Editor’s note: Operation Giving Back (OGB) is a program carried out under the aegis of the American College of Surgeons (ACS) Division of Member Services. OGB’s mission is to “leverage the passion, skills, and humanitarian ethos of the surgical community to effectively meet the needs of the medically underserved.” Through an extensive database, OGB pairs member volunteers with partner organizations to provide volunteer experiences domestically and internationally. This article is the first in a series of feature stories that the Bulletin will be publishing to profile the volunteer-related accomplishments of ACS Fellows. Upcoming articles will focus on the experience of volunteers who are working to establish a training hub at Hawassa University in Ethiopia through the ACS-College of Surgeons of East, Central and Southern Africa (COSECSA) Surgical Training Hub Collaborative.
Mark W. Asplund, Jr., MD, FACS, a retired general surgeon in Wausau, WI, remembers reading about OGB on the ACS website soon after the program’s genesis in 2004. In search of a volunteer opportunity, he contacted one of OGB’s partner organizations, Physicians for Peace, a nongovernmental organization (NGO) that aims to educate and empower local surgical care providers in under-resourced environments. Physicians for Peace requires a three-month commitment from volunteers, which, at the time, was infeasible for Dr. Asplund because he was still in active practice. However, his interest persisted, and since 2016, Dr. Asplund has volunteered through OGB three times in two different countries.
In 2016, Dr. Asplund spent three months with Physicians for Peace at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, one of two teaching hospitals in the small, landlocked African nation. Malawi has a population of nearly 18 million, with a surgeon density of approximately 0.24/100,000* population, substantially below the recommended standard of 20/100,000 population.†
Malawi has a three-tier health care system in which community clinics and health care outposts refer to district hospitals, which, in turn, refer complex cases to central hospitals like QECH. The network consists of government-run and private facilities (generally NGOs or faith-based organizations). Certain private hospitals in the country are well equipped but are difficult for most of the rural and agriculture-dependent population to access because of the fees they charge. Thus, most Malawians use the under-resourced government facilities, which commonly face staffing, medication, equipment, and space shortages.
Dr. Asplund found the initial transition to providing surgical care at QECH challenging, but he soon became acquainted with the hospital and its faculty and residents. He primarily saw general surgery cases—a term that differs in meaning from what general surgeons would expect to see in their U.S. operating room because of late-stage presentation and the broad scope of general surgical practice in a setting like Malawi. For example, patients with cancers often present with stage IV disease as a consequence of various social and economic delays in accessing care. Immunosuppression and coinfections were common among his surgical patients, a reality in many countries that continue to face high rates of human immunodeficiency virus. Reflecting on the breadth of etiologies he treated, Dr. Asplund commented, “Professionally, it is interesting every day to see a whole new world of pathology; small bowel schistosomiasis, the complications of malaria, dozens of cases of volvulus, and so on.”
In addition to providing surgical care, Dr. Asplund trained residents at QECH. One of the second-year trainees, also known as registrars, was Raymond Nyirenda, MD. Following his return to Wisconsin, Dr. Asplund sponsored Dr. Nyirenda’s visit to his practice for 10 days to learn from his partners. Dr. Nyirenda is now a fourth-year registrar at QECH.
Two experiences in Palestine
Before he was able to dedicate three months to volunteer work, Dr. Asplund took advantage of an alternative opportunity he found through OGB’s volunteer database with partner organization Palestine Children’s Relief Fund (PCRF). PCRF has worked for 25 years to provide medical treatment to children in the Middle East. In the spring of 2016, Dr. Asplund arrived in Palestine, where his training in vascular surgery was put to great use. He was able to address the burden of complicated vascular diseases and work with his son, Martin Asplund, MD, a third-year general surgery resident at WellSpan Health, York, PA. Dr. Mark Asplund attributes the prevalence of vascular disease in Palestine to high rates of smoking and other lifestyle factors. On this first volunteer trip to Palestine, he experienced a relatively peaceful atmosphere, with well-stocked hospitals and few extenuating circumstances.
Two years later, in the spring of 2018, Dr. Asplund returned to Palestine with PCRF, but this time, the environment had changed tremendously. Because of the decades-long conflict in the Middle East, he saw a high incidence of vascular injuries, particularly to lower extremities. In addition to seeing patients, Dr. Asplund took the opportunity to explore the history of tension in the region and brought some of that awareness back home. Last winter, he participated as a panelist in an interfaith community dialog about the Israeli-Palestinian conflict. Dr. Asplund doesn’t anticipate visiting the region again but plans to create a registry of leg injuries to help local hospitals document and tackle them.
Reflecting on his experiences in Malawi and Gaza, Dr. Asplund said, “We, as health care providers and consumers in the U.S., lead a sheltered, spoiled existence with immediate availability to all the latest and greatest [medical resources]. We also expect our patients to get better in general. Neither is true in Malawi and Gaza. Obtaining a single unit of lifesaving blood for a postpartum mother is usually not available. What I learned most, therefore, is perspective and how fortunate I am to live and practice here.”
Find the right opportunity for you
OGB provides volunteer opportunities around the world for ACS members through partner organizations, including NGOs, academic institutions, and hospitals. At press time, the OGB database listed nearly 50 opportunities in 20 countries for surgeons at all stages of practice and training (from medical school through retirement). If you would like to register as a volunteer with OGB, visit the Volunteer and Partner Portal and create a volunteer profile. If you are considering volunteering, Dr. Asplund suggests, “Go for it. It can be life changing.” He added, “One learns about human nature. People and families are the same everywhere, with the same hopes and dreams.”
For more information on how to get involved, contact Operation Giving Back at email@example.com.
*College of Surgeons of East, Central and Southern Africa. Global surgery map. Available at: www.cosecsa.org/global-surgery-map. Accessed July 23, 2019.
†World Health Organization. Surgical care systems strengthening: Developing national surgical, obstetric and anaesthesia plans. Available at: https://apps.who.int/iris/bitstream/handle/10665/255566/9789241512244-eng.pdf. Accessed July 23, 2019.