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FEATURES :: WINTER 2014
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Making a World of Difference


By Kathy Whitney
February 2013

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“It is often said that Africans excel in relationships. I have discovered over the past two years that it is true. I cherish the relationships that are slowly building here in Kijabe; I feel a part of the staff now, and we have a wonderful time talking, teasing, swapping Swahili…It is a country of incredible beauty not only in its mountains, plains, valleys, lakes, but especially among its people.”

These words are from a blog kept by Leland Albright, M.D., HS ‘70, and his wife, Susan, who are living in Kijabe, Kenya, treating children with neurosurgical conditions. Ask any Vanderbilt University School of Medicine faculty member, medical student or alumnus who has devoted his or her time to work in the world’s most impoverished places why they do it, and the answer is usually the same: the people.

From Africa to Asia to South America, Vanderbilt is represented by the hundreds of dedicated men and women who leave the comfort of home to endure danger, political strife, homesickness, language barriers and sub-standard living and working conditions for the greater good. Some feel they are called by God; others feel it is simply the right thing to do. Some have moved their families to remote villages and put down roots, while others make yearly treks to see old friends and to share their expertise with local health care providers.

Fourth-year VUSM student, Matt Gartland, director and co-founder of Harambee For All Children, summed it up this way on a recent return trip to Kenya: “Touching down in Kenya was like coming home. Pulling out of the airport I caught the familiar smell of red clay and it was like I hadn’t been gone even a day.”

Inside are a few of their stories. There are, and will be, many more to tell as Vanderbilt continues to leave its mark on the world.

* * * * *

AIC Kijabe Hospital, Kenya

When Mark Newton, M.D., speaks of the urgent need to reach medically underserved populations throughout the world, his words of compassion are backed up by more than 14 years’ worth of action. Newton, an associate clinical professor in the Department of Anesthesiology and a pediatric anesthesiologist at Monroe Carell Jr. Children’s Hospital
at Vanderbilt, directs the Vanderbilt International Anesthesia (VIA) program. VIA is a global service, education and research division which focuses on anesthesia and ICU issues in low-income countries. Newton returns to Nashville for short stints to work and teach anesthesia residents and fellows at Children’s Hospital but spends the vast majority of his time in East Africa developing anesthesia capacity.

Under Newton’s guidance, anesthesia residents from Vanderbilt and elsewhere have an opportunity to receive training and to educate African anesthesia care providers in rural Kenya. Newton has developed a non-physician anesthesia program in rural East Africa while traveling to Southern Sudan and the Horn of Africa to help develop medical education programs.

“These areas of the world have some of the highest maternal mortality rates in the world, and the anesthesia care is really non-existent,” Newton said.

In 1997 Newton and his wife, Sue, made the decision to leave Denver Children’s Hospital to serve the poor at AIC Kijabe Hospital, a faith-based church hospital established in 1927 with a strong surgical capacity and educational foundation.

“The reason that we have remained in Africa for so many years is based in the transformational message of God’s love for the poor. A deep-rooted, sustainable impact will happen when medical educators are willing to leave the comforts of an American doctor’s life and mentor and teach alongside African colleagues,” Newton said.

The Newtons have five children.

One of their daughters was born in Kenya (Kijabe), two boys were born in the United States, and the couple adopted a Kenyan boy and girl. Sue helped establish a children’s home and a Massai women’s community development program.

Newton’s humanitarian efforts in health care were recently applauded by the American Medical Association (AMA) when he received the Dr. Nathan Davis International Award in Medicine. Named for AMA’s founder, the award recognizes physicians whose influence reaches the international patient population and changes the future of their medical care.

For South Texas native Erik Hansen, M.D., HS ‘08, home has always been where the heart is. So, for Hansen, his wife and four young children, Africa has become home.

Hansen will return to the United States in March for a few months following a two-year stint at AIC-Kijabe.

Hansen’s hybrid appointment, which has him practicing in both Africa and the United States, is an emerging model for academic physicians with global health interests.

“My faith instructs my decisions and fuels the work here,” said Hansen, who holds joint faculty appointments in Pediatric and General Surgery, and serves as associate program director for the General Surgery Residency with responsibility for the Vanderbilt International Surgery initiative. “My family and I feel very blessed to live and work in Kenya. This is so much more than just a job; it’s a calling.”

