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Surgeons Scope Magazine - December 2022
A First for Africa
DR FRIDAH BOSIRE, A KENYAN GENERAL SURGEON, IS THE FIRST WOMAN TO BE AWARDED THE GERALD O’SULLIVAN MEDAL, NAMED AFTER THE LATE PRESIDENT OF RCSI WHO INITIATED THE COLLABORATION WITH COCECSA
Each year, the candidate who achieves the highest results in the COSECSA (College of Surgeons of East, Central and Southern Africa) exams, across all countries and specialties, is awarded the Gerald O’Sullivan Medal. The medal was first awarded in 2012 and is named after the late President of RCSI who initiated the collaboration with COSECSA. In 2020, Dr Fridah Bosire, a general surgeon based in Nairobi, Kenya, became the first woman to win the prize. Dr Bosire came to Ireland in February 2022 and gave a presentation entitled Global Surgery: Enhancing Safe Quality Evidence-based Surgery in LMICs (low to middle income countries) at the Millin Meeting, after which she was formally presented with the medal by Breda O’Sullivan, widow of Gerald O’Sullivan.
Fridah Bosire was born on the morning of 27 July 1988, at a small dispensary in Kisii, rural Kenya. Her father, Joseph Bosire, is Professor of Curriculum and Instruction as well as the Deputy Vice Chancellor Academic Affairs at the Jaramogi Oginga Odinga University of Science and Technology in Bondo,
“I am told that I made my debut into the world exactly 15 minutes after my mother checked into the dispensary,” she says, via Zoom from her home in Nairobi. She is one of a family of five girls, in a majorly patriarchal society. “There is a preference for male children in the traditional African community, and so it is a huge stigma for a family to have only daughters. However, my father has always been my greatest supporter. Our parents empowered us by ensuring we got a good education, overlooking the stigma. My father fought all the cultural challenges, encouraged us to study hard, follow in his footsteps and reach great heights. I understood from a very early age that as a female in Africa, I had to break through glass doors and cultural barriers so as to excel in life, and be a good example to all the young girls in my community. I owe everything to him,” she says.
Fridah says she knew from an early age that she wanted to make a career in medicine. “I developed an interest gradually while in primary and high school, thanks to a wonderful science teacher, Mr Japheth Bett.”
At the tender age of 13, Fridah enrolled at Mount Saint Mary’s Catholic boarding school, where she says she learned the value of hard work. She excelled in her primary level exams and went on to join Moi Girls High School, Eldoret, a prestigious high-performing National School. Her favourite subject was, of course, biology. “I was taught from an early age to have discipline, integrity, and consistency. Our school motto was ‘honour, courage and industry’. I always knew I wanted to work in the health sector, as I was fascinated by the idea of nurturing patients back to good health.”
After high school, Fridah went on to do her medical undergraduate degree at Kenyatta University in Nairobi. “Surgery became an area of interest whilst in my undergraduate years, as I greatly enjoyed my surgical rotation during my senior clerkship years.”This interest was further heightened during her internship year at Tenwek Mission Hospital in Bomet, Kenya, a high-level Surgery and Trauma Centre. “I interacted with various surgeons, adept in their expertise. We had immense support in training from visiting missionary surgeons from abroad, through the PAACS (Pan-African Academy of Christian Surgeons) programme pioneered by Professor Russ White, clinical Professor of Surgery at Brown University School of Medicine, Cardio-Thoracic Surgeon and Dr Carol Spears, General Surgeon, Diplomate of the American Board of General Surgery.”
After completing her intern year at Tenwek, Fridah got a brief administrative role at a county hospital where she worked as the Sub County Medical Officer in Charge of Health in the whole county. “I learned a lot about health systems, policies and governance during this period. The role involved improving standards of practice and policy making, as well as driving public health initiatives to improve health care accessibility and affordability. However, my passion was still in surgery.” She went on to apply for the Tenwek COSECSA/ PAACS general surgery programme in 2016 and was delighted to be admitted into the programme after an extremely competitive interview. PAACS has a longstanding partnership with COSECSA that allows trainees from PAACS accredited institutions to participate in the COSECSA training programme. “I had the privilege of working with and having great female surgeons as mentors, including Dr Agneta Odera, Dr Carol Spears and Dr Andrea Parker,” says Fridah.
