Fellow initiates program to train Future Doctors for South Sudan

South Sudan (Photograph by John Wollerth/Shutterstock.com)

South Sudan (Photograph by John Wollerth/Shutterstock.com)

A young man with tetanus. Because no critical care was available, the patient would die within hours.

A young man with tetanus. Because no critical care was available, the patient would die within hours.

A baby with a bowel obstruction. The family refused surgery and took the baby home to die.

A baby with a bowel obstruction. The family refused surgery and took the baby home to die.

A child with an untreated eye tumor. Eye surgery is completely unavailable in South Sudan.

A child with an untreated eye tumor. Eye surgery is completely unavailable in South Sudan.

Hellen, a third-year FDSS medical student studying in Kenya

Hellen, a third-year FDSS medical student studying in Kenya

Ken-Waxman
Dr. Waxman with Malueth

Dr. Waxman with Malueth

Ken-Waxman

Dr. Waxman

Editor’s note: Many Fellows of the American College of Surgeons (ACS) are actively involved in medical relief organizations. Following is a summary of an interview that Brittanie Wilczak, Program Administrator, Operation Giving Back, conducted earlier this year with Kenneth S. Waxman, MD, FACS, a retired general and trauma surgeon, a Past-Governor of the ACS, and the founder of Future Doctors for South Sudan (FDSS).

 


What is FDSS?

Founded in 2011, FDSS is a not-for-profit organization that I established to help improve the future of health care in the Republic of South Sudan, the world’s newest nation. The goals of FDSS are to help South Sudan develop a new health care system, to help educate health care professionals by supporting medical education, and to support efforts to develop quality hospitals in the country.

Why did you decide to start FDSS?

After working in South Sudan with Doctors Without Borders in 2010, it became clear to me that a sustainable future for health care in this newly formed, underdeveloped nation will not be based upon expatriate volunteerism. Instead, a new paradigm is needed, one that is led by South Sudanese health care professionals.

How did you become interested in the health care challenges facing South Sudan?

While working as an expatriate provider in South Sudan, I was overwhelmed with the suffering caused by a lack of health care. I have come to the realization that educating health care professionals and working together with South Sudanese leaders to create a vision and plan for a health care system offers the best hope for a brighter future.

What is the health care situation like in South Sudan?

After decades of invasion and war, South Sudan has been left without any semblance of a modern health care infrastructure. There is a terrible shortage of South Sudanese physicians and nurses, and patients have no access to quality secondary or tertiary care hospitals. Expatriate organizations have provided most of the care that is available, but many of these organizations have withdrawn from South Sudan due to ongoing violence and political unrest. The vast majority of the South Sudanese population has no access to quality health care.

What is the ratio of physicians to patients in South Sudan?

There is a severe shortage of medical workers within South Sudan. According to the World Health Organization, there may be as few as one trained physician per 65,574 people.1

What are the predominant health care issues facing South Sudan?

South Sudan faces many health care issues as a result of an intense workforce shortage, poor public health infrastructure, and violent conflict.2,3 Approximately 63 percent of total deaths for all ages and both sexes are due to “communicable, maternal, perinatal, and nutritional conditions,” while injuries and other noncommunicable diseases each account for 10 percent of total deaths for all ages and both sexes.4 Moreover, surgical diseases are ubiquitous, and the use of surgical interventions to treat health-related issues are increasingly in more demand within South Sudan.

How many trips have you personally made to South Sudan?

After traveling to South Sudan as a volunteer for Doctors Without Borders, and subsequently establishing FDSS, I have been to South Sudan on three separate occasions, for as long as three months at a time.

How did you get funding for FDSS?

FDSS is an approved 501(c)(3) not-for-profit organization. We initially relied upon personal funds, but have now received help from dozens of individual donors. At this time, we have not been successful in obtaining grants from agencies. We continue to struggle to raise sufficient funds to sustain and grow FDSS.

How many physicians has FDSS trained?

At present, we are providing financial support for 11 South Sudanese students to attend medical school. We will have our first medical school graduate, a postgraduate student named Ruot, in 2017. We also have a list of more than 20 exceptionally qualified applicants from South Sudan who desire to become doctors through FDSS.

What educational resources does FDSS use?

We provide our students with tablet computers loaded with medical textbooks and online reference resources. When our students graduate, we intend to support their postgraduate training, and, at that time, we hope to facilitate access to all of the educational resources that the American College of Surgeons offers.

Where do you see the health care situation in South Sudan heading in the future?

