Global Initiatives
Introduction
Chigere Yellem, No problem. This is probably the most common phrase you would hear in Ethiopia. It would not take long to realize why this phrase is so commonly used. Between dreadful poverty and lack of the most basic medical care, few problems in life are worth a worry- the rest is simply, chigere yellem.
Stanford Department of Otolaryngology-Head and Neck Surgery has had a longstanding legacy of international medical missions. The faculty and residents have been serving across the globe caring for the underprivileged in Asia, Central and South America, South Pacific, and Africa. The objectives of these missions are on one hand to contribute to the wellbeing of the less-fortunate, and on the other to disseminate knowledge and expertise amongst the local physicians. We do bear in mind, however, that performing meticulous challenging surgeries in remote locations, albeit commendable, is of limited lasting effect.
Even the most noble, tireless service rendered by a visiting physician in the span of one to two weeks would only address but a few cases in countries where access to medical care is considered a luxury. For this reason the goal of many medical missions has evolved from “feed a man a fish” to “teach a man how to fish”.
Unfortunately this model is not without its limitations either. First, training local physicians in surgeries such as mastoidectomy and endoscopic sinus surgery requires not only years of proctored training but expensive equipment not available in many of these countries. Second, in some unfortunate circumstances, the local trained surgeon would not freely pass on the knowledge to other local surgeon, or worst, would not avail the services to the public without requesting unreasonable compensation.
For this reason, many of our faculty members have been participating in missions aimed at developing self-sustaining educational programs. The aim is to develop ongoing training programs in which, over the span of a few years, both the trainers and the trainees are local surgeons. This model allows the limited resources in the country to be better allocated for training of the physician in areas most needed by the population. It also creates an academic environment where sharing of knowledge and expertise is welcomed nay required.
Below you’ll find a few examples of the many missions our department members have participated in. It would give you an overview of what has been achieved and what is planned for the future. We hope that these examples would inspire the readers to volunteer their time or provide resources which are vital to the progression of such missions.
Manuelito is a 2 1/2-year-old orphan who early in his life developed subglottic stenosis from multiple, prolonged intubations for pneumonia (A). Because his orphanage was unable to care for his tracheostomy, for much of the past year he has lived at HBO, separated from his brothers. During one of the missions, a laryngotracheal reconstruction was performed on Manuelito which allowed him to be decannulated. We are able to catch up with him at the orphanage on the next trip (B). |
How you could get involved:
The importance and value of humanitarian missions could not be over-emphasized. The effect on the local communities, although limited at times, is undeniable. From the participants’ point of view, it simply reminds us of the ideals we aspired to choosing medicine as a career- for some it is the knowledge that they had touched the lives of the less-fortunate, for others a pathway of service and spiritual growth. One could argue that this is the least act of service one could render as a member of a privileged community.
Human beings are limbs of one body,
In creation of one soul and essence.
Should one limb be afflicted with the torments of fate,
The other limbs would not remain in silence.
If thou hast no sympathy for others’ despair,
The human name thou no longer share.
-Saadi Shirazi, 13th century Persian poet
Should you have any interest in contributing your time, financial resources, or equipment please contact Dr. Ashkan Monfared (650-725-6500 monfared@stanford.edu) or Dr. Anna Messner (650-736-4155 amessner@ohns.stanford.edu). We would be glad to provide you with a non-profit contribution tax deduction letter for your generosity.
Ethiopia
Yekatit 12, Addis Ababa
Chronic ear disease is endemic to Ethiopia and it is estimated that close to 10% of the population is afflicted by it. The country of 77 million people currently has 7 otolaryngologists none of which performs complex ear surgery for the public. In 2006 a group of three doctors and one audiologist, under the auspices of Global ENT Outreach, spent two weeks in Addis Ababa treating some 350 patients with otologic abnormalities. About 60 surgeries were performed including mastoidectomies for chronic otitis media and cholesteatomas, ossicular chain reconstructions, tympanoplasties, and stapedotomies.
