Health Care Goes Global

BY NANCY A. RUHLING

The patient, a mother with two young children, was in debilitating pain. A 35-pound fibroid in her uterus made it difficult for her to sleep or to even walk more than a couple of steps at a time.

In this painful condition, she rode for three hours by bus to reach the Tetteh Quarshie Memorial Hospital in Mampong, Ghana, to undergo a hysterectomy performed by an NJMS-led team that was on a global health care mission.

“She was bleeding profusely during surgery,” says Erica Rego, a fourth-year NJMS student who is planning a career in ob-gyn. “Because there was no blood bank, patients were required to bring a unit of their own blood, but in her case, it wasn’t enough.”

As others on the team frantically worked to stanch the bleeding, Rego tracked down the woman’s sister in the hospital’s hallway, and, with a local nurse, took her across the street to draw blood.

“It was scary,” says Rego, who participated in 10 surgeries during the trip, ran the ob-gyn floor and did post-op consults.

The experience was transformative for the patient—and for Rego.

“It helped me develop skills in a resourcelimited environment, and it made me appreciate how much we have in the U.S., in terms of tools and medical equipment,” she says. “And it was rewarding—we were able to make a difference for this woman and others just by spending a week there.”

September’s mission was the brainchild of Ziad Sifri, MD, NJMS professor of surgery and director of the school’s Office of Global Health.

Since 2009, when he co-founded the all-volunteer nonprofit International Surgical Health Initiative (ISHI), Sifri has led 32 missions, eight of them to the Ghana hospital that treated the fibroid patient.

The missions, which include surgeons and supporting staff members from NJMS and around the country, encompass teaching and training sessions as well as donations of vital equipment ranging from anesthesia monitors to urinary catheters and personal hygiene packages. There are three missions a year. In addition to Ghana, the teams go to Sierra Leone and Peru. The organization is financed by private donations, and the volunteers on Sifri’s teams pay their own airfare. The tab for their food and lodging is picked up by ISHI.

The record 79 surgeries performed on the latest Ghana trip by the 25-member team included burn scar reconstructions with skin grafts—a first for ISHI. NJMS’s Edward S. Lee, MD, MS, associate professor of plastic surgery, performed 20 surgeries.

“One woman came in with a beautiful scarf tied around her neck,” says Lee. “She had been burned, and for three years, she had been covering up the fact that her chin was stuck to her chest on her right shoulder. And there was an electrician who had a fatty tumor the size of a football on his arm that prevented him from putting on his shirt, raising his arms or extending his fingers.”

The experience of helping these patients, he says, “was eye-opening and enlightening.”

Harsh Sule, MD, MPP, associate professor of emergency medicine and associate director of the Office of Global Health, has been to Ghana five times. In addition to doing pre-op and providing point-of-care ultrasound and other diagnostic tests, he conducted bedside teaching sessions and taught short courses, training local personnel in relevant surgical and anesthesia techniques while on the clinical mission.

“Additionally, in 2019 we were asked to conduct a two-day course on disaster management, and in September 2023 a three-day course on point-of-care ultrasound,” says Sule. “Currently we are working on a potential expansion of the point-of-care ultrasound course to include a basic, intermediate and advanced level course as well as a train-thetrainer component.”

He adds: “The classes extend the reach beyond the individual patients who benefited from the surgeries. And we keep in touch—we hold Zoom case conferences almost every week with the local team in Ghana, which allows faculty members from other specialties who have not taken the trips to contribute.”

Sifri hopes to expand the program and is recruiting and training other mission leaders for future trips. Although Rego was not on the next mission—to the Philippines in February— she’s hoping to land a residency with a global health care component.

“Going to Ghana was a unique opportunity,” she says. “I want to continue doing international work.”