Surgical Services

The KNH Dentistry department is situated on the ground floor of the old KNH building below the University of Nairobi, School of Pharmacy.

The department provides general outpatient dental services to both adult and children patients drawn mainly from Nairobi and its environs. The department is also a referral centre for specialized care in:

• Paedritric dentistry (Child Dentistry)
• Orthodontics (the science of braces)
• Periodontology (gum diseases and tooth-supporting structures)
• Conservative Dentistry (concerned with conserving and repairing your teeth which are important in your overall health)
• Prosthodontics/prosthetic Dentistry (the science of making artificial replacement of teeth and other facial bone structures)
• Oral and Maxillofacial Surgery which is the unit concerned with the management of inpatients with complex injuries of the facial region, infections, tumors and cancers as well as congenital malformations among others.
• Dental Laboratory Technology
• Restorative dentistry

The KNH ENT department is located at Clinic No. 34 and run by ENT consultants, residents in training, registered clinical officers, student clinical officers, audiologists, speech and language therapists and ENT nurses. Our clinics are Monday-Friday, 9a.m.-1p.m., with an emergency clinic running from 8-5p.m. on weekdays. We also have multidisplinary head and neck clinic run monthly and tumor board meetings run weekly.

The out-patient services offered are:

• Consultations for ENT diseases
• Audiology services- Pure tone audiometry, tympanometry, BERA, newborn hearing screening
• Vestibular assessment and rehabilitation.
• Speech and language therapy
• Foreign body removal in the ear and nose.
• Aural toilet and examination under the microscope
• Nasal packing, nasal cautery, nasal douching
• Punch biopsies for masses in the oral cavity and nose
• Drainage of neck abscesses
• Video- diagnostic procedures- videolaryngoscopies, rigid nasal endoscopy and video-otoscopies.
• Change of tracheostomy tubes

The in-patient surgical services offered are:

• Emergency surgeries which include- insertion of tracheostomy tubes, drainage of abscesses, foreign body removal in the nose, ears and throat. Repair of penetrating neck injuries.
• Tonsillectomy and adenoidectomy
• Ear surgeries- tympanoplasty, mastoidectomy, myringotomy and grommet insertion, lateral skull base surgery, ossiculoplasty.
• Nasal surgeries- turbinoplasty, endoscopic sinus surgery, endoscopic approach to the skull base, repair of CSF leaks, reduction of nasal fractures, septorhinoplasty
• Laryngeal surgeries- direct laryngoscopy+biopsy , microlaryngeal excision of laryngeal nodules, cysts, papillomas and polyps, Laryngotracheal reconstruction
• Head and Neck surgeries- parotidectomy, submandibular gland excision, total laryngectomy, neck dissection and reconstruction, hypopharyngectomy and reconstruction, excision of branchial cleft cysts, cystic hygromas and thyroglossal duct cysts, thyroidectomy.

Specialized services:

• General ENT
• Head & Neck
• Otology
• Audiology
• Speech and Swallowing Therapy
• Rhinology
• Laryngology

The Rehabilitative Services Department is established to provide holistic preventive and promotive rehabilitative care. It is an important part of the recovery process after surgery or significant injury. Rehabilitative services aim to restore functionality across physical, psychological, social, and vocational domains. Each form of rehabilitation serves a unique purpose in helping a person reach full recovery, but all share the ultimate goal of helping the patient return to a healthy and active lifestyle.

Specialized services:
Physiotherapy
At Kenyatta National Hospital, the Physiotherapy unit is located at the ground floor, main tower block. The unit offers both inpatient and outpatient services for adults, infants, pediatrics and children. Prime Care Physiotherapy outpatient services are located at the Day Care Centre, next to clinic 66. The unit provides the following services:

• Orthopedic Manual Therapy
• Lamaze Child Birth Education Programme
• Wellness and Fitness Classes
• Women’s Health
• Ergonomics (Education and work Related Injury Prevention)
• Infant Massage (Education, Colic prevention and treatment)
• Sports Injury Management Services (Prevention, treatment and Rehabilitation)
• Pelvic Rehabilitation Management (Both for males and females)
• Neuro-Rehabilitation (Including Vestibular Rehabilitation)
• Provision of appliances (Walking aids), training for the use and home programme.

