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Fellow Spotlight: Wayneho Kam, MD

Tuesday, August 6, 2019
W Kam

Our newest stroke fellow, Wayneho Kam, MD, first became interested in neurology as an undergraduate student, while he was working in the lab and investigating the mechanisms by which Parkinson's disease becomes a chronic neurodegenerative process. Since then his path has taken him to Philadelphia and Nashville, respectively, for his medical school and residency, as well as to the South American country of Guyana, where he treated patients with stroke, and helped develop an inpatient consult neurology service and a telemedicine program. Kam talks to us about his journey towards practicing vascular neurology, the usual (and unusual) cases he treated in Guyana, and his plans for the future.

What are your current responsibilities as a Stroke Fellow? What does a typical day for you look like?
As a stroke fellow, my primary responsibilities are that of a learner and a teacher. I will be rotating through a variety of subspecialty rotations throughout the year, working with members of the stroke, neurocritical care, neurointerventional, and neurorehabilitation teams. While I am only a month into my fellowship, I have already learned a great deal from our neurorehab colleagues. I have served in a neurohospitalist role at Duke Regional Hospital, taking consults, responding to code strokes, and being on call. I have also participated in some emergency department-based quality improvement projects. I look forward to starting my time on the stroke service come September.

How and when did you first get interested in neurology? What do you find most interesting or satisfying about the field of stroke and vascular neurology?
I first became interested in neurology when I was doing neuroscience research in college. I was intrigued by the complexities of the human brain and all the things that could go wrong with it. I wanted to be in a field that helps address some of these problems. What I find most gratifying about vascular neurology is the acute decision-making and the collaborative teamwork that is required of the field. Stroke is a neurologic emergency that demands swift action among members of multiple professions: EMS personnel, emergency medicine physicians, neurologists, neurosurgeons, radiologists, advanced practice providers, nurses, and pharmacists (to name a few!). Physiotherapists, case managers, and social workers are integral members of the team as well, ensuring that the stroke patient adequately transitions from acute care to recovery post-discharge.

What plans do you have for after you complete your fellowship? If you could have any job in the world, what would it be?
I would like to be a neurohospitalist and stroke provider. I would like to do some global health work and help streamline stroke prevention efforts in underserved and disadvantaged communities, both in the United States and abroad. I love what I do and wouldn't change a thing.

You recently spent time in Guyana (in the northern tip of South America) practicing neurology. How did you end up traveling there?
I always wanted to practice medicine in a low-resource setting. I decided to spend some time in Guyana earlier this year. The Vanderbilt Emergency Medicine program has an established partnership with the country's largest hospital, the Georgetown Public Hospital Corporation, so I reached out to the EM leadership to see how a neurologist could help. It was a mutually beneficial experience where not only did I get the opportunity to help the local community, but it also allowed me to view medicine from a different perspective.

What kind of work did you do while you were there? How do the neurological needs of the population of Guyana compare to those of the United States?
Aside from taking consults and seeing neurology cases, I spent a good amount of time teaching neurology to local Internal Medicine and Emergency Medicine residents. I also worked with local staff to develop an inpatient and consult neurology service for the hospital. I realized that this may not be a sustainable feature without the year-round, in-country presence of neurologists, so I helped formulate ways to continue the delivery of neurological care through telemedicine.

The neurological conditions didn't differ all that much from what we see here in the United States. There were lots of patients who presented with strokes. Unfortunately, there wasn't much that could be done for these individuals. Thrombolytics or mechanical thrombectomy were not options. CT scans often got delayed, and so we didn't know if we were working with hemorrhagic strokes or ischemic strokes. Ideal blood pressure parameters could not be set. I worked with the local residents to collect some stroke data so that such processes could be optimized.

Aside from strokes, there were lots of seizures with lots of Dilantin use. There were quite a few cases of AIDP. The local folks speculated that this may have been from Chikungunya and Zika viruses on the basis of seasonal variations. Cerebral toxoplasmosis and cerebral malaria were some of the other unique cases that I saw.

What other passions or hobbies do you have outside of the Department?
It has been more than 8 years since I last attended a Duke basketball game at Cameron Indoor Stadium (when I was a college student), so I am much overdue for one! Otherwise, I enjoy spending time with my fiancée. We are big foodies and we always find a reason to go out and try a new restaurant or find a new coffee spot. We love to be outdoors, particularly during the autumn months. We enjoy traveling and exploring new cultures.

Above, Kam gives a morning report to the local internal medicine residents in Guyana, while below, he enjoys a vacation with his fiance in Kauai's Waimea Canyon.