Hansen’s practice is similar to those of an attending physician in the United States and includes “typical” pediatric general surgery, patients in pediatric urology, some adult general surgery and cleft lip and palate repairs.

One significant difference, however, is that because of the limited access to health care in the region, patients often present at much later stages in their illnesses.

“We see complications, infections and end-stage presentations here that we almost never see in the United States because so many East Africans simply can’t get to a doctor sooner,” said Hansen, who received his Master of Public Health degree from Vanderbilt in 2006. “Working here provides the opportunity to care for the vulnerable and train surgeons for future generations. It’s why I’m here.”

Hansen and his family live in a mission compound with families from all across the globe. His wife, Amanda, teaches at a Bible college and holds down the fort with three children in school and a 4-year-old still at home.

“Our kids seemed to adapt to life in East Africa almost from the moment our plane landed,” said Hansen. “Life is a lot simpler here. They walk to school; I walk to work, and everyone knows everyone. You might compare it to a small town in America in the 1950s.”

Hansen and his family expect to return to Kenya in August. “Kenya is our home, and this is where we are supposed to be,” he said.

Both Hansen and Newton, who live and teach with their families in this rural, faith-based, African hospital, feel that the opportunity to provide medical care for the poor while educating national health care providers fulfills the deep passion that prompted them to become medical doctors and pediatric specialists.

– Mimi Eckerd and Jill Clendening

* * * * *


Senegal

If anyone in Julie Thwing’s 2002 medical school class is wondering where in the world she is, they would not be surprised to learn that she is living and working in Dakar, Senegal.

Thwing moved there in January 2012 with her husband, Ed Hopkins, and infant son, J.B. She is the Centers for Disease Control and Prevention resident adviser for the President’s Malaria Initiative.

Thwing, a Canby Robinson Scholar, completed medical school and a residency in internal medicine and pediatrics at Vanderbilt in 2006 before moving to Atlanta to train at the CDC’s Epidemic Intelligence Service (EIS).

As the resident adviser with the Centers for Disease Control and Prevention, Thwing works to improve access to prevention, diagnosis and treatment of malaria.

As the resident adviser with the Centers for Disease Control and Prevention, Thwing works to improve access to prevention, diagnosis and treatment of malaria.

The EIS is a two-year post-graduate fellowship for health professionals interested in applied epidemiology. While in EIS, she served in the Malaria Branch, supporting public health interventions and conducting research in Niger, Angola, Kenya and Madagascar.

After completing the EIS training program, Thwing remained in the CDC’s Malaria Branch as a medical epidemiologist. She provided technical support for the PMI in Senegal, as well as supporting various research projects and malaria control initiatives.

As the resident adviser, she works with USAID, the National Malaria Control Program, and numerous other partners including the University of Dakar to implement malaria prevention and treatment in Senegal, improving access to insecticide treated bednets, prompt diagnosis, and treatment with artemisinin-based combination therapy.

“The Senegalese are very active partners and participants in their own malaria control, and I am privileged to get to work alongside them,” Thwing said. “I love working with a group of highly intelligent, motivated, engaged people, on something that saves lives – it’s quite a treat.”

Thwing focuses on strategic information to ensure that these interventions are working, providing technical assistance for malaria surveillance, monitoring of insecticide resistance and drug efficacy, and operational research on management of malaria.

“I will stay as long as they will let me and as long as my husband is happy,” said Thwing, who lives with her family in a quiet neighborhood a few hundred yards from the coast. “We have wonderful colleagues and friends in Senegal. We’ve been really happy.”

– Kathy Whitney

* * * * *


Nigeria

John Tarpley, M.D. ‘70, AB ‘66, has traveled to Nigeria every year since 1978. He originally went to help others feel better; now he goes because it makes him feel good.

For 15 years, he and his wife, Maggie, spent three years at a time in Nigeria where Tarpley was the director of a small, but expanding, residency training program in Ogbomoso, working with medical students and residents there and in Ibadan, helping train them to become physicians and teachers.

