The uncertainty of where you are going to spend your first night in a city known for its housing challenges was an addition to the roller coaster of emotions we endured. The thought of traveling to Europe was just a dream and seeing it play out in life was an opportunity that I am extremely grateful for.

The process was quite the effort and sheer determination in believing in what you want is something that I saw unfold in this trip. The power of positive thinking and mindset is really what drove my experience in a city loaded for its technology, culture and diversity. Throughout the experience, there were possible roadblocks, but trusting the process and thinking positive ensured the universe was always on my side one way or the other.

Berlin welcomed us with open arms from the minute we jetted in. Right from our Bolt driver to the fantastic lady at the grocery store, the hospital staff, our student accommodation and the lively streets of Berlin. We interacted with amazing people who were all so friendly and willing to help which contributed an integral part of our experience.

Day 1 at the hospital, fueled with adrenaline and excitement, I was all set to begin my medical elective in the Child Orthopedics and Trauma department for the next 4 weeks. Working in the children’s orthopedics was a new experience for me as compared to my previous experience in the adult orthopedics. I was warmly welcomed by our head of department and thereafter was given a tour of the hospital. As mesmerized as could be, I spent my first hour getting a tour of the hospital and recall being stunned at the infrastructure & technology invested with special mention into the laundry dispatch area. Thereafter, I spent my weeks at the department learning, observing and assisting where possible. As I continued to stay in Berlin, I was able to see why Germany is the house for innovation and technology.

Limb length discrepancies, Spine and back, corset posture correction, hip dysplasia correction, fracture repairs were amongst the various services offered by the department. In a nutshell, anything bones related to children was referred to us! These procedures were those I had only read in textbooks or seen virtually, and getting the chance to see these in real time was ecstatic. Techniques in assessing limb discrepancies and thereafter implementing a treatment plan and educating the patient on the next course of action was a valuable learning experience for me. Cool technology where one magnetic rod is surgically inserted into the femur which then extends to increase the length of the limb when an external magnetic machine is held close to the region of the femur was amongst the most fascinating things i saw. Patient management was an area that was well understood by the facility and patient comfort treated with utmost dignity. Need based care was well executed and the doctors took their time in the management of each patient which I believe is important as an important part of their management is solved when they (patient) is well informed & educated about his/her condition.

Each dawn brought with it new scenarios/cases- some cases that we in Kenya do not perform as regularly. Every morning the day began by reviewing scans of patients who had presented the previous night which was then followed by a department discussion where we reviewed our inpatients. I attended the daily rounds where progress of each patient was evaluated and further direction given. For me, that was enlightening as I enjoyed knowing the “what next’ aspect in patient management. Thereafter, I would spend the day in the outpatient clinic and the emergency trauma department. The outpatient clinic served as a major platform to review patients and determine the outpatient management. The adrenaline rush when casualties present to the ER and application of trauma protocols was one that is indescribable. Immediate initial stabilization and the ability to remain calm and focused is a skill that takes practice to develop.

One of the major highlight of my medical elective was the opportunity to scrub into theater. Did I ever think I would be in a theater in Germany assisting in a surgery? Not in my wildest thoughts! Each time I stepped out of the theater, a feeling of satisfaction & fulfillment reinforced my vision to become a surgeon.  It is a journey that I am passionate about and each contribution along the way cements my ambition towards this profession.

Walking into modern day theaters with state of the art technology and equipment was a surreal experience. Every Wednesday was spine correction procedures. Now this was mesmerizing!

How long would such a surgery take? A question that would have never been answered and experienced if it weren’t for the elective. Having assisted through a 6 hr. spinal surgery, unmasking each vertebrae and visualizing them as raw as they could be, thereafter inserting magic roads for a correction of Scoliosis was a big opportunity to learn from one of the best consultants renowned for his contribution to spine surgery. The precision and patience it takes to carefully expose each layer of the back and thereafter aligning each vertebrae so that correction can be achieved was one to watch. Maintaining still so the driver doesn’t move out of position while trickles of sweat gently race down your back as a result of the underlying lead coat and scrubs were all drops that contributed to my pond of experiences.  From the preoperative testing and thorough counseling and understanding of the patient allowed me to imply a more holistic approach to treatment of patients as you are able to make right decisions in the best interest of the patient, a skill that I am happy to return home with. Thorough explanation of the procedure from the operating surgeon allowed me as a student and assistant in the surgery to well visualize what we were expecting to do during the 6-hour procedure. And oh did I mention, the meticulous suturing skills and each surgeon’s approach to suturing were key observing moments for me.

