical exam skills to diagnose and then treat patients.”

Dr. Milanes and Kurt Sanford, M.D., a Munson gastroenterologist, provided care at P.C.E.A. Hospital in Chogoria, Kenya, last November as part of a growing relationship between the hospital and Munson Medical Center. Rawlin said the relationship with that hospital began with Munson Cardiologist David MacIntosh, D.O., doing volunteer work there. Last year, a Munson resident Heather Kennedy, DO, and Munson Family Practice faculty member David Klee, M.D., visited and spent time caring for patients. Dr. Klee is currently in Kenya on a second visit.

“The frequency of faculty involvement is still in development,” Dr. Rawlin said. “The purpose of faculty will be to work alongside the resident as a supervisor, but also to participate in the care for their own experience. It will help them gain insight to international medicine. The intention is that whenever a resident goes, we hope to have either a core Family Medicine faculty member or other member of the Munson Medical Center staff go as well.”

Dr. Rawlin said there is a lot of value in the relationship with PCEA in Chogoria because it helps with recruitment of residents.

“In the past we have lost some good candidates by not having this opportunity,” he said. “It will help the Munson Healthcare system as well. We hope that we are establishing the groundwork and creating the process that any physician in the Munson Healthcare system who wants the opportunity to participate in an experience like this can, regardless of their specialty.”

Dr. Milanes said in both Kenya and Morocco, patients have to pay for care before they receive it. In one instance, a trauma patient was brought in by friends after crashing a bike.

“To get a CT scan you have to pay for it. If you don’t have the money, they will let you wait until family or friends come in to pay,” he said. Instead of dealing with issues such as hypertension and diabetes, medical staff in Kenya deal with TB, HIV, and malnutrition.

“I got a lot more out of being there than the help I gave them,” Dr. Milanes said.

Dr. Rawlin said one of the projects Munson Family Practice Residency is working on is helping the hospital in Chogoria create clinical pathways and order sets for common problems, such as pneumonia.

“That is something we take for granted here at Munson, but does not exist in Chogoria. Not only will Munson be providing excellent care to the people of northern Michigan, but we will be able to extend that to people in great need in Chogoria,” he said.