Now, Tarpley uses two weeks of his vacation time from his surgical post at the Nashville VA Medical Center to return to Nigeria to “water friendships.”

“If I don’t go, then I’ll lose touch with these people that I invested the most important 15 clinical years of my life in. I am there to encourage, help, facilitate and commiserate. They have a hard job. Nigeria is a hard country. It has lots of issues, but the people are fantastic.”

Pediatric surgeon Wallace (Skip) Neblett, M.D., ‘71, along with other specialists, have accompanied Tarpley over the years, working with the Nigerian surgeons and registrars to improve their skills and knowledge.

“I take a specialist with me and we do a focused, two-week skills course for the folks over there as a way to improve their care in various areas of service,” said Tarpley, director of the General Surgery Residency Program and professor of Surgery and Anesthesiology.

Tarpley recalls how he and Neblett worked together to rebuild the esophagus of a patient who attempted suicide by drinking lye. Years later, she returned to the hospital, married, to introduce her baby to the doctors who saved her life.

These days, Tarpley works mostly with nurse anesthetists, helping to ensure safe airway management, a major health disparity he has witnessed first-hand in Sub-Saharan Africa.

He and Maggie hope to spend half of their time in Africa once they retire. “I am blessed to do what I like to do; it’s fun. We invested ourselves in people, and we continue to do that,” Tarpley said.

– by Kathy Whitney

* * * * *


Indonesia

When Kris Olson, M.D. ‘98, landed in Meulaboh, West Aceh, Indonesia and exited the float plane, he wanted nothing more than to catch a few hours of sleep. Instead, he was immediately greeted by a midwife, Anjani, who told him she wanted him to come with her to meet a baby she delivered.

The midwife took him out to a little village and showed him a healthy 2-month-old baby, who was born full-term but asphyxiated upon delivery. She held up an $8 tube and mask that she had received from Olson in an infant resuscitation class he had taught. She had used it to save the baby’s life.

For more than 20 years Olson, right, has dedicated much of his time to bringing medical technology to developing countries with the hope of improving neonatal care. Here, he shows midwives how to use an inexpensive tube and mask to help resuscitate babies.

For more than 20 years Olson, right, has dedicated much of his time to bringing medical technology to developing countries with the hope of improving neonatal care. Here, he shows midwives how to use an inexpensive tube and mask to help resuscitate babies.

“Any other time, the midwife would have looked over and said ‘it’s dead’ and pulled the blanket over the baby,” Olson said. “Mothers don’t even name their babies until they are 2 months old (a cultural adaptation to the high neonatal mortality rate).

As a consultant with the International Organization of Migration (IOM), Olson selected the simple plastic device, approved by the Ministry of Health process but not yet scaled, and trained hundreds of midwives how to use it.

“It was the midwives who morphed it into something that was culturally better there. These gracious colleagues said, ‘let us take it from here.’ They asked me to do an outcomes evaluation so they could advocate for the program once we left,” Olson said. “I wake up each day and think about how that training program is ongoing. It might be a small piece I did, but how rewarding it is.”

Olson is an inpatient clinical educator in the Department of Medicine at the Massachusetts General Hospital. He spent most of 2003 working in refugee camps along the Thai-Burmese Border. In 2005, he worked with the American Refugee Committee in Darfur. From 2005 to 2009, he worked as a consultant with the International Organization of Migration (IOM) in tsunami-affected regions of Sumatra. He currently serves as the medical director for Consortium for Affordable Medical Technology (CAMTech) at the Mass General Center for Global Health.

– Kathy Whitney

* * * * *


Guyana

Until recently, graduates of the University of Guyana Medical School began to practice medicine after a year of internship but no specialty training.

Graduate medical training was strongly desired locally, but it took many years of collaborative work developing an ACLS program and emergency care courses with Vanderbilt before the residency became a reality in 2010.

“We are grateful for funding from Project Dawn that has allowed us to hire a faculty member with international health experience, write a curriculum and launch a training program for the purpose of creating a self-sustaining emergency medicine residency at the teaching hospital in the capital city,” said JP Rohde, M.D., HS ‘02, assistant professor of Emergency Medicine.

