Benjamin Wabwire: The plastic surgeon with hands that heal

"First, when most people hear we are plastic surgeons they think all we do is boob jobs and lift buttocks."

He sighs behind his face mask. "Second, and perhaps because of that, 90 percent of vital procedures are rejected by SHA [Social Health Authority] because they think it's cosmetic work, like what we are about to do now.

A lot of important reconstructive surgeries we do are critical to the health and wellbeing of patients. I need you to have that in the piece. Critical," he says.

This frustration with public perception weighs heavily on surgeons like Dr Wabwire, especially given the groundbreaking work happening in their operating theatres.

Just a few weeks ago, he and a team at KNH accomplished the world's first transhumeral targeted sensory reinnervation surgery.

The procedure reroutes nerves from an amputated limb to the remaining skin, creating a sensory map that allows the brain to perceive touch and sensation as if it were coming from the missing limb, essentially giving patients back a sense of their lost limb.

It was a triumph. Such triumphs, however, don't last long in his profession. He's almost always scrubbing in again before the champagne bottle is popped. His profession is characterised by so many unopened bottles of champagne abandoned on ice.

Why a doctor? Why not a farmer?

In high school, I was made a medical prefect.

This involved seeing sick students in the triage every evening, dispensing basic prescriptions like painkillers and antacids, and determining who needed to go to the hospital for treatment and who needed to stay in school. This was in Vihiga High School in western Kenya.

A sharp student, I suppose.

[Chuckle] I don’t know, but I ended up in medicine. In high school, you’re just trying to find your path. It usually takes someone to recognise certain qualities you might not see in yourself. They can then guide you into an environment that not only leverages those qualities but also helps you realise your potential.

What did your parents do?

Funny you should ask; my dad served in the Second World War. Yes. But he wasn't that educated, and never went to school.

My mom was a housewife. I don’t know how this connects to everything, but I come from this clan who are traditional circumcisers, and some people usually think that's where I got my surgical orientation from. I’m from Banyala, also known as Banyala Ba Ndombi.

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You fellows are good with a knife.

[Laughs] Not all of them. But there is a general belief that this is a gift you are born with.

I don’t know if I was born with this thing, but I have been a reconstructive surgeon for 10 years, though as a surgeon, I go back to 2004 when I joined the postgraduate training programme for surgery here at KNH through the University of Nairobi. In total, I have been in the surgical field for 21 years. I previously worked in the Gusii region before I got hired by KNH.

Why reconstructive surgery, why not a different discipline?

Just like with my high school medicine prefect role, this path was chosen for me. When I was hired at KNH, I thought I was coming to do abdominal surgery, the general surgery stuff.

But when I got here, the director of clinical services in Kenyatta, then, a plastic surgeon, Dr [Bernard] Githae pushed me into reconstructive surgical work. Honestly, I didn’t want it. But he and another colleague, Dr Kahoro, and the likes of Prof [Ferdinand] Nangole, encouraged me to give it a shot.

Later on, I realised that when I was doing the postgraduate training, they must have picked out an element—that this guy is one we could mentor in this direction.

What's that thing they picked?

Reconstructive surgery requires a lot of patience, intuition, and an analytical mind. The ability to assess the pros and cons of everything you do, and then communicate with the patients what you need to do.

Some procedures are long and taxing—you could be in the theatre, from 12 to 24 hours, leave, get home, and are called to come back. So, it is work that requires the extra mile. You need to be able to go that extra mile, to endure and sustain that brutal commitment. Of course, on top of the skills required.

If you were to reconstruct any part of your body, what would that be?

[Laughs] That’s an interesting question that I've never considered. [Long pause] I honestly can’t think of anything. I’m satisfied and happy with my body as it is. Yes, absolutely.

You mentioned the punishing hours here. After you've given this place so much, what is left?

[Sighs] That's a big question. [Pause] I believe people refer to it as work-life balance, and it is a tough one, particularly not just for you, but also for your family. With a family, it gets tricky because I will mostly leave home at 6 am and won't return until late, sometimes as late as 1 am. If you have small children going to school, they might wake up, find you gone, come back, and you're still gone.

