Surgery without boundaries:
Preparing American surgeons for humanitarian work abroad
Dr. David Kuwayama in the operating room with Congolese colleagues
Vascular surgeon David Kuwayama, MD, MPA, has a passion for bringing medical care to parts of the world that need it most desperately. His volunteer work has taken him to Haiti, Sudan, Congo-Brazzaville, and the Democratic Republic of the Congo.
Very early in his work abroad, Dr. Kuwayama discovered something surprising: despite his exemplary medical education (Harvard Medical School, a surgical residency at Johns Hopkins), he had a great deal to learn from his peers from other nations, who were actually better prepared than he was for performing the needed types of surgeries with the available tools.
Given that the United States is a world leader in medical care, research, and education, one would expect American surgeons to lead the way when volunteering with international aid organizations. But Kuwayama says that is simply not the case: "In my experience, when you go abroad, the American surgeon is the one who can do the least."
Dr. David Kuwayama
What can account for this puzzling—not to say embarrassing—state of affairs? The heart of the problem, Kuwayama believes, is not a lack of quality in American medical education, but rather, a high degree of specialization. Becoming expert in a small number of procedures makes sense in American hospitals that have the latest equipment and a team of specialists to treat every condition. In humanitarian work, however, surgeons need a broader array of skills. In particular, they need experience and knowledge of particular procedures that are in high demand in developing countries, but which are no longer emphasized in general surgical training in the United States due to the increasing specialization of treatment. Prominent examples include delivering babies via C-section and performing orthopedic procedures such as bone stabilization.
Compounding the difficulties for American surgeons volunteering abroad, these treatments must often be performed without access to the kind of state-of-the-art equipment available in the U.S. In fact, some of the clinics that need help most urgently do not even have electricity.
In a recent paper published in the World Journal of Surgery, Kuwayama and his fellow authors (including lead author Yihan Lin, MD, a resident here at CU) investigated the preparedness of American surgical residents going abroad for humanitarian work. The paper, entitled Are American Surgical Residents Prepared for Humanitarian Deployment?: A Comparative Analysis of Resident and Humanitarian Case Logs, has attracted recent media coverage from National Public Radio and Retuers (see links at the bottom of this article).
Not satisfied with merely identifying the problem, Dr. Kuwayama wants to be part of the solution. For the past three years, he and Dr. Lin have organized the Colorado Humanitarian Surgical Skills Workshop, which prepares surgical residents for humanitarian work around the globe. In these workshops, surgeons get hands-on practice performing operations on cadavers using the types of low-tech tools that will actually be available to them in war-torn regions, remote rural areas, and other places most in need of their assistance.
Kuwayama plans to go abroad every year and continue performing surgery in communities that lack access to adequate care. Meanwhile, he multiplies his influence by teaching other American surgeons how to do the same. In a world filled with violence, poverty, and complex problems, it is efforts like these that offer hope.