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.
