ENT Global Surgery Outreach in Mwanza, Tanzania

by Lia Jacobson, MD

Facilitated by Mending Kids, a pediatric humanitarian surgery nonprofit organization, I developed an ongoing academic partnership with a new ENT residency program at Bugando Medical Centre in Mwanza, Tanzania.  Bugando is one of the largest hospitals in Tanzania; it serves a catchment area of 16 million people and faces severe shortages in surgical infrastructure and capacity.  A principle goal of this partnership is to promote sustainable improvements in Otolaryngology surgical care and resident training through knowledge sharing and support from academic, nonprofit and governmental sectors.

In response to a request by Bugando’s ENT director for a surgical teaching mission with Mending Kids, I conducted a site visit and needs assessment with the organization in November 2016. I returned in November 2017 to coordinate a pediatric ENT training mission with Pediatric Otolaryngologist Dr. Ayal Willner, and Anesthesiologist Dr. Sia Fooladian, both of whom have led Mending Kids missions to Guatemala previously. During our weeklong visit, we performed 12 surgeries with residents and faculty from Mwanza. The procedures we performed included laryngoscopy and bronchoscopy, congenital neck mass excision, and tracheotomy. In addition, we developed a daily lecture series on pediatric airway management and otology, two topics identified by local and visiting teams as areas in need of academic development.

Onsite at Mending Kids Pediatric ENT Training Mission Nov 2017

I’ve also applied for and received grant funding by USC’s Dhablania and Kim Family Global Health Fellowship. I returned to Tanzania in Winter 2018 to build on this service-learning program through implementation of electronic and remote teaching resources, partnerships with local and global organizations to improve audiologic and otologic services, and coordination of a second surgical training mission. Dr. Lindsay Reder, a Laryngologist in the USC Caruso Department of Otolaryngology – Head and Neck Surgery, also plans to travel and participate in this training mission with me.  Future directions for this project include developing research and service opportunities for USC residents at Bugando hospital, and facilitating reciprocal opportunities at USC for visiting residents and faculty from Tanzania.

My global health experiences are a cornerstone of my professional aspirations as a surgeon.  I am humbled and grateful to have gained perspective on the realities of surgical and medical disparity in developing countries, and I am inspired by the patients and health care professionals who persevere in the face of such challenges.  I intend to continue to build humanitarian partnerships and contribute to training and capacity-building in Otolaryngology-Head and Neck Surgery globally in the future.

Implementing Smart Phone Adapters for Direct Laryngoscopy
Operative Training at Bugando Medical Centre
In the Operating Theatre with ENT Faculty and Residents in Mwanza, Tanzania

Stoneman Family Global Education Program

The Stoneman Family Global Education Program aims to enhance residency, fellowship, graduate and post-doctoral training by funding one of our trainees to participate in an international elective. The studies may be related to learning innovative clinical approaches to caring for patients, learning alternative health care delivery systems, training in novel research techniques, or learning different educational approaches.  To become a Stoneman Family Global Education Scholar, there will be an application process and one trainee per year will have the opportunity to spend up to 4 weeks in this educational elective. At the culmination of the experience, each Scholar will give a presentation to the department. Mentorship will be provided by the Stoneman Family Global Education Program Committee and other interested faculty members. There may be a chance to participate in one of several ongoing international partnerships, as well as to forge new opportunities worldwide.

Program committee

The Program Committee consists of USC Department of Otolaryngology clinical and research faculty members and 1 senior resident. The Otolaryngology Resident Program Director or Assistant Program Director will serve as a committee member. The previous year’s grant awardee will sit on the committee for the following year. If the awardee is not a resident, a resident who will be going into their last year of training will be selected by their peers (all other residents). This committee is chaired by Elisabeth Ference, MD. Other members of the committee include Tamara Chambers, MD; Uttam Sinha, MD; Ray Goldsworthy, PhD; and Jeehong (Peter) Kim, MD.

 

Guidelines:

  1. The Program Committee selects one person per academic year to be a Stoneman Family Global Education Scholar.
    • Eligible applicants include residents, clinical fellows, graduate students, and post-doctoral fellows within the USC Caruso Department of Otolaryngology – Head and Neck Surgery
    • Up to $4500/academic year can be allotted; any additional costs must be self-supported by the scholar
    • Up to 4 weeks may be taken for the elective. The committee will consider a longer elective if the educational value is well characterized and the time away from USC can be managed in accordance with USC policies.
    • If awarded to a medical student, approval must also be obtained through the Dean’s office. If awarded to a resident, the GME office must be notified and time approved. The program committee can help facilitate this. If awarded to a graduate student or post-doctoral fellow in a basic science lab the PI must approve the experience and time away.
  2. The studies may be related to learning innovative clinical approaches to caring for patients, learning alternative health care delivery systems, training in novel research techniques, or learning different educational approaches.
  3. These experiences should take place anywhere in the world outside of the United States.
  4. Upon their return, trainees will write a short report describing their experiences and will be asked to formally present their experiences during Grand Rounds so that they may educate others.

Application requirements

The deadline for applications for the next academic year is April 1, and the awardee will be announced May 1. An application should be submitted electronically to the committee chair. It should consist of a CV, cover letter, project proposal and if the application is for a research experience, should also include a research statement. Clinical fellows, Graduate students and post-doctoral fellows should provide a short statement from their mentor/PI to ensure the experience is supported. Medical students and residents, if awarded, will have to notify the medical school dean’s office and GME office, respectively. The project proposal should be no more than 4 pages and include the following:

  1. Title of the project
  2. Location
  3. Contact information for the mentor/colleague at the international location
  4. Goals of the experience
  5. Significance for the scholar, for USC, and for the international site
    • Clinicians i.e. medical students, residents, clinical fellows must include a statement of how the experience will help them in their career in Otolaryngology
  6. Details of how the experience will occur including plans for housing
  7. Timeline for preparation, travel, the various experiences, and follow-up
  8. Explain how the scholars time away from USC will be managed
    • Residents are allowed 6 weeks/year total of vacation + sick leave, so some vacation time may be included in this time away depending on the length of the project.
  9. Explain how the scholar’s health and malpractice (if applicable) insurance will be covered during the trip
  10. Potential risks/safety/immunization issues and how they will be managed
  11. Budget

Some possible opportunities (Trainees may select one of these opportunities or design their own experience):

Tuebingen training program (more information from John Oghalai, MD)

Clinical rotation in head and neck oncology surgery in India (Tata Hospital) or China (Mentor and more information from Uttam Sinha, MD)

Clinical rotation in otology with Richard Wagner, MD: Global ENT Outreach:
Global ENT Outreach provides Otology education and humanitarian surgery for the treatment of chronic ear disease and deafness in several countries throughout the developing world.  Resident surgeons are able to apply to join GEOutreach missions to gain exposure to low-resource otologic surgery settings, develop research topics and assist with educational initiatives.  For more information, please contact info@geoutreach.org

Research + clinical experience with Mending Kids (More information from Lia Jacobson, MD)