This project will consist of a multidisciplinary team that will provide perioperative surgical services and supplies to the communities of Taomasina and Diego. My role will specifically be to provide anesthetic care and management during the operations. The mission work will make a difference as the people of Madagascar do not have access to safe anesthetic care. Additionally, the trip will include working alongside members of the community and training the local community so that the care can turn into sustainable work.
The multidisciplinary team that I am traveling with involves anesthesiologists, residents, general surgeons, emergency physicians, ob/gyns. The wide breadth of providers excites me because I believe we will be able to leave a lasting impact on the poeple of madagascar- in care that they do not normally have access to. Additionally, since we are traveling to two locations for the trip, we are going to be able to provide care in very remote locations. For me, I am excited to work with such a large subset of there population because I am hoping we will be able to provide care in many different surgical subspecialties- helping children, mothers, fathers, elderly. I am excited to have the opportunity to deliver first hand care and am hopeful it will make me a better provider all while addressing an unmet need.
At large, my main motivation for this grant is to address unmet patient needs through education of the communities’ providers. I feel strongly that one of the most impactful things I can do for underserved communities is provide education, so that the communities can form sustainable, safe care. I know that there is a stark disparity in the availability and quality of anesthesia care between developed and underdeveloped nations, in part because of the shortage of trained providers. For me, this is my motivation to teach anesthesia internationally- I hope to equip local community members with skills and knowledge to deliver safe care, with the hope that this can make the care sustainable. I have been on a previous mission trip and saw firsthand the profound impact on the community and on me. These missions showed me firsthand the abundant need for international education and support. I quickly realized that my teaching
styles had to be adaptable and saw firsthand how challenging education can be when resources are scarce. I truly gained a deeper understanding of my own cultural biases and was profoundly impacted by how significantly the work aided in my development of flexibility, humility and emotional intelligence, something that directly impacts me every day- both professionally and personally. I am applying for this grant because I have seen from my previous work how transformative this experience can be.
This trip to Madagascar is hard to put into words the impact it has had on me- both as a person and as a physician. This trip would not have been possible for me without the generosity of Dox Foundation, and I am incredibly grateful. Our trip to Madagascar with global healing hands has been eye opening, rewarding, and full of memories that we will cherish for many years to come.
Toamasina:
Day 1:
6 am- The day started with beginning our work at Bethany hospital in Toamasina.
My initial impression of the facility was that it was filled with people who care so much for there community. Dr Fabruce, the local surgeon who welcomed us with open arms, single handled founded this private hospital. He amazingly has trained staff, anesthesia providers, and welcomes visiting doctors. He currently has Dr Thomas who trained under him as part of his team. I can speak for the group when I say that Dr. Fabruce inspired us with his dedication- he lives above the hospital with his four kids and his wife, who is a hospitalist. Needless to say, he is very dedicated to his work.
Day 1-4
Our home for the next few days looked like two operating rooms, equipped with anesthesia supplies to deliver safe care.
The hospital is currently on rented land, but Dr Fabruce recently bought land where a surgery center now lives. Dr cranshaw, a general surgeon who practices in Ohio was able to complete the inaugural case at this surgery center, something we were very excited to be a part of.
Currently, they are working to build a bridge over to the land that the surgery center now lies on, but the current setup involves walking 10 minutes to the location.
10 am- Meanwhile at the main hospital, Dr Natalia Ferrando’s team was able to provide anesthesia for patient with thyroid tumors. Dr. Cathy Baker also had her own room providing obstetric care- hysterectomy’s as well as c sections.
Day 4: We had a banquet celebrating our work, receiving a beautiful gift of handmade t shirts from the hospital. The people of Toamasina left a lasting impact on our group. Much of the community has minimal, but were very generous to our group welcoming us with open arms. The care that Dr Fabruce is able to provide has quite literally changed the community; he has given his heart and soul to the people and it was inspiring.
Day 5: We were able to move on to our next destination- Antsirinana, better known to the community as Diego. Flights were challenging again- with bag issues still a problem, but somehow we were able to bring supplies to complete many cases.
Day 5-10
We met Dr Harry, or as the locals call him Professor Harry - professor of surgery at university of antsiranana.
The facility we were able to utilize was polyclinique universitiair. It is a nonprofit hospital founded by Luigi Bellini 10 years ago. Luigi inspired many of us during our time, bringing many in the group to tears telling his story. He visited Madagascar many years ago, and saw just how in need the community was of education in the sciences and medicine. He decided to move full time to Madagascar from Italy to dedicate his life to this mission, inspiring in itself. What started as a biology lab, then realized there was a great need for healthcare, with disparities that are difficult to imagine in the United States. He established the hospital, and quickly realized he would also need to staff the hospital, making it part of his mission to educate members of the community to become doctors, nurses, ancillary staff. The hospital is run by nuns, who also welcomed us with open arms.
We were able to provide 50-100 screenings for patients with many problems.
Ent, thyroid, gynecologic problems were all addressed by the many physicians in our group.
For me, some of the difficulties we face in the OR in our daily life felt similar to Madagascar, just on a larger scale. Communication is so important in the operating room, and language barriers only showcased this more. We are extremely grateful for the local translators and members of the group who spoke French. Additionally, the importance of working as a multidisciplinary team was also greatly magnified with more limited resources and new equipment and settings.
The group will carry in day to day life both the generosity and gratitude our patients and family members showed us. When surgeries were completed and the patients were brought back to there room by our anesthesia staff and nursing staff at the hospital, we were welcome by generations of family members. This highlighted just how important family and connection are to the people of Madagascar.
It did not go unnoticed how hard the staff worked at the hospital, with many members living at the hospital so they could be available at all hours of the day. I was amazed at the commitment they had to there profession, how grateful they were for the opportunity to learn from our group, and amazed that there was never a complaint about how hard they were working, or that maybe they were too busy to stop and eat lunch or that a emergency c section had to occur in the mere hours of the night. To be able to connect with local nurses, fellows, nurse anesthesia students, and ancillary staff was one of the most special parts of the trip.
Day 12: Our trip ended with a party with the community members we had worked alongside. I was reminded that music, food, and sports connect people worldwide. Laughter is medicine and dancing can unite people regardless of language barriers, age gaps, socioeconomic gaps and the party highlighted this.
To end, I think it’s hard to put into words how meaningful and impactful mission work with Dr Starnes and Global Healing Hands is- on not only the communities he serves alongside, but also as a volunteer. As I finish residency within the next year, this trip reminded me of many of the reasons I decided to pursue medicine, made me extremely thankful for the opportunity of education I had in the United States, and that even some of my worst days during residency, could be some of the Malagasy patients’ day that they could only dream of. Work like this humbles me, helps me to maintain perspective and reminds me how large the world is, and visiting other countries makes me appreciate and have humility for where I came from and how I was raised so much more.
