By Greg Borzo
Photo courtesy of Joe Ogarek

We’re setting our sights higher for next year, planning to measure our effectiveness through outcomes data and to help rebuild medical education and establish standards of care.”
—Janis Tupesis
Associate Residency Director of Emergency Medicine at UCMC

When physician Christian Theodosis and two colleagues went to Liberia a few years ago to help staff the country’s only teaching hospital, their arrival doubled the number of physicians at the center.

The emergency medicine physicians from the University of Chicago Medical Center saw how health care had suffered during Liberia’s recent 15-year civil war. Hospitals had been looted, medical supplies were scarce, and malaria and typhoid fever were rampant. Toward the end of the war, the few remaining physicians at John F. Kennedy Hospital in Monrovia carried weapons to fight off rebels in the halls of the institution.

Things have improved considerably since the war ended in 2003, thanks in part to Medical Center physicians who took the lead in staffing JFK’s emergency department around the clock for the 2008-09 academic year.

A Willingness to Serve

“When we made this commitment, we thought it would be hard to staff the ER 24/7,” says Christian Theodosis, Assistant Professor of Emergency Medicine. “In fact, that turned out to be easy since so many physicians from Chicago and other teaching hospitals have been willing to serve.”

And their services are sorely needed. In addition to the usual problems at any emergency department, the physicians encountered a host of problems they never would have seen in America—from women burned with boiling water as a punishment from their partners, to children who die from mistakenly drinking clear, caustic liquids sold in bags that resemble the bags Liberian merchants use to sell water.

Joe Ogarek, Chief Resident in Emergency Medicine at UCMC, who spent April working at JFK, was frustrated when patients refused medical care and left the hospital to seek the services of traditional healers.

“Often they would come back days later in worse shape,” he says. “Many patients with open wounds would prefer to go to a bush doctor, who would rub herbs over the wound. In some cases, they would come back and need an amputation that would not otherwise have been necessary.”

Practicing medicine in such settings offers a unique kind of training for American physicians, says Funmi Olopade, Associate Dean for Global Health and Director of the new Global Health Initiative at the University.

“This is a wonderful program, not only for the immediate assistance it provides, but also because the lessons learned from caring for patients in resource-limited settings can be applied to addressing challenges in urban health care delivery,” Olopade says.

Building a Program from Scratch

The program began several years ago, when James Sirleaf—the son of Ellen Johnson Sirleaf, who subsequently became president of Liberia—founded Health Education And Relief Through Teaching (HEARTT), a non-governmental organization in Liberia. Sirleaf is Senior Emergency Physician at Bridgeport Hospital and Clinical Instructor at Yale-New Haven Hospital.

Theodosis worked with Sirleaf while a resident at Yale-New Haven. After getting involved with HEARTT at Yale, Theodosis brought the program to the Medical Center two years ago.

UCMC and other medical schools collaborate with HEARTT in staffing JFK. This academic year, UCMC sent eight residents and three faculty to JFK for one month at a time. In addition, Yale, Harvard, Brown, Mount Sinai, and Johns Hopkins sent one to three physicians each.

The physicians have focused on patient care and training local medical providers and allied health care workers. The training is mostly hands-on but includes an extensive lecture series. Plans call for helping with more formalized training and medical education as funding becomes available.

“We want to help build capacity on the ground,” says Janis Tupesis, Associate Residency Director of Emergency Medicine at UCMC. “Next year, there will be 15 local physicians graduating from the local Liberian medical school, and it’s great to know that we helped train those physicians, to make that happen.”

But UCMC physicians are learning a lot, too. “The most striking thing is seeing disease processes that are completely foreign to us,” Tupesis says.

Setting Sights Even Higher

Working conditions in Monrovia can be challenging. “One day we were suturing a large-scale trauma wound when we got hit with a blackout,” Tupesis says. “We had to finish the job with a head lamp.”

Despite such conditions, or maybe because of them, UCMC physicians eagerly await their turn to work at JFK. Before her departure for Liberia, Heather Dieperink, a third-year emergency medicine resident, says, “I’m a little worried about catching malaria or something, but this is an incredible opportunity to be of service and to learn from seeing conditions in another country firsthand.”

Even with the extra help, the medical needs in Liberia are enormous, says Theodosis. He would like to extend direct medical assistance to the 15 county hospitals around this country of 3.5 million inhabitants, where the physician-to-population ratio is one of the worst in the world.

“We’re setting our sights higher for next year, planning to measure our effectiveness through outcomes data and to help rebuild medical education and establish standards of care.”