Two teams from the UNMC Department of Anesthesiology recently returned from a month-long global health trip to the University Teaching Hospital in Lusaka, Zambia, as part of the Global Academic Anesthesia Consortium. In addition to providing hands on and didactic clinical training to the residents of UTH, this annual trip provides medical and cultural education to UNMC residents, fellows and faculty.
The GAAC is a collaboration of academic anesthesiology departments, providing in-person and virtual anesthesia education programs, research and perioperative clinical training in areas where a sustainable partnership is possible.
Megan Chacon, MD, director of Global Health for the department, said the educational aspect and sustained presence is what differentiates this program from global health trips in the past, which were strictly clinical.
“The consortium allows for a continuation of training over several years,” she said. “The participating institutions share planning and curriculum development, leaving UTH faculty and residents with the skills to handle complex cases and OR management long after we’re gone.” The GAAC has a presence at the UTH 10 months out of the year.
Dr. Chacon said the first team faced some unique challenges this year because of drought conditions.
“When we arrived, we only had generator power, enough to power lights and charge our phones, but no hot water or air conditioning,” Dr. Chacon said. “The country relies on hydropower from the dam, and the rainfall has been so low it caused rolling blackouts, 17-20 hours per day.”
The hospital was mostly unaffected, but residential and retail buildings were often without power. Dr. Chacon was in line to pay for groceries when the power went out and the generator failed. “We were stuck in the dark and had to abandon our items and use our cell phone flashlights to navigate out of the store.”
Dr. Chacon said the trip provided UNMC trainees and faculty the opportunity to practice medicine in a resource-limited environment, as well as increase critical thinking skills. “The residents saw how limited supplies and resources change the way we think about both the practice of anesthesia and limiting waste during an anesthetic,” she said.
Cardiothoracic anesthesiology fellow Megan Rolfzen, MD, said that although medical care in different time zones parallels the United States temporally, the resource limitation is completely different than the environment in which UNMC professionals train. “Although knowledge may exist, the lack of resources limits extensive complication management, which is the biggest differentiator,” she said.
“I think it is important to see how medicine, surgery and anesthesia is performed worldwide because it provides perspective on how we can be environmental, social and emotional stewards of the capital we are fortunate enough to possess,” Dr. Rolfzen said.
Lucas Deschenes, MD, said helping and caring for people is at the core of an anesthesiologist’s role. “Whether you’re a physician or a patient, nobody has ever made it through life without someone’s help.”
He said with only 30-35 anesthesiologists in the entire country of Zambia, the average wait time for an internal fixation of a long-bone fracture is often more than six months — a similar surgery in Nebraska would be done often within a week. “Patients that we see are grateful that they receive medical care at all,” Dr. Deschenes said.
One of the primary goals of the trip was to provide regional anesthesia and point-of-care ultrasound training to the residents at UTH, said Dr. Chacon.
“The residents have been very keen and receptive to point-of-care ultrasound utilization, which has had tangible benefits,” Dr. Rolfzen said. “For example, we helped place a lower extremity block for postoperative analgesia.” Dr. Rolfzen taught residents how to place ultrasound-guided IVs and Dr. Chacon allowed the residents practice on her.
Drs. Chacon and Rolfzen joined Aleem Siddique, MBBS, professor with the UNMC Department of Surgery at the newly established National Heart Hospital in Zambia.
Dr. Siddique said his interest in global surgery and involvement in a national committee on global surgery is what led him to join the anesthesiology department’s trip to Zambia, and he hopes it will be the start of a collaboration with the UTH team to help expand their surgical capabilities and establish a training program.
”I was interested to see the great work being done by my anesthesiology colleagues and to see if I could learn and assist from the surgical side,” Dr. Siddique said. “I would love to be more involved in attempts to expand surgical capabilities worldwide.”
Dr. Rolfzen said they were able to repair a ventricular septal defect on one fortunate 2-year-old.
“Geoffrey Changwe, MD, one of the cardiac surgeons at the National Heart Hospital, repaired a defect in the wall that separates the lower two chambers of the heart,” Dr. Rolfzen said. “Dr. Chacon and I ran the anesthetic with Patrick, the anesthesiologist on staff.” They also taught the cardiac anesthesia providers different regional techniques for post op pain control during cardiac surgery.
The challenge in Zambia, Dr. Siddique said, is lack of depth in personnel and resources.
“They have the expertise but without more resources it is difficult for them to maximize the abilities of those present and serve all the needs of their population,” Dr. Siddique said. “They do not train their cardiac surgical team locally, and establishing their own training program would be critical to increase the depth of their team.”
Nancy Rogic, MD, said the pediatric surgery department is the only department with a fellowship program at UTH and was most impressed by how the local team was able to accomplish so much with the limited resources.
“Ultimately, the greatest satisfaction was in helping others — residents, attendings, anesthesia assistants and medical students — although I think I learned more from them than they did from me,” Dr. Rogic said. “When we finished the medical student workshop, two UTH medical students told me that they may go into anesthesia and that up until then they had never even considered it.”
Dr. Chacon said she would encourage any department resident or faculty interested in expanding their way of looking at the practice of medicine to consider going on future trip.
“It gives you such a unique perspective on culture, health care and patient interaction that is so different than what we see here in the United States,” Dr. Chacon said. “As Mark Twain said, ‘Wholesome and charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one’s lifetime.’”
Interim chair of the department, Mohanad Shukry, MD, PhD, said the department’s global mission is critical as it not only provides excellent patient care and educational opportunities in a less fortunate part of the world, but it also provides a life-changing experience for the UNMC department of anesthesiology residents, fellows and faculty.
“At UNMC, we are fortunate to have faculty and learners who believe they are global citizens,” Dr. Shukry said. “I notice all who participate in a global mission return a completely changed person. The department is very proud to be able to provide this experience to our faculty and learners.”
UNMC/Nebraska Medicine team members were:
Team One
- Megan Chacon, MD, Director, Global Health
- Dennis Thiel, MD, assistant professor
- Jeremy Payne, MD, CA3 resident
- Elizabeth Ternent Rech, DO, CA3 resident
- Megan Rolfzen, MD, Cardiothoracic Anesthesiology Fellow
- Aleem Siddique, MD
Team Two
- Lucas Deschenes, MD, assistant professor
- Nancy Rogic, MD, assistant professor
- Lauren Costello, MD, CA3 resident
- Taylor Ziegler, MD, CA3 resident
- Nathan Goergen, MD, CA3 resident