Donated Supplies Help Deliver Care in East Africa

Last summer, Phoebe Wright completed her third volunteer mission to the Elimlim Community Health Center in Kitale, Kenya. It was the second year the University of Washington biology major took medical supplies donated by Virginia Mason; basic items to support health services for some of the poorest people in the region, including many young children.

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Left to right: Phoebe Wright; Evelyn, clinic nurse; Samantha, ICU nurse volunteer. 

Phoebe, who plans to attend medical school, describes the extraordinary education of assisting in a clinic where easily preventable conditions are a constant risk to life. Simple things like sanitary linens, packaged gauze and aspirin create treatment options and help promote healing. Sharing knowledge and techniques – Phoebe remembers a health worker intrigued to learn that silicon bandages could reduce burn scars – is another form of exchange desperately needed in remote areas.

“I now have a genuine compassion for the people part of medicine,” writes Phoebe about her months spent at Elimlim, which offers everything from wound care, family planning and eye glasses to treatment for HIV. “I’ve seen first-hand how completely preventable diseases and conditions affect mothers, children and people living on the streets. Improving basic education of medicine and the human body would prevent many deaths and needless suffering.”

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Multipurpose patient room with donated bed linens.

Kenya’s patchwork health care system stems in part from the lack of a long-term commitment by the government. State-run clinics, even when accessible, often fail to provide the consistent, reliable care needed to prevent or treat chronic illness. Access to free, donor-funded clinics like Elimlim is critical, says Phoebe, to fill gaps in care and for treating the whole patient.

Elimlim currently employs a Kenyan medical staff of four, with rotating volunteer physicians, nurses and clinicians, serving more than 350 patients per month. A mobile clinic brings health care to remote villages as resources will allow, a schedule the clinic hopes to increase.

In her post-trip letter to Virginia Mason, Phoebe wrote: “I am very thankful for the opportunity to partner with Elimlim as well as Virginia Mason to serve the people of Kitale, Kenya. I was able to spend quality time building relationships with the staff, following up with returning patients, learning about tropical medicine and not being afraid to say yes to unique learning opportunities. I cannot emphasize enough my gratefulness for the support and generosity of the team at Virginia Mason.”

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New supplies for Elimlim’s pharmacy. 

Reflections on Doctoring: Finding Joy and Healing in Africa

**By Una Lee, MD**

It was my third trip to Mbarara, a bustling city in rural Southwest Uganda and home to a regional hospital. Visiting the first time as a UCLA fellow and then as an attending surgeon, the people and places had never left me. I felt excitement but also a new responsibility: this time I would serve as trip medical director for Medicine for Humanity, a nonprofit organization dedicated to improving women’s health through direct care and education, in partnership with the Mbarara University of Science and Technology. The mission had grown, but it felt like a homecoming – a connection I needed more than I knew.

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 From left: Wai Lee, MD; Una Lee, MD; Carli Hoaglan, MD and Brooke Reagan, surgical tech; overlooking Lake Mburo National Park, Uganda.  

The visiting team included three Virginia Mason colleagues: Brooke Reagan, surgical technician; anesthesiologist Carli Hoaglan, MD, and urology fellow Wai Lee, MD. We and our UCLA counterparts became a well-oiled machine from the moment we met, organizing 22 bagged loads of medical supplies and gear. The Virginia Mason team moved into a university provided house, and soon we would familiarize ourselves with the local food, sights, smells, as well as traditions like mid-morning tea with chapatti and samosas. We would also come to know operating rooms stripped to the basics. Sometimes the power would go out and we would keep operating with flashlights and cell phones to illuminate the surgical area.

Our mission was two-fold: to collaborate with and teach Ugandan surgeons, and to provide fistula surgery to the region’s women in need. It is a sad but common story that many young Ugandan women suffer traumatic childbirth. Because of prolonged labor and the lack of access to health care, the baby’s head causes severe damage to the pelvic floor, resulting in constant urinary and/or bowel leakage. Surgical repair is the only way to restore function and enable these women to return to their lives and communities.

“Every member of our surgery, anesthesia and operating room teams worked with a common purpose and a joyful attitude, helping us accomplish so much with so little.”
— Una Lee, MD

Radio announcements were made of our medical team’s arrival, bringing local women by way of compact “boda boda” motorcycles, busses, and on foot from area villages. The women are poor and often work as sustenance farmers. Many have lost their babies, spouses or families in the aftermath of their birth-related injuries. Every member of our surgery, anesthesia and operating room teams worked with a common purpose and a joyful attitude, helping us accomplish so much with so little. It was invigorating to work with such an amazing team of people – American and Ugandan – from sunrise to late into the night.

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Dr. Lee teaching Ugandan and American residents and fellows in the Mbarara University of Science and Technology operating room.

