VOLUME 35, ISSUE 2

“The best way to find yourself is to lose yourself in service to others.”

– Mahatma Ghandi

So many aspects of our lives have changed following the COVID pandemic. Mental health in the medical field has become a greater concern and burnout is evident at all levels of the workforce. We have seen devastating effects of racial and socioeconomic disparities; increased violence and hunger boiling over and taking a toll on everyone, especially the most vulnerable. Anesthesiologists, trained in resilience, are not immune to the intensity of our work and frustrations. Global health initiatives can assist our colleagues overseas who face not only our common challenges but also limitations on resources and expertise. Recently we had the opportunity to work together to make a small difference in the lives of patients 6500 miles away who may not otherwise have received these life changing surgical procedures. In addition, the experience helped everyone on the team reset their views on life in a very positive way. Serving the underserved has been shown to reinvigorate physician volunteers.1

The United States has a physician shortage, 2.6 physicians per 1000 people, with 20.82 physician anesthesiologists per 100,000 people.2,3 In Ghana, there are 0.2 physicians per 1000 people and 0.4 physician anesthesiologists per 100,000.2,3 When I heard a Penn State orthopedic surgeon would resume yearly missions to Ghana (following a hiatus due to the COVID pandemic), I volunteered to join their mission team and recruited a senior anesthesiology resident. Dr. Henry Boateng graciously accepted us for his team of surgeons (orthopedic and plastic) and anesthesiologists from Pennsylvania, Massachusetts, Virginia, Maryland, and Texas. Following months of preparation and with Ghanaian medical licenses in hand, 10 American doctors piled into a Ghanaian van with our supplies and drove into rural Koforidua, with more to follow over the next several weeks.

We served at the 356-bed hospital that served a population of 180,000 in the eastern region of Ghana and is a secondary referral hospital for 16 district hospitals.4 This region has water and electricity most days but does not have access to orthopedic or plastic surgeons. Patients had been called in to await our arrival for specialized surgery at no cost, thereby relieving months on the waitlist for the University hospital 90 kilometers away. The day of arrival we rounded, triaged patients, scheduled our cases, prepared operating rooms, and started regional analgesia for reconstructions. We shared our knowledge and technical skills and we learned the Ghanaian methods to minimize waste and maximize safety while conserving materials and oxygen. We marveled at the care they provided with their limited resources: wound care with papaya leaves, opioid-free surgical anesthetics, ordering each medication for patients to bring for their surgery. Every item used in each case was carefully considered, a built in resource containment system. We learned the nuances of expressing respect for diverse backgrounds to improve outcomes and satisfaction among patients and physicians. We awoke each day with sunrise and worked into the moonlight hours, never tiring because the energy of our patients and Ghanaian colleagues buoyed us with their gratitude and eagerness to share knowledge. We walked away enriched in our clinical skills and in our souls. At the end of our time, we were granted a ride further into the countryside. We visited a palace, walked through its museum, and watched the iron chains that had held Ghanaian slaves picked up and thrown to the ground with a resounding clang that made us shudder. This was the palace where Dr. Boateng had spent his childhood. Seven years I had worked with this humble orthopedic surgeon who poured his heart and soul into patient care. He had never mentioned that he was a prince in Koforidua, a city that Penn State partnered with in their global health mission.

There are many global health initiatives and unsung heroes who work tirelessly to level the playing field for the resource limited people all over the world. Our resident, Ahmed Buazza, and I were fortunate to share this journey and this is just our story. Our colleagues at Baylor Scott and White Medical Center-Temple, including Drs. Jana Rivera, Russell McAllister, and Keller Matthews, who have worked in various countries in Central America, have many more stories. Health care disparities are evident and we anesthesiologists can intervene to improve health equity.5 The transformation of our younger colleagues as they recognize our role is invaluable and sets them up for improved career satisfaction with a thirst for future opportunities. Global patient advocacy and the exchange of ideas can revolutionize anesthesia education and patient care.6 The appreciation of the patients and local citizens helps the volunteers transcend the boundaries of our everyday work life and enlightens us with an entirely different aspect of medical care. Every trip enriches us as anesthesiologists, cognizant of our impact on economics, patient care, and society.