Thursday, March 12, 2020

Rwanda medical mission trip ‘a jewel in our curriculum’

Faculty and medical students from the University of South Alabama College of Medicine cared for patients at Kibogora Hospital in Rwanda as part of a medical mission trip with the Christian Medical Ministry of South Alabama.
Practicing medicine in remote areas of the world presents challenges for even the most seasoned clinicians. For medical students, the experience allows them to apply the knowledge and skills they’ve learned in a completely unfamiliar setting, creating numerous teaching moments they will carry with them for the rest of their lives.

Representing the University of South Alabama College of Medicine and USA Health, a group of 25 clinical faculty members, fourth-year medical students, advanced care providers and support personnel recently served on a month-long medical mission trip in Rwanda. Since 2012, the Christian Medical Ministry of South Alabama (CMMSA) has led the annual trip to Kibogora Hospital, a rural referral hospital in Rwanda.

Andrew Bright, D.O., assistant professor of surgery at the USA College of Medicine, has participated in the Rwanda mission as a medical student, resident, fellow and twice as an attending physician. Each trip is unique in terms of the pathology encountered, group dynamics, and intended specialties and goals of the students, he said.

“I have noticed that senior medical students, displaced from their normal environment, tend to have that same amazement that they had when they saw their first patients,” Bright said. “I get to witness a new beginning of sorts when they see 30 to 40 patients in the same ward, which is a large room. There is barely enough room to walk bed to bed as the whole room is full.”

Fourth-year student Kelsea Wright, who is pursuing an anesthesiology residency, assisted in anesthetic procedures for surgery. “At USA, we are encouraged to be very hands on and to take responsibility for our patients, even as students, which helped prepare me for the increased autonomy I was given during this trip,” she said. “During my anesthesiology rotation at USA, I performed multiple intubations and spinal blocks, so when the opportunity came for me to perform those procedures at Kibogora Hospital, I felt confident in my abilities, with some guidance from the CRNAs.”

As a fourth-year student going into emergency medicine, Travis Goodloe III worked in the procedure room performing laceration repairs, abscess drainages, minor excisions, burn and wound care, and dressing changes. He also coordinated the delivery of medical supplies the group donated to the hospital, which is often burdened by a shortage of supplies and qualified staff.

“There is an endless flow of patients that funnel into Kibogora Hospital, thus having USA physicians, residents, and medical students present for a month really allows for a stress reliever on the existing medical system,” Goodloe said. “The local staff that we interacted with during our trip made it very clear how grateful they are for this. It truly keeps the hospital afloat in a lot of ways.”

Bright, who also serves as a trauma, critical care and burn surgeon with USA Health, said the hospital’s lack of tools and technologies he is accustomed to using in the United States forced him to become a more resourceful surgeon. The staff at Kibogora, which includes only one general surgeon, are experts at maximizing the reach of materials and minimizing waste, he said.

“We operated successfully on a 94-year-old man with large chronic burn-related wounds of the legs. I had to set up the whole case from start to finish, not just ‘my part,’” Bright said. “There were no blood transfusions available, and blood loss was expected as he had significant tissue destruction. We had to find enough ACE dressings in the hospital to facilitate mechanical hemostasis, and mix our own epinephrine bath for hemostasis. We had to mix our own antibiotic solution, made with bleach.”

In addition to addressing the patients’ medical needs, the hospital staff and volunteers tended to the patients’ spiritual needs.

“The hospital has a few chaplains and a prayer team that visit the wards each Sunday afternoon to sing songs with the patients,” Wright said. “We joined them for two Sundays, and it was so moving to see the patients and their families filled with joy as they sang, danced and clapped.”

Goodloe was also touched by the Rwandan people’s culture and focus on spirituality, he said.

“They are often more vocal and intentional about their faith than many of us are here in the U.S.,” Goodloe said. “Their freedom of worship even within the hospital during spiritual rounds on Sunday afternoons was powerful and eye opening to many of us. I do believe that these spiritual rounds consisting of praying, singing and dancing, and worship provided just as much healing as any medical care that we were able to provide.”

A particularly moving experience for Goodloe was a home visit. The patient lived high in the mountains, in a small mud home with dirt floors and no electricity. Goodloe, classmate Will Martin, and the palliative care nurse from the hospital provided care for the patient, who was a quadriplegic and no longer able to provide for his family of eight children. As they talked with him about how to care for his wounds at home, the patient described how he trusted in God’s plan for him and his family.

