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In Fall, 2023, The American Board of Surgery approved MUSC’s Global Surgery Rotation and Daniel Akyeampong, M.D. (PGY-3), was the first surgical resident at MUSC to have made the voyage to George Hospital, located in the Southern Cape Region of South Africa. Medical student and incoming global surgery member, Cassandra D'Amico, sat down with Daniel to capture some of his global surgery highlights.

Q: What sparked your interest in global surgery? 

A: From a young age, I've always had an interest in increasing access to care in under-resourced communities. Working on the front lines 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.

Q: What does a typical day look like for you?

A: I start my day early in the morning rounding with the surgical team, including medical officers (surgery-focused general practitioners who have gone through medical school training, two intern years and two community service years) where we have a quick team huddle on our plan for the day before quickly rounding on our patients in the hospital. It depends on the day, but we will either stay at the provincial George Hospital or go out into the surrounding community to perform surgeries ranging from hernia repairs to vascular grafts. I usually wrap up my day around 5-6 in the evening and get ready to meet up with some of the other visiting residents in the neighboring doctor's village for a bite to eat or to take a stroll in the beautiful town to admire the mountain views. 

Q: What are some tangible and non-tangible things you've learned so far?

A: The most special part of this program is going into the surrounding community which has taught me how to handle a wide range of complex pathologies, including lumpectomies and pediatric cases, which I might not see at my current stage of training. We also do a lot of diagnostic care here which can then be handed to their local doctor for continued management. Since George is a state-run hospital where the majority of specialist care is located, a lot of patients have to travel at least 3-4 hours to receive healthcare but that comes with a lot of other barriers such as transportation and the need for childcare during these visits. In addition, imaging services such as MRIs 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. 

One thing I'll never forget is the second day of my rotation. While I was performing an upper endoscopy on an individual, we found a perforated ulcer concerning for malignancy. We ended up referring him to George for further evaluation and a couple days later, while rounding in the hospital, I encountered this same patient who I was going to soon operate on again. To our relief, when we opened him up, there was no sign of metastatic disease. Instead, we found a large liver abscess which had perforated into his liver. We repaired it by bypassing his GI contents from his stomach to the duodenum and jejunum. This was a very cool case not only because of the optimistic result, but because I was able to physically follow this patient from start to finish, all the way from his home to the operating room! This experience opened my eyes to the region's inaccessibility of care due to transportation/equipment and has made me think of ways to work with our team to shift the healthcare paradigm and bring the care to patients. 

Q: Coming back to MUSC, how do you foresee your experience shaping your surgical career and outlook of medicine moving forward?

A: During my time in South Africa, I've been fortunate to be paired with and work closely alongside Dr. Hugo Stark, the Chief Surgeon in the Western Cape. He not only started the initiative of going into the Southern Cape communities and pioneered his own electronic medical record (EMR), but he's just an overall great human being. His focus on patient-centered care serves as a model for how I want to serve my patients moving forward. His focus of "caring over curing" is a refreshing contrast to the mindset often seen in Western medicine. I would like to shift my practice to start better understanding my patients as a whole and focusing on how to provide them with a better quality of life.

Moving forward, I definitely hope to return to George to continue some of the research and education initiatives started by Dr. Stark. We are hopefully looking into extending our Global Surgery

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 April Issue

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November 2023

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Winter Progress Report

January 2025

Fall 2024 Progress Report

Hungry4Global Surgery and Break the Fast Pre-Thanksgiving Meeting

On November 25th, we hosted our 3rd annual #Hungry4GlobalSurgery Fast which supports MUSC Global Surgery's growing partnerships with physicians in low-to-middle-income countries (LMICs). Participants were encouraged to donate what they would have spent on food during the day, with 100% of the proceeds going towards strengthening our international relationships in Kenya, South Africa, and Ecuador. We were thrilled by the huge turnout with attendees from multiple interdisciplinary faculty, residents, students, nurses, as well as community leaders and members from College of Charleston and Porter-Gaud among others. We are deeply grateful to BD, who sponsored the event, and to all who encouraged others to contribute through our website to further our mission of improving patient care locally and abroad.

Publications

• World Journal of Surgery Surgical training trends in the Americas: A cross‐continental assessment
  Authors: Benjamin P. Cassidy, C. Sierra Stingl, Napoleón Méndez, Gustavo M. Machain, Felipe Vega-Rivera, Marcelo A. F. Ribeiro Jr., Hernan Sacoto, Pablo Ottolino, Susan K. Beitia, Martha Quiodettis, Edgar B. Rodas, Mike M. Mallah
• Surgery Open Science Early use of professional interpreters improves trauma outcomes
  Authors: S.Bertram, R. Nichols, L.Cox, & M. Mallah

Global Surgery Resident Journal Club

In October, our program hosted its first journal club for surgery residents. This event provided an opportunity for attendees to engage in meaningful dialogue about global surgical challenges and solutions. A special thank you to Kerecis for sponsoring the dinner.