The training programme was intense. “But I love what I do. I am ecstatic in the operating theatre and elated when I see a patient do well. I find joy in teaching and mentoring my junior colleagues and seeing them excel. I have a strong desire to bring about change in the number of females who enrol for surgical training in my country. Being a competent female surgeon is a great privilege, and very rewarding. I consider my strongest points to be enthusiasm, stamina, resilience and tenacity.” She won the best MCS candidate award during the 2017 COSECSA exam in Maputo, Mozambique, when nursing her two-month-old baby.
Fridah explains the challenge facing pregnant female surgeons. “It was really tough. During my cardio-thoracic rotation I was often in the operating theatre for nine or ten hours, sometimes more. I also did an Orthopaedics rotation, which was very physically demanding, during my third trimester. I did my written MCS COSECSA second year exam when I was 38 weeks pregnant, and the oral exam just two months post-partum. Looking back, I must have studied really hard!” She says she spent her days learning in the operating theatre, her nights studying Schwartz’s Principles of Surgery.
Fridah had her daughter, Yvette Ayira, who is now five, in 2017. Due to prolonged labour, she was delivered via Caesarean section by an Irish urogynaecologist, Dr Jonathan (Johnny) Shaw, who was visiting Tenwek from the US to help patients with obstetric fistula. She says if her baby had been a boy, he definitely would have been named after him!
When Fridah completed her residency in 2021, she moved to Nairobi to take up a position at St Mary’s Mission Hospital, which looks after the population of Kibera, the largest slum in the city. The 300-bed hospital has just two general surgeons, and outsources the other specialist surgeons.
“We are trained to give back to society,” she says, “to go to a place where there is a surgical need. We deal with lack of equipment, infrastructure, poor resources, and finanancial shortcomings on a daily basis. Our biggest challenge is that we do not have an ICU, so I am trying to set one up at the moment so that we can provide critical care services to our patients who are in dire need. “
After just a year at St Mary’s, Fridah was appointed medical director of the hospital and she now heads up the hospital’s clinical services. As there are only two surgeons, she is on a one-in-two call rota. “The administrative role is challenging but rewarding at the same time. I use the responsibility accorded to me to advocate for the provision of quality healthcare services for patients, and I am excited to say that we are now in the construction phase of our ICU/ HDU/Renal Unit, Oncology Unit as well as Dialysis Centre.
“We see a lot of cancer cases – oesophageal, breast, cervical/ovarian and colon. Patients come in really advanced stages, and it breaks my heart. They cannot access the service because they do not have the money, so they present at an advanced stage of disease. It is a Catch 22 situation, in that they lack the resources to come, and we lack the proper resources to help them. At the moment we have to move patients to another hospital if they need ICU care. The healthcare system in Kenya is complex, and treatment is not free, so patients have to be able to afford a deposit or down payment to the referral facility. In the mission hospital the cost to the patient is less, and we do not turn them away, but we are very stretched.” It is a constant struggle but clearly rewarding when the team sees patients do well. “I am excited for the next phase, where we actually get to make these services available to our patients.”
Fridah’s intention when she arrived at St Mary’s was to stay short-term and then go abroad on fellowship and train in a sub-specialty.
“My initial interest was in breast oncoplastic surgery, but due to the need, I am inclining towards Trauma and Critical Care,” she explains. “Having patients under my care makes it very diffcult for me to move. I get a lot of satisfaction from my work now.”
St Mary's Mission Hospital, Nairobi
When Fridah visited Ireland in February 2022 she had the opportunity to undertake an observership with Mr James Geraghty at SVUH, where she witnessed robotic surgery for the first time. “I was able to observe his breast care clinic as well, and it gave me the idea to start a breast clinic here at St Mary’s. Since I returned from Ireland we have already seen more than 300 patients, and the idea is to screen more, as early diagnosis saves lives.”
Fridah sat her final written COSECSA exams in December 2020, and the oral exam in January 2021. “I had great tutorship from all my PAACS faculty at Tenwek, and indeed I owe the award to the effort they put in my training. I was equipped to face the exam with confidence.”
