Tuesday, November 9, 2021

The Significance (Not Statistical) of Research

By Bob Parker

To say that I enjoy my role in research is a bit of an understatement. As a good friend said in a recent email message after having read through a draft of a research paper:

"Here is my favorite sentence in the draft: 'The model was performed as a log link function and gamma distributional family determined by the Box-Cox and modified Park tests, respectively.' I didn't understand this, so I put it through Google translate and Google says that in English it says: 'Bob Parker is a total nerd'."

When it comes to my love for research, I am a total nerd. So, I decided it might be fun to explain why research here at Tenwek has become a passion of mine to the point of being labeled as a total nerd. And to further explain why this is a passion and an essential part of what I do as a surgeon, an educator, and a missionary. 

Research is vital for trainee education and patient care. Pre-pandemic photo with patient consent. PC: David Shirk

In 2007, I came to Tenwek as a medical student to help with a few research projects. Through this, I began to appreciate the importance of research in sub-Saharan Africa. Research allows us to investigate challenges within our setting. It allows us to share with others in the region and the world some things that we do to advance and improve care. Research helps us to solve problems in methodical and meaningful ways. It allows us to contribute to building a more thoughtful society that strives to improve health for all people. And it gives us the chance to collaborate with others. On a more relational level, it often opens doors to build partnerships and community and advance and improve patient care. As a believer, research is one way for me to love God with all of my mind; and improvements in care are a way of loving my neighbor.

When we returned full-time in 2015, the Tenwek Hospital board decided to create a Research Department to advance and build research capacity among staff, trainees, and faculty. I have had the opportunity, along with an excellent team, to do just that. As I reflect on the last 7 years, I can see how we have advanced patient care and healthcare education through various research projects.

  • We successfully achieved accreditation to have our research ethics committee nationally certified.
  • We have developed research education and ethics teaching materials.
  • We have developed and advanced local authors who contribute meaningfully to projects.
  • We have obtained multiple funding grants from various sources.
  • We have facilitated advanced training for numerous individuals, including 6 who are currently pursuing or have obtained Master of Public Health (MPH) degrees.
  • We have seen investigators from Tenwek increasingly participate in and publish their research projects.

An institutional ethics review committee (IERC), sometimes called an institutional review board (IRB), is vital to ensuring that research conducted at Tenwek Hospital meets the highest ethical and safety standards. The national accreditation of our IERC is commemorated here. PC: John Rotich

We recently looked at the trend in the number of publications over the years, and since the development of a research department in 2015, there has been a clear increase. And 2021 will continue this trend.

Tenwek publications by year.

While often the idea of research evokes images of a lab, a Bunsen burner, and pipetting solutions into small vials, that is not the nature of research at a mission hospital in Kenya. Rather than that sort of foundational research, our research tends to examine things like how different factors affect whether a patient in Kenya develops a disease or has a good outcome after surgery. I've listed below some of the projects I have been involved in over the last couple of years, either as a collaborator, primary investigator, or mentor. While the titles may not make sense in some cases, these papers examine a range of topics from potential causes of esophageal cancer to the ways that surgical residents help prevent death for patients after surgery and from how colon cancer is increasing in Kenya to the quality of surgical trainees in our region and many more.

Kemunto and June, two aspiring researchers. Kemunto's work has been accepted into the premier surgical journal, and June has published exciting work on surgical simulation in East, Central, and Southern Africa. PC: David Shirk

It has been encouraging to help trainees develop and lead their own projects. And it has been fun to see how they think critically to solve the problems that we face. It has been an incredible joy to have colleagues passionate about advancing research and brainstorming possibilities with excited trainees. As we look at the future, I hope that we can continue to pursue excellence to improve care for and show love to our community, inspire the region, contribute to the global scientific community, and bring glory to God.

Listen to advice and accept instruction,
    that you may gain wisdom for the future.

Proverbs 19:20

Selected Publications List:

Implementation of a Surgical Critical Care Service Reduces Failure to Rescue in Emergency Gastrointestinal Surgery in Rural Kenya. Annals of Surgery. 2021 Sep 13.

A cross-sectional survey investigating the impact of COVID-19 on surgery training at teaching hospitals accredited by the College of Surgeons of East, Central and Southern Africa. East and Central African Journal of Surgery. 2021 Jun 30;26(2).

Indoor wood combustion, carcinogenic exposure and esophageal cancer in southwest Kenya. Environment International. 2021 Jul 1;152:106485.

Gastrointestinal endoscopy experience of surgical trainees throughout rural Africa. Surgical Endoscopy. 2020 Nov 30:1-9.

Operative self-confidence, hesitation, and ability assessment of surgical trainees in rural Kenya. Journal of Surgical Research. 2020 Sep 30;258:137-44.

Operative Case Volume Minimums Necessary for Surgical Training Throughout Rural Africa. World Journal of Surgery. 2020 Jun 2.

Referral patterns of burn injury in rural Kenya. Journal of Burn Care & Research. 2021 May;42(3):454-8.

Necrotizing Fasciitis: A Predictable Burden in Rural Kenya. World Journal of Surgery. 2020 Sep;44:2919-26.

Surgical Training Throughout Africa: A Review of Operative Case Volumes at Multiple Training Centers. World Journal of Surgery. 2020 Mar 10:1-8.

Laparoscopic Heller Esophagomyotomy is Safe and Effective in Rural East Africa. Ann Afr Surg. 2019; 17(1)

Curative Surgery Improves Survival for Colorectal Cancer in Rural Kenya. World journal of surgery. 2020 Jan;44(1):30-6.

Mortality Prediction in Rural Kenya: A Cohort Study of Mechanical Ventilation in Critically Ill Patients. Critical Care Explorations. 2019 Dec 1;1(12):e0067.

Colorectal cancer is increasing in rural Kenya: challenges and perspectives. Gastrointestinal endoscopy. 2019 Jun 1;89(6):1234-7.

Investigating tea temperature and content as risk factors for esophageal cancer in an endemic region of Western Kenya: Validation of a questionnaire and analysis of polycyclic aromatic hydrocarbon content. Cancer epidemiology. 2019 Jun 1;60:60-6.

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