Stories from the Road: Sikiza Society, Nairobi, Kenya
Residents from Kenya and the United States trade surgical techniques through a program emphasizing joint learning in otologic care.
Shane White, MD, on behalf of the Humanitarian Efforts Committee
The Sikiza Society was founded in 2011 through a partnership between Matthew Bush, MD, AAO-HNS Coordinator for Research and Quality, and John Ayugi, MD, both neurotologists—and now chairs—at their respective institutions of the University of Kentucky and the University of Nairobi. The goal of the partnership was to promote shared education efforts between the two institutions. Since its inception, there have been several trips in each direction with the focus of learning from international colleagues in their home environment.
When traveling to Nairobi, residents accompanying Dr. Bush participate in surgical workup, intraoperative, and post-operative care of patients. There is also a dedicated lecture period set aside for each visit. Work is performed in coordination with University of Nairobi residents on their otology rotations with Dr. Ayugi.
Location and Need
Nairobi is the most populous city in Kenya and ranks eighth-most populous on the African continent. It serves as a major hub for the surrounding sub-Saharan region and is the premier medical destination for Kenya’s 56.4 million residents. Otologic and audiologic care is considerably underserved in the sub-Saharan Africa region compared with that in the United States, with approximately one otologist per 27,800 U.S. citizens compared with around one per 555,000–833,000 sub-Saharan citizens.
This low number of physicians results in delayed access to care, meaning that the burden of disease is often more severe at the time of presentation. Although efforts are being made to increase access to otologic care, there are challenges to training the next generation of surgeons. At the University of Nairobi, there are currently 36 residents working with 18 regular faculty members across otolaryngologic subspecialties. This is a significantly higher resident-to-faculty ratio compared with most training programs in the U.S., resulting in limited exposure to complex otologic cases for surgical residents.
Clinical Experiences at the Royal Eye and Ear Hospital
My experience with Dr. Ayugi and his residents was based out of the Royal Eye and Ear Hospital, which was founded by Dr. Ayugi and ophthalmology colleagues to create a space for efficient surgical management of patients apart from the much larger university hospital.
Following arrival in Nairobi on the evening of September 6, we traveled to the Royal Eye and Ear Hospital the next morning, where we would spend the next four days working alongside the local team.
Our daily itinerary started with assessment and discharge of the prior day’s patients as well as discussion of planned cases for the upcoming day. There were two operating rooms in use, and each room typically had two complex cases per day, which had been set aside by Dr. Ayugi for collaboration with our team and Dr. Bush’s expertise. Patients were typically in the operating room by 9:00 am and surgery commenced, with two University of Nairobi residents assigned to each room along with a chief resident from Kentucky. Outside the operating rooms, Dr. Bush and Dr. Ayugi monitored cases closely via transmitted video feed from the operating microscopes—intermittently scrubbing in or monitoring more closely during critical operative steps.
Collaboration and Knowledge Sharing
Education was shared bidirectionally. I was able to demonstrate and assist with drilling techniques, which local residents did not have much experience. In turn, they were able to teach me techniques for evaluating CT images on printed still-shots, a new approach to me given the typical luxury of scrolling seamlessly through digital images.
Memorable cases from the week included multiple revision canal wall cholesteatomas and keratosis obturans (a first for me). Beyond the cases themselves, there were multiple unique experiences relating to supplies and resources, including multiple operative microscopes breaking down mid-case requiring repair or replacement, a ventilator failure resulting in OR closure for eight hours, and a lack of standard otologic instruments—including an instance that resulted in dissection of tumor off the facial nerve using a Freer elevator.
The final day included a morning of lectures, including my presentation on graft selection considerations for myringoplasty and tympanoplasty.
Details
Service Commitment: Approximately 1 week Clinical Emphasis: Otology Financial Aspects: Total cost, including travel, estimated at $2,000 Language Skills: English, Swahili Global Region: Africa Research Opportunities: Basic, clinical Services Provided: Surgical otologic management
US Coordinator Contact Information Name: Matthew Bush, MD Title: Chair of Otolaryngology at University of Kentucky Email: matthew.bush@uky.edu
AAO-HNS Humanitarian Travel Grant
Applications Now Open for 2026 Outreach Trips
Dr. White was a 2025 recipient of an AAO-HNSF Humanitarian Efforts Travel Grant, which helped to offset his travel expenses to Kenya. These Foundation travel grants provide residents who are AAO-HNS members an opportunity to contribute professional service to people in countries with limited resources.
Learn more about the AAO-HNSF Humanitarian Travel Grant program and apply.
November 15 is the deadline for grant applications for outreach trips taking place January 1–June 30, 2026.
