The PAACS Bulletin

PAACS MISSION
PAACS’ mission is to glorify God by training and
discipling African surgeons and related specialists
to become Christ-like leaders and servants providing
excellent and compassionate care to those most in need.

PAACS VISION
PAACS envisions a growing number
of African surgeons and related specialists
living out the Gospel and ministering to the sick.
 FROM THE DESK
OF THE CEO

Dear PAACS Family, Susan Koshy, JD, MPH

As we celebrated the birth of Jesus this Christmas, I was reminded
Chief Executive Officer
of the hope and peace He brings to our world. Romans 15:13 captures
this beautifully: “Now may the God of hope fill you with all joy and peace
in believing, that you may abound in hope by the power of the Holy Spirit.” We are
grateful for God’s gift of salvation through Jesus and the privilege of sharing His love
through the ministry of PAACS.

With this being the last month of the year, December has been busy for PAACS. I was
able to meet with several PAACS supporters, partners, and foundation leaders. It was a
wonderful opportunity for me to get to know these individuals and organizations, their
work, and their interest in our ministry. We are especially thankful that PAACS was the
recipient of two grants from two separate foundations this month. This will go a long
way in helping us to train and disciple the 50 new residents who will be joining PAACS in
January 2025.

December is also a month of celebration, as we rejoice in the accomplishments of our

residents at the COSECSA examinations. On December 2nd and 3rd, PAACS candidates
took their exams in Harare, Zimbabwe and 27 out of 29 successfully passed them. In
November, 25 residents passed their MCS oral exams via Zoom with a 100% success rate.
We thank God for the success of these residents.

In addition to all of this, we celebrate the graduation of approximately 30 residents who

are completing their training. We are excited to see how God uses them to touch many
lives across Africa. As you will read in this issue, among these graduates are two
residents from Malamulo Adventist Hospital, the first Malawians to be trained and
discipled by PAACS in their own country—a significant milestone that we believe will
open doors for many more to follow.

Thank you for your prayers and support. You are an essential part of this mission, and we
couldn’t do this without you. From all of us at PAACS, we hope you had a joyful
Christmas and wish you a blessed New Year!

Blessings,

Susan A. Koshy, JD, MPH

Chief Executive Officer
PAACS
COSECSA EXAMS AND GRADUATION
Keir Thelander, MD, FACS, FWACS, FCS (ECSA)
Executive Vice President

Congratulations to the 27 PAACS residents and fellows who successfully

passed their COSECSA exams in Harare, Zimbabwe, December 2nd and
3rd, 2024. PAACS candidates were successful in General Surgery (16),
Orthopaedics (6), Cardiothoracic Surgery (2), Pediatric Surgery (2), and
Neurosurgery (1). Overall PAACS graduates represented 19.6% of the 138
total COSECSA graduates. Over 15 PAACS faculty members participated. PAACS EVP, Keir
Thelander, accepted the invitation to be the external examiner for the General Surgery
examination process, while he also represents PAACS on the Examination and
Credentialing Committee of COSECSA. Tim Love represents PAACS on the Education,
Scientific, and Research Committee (ESRC). Notably, as COSECSA strengthens its research
position, the ESRC separated into two committees, the Education and Scientific
Committee and the Research Committee. Keeping with tradition a PAACS’ celebration
dinner took place Tuesday, December 3, 2024, attended by around 80 PAACS’ current
grads, previous grads, faculty, and friends.

Wednesday’s graduation ceremony marked another year of PAACS graduates receiving

top awards when Dr. Violet Otoki (Tenwek) received the award for the highest score in
General Surgery and Dr. Yonas Ademe (Tenwek) in Cardiothoracic Surgery. The ceremony
was well attended and quite celebratory on this 25th year of COSECSA. Special
congratulations to Dr. Otoki and Dr. Ademe on these significant accomplishments.

Drs. John Tarpley, Violet Otoki (Tenwek-GS), Drs. Yves Yankunze (Tenwek-GS), Gallina Dr. Emmanuel Ikwutah
and Keir Thelander. Kazobinka (COSECSA Burundi Representative), (Galmi-GS)
and Jason Fader (Kibuye - Faculty).

