A Kansas doctor’s day in Kenya

Sunday, March 2, 2008
The Wichita Eagle

John Epperly wasn’t out of medical school yet, and he had to do the work of 10 U.S. doctors.

In 2006, Epperly and his wife, Shea, were fourth-year students working at Tenwek Hospital, a 300-bed clinic in the rural village of Bomet in southwes tern Kenya.

There, they learned how inadequately they were being trained in school.

“That’s what really opened our eyes,” Epperly said.

He kept a diary of his experiences in Kenya. He recently recalled a day in February 2006:

He worked the pediatrics unit, which included the care of newborns in critical condition. In the U.S., that would be a full-time job. In Kenya, Epperly also had to run the emergency room.

Two children were suffering from HIV. Another boy had Stevens-Johnson syndrome, a rare, life-threatening skin condition.

Another pair of children came in with hydrocephalus: fluid on the brain. Both needed taps put into their brains to drain the fluid.

Epperly treated two malaria patients and performed a biopsy on a patient with a tumor obstructing his bowel.

“And that was just the morning,” he said.

That afternoon, he took care of 10 premature babies. One had tetanus. He delivered another with a “double bubble” stomach obstruction requiring surgery. He’d never done it before. He read a textbook and made the incision. He also set two broken arms and performed an emergency C-section.

Then a boy walked in with a leech growing in the back of his throat – something Epperly hadn’t learned about in Kansas.

“It’s really a quite deadly condition,” Epperly said.

The leech enters the throat through infected drinking water. It attaches to the pharynx, where the nasal cavity meets the throat. There, it grows, and may go unnoticed until it’s big enough to block an airway.

“We luckily were able to tease him out. Sometimes they slip down the esophagus and get stuck there,” Epperly said.

Epperly said he wished he’d had more training that day, after a man from the Maasai tribe traveled 24 hours to get to the Tenwek ER.

“It would have taken about 10 specialists in the United States to take care of those kinds of patients,” Epperly said. “There in Tenwek you have one, maybe two people.”

Two doctors.

“This is one day that showed me we need to be better prepared, so days like this aren’t so overwhelming.”

The Maasai man had been out tending his cattle when an elephant pinned him against a river bank and gored him four times. He had several tusk wounds in his arms and a 10-centimeter hole through his thigh.

Epperly spent hours just getting his wounds cleaned before treating him.

Eventually, Epperly returned to Wichita, where he had attended Northwest High School. He and his wife began their residencies at Via Christi. They reunited with Todd Stephens, a doctor they’d met in Kenya.

Epperly and his fellow residents helped conceive the curriculum that would become Via Christi’s International Medicine Fellowship.

As Epperly thought about the new training, he remembered the Maasai man.

“We don’t know why he died later that night,” Epperly said. “Not that you can ever be prepared for elephant attacks, but I wonder if we had been better prepared in trauma, we could have figured out something that potentially could have saved that gentleman.”