MAR-A-9
TWO GENERATIONS OF CHIEF SURGICAL RESIDENTS
CONTINUING ON IN INTERNATIONAL MEDICAL
PRACTICE
From: William Barrett <wbarrett@pol.net>
To: <adamkusher@yahoo.com>
Date: 3/10/03 12:12AM
Subject: Re: Fwd: Your thoughts
Adam
I received a note from Glenn about your experience in Africa ‑
congratulations on your effort and results.
I too was encouraged by Glenn to spend some time after my residency
and it was truly a life shaping experience. I travelled with Glenn
to Northern India and ended up spending three months in the city of
Manali working with a Dr. Laji Varghese. It was great!! I still
keep in close contact with Laji and and help him to acquire
equipment and supplies from time to time.
I am now working for the Indian Health Service in Ada, OK and am
finding it a great fit as I begin my career.
I see that you mentioned an interest in starting a fellowship
program in international surgery. I think that that is an
outstanding idea and would love to help you accomplish that goal.
In fact, I have some ideas on how it might be funded.
I would be more than happy to speak with you at some point if you
are interested in my input and help.
Sincerely,
Bill Barrett
‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑ Reply Separator ‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑
Originally From: Glenn Geelhoed <msdgwg@gwumc.edu>
Subject: Fwd: Your thoughts
Date: 03/07/2003 09:18am
I had encouraged Adam Kushner, a just finished general surgery
resident, to come to Malawi, and he has summarized his results
(attached) He has also done an "every fifth patient" trauma review
for
Lilongwe General Hospital and those results are seen pasted below.
This gives an idea of what kind of experience such a volunteer period
can produce..
Cheers!
GWG
Trauma at the Lilongwe Central Hospital: Malawi, AfricaMvula CJ,
Kushner AL, Muyco APLilongwe Central Hospital, Lilongwe, Malawi,
Africa
Trauma is a Global problem. Malawi, a country in southern Africa
has a
per capita annual GNP of US$ 190 and is one of the world's poorest
nations. The Lilongwe Central Hospital (LCH) is the only tertiary
care
referral center capable of undertaking complex trauma care for the
Northern and Central regions of the county. Methods: A prospective
survey recorded age, sex, transport time and mode, injury and
treatment
for every fifth trauma patients presenting to the emergency
department
at LCH from January through June 2002. Results: The study included
300
patients. Seventy five percent of patients were male and 108 (39%)
were
less than 15 years old. Sixteen percent presented within one hour of
injury with a mean time to presentation of 7.33 hours. Transport to
the
hospital included 78% by private transport, 19% walk‑in and only 2%
by
ambulance. Six percent of patients presented with poly‑trauma, while
respectively, 35%, 26%, 16% and 12% of patients presented with only
soft
tissue injuries, limb fractures, visceral organ injuries or isolated
head injuries. Eleven percent had a FAST examination and 31% had
x‑rays. Seven percent of patients underwent an immediate operation.
Conclusions: Pre‑hospital care and transport in Malawi are limited
and
should be enhanced through cooperation with the Ministry of Health
and
local providers such as police and fire departments. Educational
programs targeting school age children may be useful in helping to
limit
the number of injuries in this high risk population. Increased
reliance
on ATLS protocols need to be followed to assure that trauma patients
receive adequate resuscitation, c‑spine immobilization and fracture
management. The use of FAST should continue as should reliance on
timely operative intervention when appropriate.
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>>> Adam Kushner <adamkushner@yahoo.com> 03/05/03 09:46PM >>>
Dear Dr. Geelhoed,
I am enclosing in this and a following email two abstracts that I am
planning to submit for posters for the Scientific Exhibits at the
ACS in
October. I would appreciate your thoughts. The first is on my
experience and the possibilities of setting up a fellowship in
international surgery in the future and the second is a trauma
abstract
(I missed the deadline for the AAST). I am also toying with the
idea of
writing up my Malawi experience for the ACS Bulliten.
I am still in the process of working on the video. I'm planning to
put
together a 15 minute piece. I'll send you a CD when it's done.
Regards,
Adam
Tertiary Surgical Care in a Developing Country: Win/win for patients
and surgeons.Kushner AL, Muyco APLilongwe Central Hospital, Malawi,
Africa Malawi, a country in southern Africa has an annual per capita
GNP
of US $190. As one of the world's poorest countries access to
surgical
care is limited. The Lilongwe Central Hospital (LCH) is the only
tertiary care referral center for the seven million people living in
the
north and central regions of the country. During a two month period
from December 2002 to February 2003 clinical surgical care was
provided
at LCH by the author (AK). In this period 81 major operations were
carried out alone or with the support of another surgeon (AM). The
volume of cases, acuity and degree of advanced presentation were
managed
to the benefit of the local population and provided a challenging
learning environment for the surgeons. Operations Log:23 December
2002‑16 February 2003
Abdominal37Trauma12Pediatrics8Urology7Head and neck6Skin and soft
tissue8Thoracic and esophageal3Total81 The opportunity
provided:╪
essential and tertiary surgical care for people in a developing
country.╪
extensive and varied training over a broad spectrum of
operations.
╪ insight into providing quality medical care in a resource
limited environment. Future programs can be established at
institutions
such as LCH whereby surgeons or even senior surgical residents
provide
care for local populations and gain a broad exposure to numerous
surgical procedures in a resource limited environment. This
experience
would benefit surgeons wishing to:╪ practice in a rural
setting.╪
practice in a third world setting.╪ improve their clinical
skills without relying on sophisticated technology. ╪ experience
medical practice in a resource limited environment. It is envisioned
that such programs may eventually develop into formal fellowship
training in international/rural surgery where trainees receive
experience in various surgical subspecialties in multiple third
world or
resource limited locations.