Spring 2024 Progress Report

Kaserem Futures

A local Advanced Practice Provider Ben King, PA-C has reached out to us to establish a partnership of some sorts with global surgery based on the alignment of his organization's mission with those of global surgery. Kaserem Futures' mission is to equip local clinicians with the tools to lead community-driven medical initiatives in areas with limited resources, improving healthcare access and outcomes. We are a medical non-profit organization dedicated to promoting health access and improved patient outcomes through financial and educational support. We want to be a catalyst for change.

In 2022, MUSC Physician’s Assistant Ben King established Kaserem Futures, an organization that supports local medical providers at the Kaserem Christian Medical Clinic in Uganda. They fund raise for education, supplies, facility upgrades, and staff support. Recent achievements include installing a water filtration system, a septic system, and doubling patient volume while retaining all staff. Ben obtained a grant to develop a Wound Care room, allowing care for more complicated wounds.

Three Surgical Residents Return from South Africa

Dr. Arjun Patel, Dr. Allison Frederick, and Dr. Daniel Akyeampong recently returned from general surgery rotations at George Hospital in South Africa.]Four more MUSC residents will be traveling to Cape Town for rotations in the upcoming year as George Hospital looks to expand multiple specialties.

McKay Meyer (M4) Presented at SIS in June.

Council member McKay Meyers presented at the Surgical Infection Society national meeting in Miami, FL. His project investigates disparities in emergent surgical care in people living with HIV, who were found to undergo cholecystectomy and appendectomy procedures at significantly lower rates compared with patients without HIV. Moving forward, our intention is to analyze this gap on a global scale, focusing specifically on LMICs where HIV is endemic.

Winter 2024 Progress Report

Global Surgery Inaugural Resident Journal Club Meeting

In October, 2024, our program hosted its first journal club for surgery residents. This event provided an opportunity for attendees to engage in meaningful dialogue about global surgical challenges and solutions. A special thank you to Kerecis for sponsoring the dinner.

 Global Surgery Meeting Invited Speaker:  Ramin Eskandari, M.D., MS

During a recent Global Surgery meeting, Dr. Ramin Eskandari spoke about his passion for global travel and health education to a crowd of aspiring medical professionals beginning with his work at a sports camp in Switzerland to performing ground-breaking procedures in the villages of Uganda and meeting with the Uzbekistan Minister of Health to implement surgical training standards. We are so lucky to have learned about these transformative experiences and have Dr. Eskandari spread awareness on the field of global neurosurgery at MUSC!

Dr Eskandari received his bachelors in science in biology/neurobiology at the University of Michigan. After college Dr. Eskandari lived in Switzerland while working at a sports camp for kids. This was followed but two more years of international travel while receiving his Master's in Medical Science. He completed medical school at Wayne State University School of Medicine, followed by residency at the University of Utah Hospital and Clinics and a fellowship at the Lucile Packard Children's Hospital. 

Fall Progress Report

The 4th Annual VCU ACCESS Global Health Symposium

MUSC Global Surgery had the incredible opportunity to participate in the VCU ACCESS Symposium on September 9th, 2023. The VCU School of Medicine event hosted students, physicians, and professionals from around the globe. We engaged in talks from established global health providers, networked with globally-oriented students and professionals, and attended many clinical workshop activities. MUSC College of Medicine and Global Surgery Council Members Riley Nichols, Sierra Patterson, and Clayton Ross presented research posters on global health topics to several judges at the event as well. We fostered discussion and collaborated with VCU ACCESS students as we look to model their successful programs and events in the future.

MUSC Global Surgery in Ecuador

Dr. Mike Mallah and Dr. Edgar Rodas, President of Cinterandes Foundation and Director of VCU Program for Global Surgery, traveled to Ecuador to work with the Cinterandes Foundation. Cinterandes is a first-of-its-kind non-profit organization that improves access to surgical care in rural Ecuador by taking the operating room physically to the patients.“ They built an operating room on the back of a large cargo truck, like a U-Haul. It is a mobile surgical OR.” Dr. Mallah described. “I don’t know what is more heartwarming, seeing the physical and simultaneous metamorphic coming together of a community around a person who is in need or watching those same patients walk out of our ‘camp’ the next day feeling much better.”

American College of Surgeons Clinical Congress 2023

MUSC Global Surgery attended the American College of Surgeons Clinical Congress this October in Boston, MA and simultaneously presented at the Association of Academic Global Surgery. Our team connected with leaders from various different Global Surgery programs such as Vanderbilt, Baylor, Stanford, Medical College of Wisconsin, Harvard, and University of Utah. We are grateful for this opportunity and can’t wait to participate next year!