For the MCS exams, the oral exams took place by zoom in November, being overseen by
PAACS graduate Dr. Ivan Seno. PAACS strong showing resulted in all 25 (15.5% of total) MCS
candidates successful completion of 161 overall COSECSA candidates, demonstrating a total
passage rate of 83.2% to PAACS candidates 100% success. Another congratulations to these
25 trainees! PAACS residents and graduates strong showings are a testament to the quality
of PAACS trainees in knowledge, critical thinking, and spiritual soundness.

We thank God for His provision. May His glory shine in and through these new surgeons.
Please pray for them as they begin their surgical careers, serving those most in need!
 NKHOMA SURGICAL DEPARTMENT

CURRENT PROGRAMS
ACHIEVEMENTS FOR 2024
Yamikani Limbe, MD
Assistant Program Director

1. New Surgical Residents

Two new female surgical residents, both from Malawi, were
recruited this year.

During the recruitment process, over five candidates were eligible for the
position, including two applicants from Mozambique. This highlights the
increasing visibility and reputation of our surgical program, attracting attention
from neighbouring countries and gender balance in our program.

2. Visiting Senior Resident

We are pleased to welcome Dr. James from Arusha
Lutheran Medical Centre PAACS Program, who joined us
for a three-month senior rotation. Dr. James brings
valuable experience and expertise which has positively
impacted the growth of our residents.

3. Resident Training and Development

Dr. Caleb, one of our senior residents, completed his rotation at Tenwek Hospital in
Kenya, focusing on intensive care unit (ICU) training. His skills are already evident as
our ICU, which opened only a year ago, is now successfully managing critically ill
patients.

Dr. Vitu is currently undergoing the same training at Tenwek Hospital, further
enhancing our department’s capability in critical care.

4. Examination Success and Recognition

Dr. Wongani Mumba, our second-year surgical
resident, achieved the highest mark in this year’s
COSECSA Membership written exam. This
accomplishment positions him to receive the Gerald
O’Sullivan medal, awarded to the top of the class of
the College of Surgeons of East, Central and Southern
Africa (COSECSA) grant for an educational visit to a
hospital in the United Kingdom providing significant
exposure and learning opportunities.

Continued on next page

 NKHOMA SURGICAL DEPARTMENT

CURRENT PROGRAMS ACHIEVEMENTS FOR 2024

Yamikani Limbe, MD
Assistant Program Director

5. Endoscopy and Urology Camps

In July, we successfully conducted an Endoscopy Camp led by Dr. Egbert-
Jan van der Wouden from Holland and a Urology Camp led by Dr. Smith
from the USA. The endoscopy camp enhanced our skills,
enabling us to manage gastric varices using glue
treatment—an innovative technique now offered for
the first time in Malawi.

The urology camp introduced transurethral resection

of the prostate (TURP), an essential procedure for our
growing number of urology patients, marking a
significant advancement in patient care.

6. Spiritual Retreat
In September, we held a successful spiritual retreat
atop Nkhoma Mountain, attended by staff and their
families. Pastor Robert Yanduya from Blantyre
Evangelical Bible College led the retreat, fostering
spiritual growth and community within our team.

7. Personal Achievement
I had the privilege of visiting Chicago and North
Carolina, USA, this summer, where I attended the
PAACS Annual Conference and the Medical
Benevolence Foundation (MBF) Board Meeting as
a guest speaker.

8. Maternity Theatre Opening

We are proud to announce the opening of the Maternity Theatre, which has
alleviated pressure on our main theatres, allowing us to schedule more surgical
cases and improve patient care. This development is a significant step forward in
optimizing our theatre utilization, especially with the high demand for emergency
Caesarean sections.