Fridah says she was elated to achieve the best score in Africa in the final COSECSA exams, and to be the first woman to achieve this. An invitation by the College to come to Ireland on a fully sponsored trip to be presented with the Gerry O’Sullivan medal, was her first time out of the continent.
“I fell in love with Ireland on that trip,” she says. “And it made me very happy that my hard work and effort was recognised. My family was immensely proud.”
During her trip to Ireland, Fridah had the opportunity to spend time at RCSI. “I got to see the RCSI heritage collections of the fathers of surgery, the people we read about in surgical books – William Dease, Abraham Colles and others. The RCSI tour by head porter Mr Frank Donegan included a viewing of the medical instruments used for surgery in the past. We came to this cabinet where there was a 19th-century amputation hand saw and he explained that this is what they used to do amputations way back. I replied, ‘This is what I have available to do amputations now’, which he found quite amusing. My favourite part of the tour was the Women on Walls portraits, which recognise the pioneering achievements of extraordinary women. I drew great inspiration reading about these phenomenal women.”
Fridah plans to stay in Kenya in the short to medium-term, but due to the limited opportunities that exist in her country still hopes to go abroad on fellowship. “I want to seek further opportunities for education, so that I can bring new skills back to help our patients. During my visit to RCSI, I had the honour of meeting and getting wise counsel from Professor Ronan O’ Connell, as well as Professor Mike Griffin (President of RCSEd) and Professor Mike McKirdy (President of the Royal College of Physicians and Surgeons Glasgow).”
Since receiving the Gerald O’Sullivan award, Fridah says she has read everything she can about the man after whom it is named. “I draw inspiration in my current practice from him, hence my choice to stay and work to serve the needy at a small mission hospital. I think he was an exemplary member of the surgical profession. I feel I am his protege by getting this award, and I hope to achieve for my patients in Kenya as much as he did for patients worldwide.” ■
THE RCSI/COSECSA COLLABORATION PROGRAMME
The partnership between RCSI and COSECSA has been running since 2007. It was initiated by the late President Professor Gerald (Gerry) O’Sullivan of RCSI and Professor Erzingatsian, Honorary Fellow, RCSI, FRCSI (1976), the then President of COSECSA. The men had been classmates at RCSI in the 1960s and 1970s.
The partnership now encompasses anaesthesiologists, ob/gyn, and perioperative nurses, and involves eight colleges working together. It has been funded by Irish Aid since its inception.
Professor Erzingatsian died this summer at his home in Zambia.
2022 COSECSA EXAMS, WINDHOEK, NAMIBIA
The annual COSECSA Fellowship exams took place in Namibia from 5-6 December 2022. 170 candidates who have trained with COSECSA in over 20 countries in sub-Saharan Africa travelled there to undergo clinical and viva exams.
COSECSA invited examiners from surgical colleges around the world to serve in these exams. Eight RCSI Fellows including President Professor Laura Viani and Past President Ronan O’Connell agreed to serve on an honorary basis. The exams were followed directly by the graduation ceremony on 7 December. Her Excellency Ms. Bronagh Carr, Ambassador of Ireland to Zambia and Mr. Brian Caden, First Secretary, attended the ceremony re ecting Irish Aid’s longstanding support to the RCSI/ COSECSA Collaboration Programme.
Dr Fridah Bosire would like to thank Professor Ronan O’Connell, Professor Laura Viani, Mr James Geraghty, Mr Eric O’Flynn, Miss Ines Peric, and Miss Deirdre Mangaoang for making her trip to Ireland possible.
She would also like to extend immense gratitude to her PAACS faculty/ family. Ms Susan Koshy (CEO, PAACS), Dr Keir erlander, Dr Bruce Ste es, Professor Russ White, Dr Carol Spears, Dr Heath Many, Dr Agneta Odera, Dr Liz Mwachiro, Dr Mike Mwachiro, Dr Bob Parker and Andrea Parker, Dr Kiprono Koech, Dr Mike Ganey, Dr Will Copeland, Dr Arega Fekadu, Dr Jens Vaylann.