Invited Speaker: James Brown, M.D., ACS Global Surgeon of the Year

 On Tuesday, November 7, 2023, we had the pleasure of hosting Dr. James Brown, the American College of Surgeons Global Surgeon of the Year, at our MUSC Global Surgery Event with over 60 attendees. Dr. Brown presented on his nearly two decades of work providing surgical education and training to physicians in Cameroon at Mbingo Baptist Hospital. He shared invaluable and transformative experiences, and we were so lucky to have Dr. Brown speak at our event!

2nd Annual #Hungry4GlobalSurgery Fast

$3001 RAISED.17 UNIQUE DONORS. A big thank you for all your support!

On Monday, November 20, 2023, MUSC's Global Surgery Program hosted our 2nd Annual #Hungry4GlobalSurgery Fast to reflect on populations worldwide who lack access to support services and clinical care. For instance, the Lancet Commission estimates that 5 billion people lack access to surgical care. A goal of our program is to leverage global relationships to create bidirectional opportunities to improve care for surgical patients in low- and middle-income countries.

Global Surgery Rotation: Approved!

The American Board of Surgery approved MUSC’s Global Surgery Rotation.

Dr.Daniel Akyeampong (PGY-3), is currently in South Africa through our Global Surgery Rotation.

Winter Progress Report

MUSC-VCU-PAACS Kenya Update 

Medical student & Global Surgery Program council member Habib Rafka (second from right, next to Mike M. Mallah, M.D.) was awarded an MUSC Global Health Scholarship to join Dr. Mallah in Kenya and work to improve surgical education for LMICs  

The Medical University of South Carolina’s Global Surgery Program conducted its first field visit alongside Virginia Commonwealth University’s (VCU) Department of Surgery and the Pan-African Academy of Christian Surgeons (PAACS) to re-think the current surgical resident case-logging system. PAACS oversees 23 resident training programs spanning 11 countries in Sub-Saharan Africa. Their 153 graduates of the program serving in low-resource settings in Africa and 150 residents currently training in general surgery (majority), orthopedics, pediatric surgery, OB/GYN, neurosurgery, and anesthesia.

Through our collaboration with PAACS and VCU, we aim to develop a simple, education-focused, surgical resident case logging system for all PAACS hospitals. Reliable tracking of surgical cases will help guide surgical education and improve future collaborations between PAACS, other LMICs, and HICs.

During the first four days of the trip, the group attended the annual PAACS Basic Science Conference where there was faculty and resident representation from most of the 23 training sites. They focused their time at the conference on hearing from program directors and faculty. Afterward, the group conducted site visits at three major PAACS-affiliated hospitals: Kijabe Hospital, Litein Hospital, and Tenwek Hospital. While at the hospitals they focused on hearing from the surgical residents and observing the workflow of the current case logging system.

Reflections from Habib Rafka, M2: 

"Kenya is a beautiful country with some of the nicest people I have ever met. One of the first things you will notice as you drive out of the capital Nairobi is the vast disparity in wealth, electricity, sanitation, and infrastructure which collectively impact health. Despite this, Kenyan surgical residents are very optimistic about their future. They have an inspiring sense of community and a strong calling to serve in neighborhoods they grew up in. I am very thankful for the opportunity to work with them on this trip and in the future to better our understanding of surgical resident training both in the LMIC context, and in the US."

MUSC Global Surgery Program Council Member Leads Team at the Emory Morningside Global Health Case Competition

Pictured left to right: Mohamed-Faisal Kassir, Shipra Bethi, Tammy Mahaney, Savannah Skidmore, Kaylee Simon, and  Adegboyega Adewale. 

Congratulations to Global Surgery Program council member Savannah Skidmore, M2 (third from the right) who represented MUSC at the Emory Global Health Institute Case Competition where she collaborated and problem solved to address the global maternal mortality crisis and led the team to the finals at the competition! The Emory Morningside Global Health Case Competition brings together 29 teams from 6 countries and 4 continents to address global maternal mortality. The tea took fifth place. 

Georgia Lydon Participates in Research at Stellenbosch University, Cape Town, South Africa

Graduating medical student and MUSC General Surgery-bound student Georgia Lydon traveled to Cape Town, South Africa on combined clinical/research experience. She will be the first of hopefully many students and residents to engage in a partnership between the MUSC Global Surgery Program and Stellenbosch University. Under the direction of Dr. Kathryn Chu, Director of the Centre for Global Surgery at Stellenbosch University, she is working on projects related to access to injury care electrical burns and colorectal cancer resection rates over a three-month period. 

Trauma Surgeon Mike M Mallah MD Joins MUSC Department of Surgery