These accomplishments reflect the dedication, growth, and impact of

our surgical department this year, with continued efforts to improve
patient care and training opportunities.
 MALAMULO PAACS GRADS 2024
CURRENT PROGRAMS Brent Sherwin, MD
Program Director

Malamulo PAACS Program celebrated our graduation

weekend on December 7 and 8 for our 4th graduating
class: Admire Munjeri (Zimbabwe), Gracious Sankhulani
(Malawi), and Rumbidzai Mlewah (Malawi). This was a special
graduation because it was the first time in PAACS history that
Malawian graduates had graduated from a Malawian PAACS training
program.

On Saturday evening we had a heartfelt program hearing from

several of the hospital staff, residents, and family members about how
God had helped the graduates along their journeys. The following day
our three graduates received their specialization certificates. We were
privileged to have two very special visitors come for the graduation:
Dr. Moses Kasumba the former program director and Dr. Ronald
Cheney who has been coming to Malamulo on a yearly basis over the
past 5 years. The graduation was a great testament to what God has
done in the lives of the graduates and we give Him all the praise!
 WHY RESEARCH? PART II
John Tarpley, MD
Academic Dean

The Fall PAACS Conference of October 2024 featured three

presentations related to research and the importance of
CONFERENCES
research to PAACS, its faculty, and trainees as we seek to
practice and provide quality and safe care in Christ’s name.
Adrian Park, former PAACS Board Chair and the current Chair of
the reinvigorated PAACS Research Committee presented on “PAACS’
Excellence in Research - a Natural Evolution.” As Dr. Park often states,
“We are not talking about killing rats and measuring cytokines.” Rather,
we are seeking to abet the critical analysis skills of our PAACS faculty and
trainees to contribute to quality improvement in our various institutions and
better understand the literature. Kat Chu, a colorectal surgeon and Director,
Centre for Global Surgery and Professor of Global Surgery, Stellenbosch
University in South Africa, presented her thoughts on the importance and
potential of PAACS physicians making meaningful contributions to improving
quality care on the continent by collaborating in multi-institutional studies
across PAACS programs and countries. Her answer to “Why PAACS Research”
centered on: “Improve patient care in Africa; improve surgical training;
strengthen the relationship between PAACS hospitals; and be a leader in
COSECSA.” Dr. Robert Parker of Tenwek addressed the “Why”: “To improve care
for our patients and community; to understand the burden of disease in our
setting; to develop problem solving skills; to share our experience with others
who could benefit.”

As to the concern re: “mission drift,” the revised PAACS Strategic Initiative #4
stipulated a research program infrastructure project be developed and
presented at this board meeting. The implementation of the proposal was to
address the initial proposed tactics of this initiative:
Develop a workgroup with members who Establish databases.
are experienced in research, public health,
and data analysis to measure the impact of Establish PAACS
PAACS programs. surgical registries for
various procedures /
Create methods and instruments to conditions.
measure the surgical impact of PAACS
programs. Conduct studies.
Create methods and instruments to Publish data.
measure the spiritual impact of PAACS
programs.

Many faculty and residents at some PAACS training sites do currently publish
and present on topics of importance to our environment and region.* Just this
week Kibuye Hope Hospital, Burundi colleagues (Alliance Niyukuri, Jason
Fader, et al.) published a paper entitled “Financial Impact and Healthcare
Expenditures Among Surgical Patients in Burundi.”

Continued on next page...

*Note: Publications by PAACS-
related authors are available HERE
 The College of Surgeons of East, Central and Southern Africa (COSECSA)
and the West African College of Surgeons (WACS) are our partners in
education and research to lead in improving health care delivery regionally.
Research is expected and encouraged by both Colleges. PAACS aspires to lead,
not follow, as we seek to improve access to safe, quality, and affordable care.

PAACS trainees, alumni, and faculty were active in leading and presenting
at the COSECSA December 2024 Silver Jubilee meeting just concluded in
Harare. COSECSA upgraded its Research Committee to an independent
status. See Dr. Thelander’s column in this issue of the PAACS Bulletin. PAACS
CONFERENCES
alumnus Michael Mwachiro, a COSECSA Executive Committee member and
former Tenwek faculty, is Education Specialist and Research Chair. PAACS
Executive Vice President Keir Thelander served as External Examiner for the
General Surgery Exams and presented one of the opening session plenary
talks on “COSECSA AND PAACS--20+ years of collaboration.”

