Inaugural Global Surgery rotation strengthens perspective on Global Health

Since joining MUSC in 2022, Mike M. Mallah, M.D., has directed the MUSC Global Surgery Program. Under his leadership, the program has flourished, facilitating global innovation by connecting some of the brightest medical talent in developing regions with the expertise, experience, resources and renowned surgical excellence of the MUSC Department of Surgery. 

 

While academic global health programs are not new, most traditionally operate from a nonsurgical research- or service-oriented approach. In recent years, there have been numerous calls from global health-minded clinicians to prioritize surgery. The MUSC Global Surgery Program utilizes international partnerships to foster bidirectional clinical education, research and innovation endeavors that enhance surgical patient care in low- and middle-income countries (LMIC) and developed nations alike.

The Global Surgery Program is growing rapidly under Mallah’s leadership. This fall, the American Board of Surgery approved an MUSC global surgery rotation for our surgical trainees in South Africa. Before clinical trainees can travel abroad, however, the Global Surgery Program employs course material to inform, expose and challenge trainees with ideas and information about international health care. As the program gains the attention of the students, staff, University and surrounding community, it aims to introduce the essential nature of surgeryin addressing the global burden of disease. 

Daniel Akyeampong, M.D., a postgraduate in his third year (PGY-3), was the first resident to participate in the new George Hospital rotation in South Africa. George Hospital is a busy regional hospital that serves as a hub for an array of critical services, including surgery, orthopedics and numerous other specialties. The hospital also provides tertiary services in areas such as maxillofacial surgery; urology; ear, nose and throat care (ENT); oncology; and neonatology. 

 

Akyeampong has always been interested in health equity and increasing access to care in under-resourced communities. “Working on the frontlines as a pharmacy technician during the emergence of the Affordable Care Act, I saw first-hand the difference it made in people’s lives, but there were still those who were unable to afford their medications,” he said. “Witnessing this discrepancy opened my eyes, not only to the lack of true access and health equality in our country but also in other countries.”

That’s why he jumped at the opportunity to participate in the global surgery rotation. 

“Since George Hospital is a state-run hospital where most specialty care is located, a lot of patients have to travel at least three to four hours to receive health care, but that comes with a lot of other barriers, such as transportation and the need for child care during these visits,” he said. “In addition,  some services in the Western Cape can take up to a year to get, further stressing the importance of the physical exam and other alternative methods to confirm or rule out a diagnosis.”  

Akyeampong said some of his more memorable and impactful experiences during his rotation were when the surgical team went into the regional communities to see and treat patients. He learned to handle many complex pathologies in low-resource settings, which he typically would not see in his general surgery training. The team also did a lot of diagnostic care in the community settings, which was then handed over to the patient’s local doctor for continued management.

He said he was fortunate during his rotation to be paired with Hugo Stark, MBChB, a renowned general surgeon at George Hospital. Stark started the program to provide local patient care in Western Cape communities and led the implementation of an electronic medical record (EMR) system in an LMIC health care setting that lagged behind in digitized technology. 

“Dr. Stark’s focus on patient-centered care is a model for how I want to serve my patients moving forward,” he said. “His emphasis on “caring versus curing” is a refreshing contrast to the mindset often seen in Western medicine. I want to shift my practice to start better understanding my patients’ overall goals and needs with a goal of improving overall quality of life.” Akyeampong hopes to return to George Hospital to continue some of the research and educational initiatives he started working on with Stark. 

“I’m honored to have been the first resident to attend this new global surgery rotation,” he said. “It opened my eyes to the region’s inaccessibility of care, due to a lack of transportation and equipment, and has made me think of ways to work with our team to shift the health care paradigm and bring care to patients.” 

“Our partnership with George Hospital aligns with our global surgery program’s values of patient-centered care,” said Mallah. “It pairs with our ethos of leveraging global relationships to create bidirectional clinical education, research and innovation opportunities. I’m thrilled Daniel got to experience all aspects of the program during his time at George Hospital.”