“This experience demonstrated the value of a robust and healthy faith, even in light of unhealthy and unfortunate physical conditions,” Goodloe said. “For all of these reasons, this experience was the most impactful of the trip for me, far more so than any specific medical care, procedure or surgery that we were able to provide over the course of our month in Rwanda.”

In the summer of 2017, after completing their first year of medical school, Wright and Goodloe spent two weeks in Senegal, West Africa, as part of a medical mission trip with CMMSA. Their experiences in Senegal largely influenced their decisions to take part in the Rwanda trip.

Rwanda was the first medical mission trip for Dorothy Dickinson, GME program coordinator for surgery. She assisted with spiritual rounds and met with the chaplain to help structure the hospital’s weekly Bible studies.

“When a person can commit their time to a mission trip to see the needs and opportunities around the world involving other people of different cultures, it gets into your heart,” Dickinson reflected. “This changes everything including how you spend your time, energy and resources.”

Goodloe called the Rwanda trip “a true jewel in our curriculum.”

“The opportunity for learning and the opportunity for development of young physicians on so many levels during this trip is totally invaluable. It is worth its weight in gold,” Goodloe said. “I have no doubt that I will begin residency in a few months much better prepared clinically, emotionally, spiritually and personally than had I not immersed myself in this Rwanda experience for the past month.”

Visit www.cmmsa.org to learn more about the Christian Medical Ministry of South Alabama.

Wednesday, March 11, 2020

Vande Waa named to state coronavirus task force

John A. Vande Waa, D.O., Ph.D., professor of internal medicine at the University of South Alabama College of Medicine, is one of four infectious disease specialists serving on Gov. Kay Ivey’s 18-member task force to prevent the spread of the coronavirus in the state.

The task force will discuss developments and precautions on a routine basis and make recommendations to the governor as necessary, Ivey’s office said. State Health Officer Dr. Scott Harris will chair the group, and lead any public announcements and directives, the governor’s office said.

"The safety of Alabamians is paramount, and we will do everything we can to limit exposure to this illness," Ivey said in a press release. "I appreciate the willingness of these individuals, from both the public and private sector, to serve as we do everything we can to mitigate risk for the people of Alabama and to keep the citizens of the state informed of our plans."

Board-certified in infectious disease, Vande Waa earned a medical degree from Michigan State University College of Osteopathic Medicine and completed both residency and fellowship training at the University of Wisconsin in Madison.

Friday, March 6, 2020

Register Now: 18th Annual Regional Sickle Cell Conference

The USA Comprehensive Sickle Cell Center will host its 18th Annual Regional Sickle Cell Conference on Saturday, May 30. The event, "What's In Your Genes? The Promise of a Cure," is scheduled for 7:45 a.m. to 4:30 p.m. at the Student Center Ballroom on the main campus of the University of South Alabama.

The one-day conference will feature national, regional and local experts addressing the recent FDA approval of Adakveo and Oxbryta in the treatment of sickle disease and advances in gene therapy. A highlight of the conference will be to engage a sickle cell patient who has undergone gene therapy.

To register for the conference, visit cmetracker.net. For more information, email vgardner@health.southalabama.edu or call (251) 470-5893.

Fast-growing uterine cancer may respond better to immunotherapy, study says

Nathaniel Jones, M.D., a gynecologic oncologist at the USA Health Mitchell Cancer Institute, is studying immunotherapy for aggressive uterine cancer.
Research completed at the USA Health Mitchell Cancer Institute suggests that aggressive uterine cancer may respond better to immunotherapy than slower growing types. This research was recently published online in the international journal Gynecologic Oncology.

The study, led by Nathaniel Jones, M.D., a gynecologic oncologist at the USA Health Mitchell Cancer Institute, suggests that women with “high-grade” cancer of the uterus -- cancer that is significantly abnormal in appearance and often fast growing -- may benefit from therapy that helps the body’s own immune system to recognize and fight cancer cells.

Cancer of the endometrium, or lining of the uterus, is the fourth most common cause of cancer among women and the most common gynecologic cancer. Immunotherapy has been shown to be effective against certain cancers, including melanoma, lung and bladder cancers. It tends to produce fewer side effects in patients than traditional chemotherapy.