The greatest need in South Sudan is to have a vision and plan for a modern health care system. FDSS has been working closely with South Sudanese physician leaders and with the Ministry of Health to plan for development of a tertiary teaching hospital and medical school. We are prepared to begin implementation as soon as the political turmoil in South Sudan allows progress. The first priority must be to develop the hospital and medical school within the country. This facility will serve as a model for high-quality and safe medical care and as a home for medical, nursing, and other professional training and education. A national health care system must also be planned, which will include the development of universal access to care, including prehospital care and transportation. There will be a great opportunity to develop this system using modern technology, such as telecommunication, to provide national connectivity and integration.

Is FDSS working with any Republic of South Sudan government agencies to achieve this goal?

FDSS has worked with leaders in the Ministry of Health, medical education leaders, and physician leaders in South Sudan. While at present there is insufficient political stability or resources to implement our plans, we are well-positioned to work together with South Sudanese leaders when the political situation allows progress to occur.

What advice would you give other health care providers who want to work in South Sudan specifically?

Clearly, expatriate health care providers can play an important role in South Sudan. However, the greater need is to help develop a sustainable health care system, beginning with educating South Sudanese physicians and other health care professionals. So my advice is to work with groups that make medical education and infrastructure development a priority. Such groups prioritize development of high-quality facilities and equipment, establishing sustainable pipelines for medications and supplies, and training local surgeons to provide ongoing care.

What are the strengths that Fellows of the ACS have to offer in terms of providing health care to the underserved?

As surgeons, we have a tendency to want to be heroic. That inclination is noble and may feel rewarding, but we should also understand that the impact of providing health care during disasters or unstable political situations is transient. My belief is that our greatest contributions are those that provide education and help local governments develop sustainable solutions.

What’s next for FDSS?

We believe the most pressing need at this time is to support as many South Sudanese students as possible to attend medical school and then to obtain postgraduate training. These individuals will become the doctors who create a better health care future for South Sudan. Financial support for their education is critically needed; FDSS continues its efforts to identify funding sources in order to support more students.

In the meantime, we have great hope that the political turmoil in South Sudan will stabilize, at which point we are well prepared to work with South Sudanese leaders to implement the development of a new tertiary care teaching hospital. From then on, partnerships to help develop clinical programs as well as medical school and surgical specialty training will be invaluable.

Dr. Waxman with Malueth

Dr. Waxman with Malueth

Malueth: The first student of FDSS

Malueth was about 19 years old when I met him. (Like most South Sudanese, he does not know his actual date of birth.) Malueth’s father is a tribal leader of a small Dinka village, who raises cattle but has no income. Malueth is a middle child of his mother’s 10 living children, and his father has four other wives, also with multiple children. Because Malueth has so many older siblings, he was not required to tend the cattle, and therefore was allowed to attend primary school. He did so well that he received a scholarship to attend a missionary high school in Kenya, where he became the top student. Upon his return to South Sudan, Malueth was hired by Doctors Without Borders to work as a medical assistant.

Malueth and I worked closely together in Gogrial, a small village, caring for patients and developing policies and procedures for Doctors Without Borders’ new critical access facility in 2010. I was amazed by Malueth’s intelligence, integrity, drive, motivation, and sincere desire to help his community. Malueth also was inspired by the care we were able to provide, and asked me to help him become a surgeon. However, we faced enormous barriers. At present, South Sudan lacks a functional medical education system. Malueth’s excellent academic record would have qualified him to attend medical school in Kenya or Uganda, but the costs were completely prohibitive, and no financial support was available.

I told Malueth that I would raise the funds to support his medical education. This was the beginning of FDSS in 2011. Malueth is now in his fourth year of medical school in Nairobi, Kenya, and is excelling in his studies. He remains passionate about returning to South Sudan to serve his country. Malueth is one of many young South Sudanese who have enormous potential to become outstanding doctors. FDSS is committed to identifying as many of these young people as we can, to financing their education, and to supporting and mentoring them as they become the future of health care for South Sudan.


References

  1. World Health Organization. South Sudan. Available at: www.who.int/workforcealliance/countries/ssd/en/. Accessed July 15, 2016.
  2. World Health Organization. Public Health Risk Assessment and Interventions: Conflict and Humanitarian Crisis in South Sudan. January 13, 2014. Available at: www.who.int/hac/crises/ssd/south_sudan_public_health_risk_assessment_15january2014_.pdf. Accessed July 15, 2016.
  3. World Health Organization. Country Cooperation Strategy at a Glance: South Sudan. May 2014. Available at: www.who.int/countryfocus/cooperation_strategy/ccsbrief_ssd_en.pdf. Accessed July, 15, 2016.
  4. World Health Organization. South Sudan. 2014. Available at: www.who.int/nmh/countries/ssd_en.pdf?ua=1. Accessed July 15, 2016.

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