Bhavana Bhagya Rao, MD
Bhavana Bhagya Rao, MD
Gastroenterology · Cleveland, OH

Gastroenterology care in Guyana

January 4th
Georgetown, Guyana

Project Description

It is with great enthusiasm that my husband Abhik Bhattacharya and I are planning our second medical mission trip to Georgetown Public Hospital (GPHC) in Guyana in January 2019! We had a chance to spend 2 weeks at GPHC in February 2018 and those two weeks were the most professionally and personally enriching weeks of our fellowship thus far! Global health has always been one of our strong career interests and it was an honor and great source of satisfaction to offer vital clinical and endoscopic services to an underserved population and conduct extensive Gastroenterology and hepatology (GI) based didactics for residents in a hospital devoid of GI specialists. Based on the positive clinical and educational impact we had, we have been enthusiastically welcomed back to continue our contribution and we ourselves are eager to strengthen and formalize this collaboration.

Hence we have set up to volunteer for another 2 week stretch in January 2019 where we will perform 3 roles: 1)serve as clinical GI consultants providing specialist's care for inpatient and ambulatory patients with GI/hepatology issues 2) perform diagnostic and therapeutic endoscopic procedures and thus decrease the waiting time faced by patients 3) conduct daily didactic sessions for the 15 internal medicine residents to train them in continued care of these patients

Population Served

GPHC is the only public hospital and tertiary referral center for the entire country of Guyana. Despite being a large tertiary care hospital, it is deeply under-resourced and lacks gastroenterology and hepatology specialists and services. For e.g patients with GI and liver related pathology, both in the outpatient and inpatient setting, do not have access to a consultant’s inputs. There is a single general surgeon who is trained in endoscopy, however given his commitment to surgical procedures, the endoscopy waiting list is nearly 6 months and there is no provision for patients needing more urgent procedures. The internal medicine residents in training, who are bright and sincere, unfortunately lack the guidance from a GI consultant. With our presence and contribution we will seek to address and mitigate the above deficits in clinical care and training.

Our reason to choose this patient community is deeply rooted in personal reasons. My husband and I ourselves hail from humble backgrounds in rural parts of India. During our medical school training we had tremendous opportunities to work and learn from an underserved population. We feel extremely fortunate and privileged to now be working in elite centers in the developed world, however we also nurture a desire and a sense of responsibility to do our share to improve the quality of clinical care and education in the developing countries.

Expected Impact

We are optimistic that during our second trip we will further the impact we made during our first visit. 1. A dedicated GI/hepatology outpatient clinic will be organized for 2 weeks, where each of us will see 6-10 patients each half day and provide care, while also educating residents on appropriate practice. 2. We will perform endoscopic procedures daily to decrease the number of patients on the waiting list. 3. We will take turns to round on the hospitalized patients with GI/hepatology issues and coordinate their care 4. We will conduct advanced level didactics, lead case discussions, organize journal clubs and mock examination sessions to help augment the residents’ knowledge of GI/hepatology topics.

At the end of our prior stay the written feedback we received from GPHC included encouraging statements such as “Thank you again so much for your dedication and enthusiasm with teaching us, we really enjoyed having you in GPHC and found you both very inspirational and excellent role models” and “It has really helped to have you guys around for the GI teaching and has motivated me to read more around GI medicine.“ Thus an interest in GI and the opportunity to participate in endoscopic procedures was enabled by our first visit. During our second visit we will share material and resources to enable continued training for future batches of trainees by the local providers. Also since I am now a member of the American College of Gastroenterology’s International Relations Committee, I am also working on providing more resources to these centers and setting up stronger, long lasting collaborations.

Trip Photos & Recap

I greatly enjoyed the chance to conduct my second medical mission rotation at the Georgetown Public Hospital (GPHC) in January 2019. GPHC is the biggest government run tertiary care center in Guyana and caters to a large population of underserved patients on a daily basis. The hospital has a thriving internal medicine residency training program, run under the supervision of Canadian universities; however additional medical specialties remain poorly developed. In particular, the residents receive no Gastroenterology (GI)/hepatology dedicated didactics during their 3 year training program.
I volunteered to work at GPHC for two weeks during which I performed the following roles: 1) round with the medicine residents and provide specialist’s input and teaching on patients admitted with GI/hepatology issues 2) supervise and coach residents as they evaluate patients in GI clinic 3) conduct daily power point slides based didactic sessions for the residents to enhance their knowledge base in GI/hepatology 3) precept medical students on bedside assessment and physical examination skills in patients with GI/hepatology diseases.
In their feedback, the residents and students expressed much excitement and gratitude, and two of them also indicated that this exposure has stimulated them to pursue GI/hepatology as the specialty for their advanced training. This has been a very professionally and personally enriching experience for me as well and I thank the team at Doximity for facilitating my endeavor.