“When women recur with uterine cancer, many times our treatment options are limited,” said Jones, who holds a faculty position of assistant professor of oncologic sciences at the Mitchell Cancer Institute. “The good news is that most women with uterine cancer have an excellent prognosis and are cured with their initial treatment. However, women with aggressive high-grade tumors often time recur, and our research aims to expand and improve treatments available.”

Jones said the researchers sought to identify biomarkers that could help physicians predict which uterine cancer patients may benefit from immunotherapy. “That’s the hot topic -- trying to find a biomarker that is a predictor of response,” Jones said.

The study involved more than 600 samples from cancer patients. Researchers used a molecular database to analyze tumors that ranged from low grade (with the best prognosis) to high grade (with the worst prognosis). They found that high-grade tumors had elevated levels of three biomarkers -- programmed death ligand 1 (PD-L1), tumor mutation burden (TMB) and microsatellite instability (MSI), indicating that these could be targets for immunotherapy. “Initially, we found that higher grade tumors have more immunogenic markers,” Jones said. “Hopefully, this new information provides us with additional treatment options for women who have a poorer prognosis.”

Jones said that further research is under way.

One current clinical trial available at the Mitchell Cancer Institute is enrolling patients with metastatic endometrial cancer in order to compare responses to immunotherapy with responses to traditional chemotherapy, he said.

In addition, researchers hope to explore whether black women have a similar response to white women when treated with immunotherapy. “We know that there is a disparity in outcomes with traditional treatment approaches,” Jones said. “In order to answer that question, we need to ensure that clinical trial enrollment is representative of the patient population we treat. Increasing black participation is one of the fundamental components of our clinical trial research efforts.”

Thursday, March 5, 2020

Mark Your Calendar: Upcoming grand rounds

Mark your calendar for the following grand rounds:

Orthopaedic Surgery Grand Rounds
"Anterior Hip Replacement"
J. Grant Zarzour, M.D., Alabama Orthopaedic Clinic
7 to 8 a.m. Friday, March 6
Strada Patient Care Center, 1st Floor Conference Room
Contact: Rhonda Smith at (251) 665-8251 or rhondasmith@health.southalabama.edu

Cardiology Grand Rounds
"Cardiorenal Syndrome"
Emad Al Jaber, M.D., Nephrologist, Assistant Professor of Internal Medicine, USA College of Medicine
11:30 a.m. to 12:30 p.m. Friday, March 6
USA Health University Hospital, Cardiology Conference Room
Contact: Angela Hunt at (251) 471-7923 or arhunt@health.southalabama.edu

Neurology Grand Rounds
"Stroke Management Guideline Updates 2020"
Steve M. Cordina, M.D., Associate Professor of Neurology, USA College of Medicine
8 to 9 a.m. Tuesday, March 10
USA Health University Hospital, 2nd Floor Conference Center
Contact: Heather Kelly at (251) 445-8292 or hdkelly@health.southalabama.edu

Surgery Grand Rounds
"Oncolytic Viral Therapy"
John Stewart, M.D., Physician Executive for Oncology Sciences, University of Illinois Health
7 to 8 a.m. Friday, March 13
USA Health University Hospital, 2nd Floor Conference Center
Contact: Tyronda Rogers at (251) 445-8230 or tmrogers@health.southalabama.edu

Cardiology Grand Rounds
"Anticoagulation in A Fib"
Bassam Omar, M.D., Cardiologist, Professor of Internal Medicine, USA College of Medicine
11:30 a.m. to 12:30 p.m. Friday, March 13
USA Health University Hospital, Cardiology Conference Room
Contact: Angela Hunt at (251) 471-7923 or arhunt@health.southalabama.edu

Medicine Grand Rounds
"Bleeding Ponies, Bloated Cattle, Breathless Climbers: Hearts and Lungs Under Duress with Hypoxia and Exercise"
Erik R. Swenson, M.D., Professor of Medicine and Physiology, Department of Veterans Affairs
8 to 9 a.m. Thursday, March 19
USA Health University Hospital, 2nd Floor Conference Center
Contact: Linda Ching at (251) 471-7900 or lching@health.southalabama.edu

Pediatric Grand Rounds
"Unconscious Bias Training"
Franklin Trimm, M.D., Associate Dean of Diversity and Inclusion, Assistant Vice President for Medical Affairs, USA College of Medicine
8 to 9 a.m. Friday, March 20
Strada Patient Care Center, 1st Floor Conference Room
Contact: Nicole Laden at (251) 415-8688 or nicoleladen@health.southalabama.edu