In my time at the facility I would regularly reflect on our local medical & surgical practices to the German healthcare system. I also interacted with passionate students from the local universities and we exchanged views on the practices of surgery in our respective states. On the global stage, Kenya is a developing health system faced with dynamic challenges. I believe these areas of challenges can be utilized as engines of collaboration which are able to drive our healthcare into the future and hence revolutionizing global surgery. Whilst on my elective, I had the opportunity to present to the orthopedics department a technique known as Wide Awake Local Anesthesia No Tourniquet (WALANT), a technique that allows for immediate intervention following trauma without the need for a tourniquet, easy to set up with minimal equipment and hence easily replicable. A technique that allows for more procedures to be performed without the need for an operating room and most importantly, reduces the wastage of resources therefore allows for big savings on the patient end and the health finance sector. I am quite positive about the benefit this technique has for the respective surgeons in the orthopedic department as well as the hand surgery department and hence through avenues like these, we are able to share and exchange innovations in surgery that would contribute to the global surgery network. Additionally, on the patient, the cost of undergoing a surgical procedure that can be done under WALANT is reduced thus elevating poverty and providing access to quality, timely surgery. This opportunity served as a good example of how global medicine can be and how we can learn from each other, the developed and developing countries. This I further believe is the essence of the electives and exchange programs.

My time there also allowed me to reflect on our local health insurance model. In Germany, the taxpayers pay insurance based on their pay while in Kenya our contributions remain at 5$ per person per month irregardless of your income. That contributory figure remains low to cater for a population of 54 million considering a working population of about 35% of which more than 50% are employed by the informal sector. The contributions fall short to addressing the needs of those who require the hospital services necessitating out of pocket payments or prolongation of treatment due to unavailability of funds. While we as a country are making great strides in our quest for Universal Health Coverage our efforts are met with a host of problems. Engagement with individuals concerned with this model made me aware of ongoing talks which exhibit the benefits of the German Healthcare model. I was glad to share my views since I had the opportunity to understand the model.

Additionally, I spent 1 week at the Berlin Tuberculosis center screening patients for Tuberculosis as part of a public health exchange. The patients were mainly refugees who were seeking asylum in Germany. As part of the process, they are expected to undertake a medical examination. The joy and excitement expressed on the face of each person upon being cleared was one that was exciting. The smiles that left the premises after the constant confirmation that “Alles gud’ was one that was impactful. For them, they were now one step closer in seeking asylum and for us, we were doing our mandate. The public health exchange also allowed me to understand the process of seeking asylum in Germany as well as better understand the drug regimen used in those who have found to be Tb positive. I was also made aware of the multi drug resistant (MDR) burden of Tb that many of the patients face in Germany. The numbers are always closely monitored in close liaison with the central committee for Tuberculosis- Berlin.

I was also made aware that the BCG vaccination which is a mandatory vaccine at birth in Kenya is not given in Germany as their incidence of Tb remains relatively low. It is also in order to acknowledge the all rounded care given to those affected with Tb as there is constant follow up and a well established contact tracing system in place that allows these patients to have improved quality of life and reduce the spread.

As I pen down my elective experiences, all work and no play makes Jack a dull boy…and so.. For the remainder of my trip, I traveled around Berlin to all the tourist sites, like I mean all! By this time, we knew our way around the city and were loving to explore the rich culture the German heritage has to offer. The preservation of architecture to the artistic streets of  Berlin, to waiting in hour lines to eat at famous food spots to comparing which doner kebap was better than the other, it was all an experience like no other. Experiencing the thrill when walking into the Reichstag and the Dom to walking 267 steps up the Berlin Cathedral to capture mesmerizing views of the beautiful city of Berlin. The ever busy train stations to the relaxing sunday afternoons that would invite us for a swim in the nearby Schlachtensee Lake is one that cannot be forgotten! The summer time allowed us to take advantage of the long days and the 9 euro August travel ticket couldn’t be more appreciated for it gave us the full opportunity to explore this beautiful city in all its galore.

And finally, as I wrap up my experience with optimism to return soon, my heart remains filled with gratitude and appreciation for all the respective individuals that interacted and gave me this opportunity to live an international medical elective dream. My passion for global surgery and health system management remains alive and as I enter my final year of undergraduate studies, I am motivated and look forward to engaging further and strengthening our global partnerships in efforts of revolutionizing surgery and creating a global community of professionals with opportunities to share. I  take back home a lifetime memorable experience with a goal to be an improved version of myself and to train the mind to positive thinking, for the best is yet to be. These are experiences that I shall cherish as we mold into the young professionals of tomorrow. Till we interact again.

Ciao!