Rohde, whose parents were missionaries, spent most of his childhood in Guyana. As a resident at Vanderbilt, he and his Emergency Medicine colleagues started a cardiac life support program there. When Project Dawn, which provided medical care to the most indigent population, began to look for new opportunities to extend their work after the loss of their founder, they approached Rohde at Vanderbilt.

With support from the Emergency Medicine department’s leadership, the Guyana Project was born. Nicolas Forget, M.D., MPH, DTMH, is the director of the Masters Programme in Emergency Medicine for the Georgetown Public Hospital Corporation in Guyana and an assistant professor of Emergency Medicine at Vanderbilt.

“I arrived in Guyana fresh from completing a fellowship in international emergency medicine and was very apprehensive at the idea of being called the residency director so young in my career,” said Forget (pronounced Forgeay). “The first few months were tough; I was the new foreigner perceived like so many who had come before for a few days or a few weeks then left to never return.”

As Forget taught evidence-based emergency medicine, the new residents learned to trust him, and together with doctors, nurses and staff they have built a strong and constructive relationship. The residency program in emergency medicine, which started with three residents in October 2010, now has 10 residents and is the largest at Georgetown Public Hospital Corporation.

“My favorite part of my job here is still to see patients with the residents,” Forget said. “They are developing their own leadership, and I am confident they will take this residency and make it their own success.”

– Kathy Whitney

* * * * *


Ikumbo, Kenya

Matthew Gartland, a fourth-year medical student, is one of the co-founders of the non-profit organization Harambee For All Children, which is responsible for building a secondary school and community library in the small community of Ikumbo, Kenya.

“One of the many meanings of the Swahili word harambee is a pulling together, as demonstrated by community fundraisers for education,” he said. “We wanted this to be a community-driven organization, so the most important aspect of our mission is to understand the needs of the community.”

Under the leadership of Gartland and six VUSM students, Ikumbo Secondary School has four classrooms, administrative offices and a science lab, all built in the last three years. It currently has 140 students in the equivalent of grades 9-12. The community library is stocked with 1,700 books purchased and transported with donations from an event held at Vanderbilt in 2009.

Fourth-year medical student Matthew Gartland, left, is one of the co-founders of Harambee For All Children, which is responsible for building a secondary school and community library in the small community of Ikumbo, Kenya.

Fourth-year medical student Matthew Gartland, left, is one of the co-founders of Harambee For All Children, which is responsible for building a secondary school and community library in the small community of Ikumbo, Kenya.

Gartland spent the past year living in Lusaka, Zambia, working with the Centre for Infectious Disease Research in Zambia (CIDRZ) with funding from the Fogarty International Center at the National Institutes of Health.

He studied the impact of universal access to antiretroviral therapy on the
prevention of mother-to-child transmission of HIV with a second area of focus on patient retention and risk factors for drop-out among all adults on antiretroviral treatment.

“We found that after one year almost 15 percent of those started on treatment were lost to follow-up (a term that encompasses deaths, drop-outs, and transfers to other facilities),” Gartland said.

Globally there are more than 8 million people with HIV on antiretroviral treatment. The biggest challenge for individuals on treatment, and for the governments, health care providers and international organizations involved in their care, will be to achieve consistent drug adherence and access to lifelong therapy for the disease, Gartland said.

Additional board members at Vanderbilt involved in Harambee For All Children include: Scott Zuckerman, M.D. ‘12; Rimal Hanif, M.D. ‘12; fourth-year student and Gartland’s fiancée, Rajshri Mainthia; fourth-year student, Billy Sullivan; and Benjamin Dean and Rafal Sobota, both MD/PhD candidates in the Class of 2015.

– Kathy Whitney

* * * * *

 

Uganda

Dirk Hamp, M.D. ‘91, has a 14-year-old daughter, Jane. She enjoys American culture and hanging out with her friends.

She attends a small, Christian school in Raleigh, N.C., where her father is a pediatrician and her mother, Paige, is a community relations manager. Her life appears to be that of a typical teenage girl. It has been anything but.