Future Plans

• Sports Medicine

Occupational Therapy
The specialization areas in Occupational Therapy that is conducted by highly skilled and specialized therapists include: –

1. Driver rehabilitation is carried out at Kenyatta National Hospital (KNH) since 2000, it involves;
   • Off-road (clinic assessment)
   • On-road assessment (practical session)
   • Assessment for suitability to driving.
   • Driver education and re-habilitation
    
2. Child development assessment for early identification and intervention for neonates in our Maternity facility and Newborn unit.
3. Hand Therapy and Upper limb rehabilitation
4. Training in Activities of daily living
5. The state-of-the-Art sensory integration unit that gives services to children with different sensory challenges such Autism Spectrum disorders

The specific interventions in Occupational Therapy at Kenyatta National Hospital include:

1. Assessment of motor, sensory, cognitive, and perceptual performance, focusing on how the impairments in these areas can have on a person’s ability to perform daily tasks
2. Education on the long-term management of conditions and temporary disabilities in daily and work
3. Functional retraining, fabricating splints, prescribing specialized aids and equipment for home adaptations
4. Liaison and referral to community services for continuous rehabilitation and provision of equipment and services
5. Pressure management for hypertrophic scars and Oedema
6. Mental Health in Occupational Therapy intervention
7. Learning Assessments and recommendation
8. Low vision Therapy

Orthopaedic Technology (Prosthetics and orthotics)
The Orthopaedic Technology Unit is situated on the ground floor of the old KNH block, next to Clinic No. 5 opposite Isolation Ward 41. The Unit provides general outpatient and inpatient services to both adult and children. The following are the Services Offered in the unit:

1. 1. Prosthetics

A Prosthesis is a device used to replace wholly or in part, an absent or deficient limb/body segment for the following categories:

1. 1. • Lower limb (all levels of amputation)
      • Upper limb (all levels of amputation)
      • Breast
   2. Orthotics

KNH offers:

1. 1. • Lower limb Orthotics e.g. HKAFO, KAFO, AFO, FO, Knee braces, Knee supports, Shoe modifications, special insoles, diabetic foot wear
      • Upper limb Orthotics e.g. splints, arm sling and various braces and supports
      • Spinal braces and corsets e.g. Taylor braces, Lumber and Thoracolumbar corsets and neck collars for a deformed or fractured spine
      • Hernia belts
   2. Mobility aids

KNH specializes in:

1. • Appropriate wheelchair services
   • Walking aids e.g. axilla, elbow, strand, platform crutches, walking frames and walking canes
   • Bionic limbs
2. Multi-disciplinary Clubfoot Clinic

KNH conducts a specialized clinic every Thursday, for correction of congenital foot deformities e.g. clubfoot in new born babies.

The Department of Ophthalmology at Kenyatta National Hospital offers diagnosis, advice and patient-centered care for diseases affecting the eye. It also conducts research in eye problems. We offer medical as well as surgical management of diseases affecting the eyes. –

Specialized services:

• Anterior Segment / External Ocular Diseases, Cornea and Cataract
• Glaucoma
• Orbit / Oculoplasty
• Pediatric Ophthalmology
• Vitreoretinal Surgery
• Uveitis
• Neuro-Ophthalmology
• Low Vision / Refraction

At your first visit to the Eye Clinic, the specific presentation of the eye problem will determine your initial assessment and treatment, as well as which of our subspecialties your care will fall under.
Our surgical services include:

• Cataract surgery
• Glaucoma surgery
• Oculoplastic surgery which includes management of eye cancers.
• Paediatric eye surgery which includes removal of cataracts and correction of squints/cross eyes.
• Retinal detachment repair
• Clearing bleeds in the gel at back of the eye.
• Repair of injuries resulting from trauma to the eye
• Screening and management of retinopathy of prematurity.
• Eye injections in patients with diabetes, infections and inflammation of the eye etc.

Milestones

• Annual glaucoma screening projects during the World Glaucoma Week.
• Routine screening of premature babies in the new born unit and management of retinopathy of prematurity.

Future plans

• Set up an eye bank and establish cornea transplant services.

For more information on Ophthalmology

Anaesthesia is a state of controlled induction of reversible temporary loss of sensation or awareness which may include some or all of analgesia, loss of consciousness, muscle paralysis and amnesia for medical purposes. This is achieved by use of anaesthetic drugs and gases. A person who is under the effects of anaesthetic agents is referred to as being anaesthetized. Anaesthesia is mainly given to patients to facilitate safe surgery and other procedures without pain.