Other presenters at the COSECSA 2024 Annual Meeting included:

Barnabas Alayande, University of Chelsea Shikuku, Paediatric
Global Health Equity in Rwanda and a Orthopaedic Fellow, Kijabe,
PAACS member, presented thrice: Kenya and Addis, Ethiopia: “Host-
“Propelling the Future of Surgical Care Perceived Impact of
in Africa through Innovative delivery of Unidirectional Short-Term Global
a district-bases junior surgical clerkship Surgery Engagements: A Survey
for undergraduate medical students in of Trainees from the College of
Rwanda: a mixed-methods review of a Surgeons of East, Central and
novel approach; “Safe Surgery Southern Africa (COSECSA) on
Organizational Readiness: Optimizing the Benefits, Challenges, and
Primary Health Centers in Nigeria for Desire for Bidirectional
Surgical Care with an Eye on the Exchange.”
Future”; and “Readiness for Future Beth Stuebing, Faculty, Nkoma
District Hospital Surgical Practice: Mission Hospital, Malawi: “Mom’s
Perceptions of Recent Graduates Got a Knife: The Challenges of
Versus District Hospital Surgical Motherhood for Female
Providers.” Surgeons” and “Theory on a
Jason Fader, Kibuye Hope Hospital, Cause of Esophageal Squamous
Burundi: “Invigorating the District Cell Carcinoma in Malawi.”
Hospital in Order to Achieve Universal Yonas Teferi, Cardiothoracic
Health Coverage.” Fellow, Tenwek, Kenya: “Cox-
Violet Otoki, General Surgery Resident, maze IV Procedure for Atrial
Tenwek, Kenya: “Comparing Fibrillation in Rheumatic Heart
Laparoscopic and Open Disease Patients: Experience
Appendectomy: Infections and Costs” from Tenwek Hospital.”
and “Feasibility of Machine Learning Blessing Ngoin Ngam, General
Models for Critical Care Outcomes in Surgery Resident, Mbingo,
Rural Kenya.” Cameroon, presented “The Role
Mercy Mitei, General Surgery Resident, of the Mentee and the COSECSA
Tenwek, Kenya: “Perceptions of Gender Global Surgery Research
Discrimination Among Surgical Program” at the Tuesday pre-
Trainees.” conference research course.
The day-long pre-conference workshop on Tuesday Dec. 3 entitled “Grant
Writing Research” was co-led by Britney Lynne Grayson, Faculty and Chief
Medical Officer of BethanyKids, Kijabe, Kenya, along with Dr. Chris Dodgion of
the Association of Academic Surgeons in collaboration with colleagues
from the Annals of African Surgery (AAS) of Kenya and the East, Central African
Journal of Surgery (ECAJS), the Intuitive Foundation, and others.
 ANNUAL SPIRITUAL RETREATS
SPIRITUAL RETREATS Ed Scearce, DMin, ThM
PAACS Spiritual Dean

One of the goals of PAACS is to build into each other's lives

as we travel along on our journeys of becoming fully devoted
followers of Jesus Christ. One of the ways we do that is through
annual spiritual retreats for each of the PAACS locations. Please
find below brief reports from Arusha, Malamulo, and Nkhoma.

