World of Difference

By Kathy Whitney

From Africa to Asia to South America, Vanderbilt is represented by hundreds of School of Medicine faculty members, medical students and alumni who leave the comforts of home to endure danger, political strife, homesickness, language barriers, and substandard living and working conditions for the greater good. Some have moved their families to remote villages and put down roots, while others make yearly treks to see old friends and to share expertise with local health care providers. Here are a few of their stories.

AIC Kijabe Hospital, Kenya

When Dr. Mark Newton speaks about the urgent need to reach medically underserved populations throughout the world, his words are backed up by more than 14 years of action. Newton, associate professor of clinical 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 that focuses on anesthesia and intensive care unit issues in low-income countries. Newton returns to Nashville for short stints to work and teach but spends most of his time in East Africa.

Under Newton’s guidance, anesthesia residents from Vanderbilt and elsewhere receive training and educate African anesthesia care providers in rural Kenya. Newton has developed a nonphysician anesthesia program in rural East Africa while traveling to southern Sudan and the Horn of Africa.

“These areas of the world have some of the highest maternal mortality rates in the world, and the anesthesia care is really nonexistent,” Newton says.

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. Kijabe has become one of East Africa’s busiest medical facilities, providing more than 10,000 surgical procedures per year.

The Newtons have five children. One daughter was born in Kenya, two sons were born in the United States, and the couple has adopted a Kenyan boy and girl. Sue has helped establish a children’s home and a Massai women’s community development program.

“The reason we have remained in Africa for so many years is based in the transformational message of God’s love for the poor,” Newton says. “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.”

For South Texas native Dr. Erik Hansen, MPH’06, his wife and four young children, Africa also has become home. Hansen’s hybrid appointment, which has him practicing at both AIC Kijabe in Africa and at Vanderbilt, is an emerging model for academic physicians with global health interests.

“My faith instructs my decisions and fuels the work here,” says Hansen, assistant professor of pediatric and general surgery who also serves as associate program director for the General Surgery Residency program 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 in Kenya is similar to that 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. “We see complications, infections and end-stage presentations here that we rarely see in the United States because so many East Africans simply can’t get to a doctor sooner,” says Hansen. “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 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,” says 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.”

“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,” says Dr. Mark Newton.

Nigeria

Dr. John Tarpley, BA’66, MD’70, 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. Tarpley was director of a small but expanding residency training program in Ogbomoso, working with medical students and residents there and in Ibadan.

Now Tarpley uses two weeks of his vacation time from Vanderbilt and his surgical post at Nashville Veterans Affairs 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,” he says. “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 Dr. Wallace “Skip” Neblett, MD’71, and other specialists have accompanied Tarpley through the years, working with 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,” says Tarpley, professor of surgery and anesthesiology at Vanderbilt and director of the General Surgery Residency program.

Tarpley recalls how he and Neblett worked to rebuild the esophagus of a female patient who attempted suicide by drinking lye. Years later the patient 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 ensure safe airway management—a major health disparity he has witnessed firsthand in sub-Saharan Africa. He and Maggie hope to spend half their time in Africa once they retire.

* Watch a video about AIC Kijabe Hospital, including Dr. Mark Newton (left), at http://vu.edu/kijabe. (photo by Eric Gitonga)
* Dr. Kris Olson (top right) shows Indonesian midwives how to use an inexpensive tube and mask to help resuscitate babies.
* Dr. Matthew Gartland (bottom right) in Kenya.

Guyana

Until recently, graduates of University of Guyana Medical School began practicing 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 with Vanderbilt to develop an American Council of Learned Societies (ACLS) program and emergency care courses before residency became a reality in 2010.

“We are grateful for funding from Project DAWN [Donors and Workers Now], which 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,” says Dr. John P. Rohde, 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 provides medical care to the most indigent population, began to look for new opportunities to extend its work after the loss of its founder in 2010, the group approached Rohde at Vanderbilt.

With support from the emergency medicine department’s leadership, the Guyana Project was born. Dr. Nicolas Forget is director of the Masters Programme in Emergency Medicine for the Georgetown Public Hospital Corp. 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,” says Forget. “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 Corp.

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

Senegal

It will come as no surprise to Dr. Julie Thwing’s former medical school classmates that she is living in Dakar, Senegal. Thwing, MD’02, who moved there last year with her husband, Ed Hopkins, and infant son, J.B., is the Centers for Disease Control and Prevention resident adviser for the U.S. President’s Malaria Initiative.