There are four main categories of anaesthesia used during surgery and other procedures:

1. 1. General anaesthesia: Patient is unconscious and feels nothing. Patient receives medicine by breathing it or through an IV.

1. 1. Regional anaesthesia: Patient is awake and part of the body undergoing the procedure is numbed.

1. 1. Local anaesthesia: Patient is awake, medicine is injected to numb a small area.

1. 1. Sedation:Patient is drowsy throughout the procedure but is able to respond to questions. It involves injection of medications through an IV catheter to help you relax as well as to block pain so that you can tolerate a procedure that otherwise would be uncomfortable. If for any reason you are not able to tolerate this kind of anaesthesia, there may be need for a general anaesthesia to be administered to complete the procedure safely. Deeper levels of sedation are used with or without muscle paralysis for patients in the critical care unit who are on respiratory support to facilitate management of their conditions.

There are indications for each mode of anaethesia used and often the patient may choose which type if there are no contraindications. Occasionally there’s a combination of general and regional anaesthesia and sedation and regional anaesthesia. The department of Anaesthesia and Theatres comprises of two units: The Main Critical Care Unit (CCU) and The Operating Theatres together with Theatre Sterile Services Unit (TSSU) and Central Sterile Services Department (CSSD). There are a total of 22 operating theaters in KNH. These include 12 in main theatre, two maternity theatre, two trauma theatres, one ENT satellite theatre, one eye satellite theatre, one burns theatre, one gynaecology day care, and one surgical outpatient clinic (SOPC) minor theatre. We also provide anaesthesia cover for the dental school theatre which belongs to The University of Nairobi. The main function of the department is perioperative care for all surgical patients including provision of safe anaesthesia, management of critically ill patients, management of theatres for safe surgery and providing safe sedation for patients in theatres and allied areas. TSSU and CSSD serves all the theatres and the whole hospital with sterilization services which is key to infection prevention and control. The allied areas where anaesthesia department offers support are:

1. 1. Radiology Department for sedation/anaesthesia for children and uncooperative patients requiring MRI, CT scans and interventional radiology procedures.

1. 1. Endoscopy suit for sedation/anaesthesia for of children and adults requiring day care and inpatient procedures.

1. 1. Cancer Treatment Centre (CTC) for sedation of patients requiring radiation and oncology procedures.

1. 1. Cardiology department (cath Lab) for sedation/anaesthesia for cardiac catheterization for children and very sick adults.

1. 1. Burns Unit and wards for procedural sedation and insertion of central venous catheters for difficult venous access.

The staff in the department include medical specialists who are both staff of KNH and the University of Nairobi. The other staff are Registered clinical officer anaesthetists, specialized trained nurses in perioperative nursing, critical care nursing, nursing sterilization and decontamination, Theatre Service Assistants (TSA) and other supportive staff. There are other support departments who work hand in hand with us and are key to our services. These include Biomedical Engineers who are stationed in the theatres, TSSU/CSSD and CCU for maintenance and safety checks of the equipments and machines, Physiotherapists and Occupational Therapiests as well as Nutritionists, Laboratory staff and Radiology staff among others. The medical specialists have sub-specialized in several areas to complement the surgical specialties ensuring patients are always handled by competent and well-trained practitioners. These include transplant anaesthesia (renal and liver), cardiac anaesthesia, neuro anaesthesia, paediatric anaesthesia, critical care medicine, Regional and pain management service. The pain management service team offers training and administration of nerve blocks and epidural analgesia to make the patient recovery from surgery less painful and comfortable. With regards to pain, the department has engaged bedside pain management protocols for burns patients to make change of dressings and other bedside procedures more bearable. The department has collaborated and supported expansion and set up of CCUs to other units. These include Obs/Gyn CCU, Internal medicine CCU, Paediatrics CCU (PICU), Cardiothoracic CCU, Neuro Surgical CCU, and Paediatric surgery CCU, all of which are now independent units. The department is involved in teaching and mentoring of fellowship students in Paediatric anaesthesia, Master of Medicine in anaesthesia University of Nairobi, Higher national diploma in anaesthesia Kenya Medical Training College, Perioperative and Critical care nurse training. We also conduct research and participate in missions and outreach services to support the counties as per the hospital mandate. The department is committed to improving care and quality, through monthly mortality and morbidity audits to evaluate performance and improve processes and service delivery.