Medicine for Humanity (MFH) programs go far beyond visiting medical teams, providing dedicated year-round gynecologic and fistula care. Local Ugandan gynecologist Dr. Musa Kayondo leads the collaborative which provides ongoing training, patient care and prevention efforts. Aided by the visiting teams, more than 800 surgeries have been completed since 2009, with a newly established fellowship program that will train surgeons to repair fistulas and serve in other areas where there is great need. Last year, MFH also helped build the 50-bed Center for Gynecologic and Fistula Care to support medical education and the community.

During the two-week mission, our team focused on doctoring, operating and teaching, without the barrage of other pressures and demands that would normally fill our workdays. We arrived in Uganda to offer surgical care and education, but through the process of talking, laughing, sweating, celebrating life, and grieving loss together, we realized the Ugandan people were giving us more that we could ever give in return. With each smile, hand held, or moment of recognition of our shared human experience, we were restored. Our patients – Sylvia, Jovia, Hope and so many more – beamed with beauty, strength, and optimism. Our hearts were filled with gratitude for these brave women and our Ugandan colleagues for teaching us these simple truths.

My time in Uganda changed me. I felt the true joy of being a doctor and a teacher. I was humbled by the privilege of helping these women on their path to healing.  And now, back in my regular life as a physician in Seattle, I am approaching each patient with the joy and openness that I learned from the Ugandan people.

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 Grateful postoperative patients in the Medicine for Humanity fistula ward, Mbarara Regional Referral Hospital.

 


Una and teamUna Lee, MD, is board certified in Urology and subspecialty certified in Female Pelvic Medicine and Reconstructive Surgery at Virginia Mason.


To learn more visit Medicine for Humanity, and give them a follow on Instagram and Twitter. You can also follow Dr. Lee on Instagram and Twitter.

Helping Women in Rwanda

In the African country of Rwanda, radio advertisements sponsored by the Ministry of Health announce upcoming medical missions when U.S doctors will provide local treatment for women. The missions, organized by the International Organization for Women and Development, Inc. (IOWD) in Rockville, NY, send teams of surgeons three times per year to treat women suffering from injuries caused by childbirth and other gynecologic problems.

Doctors Linda Mihalov (left) and Blair Washington

Doctors Linda Mihalov (left) and Blair Washington

In February, VM gynecologist Linda Mihalov, MD, and urogynecologist Blair Washington, MD, joined the 10-day Rwanda mission to both perform and teach surgery. During the country’s 1994 genocide, thousands of educated professionals perished, leaving a shortage of experienced medical practitioners. Without access to training from volunteers, Rwanda’s budding medical community could never address the population’s growing need for medical treatment.

Most of the women who travel long distances to the participating hospitals are suffering from fistulas, an injury caused by prolonged obstructed labor. Without access to medical intervention, a baby who can’t pass out of the birth canal can remain there for days, cutting off the blood supply to tissue that separates the vagina, bladder and rectum. When the tissue dies one or more holes can form, through which a woman will leak urine, feces or both. The condition often makes the woman an outcast, abandoned by her husband and even her family. Most women have no way to pay for surgery and must wait for the visiting medical teams.

Dr. Washington provides guidance to the Rwandan medical student and resident team.

Dr. Washington provides guidance to the Rwandan medical student and resident team.

“It’s primitive conditions, so VM donated a lot of supplies to help us,” says Dr. Mihalov, who was new to the program this year. “We don’t have a lot of instruments, suction or electric cautery, among other things. I had to double as a scrub tech, because there wasn’t one.”

Dr. Mihalov mainly performed surgeries to remove fibroid tumors, repair vaginal prolapse and treat other gynecologic conditions, while Dr. Washington exclusively operated to close fistulas. More than 200 women came to the hospital to be evaluated, and 46 fistula repairs were completed by Dr. Washington and the team. Some women’s injuries are so extensive or complicated by botched operations that there’s nothing the surgeons can do. These patients take an emotional toll on the medical team members who want to help, but the patients appreciate even small attempts to ease their suffering.

“They are so grateful to be helped,” says Dr. Washington, who notes that women who can’t be cured surgically are offered specially designed waterproof undergarments. “They have none of the resources we do, which gives me a sense of purpose. It reminds me why I went into medicine.”

Rwanda’s Ministry of Health is closely monitoring the success of treatment provided by IOWD volunteer teams. Surgery outcomes are documented and patients receive follow-up care during subsequent missions. In the three years Dr. Washington has volunteered with IOWD, cure rates, or the percentage of women who regain continence, are consistently high. For many of the mission’s patients it means a second chance at life.

“I am renewed by the dedication and camaraderie I experience on these trips,” says Dr. Washington. “They always bring me back to center.”
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A version of this article was originally published on VM’s internal news site.