School of Public Health
In Mozambique, there is great need to provide surgical care to support burn victims and people with non-healing wounds. I will be working with a team of plastic surgeons, wound care specialist, nurses, and healthcare professionals who will help provide surgical care in the areas with greatest need around Maputo. I will be engaged in creating a comprehensive needs assessment and evaluation of existing wound care protocol at Maputo Central Hospital in Mozambique. Recommendations for improvement will be made based on that assessment. I may also be responsible for creating a wound care manual for the hospital if necessary. I will regularly participate in the surgical and post-operative care of the patients ensuring that they have well healing post surgical wounds. Data will be collected from the operative cases and l will be expected to perform a thorough data analysis. My deliverable will be a presentation and literature describing the findings from the operative cases. The overall expectation is to create a sustainability model to encourage local self-sufficiency in providing surgical care particularly regarding burns and wounds. I believe this experience will help me learn more about the challenges in providing surgical care to LMICs
Mending Kids | Burbank, CA
I was given the unique opportunity to join Mending Kids, Inc. (MK) in Mozambique on one of their many medical missions to help increase access of essential surgical care to children around the world. The mission was led by Dr. David Kulber, a renown plastic surgeon based in Los Angeles, CA. He and the team come to help train the plastic surgeons in Maputo on complex plastic surgery cases which typically are burn wound contractures that were improperly managed. He has been coming to Maputo, Mozambique for several years now and the team has expanded each year. The team traditionally has only worked at Maputo Central Hospital but this year they were able to expand to Matola Hospital which is a suburb of Maputo. I was one of 26 people, mixed with a variety of health professionals and volunteers who attended this year. My particular role as a preventive medicine resident with a background in general surgery and wound management was 2-fold:
- Analyze current wound management protocol to help establish a formal protocol
- Facilitate collection of operative data using a global operative data collection tool
I fully embraced this role, understanding that there are many challenges that I would have to face in a low resource setting that I may not have experienced before. Upon arrival to Maputo, I quickly realized that the hospital lacked many of the amenities that we may take for granted in most American hospitals such as automated IV drips and rooms with no more than 2 beds in them. Despite the lack of advanced amenities, it did appear that the hospital was pretty functional. Most of our time was spent in the plastic surgery/burn ward which was far from ideal for a burn unit. However, aggressive antiseptic use helped reduce rates of infection for burn victims and allow healing in many instances. This was quite surprising given that the use of these solutions for long term are typically recommended against for long term use in western medicine. I had the opportunity to give several presentations on wound evaluation and management based on my assessment of what was available at the hospitals. Many of the nursing staff and resident staff was already well educated on what I presented which was quite reassuring.
Left: Me giving a talk to the MCH Department of Surgery on wound evaluation and management. Right: MK lead, Dr. David Kulber providing advise to Matola Provincial Hospital head plastic surgeon, Dr. Pedro Santos and other surgical team members
I also found it impressive that many patients had relatively positive intra-operative and post-operative outcomes despite the lack of common resources. Between both hospitals there were almost 30 patients that MK staff operated on, none of which had any major complications. I believe that over time, the plastic surgeons have been able to work well with the resources made available to them although they may not be considered standard of care in western world.
The most important lesson I learned from this experience is that there are ways to overcome challenges of working in low-resource settings yet still provide quality health care if the staff are trained well enough. Missions should definitely be focused on training and education much more than doing the actual work. It is often quite easy to get caught up in the work not realizing that you do not leave the people any better off then they were before you came in.
I would definitely recommend this type of experience to anyone interested in global health because I had the opportunity to learn about all elements of quality health care in a low-resource setting. I was able to meet with government officials, hospital staff, and patients who all gave input on how the health system can be improved. I want to commit my career to helping improve distribution of quality health care in low-resource settings and this trip is a huge first step in doing so.
Me with MK and MCH nursing staff after presenting information on basic wound management