Your Tenwek Orientation - Part 1: Understanding the Lingo
Prologue: What’s going on here?
As we get deeper and deeper into life at Tenwek Hospital, much of the updates from our lives will involve people who serve, work, and learn within the Kenyan healthcare system. This is the first of a series of posts (we will see how many) that are intended to help readers be able to parse through the differences and similarities of the Kenyan and US hospitals and how that affects our daily lives.
Many of the job titles of our friends here may sound a little different than the terms used in the US. Let’s start with that. Here goes!
Sign by the front entrance of Tenwek Hospital
Part 1: The Lingo - What are all these titles about?
You may have heard us use these terms in passing. Here are some quick and dirty definitions for you:
CO – Clinical Officer
Similar to what a Physician’s Assistant (PA) would be in the US. In the Tenwek OB/GYN department, much of the day to day work of triage, patient care, etc. is done by CO’s. After high school (secondary school here), they do three (sometimes four) years of classroom learning followed by an internship. There are a plethora of CO schools, and Tenwek recently got into the mix through their College of Health Sciences.
MO – Medical Officer
Similar to what an MD is in the US. After high school, students do 5-6 years of medical school. The main difference is that most MO’s in Kenya have not gone through a residency to specialize. They are mostly “generalists” who can gain experience with focus areas such as OB/GYN, Medicine, Peds, etc. Ten years ago, there were three medical schools. Now, there are 12 recognized medical schools.
Interns
The final year of training for both MO’s and CO’s is their 1 year “Internship”. They rotate between the departments of Peds, Internal Medicine, OB/GYN, and Surgery to set them up with practical experience. They now have a community health experience as well.
Tenwek Hospital is a teaching hospital that has trained interns for over 20 years. It now sees approximately 20 interns come through it every year. Many of the full-time doctors see the mentoring opportunities with interns as a large part of their ministry. People who come to train at Tenwek know their training will be more challenging than at most other hospitals, but they also come because they have a heart for missional application of their medical skills.
Consultants
Similar to what an “Attending Physician” in the US. Any MO who has also gone through a residency training program or a university MMed Course (Masters Level training). These are increasing in number, but remain rare.
PAACS – Pan African Academy of Christian Surgeons
An oversight body for Tenwek’s surgical residency programs. The OBGYN residency program will be a part of PAACS, too.
Game night, rolling dice on our porch with some of the CO’s, MO’s, Interns, and Consultants of the Maternity Ward.
Pathways for American and Kenyan Medical Students
You learn something significant about somebody when you understand the path they have taken to be where they are today. Kenyan Consultants and US Attending Physicians share many common experiences in their training, but there are some differences worth noting as well. Here is an outline of each, so you can compare and contrast.
Typical path to become a Medical Doctor in the United States:
Elementary School, Middle School/Junior High, High School
Roughly 6 yrs, 3 yrs, and 4 yrs respectively. Near the end of high school the SAT or ACT determines eligibility for higher education.
College / University
4 years pursuing a bachelors degree with a “Major” and pre-med emphasis, studying medical school pre-requisites. MCAT standardized test completed during or after University studies helps determine eligibility for medical school.
Medical School
4 years. 2 in academic studies, 2 in “rotations”, experiencing and learning in real medical situations. STEP exams completed during med-school determine eligibility for different residency programs and focuses.
Residency (Mandatory in most states)
3 to 7 years, specialized training in focus area of practice such as Family Practice, OB/GYN, General Surgery, Internal Medicine, etc. Residents are paid throughout this time by their training institution.
After residency, and passing your “boards” tests, you are able to be a practicing Medical Doctor in your field. Internship is typically just the first year of a residency program.
Optional Fellowship
Further Specialize within your field. For OB/GYN, there are fellowships for Maternal Fetal Medicine (complicated pregnancies), Gyn Oncology, Urogynecology, etc. Fellows are also paid by their institution while they are in training.
Typical path to become a Consultant in Kenya:
Pre-Primary School, Primary School, Secondary School
2 yrs, 8 yrs, and 4 yrs respectively. (This may change in the near future to 2 yrs, 6 yrs, and 6 yrs.)
National standardized tests are taken at the final years of primary and secondary school to determine eligibility for secondary school and then university placement and focus of university education.
University Medical Officer Education
4 years academic study, 1 year with early rotations, and 1 year “Internship” doing actual work in the departments of Peds, Internal Medicine, OB/GYN, and Surgery.
After passing the internship, students become practicing Medical Officers, who function as “generalist” doctors who can help in any department they like. The degree title for MO’s is MBChB, standing for “Bachelor of Medicine and Bachelor of Surgery”.
Consultant Education (Optional, to Specialize)
Either a University MMed (Masters of Medicine) Course or Residency program
MMed Course is 4-7 years and has historically been more classroom focused with a thesis and defense.
Residency is 3 to 6 years. In Kenya, many residencies walk the line between a MMed and a US residency program.
Residency is not free to these students, and they have to either be sponsored by a government or entity who will cover the costs for the residency education. Sometimes students will be self-sponsored, saving up enough through their own practice to pay for residency education.
After completing a Residency program and any necessary exams, a medical officer can become registered as a specialist (Consultant) with the Medical Practitioners Board.
Team finishing up a hysterectomy in the Theater
NOTE: The Pan African Academy of Christian Surgeons (PAACS) residency education differs from traditional Kenyan residencies in a couple notable ways:
The PAACS emphasis is on practical supervised patient care, learning with graduated levels of responsibilities, and relevant research contributions, rather than the academic focus on classroom lectures and a long thesis.
PAACS (through fundraising) pays for the residents’ education and provides a stipend for living expenses. This prevents residency from being selective based on connections or family wealth, opening the door to many more qualified and passionate potential residents.
Other oversight bodies, like the College of Surgeons of East, Central, and Southern Africa (COSECSA), help with accreditation and certification.
I hope this gives you all a little more insight into what goes on
There is so much else that I hope I can get to outline for you all to help you understand differences between Kenya and US healthcare. But one bitesized chunk at a time. Maybe next time I can start outlining the differences between being a patient in the US and in Kenya. We will see!