The primary goal of the trip was to familiarize and train local ENT doctors in the art of middle ear surgery. Considering that the only otologic surgery that the local doctors are familiar with is emergent mastoidectomy for mastoid abscess, long systemic training is critically needed. This was the second of the four trips to Ethiopia during which we attempted to create the first residency program in the country. After creating a curriculum and securing several international physicians to serve as faculty, the program was terminated by the hospital administration due to internal problems. We are seeking alternative venue for the program at this time.
| Many routine basic components of operating rooms are nonexistent in Ethiopia. The anesthesiologist manually ventilates the patient for the entire case with no pulse oxymeter or electrocardiogram. |
This 11-year old boy has been suffering from fibrous dysplasia for 6 years. Due to the extent of the disease surgical management was not possible in Ethiopia. By the time arrangements were made to transfer him to Lucile Packard Hospital he had returned to his village and lost to follow up. |
Ecuador
Hospital de Niños Baca Ortiz, Quito
This project was initiated four years ago by Dr. Anna Messner in collaboration with the pediatric otolaryngology staff at the Hospital de Niños Baca Ortiz. She has returned there annually often accompanied by Stanford Residents (Dr. Vanessa Erickson, Dr. Man-Kit Leung).
According to the World Health Organization, about half of Ecuador’s population of 13 million subsists at or below the poverty line. Ecuador’s indigents rely heavily on medical services provided by public hospitals such as the Hospital de Niños Baca Ortiz (HBO), the sole children’s hospital in Ecuador’s capital, Quito. Resources are limited and there are often long waiting lists for much-needed procedures. Children from all over the country travel to HBO seeking medical care. In fact, families can be seen camped overnight outside the hospital in the hopes of being the fortunate ones who are given appointments for the following day. The goal of our collaboration with this hospital is to assist and train the local surgeons in complex surgical procedures including airway reconstructions, endoscopic sinus surgeries, and complicated middle ear surgeries. Thanks to the generosity of charitable individuals and companies surgical supplies and instruments have been donated through the project as well. One of the major strengths of the project is its long term forecast which has allowed for close follow-up of patients who had been operated on during prior visits. When viewed from the perspective of time elapsed, the positive impact is remarkably clear.
El Salvador
Instituto Salvadoreno del Seguro Social (ISSS), San Salvador
As in many other countries in the Central America, chronic ear disease is quite common in El Salvador. In this nation of 5.7 million people many are affected by chronic otitis media, cholesteatomas, otosclerosis, and tympanic membrane perforations. The limited number of trained Otologists and resources remain significant barriers to treating these patients. Fortunately, strong leadership among the ENT community in El Salvador has emerged and many of the local physicians have become involved. During 4 semiannual missions organized by Global ENT Outreach, about one hundred surgeries have been performed. More importantly, the plans for a national hearing loss screening and management project were formulated. The project will be inaugurated by a one-week training course for nurses, audiologists and medical students under the auspices of the medical school.
Peru
Loayza Hospital, Lima
In February 2003, Dr. Jose Barrera, participated in a medical mission to Lima sponsored by the Church in the City from Denver, Colorado. The large team of physicians, nurses and technicians organized a two-day symposium on otitis media which was attended by sixty healthcare professionals. During the mission, the team treated some 700 patients and performed 13 surgeries. The goal of this annual mission is to impart medical and surgical knowledge to the local physicians thus creating a lasting impact on the underprivileged of Peru.
The team of surgeons in Machu Pichu, Peru
American Samoa
LBJ Tropical Center, Faga'alu
Medical missions to the Amerian Samoa are undertaken in collaboration with Global ENT Outreach. During the latest mission, which lasted 30 days, Stanford staff and residents evaluated and treated more than 150 patients and performed 30 surgeries. The goal of this program is to provide advance level otolaryngology care since due to lack of a resident otolaryngologist, creation of a self-sustaining educational program is not possible at this time. As in every location, American Samoa has unique set of challenges the least of which is lack of resources. On one hand the level of preventative care is extremely low and on the other most of the indigent population do not have a strong belief in modern medicine. For this reason, majority of the patients do not refer to physicians till the diseases are in their late stages. A collaborative effort is underway to create newborn hearing screening and community outreach programs.
Arial view of the American Samoa.
Waiting room of the Hospital de Niños Baca Ortiz, Quito, Ecuador.
