Addressing a Global Health Need

Addressing a Global Health Need

Creighton’s first Global Surgery Fellow discovers a wide range of experiences working in Tanzania

By Adam Klinker

After 10 weeks in Tanzania as Creighton’s inaugural Global Surgery Fellow, Kelly Shine, MD, has added a few procedures to her retinue.

There have been perforated intestines — results of untreated cases of typhoid fever and salmonella — and a bowel obstruction that turned out to be severe appendicitis and almost proved fatal. She’s pulled teeth, assisted with anesthesia and popped in dislocated shoulders. Then, there are the three gorings by Cape buffalo she’s patched up.

“All things that most general surgeons don’t see too often or don’t do at all,” says Shine, who earned the two-year fellowship sponsored by the School of Medicine and the Creighton Global Initiative. “Surgery is something we take for granted (in the U.S.), but it’s been getting more attention as an international health topic.”

A battery of studies has revealed a global health crisis when it comes to surgery. The World Health Organization found more than 5 billion people worldwide have no access to surgical care. In Tanzania, the patient-to-surgeon ratio is 1.2 million to 1. For comparison, it’s about 15,000 to 1 in the United States. The Lancet Commission estimates 143 million people require additional lifesaving or disability-preventing surgical procedures annually, but lack access to necessary surgical care.

But it wasn’t so much those big numbers that initially inspired Charles Filipi, MD, to create the Global Surgery Fellowship. In 2001, his son, a Creighton undergraduate, took a study abroad trip to Creighton’s Institute for Latin American Concern (ILAC).

“It was a life-changing experience for him,” says Filipi, the fellowship program director and an emeritus professor of surgery in the School of Medicine. “He said, ‘Dad, you’ve got to go down there.’ They didn’t have a surgery option there initially, but then a surgery center was built, and we organized a hernia surgical team and started performing surgery there. For a physician, as much as the patient, it’s a life-giving, heart-opening experience.”

Seeing the dire need for surgeons, even in a relatively prosperous nation like the Dominican Republic, Filipi started a nonprofit organization to send surgical teams to countries throughout the western hemisphere in need of surgical care, especially for hernia. When a massive earthquake shook Haiti in 2010, Filipi coordinated teams from all over the globe to respond, using ILAC as a staging site and supply center.

From those experiences, it was Filipi’s desire to see Creighton live out its mission through a surgical post that could have a global impact. With the creation of the Creighton Global Initiative by Creighton President the Rev. Daniel S. Hendrickson, SJ, and the backing of School of Medicine Dean Robert “Bo” Dunlay, MD’81, the fellowship began taking shape.

“Fr. Hendrickson’s emphasis on global awareness made this a perfect fit,” Filipi says.

As designed, the two-year fellowship begins in Omaha with about a year at Creighton’s medical facilities. Following the time at Creighton, the fellow is then sent abroad.

Filipi’s own global encounters led him to the Foundation for African Medical Education (FAME) in Tanzania. Operating a 25-bed hospital in Karatu on the fringes of the Serengeti, FAME fit the fellowship’s international site criteria, and Shine started her work there earlier this year.

“It’s classic Africa,” Shine says. “The soil is all red; we’re just at the end of the wet season so the vegetation is quite green. We’re surrounded by agriculture — sunflower seed and coffee plantations — and then go a half-hour from the hospital and you’re in the Ngorongoro Conservation Area. I don’t see much wildlife from the hospital grounds, but we have had the Cape buffalo wounds and a few people bitten by baboons.”

Shine says the hospital itself is small but has a dedicated staff. In many ways, much of the work of the fellow is to train staff in new practices and procedures.

Shine, with 15 years practice experience and several stints abroad, including work with Filipi’s Hernia Repair for the Underserved, was selected out of several applicants and was an ideal candidate.

“I feel fortunate to be able to start this fellowship for Creighton,” Shine says. “But the real hope is that this isn’t just a year or two. We want to build long-term relationships with the sites where the fellows go. We want this to blossom and to be a learning experience not just for the people we serve, but for the surgeon, too.”

Creighton’s second Global Surgery Fellow, Megan Straughan, MD, is currently working on the Creighton-based portion of the fellowship. When she’s done in Omaha, she’ll ship out to another site, most likely in Rwanda.

“I’m glad it’s something Creighton has started, and I’m glad to be a part of it,” says Straughan, who will be taking her family, including two young children, on her international rotation. “Global health and global surgery are something that have always been close to my heart, and it’s good to see that it’s getting some recognition as a public, global health issue.”

Filipi, Shine and Straughan are hopeful the fellowship will create an important acute-care global surgery model whereby lives are saved, in-country providers are trained and thereby extend the benefit exponentially. Moreover, the fellowship seeks to enlighten Creighton students at all levels to understand the desperate need and respond how they are able. While the numbers of those lacking care may be daunting, there’s a feeling the educational opportunity is one physicians are seizing upon.

“It seems like a drop in the bucket when you’re talking about tens of millions of people to one surgeon,” Filipi says. “But if we can spread knowledge in the country and train the trainers and we can find that one particular doctor who is a good surgeon, intelligent and patient, and he or she can teach others, we start making a difference. And that can go for nursing care, diabetes care, neurology, on and on.”