Dr. Stanley Aruyaru
The Village SurgeonDr. Stanley Aruyaru is a Consultant General and Laparoscopic Surgeon and a Healthcare Manager. He has solid experience in managing
I became a surgeon to fight diseases. Those dangerous and scary ones that consume your mind and body for hours on end, eating into your private time. Those that others shy away from. It is my passion! I feel at home and at ease doing it.
But no sooner had I started out as a surgeon in a rural setting in a developing country than I realised that being a surgeon entails more than fighting disease using the knife. It entails fighting rigid systems to make surgery more accessible, affordable and of better quality. So, when I’m not clad in green scrubs, blue gowns and cream gloves resecting a tumour or repairing a hernia, I am on my social media platforms championing the cause for access to surgery.
What motivates me is that the access to surgery in not at its best in Kenya. And irrespective of how many heroic and meticulous operations I do, patients presenting late will have bad outcomes. Countless times patients will arrive at my ward or clinic with advanced cancer despite having had symptoms earlier. Because they could not afford a vital investigation. Often because the waiting times in majority of our public health facilities are months running to years.
A few years back, I lost a patient to inguinal hernia. It rarely happens. It should not happen. It happened! The middle-aged lady hailed from a remote part of a neighbouring rural county in Kenya. Despite my swift reaction time upon being called, I was too late.
The hernia had been strangulated for days. The affected bowel had broken down, releasing stool onto the tissues of her abdominal wall, eating them up.
“The abdomen feels boggy with crepitus,” the medical officer had mentioned. At which point I had already sensed what the issue was. Hernia repair in record time upon arrival could not undo the damage done by days of slow release of gut toxins into her blood stream.
There wasn’t expertise where she came from. She had been treated for medical abdominal problems because there was no capacity to pick the ticking time bomb that was the surgical diagnosis. My efforts looking for critical care support and parenteral nutrition did not bear fruits. Relatives were hard to come by; language barrier masked the weight of the life and death issues. Financial challenges could not allow her what I recommended.
This case reminded me of where the greatest need for a surgeon remains acute- at the system level. Access, availability and affordability of quality surgical care remains a mirage in some corners of my country. It is the same across multiple developing countries. Being able to impact at system and policy level will reap bigger dividends than my swiftness with every emergency phone call.
As a senior once said, “ the system is sicker than the patient it is meant to help”.
That is what motivates me to remain at the C-suite, arguing budgets out, pushing my team to improve response time to emergency cases, pushing the quality of care level up. Some days we stare at each other’s faces as a finance officer presents a poor patient’s case whose care the family cannot pay for. The same bug has bitten me again, applying for a PhD program in Global Surgery (the Surgical Equivalent of Public Health and Health Systems Management combined). Am I nuts? Time will tell.
“I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work.”- Harvey Cushing (father of neurosurgery).
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