Seven years ago, Jane was living with her birth mother and sister in a small village in Western Uganda. After a horrific attack during the night as the result of a land dispute, her mother and sister died. The attackers came at Jane with a sledgehammer and a machete. She suffered a skull fracture and brain injury and multiple wounds. She was left to die alone, but survived.

Co-founder of Embrace Uganda, Hamp is greeted by two Ugandan orphans from the village of Kaihura. They are representative of the many, many young children in Uganda who have nothing and smile all the time, he said.

Co-founder of Embrace Uganda, Hamp is greeted by two Ugandan orphans from the village of Kaihura. They are representative of the many, many young children in Uganda who have nothing and smile all the time, he said.

A charitable organization stepped in, and Jane was flown to Los Angeles for medical treatment. Across the country, in North Carolina, Paige learned about Jane from an acquaintance. Sitting in the comfort of their home, Dirk and Paige looked at each other and said, “Now what are we going to do?”

They traveled to Uganda, and within a few weeks, they were granted guardianship and adopted Jane. They spent a month exploring the area, learning more about the conditions in which their daughter lived.

“What struck us is that while we were bringing Jane home, what are we going to do about all of the other children there? Many had heart-wrenching stories; some in orphanages, others were living in mud homes. There is all this work that could be done to improve the lives of those children,” Hamp said.

The Hamps and two other couples put their heads – and hearts – together and started Embrace Uganda.

“We did not want to superimpose what we felt needed to happen, but we wanted our Ugandan partners to tell us what they needed and we would figure out a solution from this end,” Hamp said.

Since the fall of 2007, the non-profit, fully volunteer organization has partnered with three villages. In Kaihura, Jane’s village, Embrace Uganda has supported Bringing Hope to the Family, constructing a new home for an orphanage, finishing an existing vocational school, making improvements to a public school in the area, and supporting clean water initiatives and self-sustaining agricultural projects. It is now completing the building of the Hope Again Medical Clinic.

– Kathy Whitney

* * * * *

 

Jamaica

For the past seven years, Thomas Nygaard, M.D. ‘78, has traveled with the Central Virginia Medical Mission Team to St. Thomas Parish in Jamaica. A team of physicians, nurses and dentists go to the destitute area on the southeastern end of the island. For Nygaard, a former cardiologist and current administrator for CentraHealth in Virginia, it is an opportunity to return to the fundamentals of practicing medicine.

“You go into medicine to take care of people and this is a very pure way to do that. You don’t worry about coding or documentation, you just worry about doing the best thing you can for each patient,” he said.

There is one surgeon for the 100-bed hospital that covers 90,000 people. One nurse anesthetist covers all surgical procedures. The ER has no physicians and is staffed by a few nurses.

Every year that he returns to St. Thomas Parish in Jamaica, Nygaard is reunited with his friend and longtime patient who suffers from congenital heart failure.

Every year that he returns to St. Thomas Parish in Jamaica, Nygaard is reunited with his friend and longtime patient who suffers from congenital heart failure.

“I met a young man the first year I went. He has complex congenital heart disease. In the U.S. it would have been repaired as an infant. It is beyond repair now. Every year I go down there he will seek me out for a visit,” he said. “It’s touching to see him. He has a hard time getting about and is slowly getting worse every year.”

Nygaard feels that his years at VUSM helped set the stage for medical mission work.

“Vanderbilt was such a patient-centric medical school and taught me so much about caring for the patient, and it really is why I went into internal medicine,” he said, citing mentors such as Tom Brittingham, M.D., Mark Houston, M.D., and Grant Liddle, M.D.

Nygaard recently became involved with Mataktaria Africa, a nonprofit organization that teaches physicians how to deliver care in East Africa. He organized an educational program in Dar es Salaam with colleagues from CentraHealth, The Medical University of South Carolina and the Tanzania Ministry of Health.

“We put together a didactic program for physicians from all over East Africa. We toured hospitals and medical facilities and put together a report with our recommendations for moving heart care forward in Dar es Salaam and Tanzania.”


– Kathy Whitney

* * * * *

Editor’s note: With many more stories to tell than we had room for in this issue, we will be updating the magazine periodically with stories of hope and healing from across the globe. Please send yours to: kathy.f.whitney@vanderbilt.edu.
 

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