Arusha Lutheran Medical Center He talked about team building and

collaboration as portrayed in Matthew
4:18-19 stressing that when Jesus was
picking His disciples, He picked people
with different talents that fit His Ministry
perfectly as they complimented each
other. He further stressed on the
importance of having the same goal
and knowing the strength of each
member of the team toward attaining
For our spiritual retreat this year, we
the set goal.
were privileged to have it at the
“Nuns of St. Francis” Retreat
As he was winding up, he thought it
Centre in Marangu, Kilimanjaro.
was important to touch on the topic of
“burnout” that is very common to
Our speaker for the retreat was Dr.
doctors globally. He wanted to shed
Johnstone Kayandabila, a doctor at
light on the important signs of burnout
the Jakaya Kikwete Cardiac Institute
that doctors need to recognize and act
who is also a holder of a Master’s
accordingly. He stressed that burnout
Degree in Business Administration.
has been a leading factor to doctors
The topic for day one was “Financial
committing suicide among other
Literacy for Doctors” as he felt that
mental issues.
most doctors lean in to medicine but
struggle financially. In this session he
He advised doctors that, while they are
talked about the “10
trained to take care of those who are
Commandments of Making Money”
unwell, they should not neglect their
where he stressed the ways in which
own wellbeing as they need to be
Christians can be financially stable
healthy to be able to take care of those
through biblical principles.
in need.
For the second day, the speaker
It was a great weekend with great
talked about “Team Building and
interactions and teachings.
Collaboration.”

Malamulo Adventist Hospital

The Malamulo PAACS program had
their annual spiritual retreat on
December 5 and 6. It occurred in the
beautiful setting of Mulanje at the
Kara O’ Mula Resort center. We had
33 people come for each day of the
retreat which comprised our PAACS
and theatre family.
 Malamulo Adventist Hospital

SPIRITUAL RETREATS
We were blessed to have Pastor These helped us understand how to
John Phiri talk as our speaker. His keep Jesus as our “Chief
overall theme was “Finding God’s Cornerstone” and use this solid
Purpose For Your Life.” foundation to improve our walk with
God. Overall, it was a refreshing time,
We had several interactive and we thank God for the time we
sessions throughout the morning had together as a team to delve
and afternoon. deeper into His word.

Nkhoma Mission Hospital

“Jesus went up on a mountain
to pray, and he prayed to God
all night.” Luke 6:12

As we all know, there are many

examples in the bible of people
retreating to the mountain to meet
God. Right behind our hospital is
Nkhoma Mountain. This year we
spent two days on Nkhoma
Mountain for our Spiritual Retreat.

.
The topic was: “The Surgeon and
the Sabbath” and escaping the
hospital for a couple of days seemed
a good idea to think, reflect, have
time together and enjoy God’s
beautiful creation. Rev. Robert
Yanduya challenged us to have
times of Sabbath in a profession
where you are on call 24/7. We
prayed and worshiped next to a fire
A mountain many of us have never under the stars. We climbed the
climbed before. Sleeping in tents peak and watched the sun rise.
for the first time. Some of us had
concerns if we can get everyone up. This year’s Spiritual Retreat was
And then there was the food, over a different, it challenged us not only
100 litres of drinking water. But spiritually but also physically. But it
when we heard our kids screams of also brought us closer together, it
joy when they expressed their gave us some memories we will not
excitement of sleeping in tents, we forget and we met God in a special
knew it was worth the effort. way too.
ASUC UPDATE - APPLICATIONS OPEN
Deborah Eisenhut, MD
Previous Faculty, Mbingo Baptist Hospital

African Surgeons to Under-Served Communities (ASUC) is an initiative

spearheaded by SIM, PAACS and MedSend intended to help PAACS graduate
surgeons and related specialists consider missionary service and serve in
remote and unreached areas of Africa. Such postings are challenging for
many reasons. African missionaries can find it difficult to raise financial
support from within Africa. Small hospitals desperately in need of surgical
care often cannot afford to pay the salary of a qualified surgeon. Also, PAACS
surgeons can find it challenging to educate their children in such places. For
this reason, such positions often go unfilled despite the great need.

ASUC was created to provide a portion of the salary/support for five years for PAACS missionary
surgeons serving in such needy locations. The actual amount will vary depending on support
needs and location. The African missionary surgeon will be able to step immediately into his/her
role as a surgeon at such an under-served hospital giving him/her an additional five years to
raise the needed support and giving time for the hospital to develop the capacity to pay an
increased salary.

