MUSC anesthesiology chair provides global learning through residency program in Tanzania

Coffin shops line the route to Bugando Medical Center in Mwanza, Tanzania. Passersby view the merchants, fashioning their products for all but certain sales, as they come and go through Mwanza, a northern city on the shoreline of Lake Victoria. The shops portend the most common perception of patient outcomes after being admitted to Bugando Medical Center for largely preventable ailments: death. “Death is the expectation,” said Scott Reeves, M.D., MBA, Chair of the Department of Anesthesia and Perioperative Medicine and Professor in the College of Medicine at the Medical University of South Carolina (MUSC). Death speculation is one of a few sciences that provide immutable certainty and therefore, revenues for coffin shop proprietors near Bugando.

Reeves has set out to change these outcomes by developing an anesthesiology residency rotation at Bugando for his residents five years ago. It has since been accredited by the Accreditation Council for Graduate Medical Education (ACGME), a private professional organization responsible for accrediting roughly 9,200 residency programs. This giant leap has allowed Reeves to create a unique rotation for anesthesiology residents, and future aspirants of the program. “Our residents’ rotation in Tanzania is no different than their rotation at the Veterans Affairs hospital or the Ashley River Tower or going to Rutledge Tower,” explained Reeves.

Reeves sends his residents abroad knowing full well the depth of transformation they are subjected to in becoming world-class practitioners. They witness rare diseases. There are few tests, and residents are given broad, but structured autonomy in providing care to patients. The physical examination is their saving grace—no better tool is more important than examination skills.

In remote locations, empathy is important to understanding the causes of disease in patients’ ecosystems. A nostalgic closeness rarely seen in first-world medical settings promotes trust between doctor and patient, which leads to openness when conducting thorough examinations. “From their perspective, it brings them into independent practice,” Reeves said of his residents’ experiences with cases in Tanzania. “Their physical exam skills are enhanced substantially upon returning to the U.S. by understanding the needs and full scope of their patient’s health issues. They also seem to become MacGuyvers in that they sometimes have to rig up equipment to make them work—but it’s to provide the best care for the patient.”

Reeves was able to secure pulse oximeter machines and monitors—phased out and surplused by MUSC—through a carefully devised, well-orchestrated process that included MUSC leadership. The simple advent of providing used pulse oximeter machines and sparse maintenance of those technologies has reduced the mortality rates alone. Other western technologies that have obsolesced also fill patient wards across Bugando and are still saving lives rather than collecting dust. Gains in life years, an increase in Bugando health official morale, and, again, a decrease in death rates in Bugando’s catchment area are directly attributed to the medical equipment donations from MUSC. “The last cohort of residents walked in the door at Bugando and all the equipment was still there, and it is working! It’s hard to believe but the pulse oximeter machines saved a woman’s life before that cohort of residents left Bugando,” commented Reeves.

Conditions at Bugando—even with donations of pre-used medical equipment—are still irremediably austere due to overlapping and opposing financial agenda setting at the hospital’s administration level. “The equipment is very rudimentary,” remarked Reeves. “And surgical mortality is very high country-wide.” This has been a challenge for Reeves and his team. Reeves and his residents are developing ways in which they are able to teach larger Tanzanian trainee groups at Bugando. For instance, the residents teach three to four courses a day that is mostly in the clinic (with some didactic learning). They also urge the local trainees to complete practical training assignments on their own with minor supervision--a strategy that empowers the local health officials and complements the sustainability model of the program. Residents provide simulations of procedures that also allow for increased autonomy. Resuscitation is a valuable staple in training, too; it is also attributed to preventing many deaths in Mwanza.

Residents, Tanzanian trainees, and patients at Bugando share the benefits of the program. Reeves made sure that the residency program has top talent, that the trainees have the best medical apprenticeships available, and preventable deaths are hampered in a country where mortality is the norm. It is important to understand that successes in interventions, like Reeves’, abroad are not manifestly perfect. Working in remote, global regions present shockingly new cultural, social, economic, and medical challenges that offer opportunities for learning and to chip away at the world’s problems. Reeves and his team are preferential to these types of challenges. “At first, there’s a gap in perception and reality,” Reeves said of the enthusiasm students have before departing. “They are shocked early on, but they find their footing and really change the lives of people with largely different circumstances. They then see the world differently and become better doctors because of it.”

View More Photos