A Canby Robinson Scholar, Thwing completed a residency in internal medicine and pediatrics at Vanderbilt before moving to Atlanta to train at the CDC’s Epidemic Intelligence Service (EIS). She served in the Malaria Branch, supporting public health interventions and conducting research in Niger, Angola, Kenya and Madagascar. After EIS training, Thwing remained in the CDC’s Malaria Branch as a medical epidemiologist. There she provided technical support for the President’s Malaria Initiative in Senegal and supported various research projects.

Now as resident adviser for the program, she works with the U.S. Agency for International Development (USAID), the National Malaria Control Program and numerous other partners, including the University of Dakar. The goal is to implement malaria prevention and treatment in Senegal, improving access to insecticide-treated bed nets, prompt diagnosis, and treatment with artemisinin-based combination therapy (antimalarial drugs).

“The Senegalese are very active partners and participants in their own malaria control, and I am privileged to get to work alongside them,” Thwing says. “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 interventions are working, providing technical assistance for malaria surveillance, monitoring insecticide resistance and drug efficacy, and conducting operational research on malaria management.

“I will stay as long as they will let me and as long as my husband is happy,” says 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.”

“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.” ~ Dr. Thomas Nygaard, BS’74, MD’78

Indonesia

When Dr. Kris Olson, MD’98, landed in Meulaboh, West Aceh Regency, 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’d delivered.

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

“Any other time, the midwife would have looked over and said, ‘It’s dead,’ and pulled the blanket over the baby,” Olson says. “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 had selected the simple plastic device—endorsed by the country’s Ministry of Health approval 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,” says Olson. “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.

“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 Boston’s Massachusetts General Hospital and medical director for the Consortium for Affordable Medical Technology at the hospital’s Center for Global Health. 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 IOM in tsunami-affected regions of Sumatra.

Ikumbo, Kenya

Dr. Matthew Gartland, MD’13, is co-founder of the nonprofit 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 says. “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 Vanderbilt University School of Medicine students, Ikumbo Secondary School has four classrooms, administrative offices and a science lab, all built during the past four years. It currently has 140 students enrolled 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.

Gartland spent the past year living in Lusaka, Zambia, working with the Centre for Infectious Disease Research in Zambia (CIDRZ) through funding from the Fogarty International Center at the National Institutes of Health. There he studied the impact of universal access to anti-retroviral therapy on the prevention of mother-to-child transmission of HIV, with a second area of focus on patient retention and risk factors for dropout 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, dropouts, and transfers to other facilities,” Gartland says.

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

Other board members involved in Harambee For All Children include Dr. Scott Zuckerman, MD’12; Dr. Rimal Hanif, MD’12; Gartland’s fiancée, Dr. Rajshri Mainthia, MD’13; Dr. Billy Sullivan, MD’13, MEd’13; and M.D./Ph.D. candidates Benjamin Dean and Rafal Sobota.

* Dr. Erik Hansen (right) in Kenya (photo by Eric Gitonga)
* Dr. Dirk Hamp (top left) in Uganda
* Dr. Thomas Nygaard (bottom left) in Jamaica

Uganda

Dr. Dirk Hamp, MD’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 an area 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 were killed. The attackers came at Jane with a sledgehammer and a machete. Suffering a skull fracture, brain injury and multiple wounds, she was left to die alone—but survived.

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 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?” says Dirk Hamp. “Many had heart-wrenching stories; some were in orphanages, others were living in mud homes. There is all this work that could be done to improve the lives of those children.”

The Hamps and two other couples put their heads—and hearts—together and formed Embrace Uganda. Since fall 2007 the nonprofit, fully volunteer organization has partnered with three villages. In Kaihura, Jane’s village, Embrace Uganda has supported the “Bringing Hope to the Family” initiative, 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.

“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 says.

Jamaica

For the past seven years, Dr. Thomas Nygaard, BS’74, MD’78, has traveled to St. Thomas Parish in Jamaica with the Central Virginia Medical Mission Team, a team of physicians, nurses and dentists that provides health care to residents of the destitute area on the southeastern end of the island. For Nygaard, a former cardiologist and current administrator for Centra Health in Virginia, the trips provide 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 says.

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

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

“Life is a lot simpler here,” says Dr. Erik Hansen of Kenya. “You might compare it to a small town in America in the 1950s.”

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

“We constructed a didactic program for physicians from all over East Africa,” he says. “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.”

Nygaard believes his years at Vanderbilt University School of Medicine helped set the stage for medical mission work. Citing mentors such as Drs. Tom Brittingham, Mark Houston and Grant Liddle, he says, “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.”

Mimi Eckerd and Jill Clendening contributed to this story.


Watch a video about AIC Kijabe Hospital, including Dr. Mark Newton.


Watch Dr. Matthew Gartland give a tour of Ikumbo Secondary School.