A week can pass before you see them, and that can cause strain.

So I have to find a way to make sure I attend to my work as is required, scheduling within the hours I'm supposed to be here, and trying to finish it within that time. If that’s not possible, it’s always good to communicate that I have a long procedure today that might go late into the night, so I'll show up maybe when you guys have gone to bed. Then make up for that lost time over the weekend or whenever.

Children. How many?

How many children do I have? [Chuckle] Only four.

Only four?

Yes, because for a Luhya man, that’s not much. I have the least number of children in my family. The rest have at least 10. They still remind me that I have six more to go. [Laughs] I’m lagging in that department.

That’s because you are always in this department.

[Laughs] Yes. Fatherhood is nice. It's interesting. It comes with its demands. But I think it's an awesome feeling.

What are your interests outside everything you do here? Do you have any time left to pursue other interests?

I do. Having grown up in the village, I enjoy farm life, village life, seeing nature and things. I find trees and leaves, and hills very calming and relaxing. Whenever I can take leave, I head straight to the village. I love walking on my farm which has nice streams.

I like to sit on a rock beside the stream and listen to the sound of water trickling between the rocks. It’s quite relaxing. The sound of nature. The simple things we forget.

How old are you now?

I’m 50.

What's your biggest struggle right now as a 50-year-old man? What’s eating at you?

At this stage in my life, it has become clear that I am nearing the end of my public service career. Retirement is on the horizon. While I’m not worried about retirement itself, I find myself focusing on the people I am mentoring and training.

They are meant to take my place and support those who will follow after them.

Much like with children, I am paying attention to the interests and thoughts of young people. My concerns are primarily about what comes after me. I had the benefit of my parents’ guidance, and I have worked hard to enhance and improve that family environment.

My worries tend to revolve around whether the next generation—whether in the workplace or at home—will build upon what we have now and make it even better.

What's your opinion on butt lifts?

[Laughs] It is a culture that is catching up with our society. Much of this shift is influenced by Western ideals, but we forget that actually the West is doing it because they admire what Africans have.

Most of our women are naturally gifted in that sense. They don't need butt enhancement. But still, some feel what they have is not good enough, and so they want to upgrade.

But we also have a category of people who have what we call Body Dysmorphic Disorder (BDD), or body dysmorphia disorder. This is a mental health condition where a person spends a lot of time worrying about flaws in their appearance.

These are people who do not believe their body is good enough, and they will want to change everything. They will want to do butt lifts, increase the size of their calf muscles, do their chin, arms. You will do that, and next time they will tell you they don’t like their tummy. It just never ends.

And then sometimes, for a beginner, picking out those can be a problem. If you are this surgeon who is just enthusiastic to operate, and you don't listen to this person, well, then you end up doing a procedure, and then they are not satisfied with it.

They come back asking for another one and another one. And because they won't get satisfied, they end up with depression, and some even can go to the extent of suicidal ideations.

As a reconstructive surgeon, where do you draw the line and say, I can't touch that, I'm not doing it, go love yourself.

That's a tough question. Let me clarify: we perform almost all reconstructive surgeries that can benefit the patient. However, there are certain surgeries we will not perform if they pose a risk to the patient's life. For example, we sometimes assess terminally ill patients and determine that a surgery could be fatal for them.

Yet, if we believe a surgery can prolong their life, even for just a month or two, we will proceed to ensure they have more time with their families.

Is there something you look back at and wish you had changed?

[Pause] I wish I had started reconstructive work earlier. [Pause] I wish I had started thinking of setting up reconstructive outreach work because a majority of the population cannot access what we do here at KNH.

[Pause] Also, the other thing that I would do differently was that when I was just about to come for my master's programme, I started building a house and it dragged me for years. So if I were to go back in time and change, I don't think I would have done that at that time.

I would have used that money instead for investment and built that house, maybe five, six years after my studies… look, I got to join my colleagues on this surgery.

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