Participants in the program need to be

missionaries with a mission agency that Contact Dr. Deborah Eisenhut at
provides quality training and excellent Deborah.eisenhut@sim.org to receive a list
member care and that is in partnership of such mission organizations, to obtain an
with MedSend, the primary source of application or to ask more questions.
funding.

Pray about your involvement!

Applicants may apply to the ASUC program and a

mission agency concurrently. Mission agency
acceptance can take time—often a year or so. If
accepted to the ASUC program, a PAACS graduate
can still be in the process of the mission agency
Applications close application. ASUC can mentor and walk through
February 28, 2025. the mission agency process with the PAACS
graduate as needed. The PAACS graduate would
have one year after acceptance into the ASUC
program to be accepted into a mission agency.

We hope that many PAACS graduates will be encouraged to consider working in underserved
and unreached areas knowing that the ASUC program is a resource to help make it possible.
 Christmas Eve
GOOD NEWS TO SHARE Baby at Mbingo
PAACS Mbingo welcomed a
baby boy on Christmas Eve.
Born to Dr. Elvis and Audrey
Sonfack, he weighed in at 3.5kg.

Successful Giving Tuesday

Preparing for the new year, we are trusting God to provide for the
work ahead. To meet the needs of our programs, we need to raise
$819,000 in December to stay on track towards our overall $4.2
million budget.
Thanks to a very successful Giving Tuesday, where
we raised $31,378—surpassing our goal of $25,000
—we got off to a great start and are optimistic
about reaching our target. If you haven’t yet made
a year-end gift, please consider doing so, here.

Every gift helps train and disciple more surgeons and related specialists who
will bring healing and hope in Christ’s name to communities across Africa.

Recently Published
Prayer Guide Alumni Newsletter
 PRAYER & PRAISE ARTICLES ON
Pray for God's favor over all PAACS
SURGERY, OB/GYN,
training programs, that they will AND ANESTHESIA
glorify God and be used to impact Compiled by Margaret Tarpley
Africa for His Kingdom. Virtual Reality for Perioperative Anxiety
Treatment in a Resource-variable Setting: An
May God sustain, protect, and provide Observational Trial (See PAACS authors)
His grace to all PAACS residents,
faculty, graduates, and their families. From Short-term Engagements to Meaningful
Pray for their spiritual well-being. and Equitable Global Health Partnerships

Pray for the newest residents Comparison of Postoperative Outcomes

beginning their journey with PAACS in Among Patients Treated by Male Versus
January 2025. May they be blessed Female Surgeons
with God’s favor and grace.
Implementing a Global Mentoring Program: A
Pray for the newest graduates of Call to Action for Mentorship in Surgery
PAACS, may they follow God’s will for
Education and Training in Global
their lives and find their place to serve
Neurosurgery: The Quest for Diversity and
Him by caring for the underserved
Equitable Collaborations
people of Africa.
The Low-Cost, Battery-Powered AI-Enabled
Each month, we pray for residents by Ultrasound Device That Could Improve Global
name. Please join us this month by Obstetric Care
covering these residents in prayer:
Menopause: A Global Health and Wellbeing
Ian Simel Issue that Needs Urgent Attention
Linda Thure
Technical Priorities for Orthopaedic Trauma
Ondago Faith Akinyi Care Development in Malawi
Brenda Laureen Nyambake
Gael Brillant Gahimbare Defining the Contribution of Human Error to
Adverse Events in a Surgical Service
George Waiyaki Karanja
Daniel Baraka Karomo Mechanical Bowel Preparation Reduces
Ian Kiptoo Phillip Mutai Anastomotic Leaks in Surgery
Nelson Kipkoros Tarus
Determining Optimal Timing of Birth for
Faith Gachie
Women with Chronic or Gestational
Ndayishimiye Jean Baptiste Hypertension at Term: The WILL (When to
Jane Kiplagat Kipsamo Induce Labour to Limit risk in pregnancy
hypertension) Randomised Trial
If you have not given to PAACS this year, Read more articles compiled by Margaret Tarpley
please prayerfully consider a year-end gift by clicking here!
before December 31st to help us train and
disciple 190 residents and fellows in 2025.
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