When Mark A. Morgan, MD, chief of gynecologic oncology at Fox Chase Cancer Center, accepted an invitation from the Stanford Eritrean Women’s Project to travel to Eritrea to perform vesicovaginal fistula surgeries, his only desire was to help a country in dire need of medical professionals who could perform fistula surgery.
Before coming to Fox Chase, Morgan was the head of urogynecology at the University of Pennsylvania and was familiar with the surgical procedure to correct vesicovaginal fistulas that occur as a complication of childbirth.
It was his experience with vesicovaginal fistulas that made Morgan believe going to Eritrea could make a difference to the large number of Eritrean women in need of vesicovaginal fistula surgery. Eritrea is an African nation near the Horn of Africa, bordering Ethiopia and the Red Sea.
“Childbirth is supposed to be a natural process and more women in the world, mostly in undeveloped countries, die from childbirth injuries than from all the gynecological cancers combined,” Morgan said.
In the last five years, Morgan has made eight two-week trips to Eritrea that have provided him numerous technical and technological challenges.
“The equipment when we first started going was pretty rudimentary, but we would bring our own things like suture material. You just have to learn how to operate without having all the conveniences common in the Western world like cauterization and suctioning,” he said.
In the time since Morgan has been visiting Eritrea, numerous medical improvements have been made, including a new hospital, Mendefera Referral Hospital, in the Eritrean highlands, where he currently works when in the country.
“During our initial visits, there were problems,” Morgan said. “The Eritreans have really worked to make changes and now have a new hospital, so things like running water are usually not a problem. Occasionally the electricity will go out.”
Morgan and colleagues also have a system in place to work efficiently with their Eritrean support staff.
“It still is not the same working environment as in the United States, but it is much better than it used to be and much cleaner,” Morgan said.
Because the technology that he is used to is not available and supplies are limited, Morgan has been forced to become faster in surgery and conscious of things like saving sutures.
“Although we have a bit finer technique, the Eritrean surgeons know how to conserve supplies and combining our two strengths together works well,” Morgan said.
Since many of Morgan’s patients do not speak English, translators and counselors try to inform patients about what is happening to them and what they might expect.
“We relate to the patients in more of a nonverbal way through expressions and certain simple phrases that we have learned,” he said.
Facing a language barrier, Morgan relies on more of an empathic bedside manner to comfort patients and gain their trust, which was new to many of his patients.
“The idea of someone being nice to them is a real change because, after getting a fistula, they are really left by themselves with little care. I think the patients definitely appreciate the display of caring and empathy,” Morgan said.
Mark A. Morgan, MD, and Samson Abay, MD, from Eritrea.
Source: MA Morgan
When Morgan first started visiting Eritrea he and his colleagues would see 75 to 100 patients, though in later trips the numbers have dropped to about 40 or 50 women.
“The decrease in patients comes from the training we [the visiting doctors] have provided to the local doctors in performing fistula surgery as well as from the development of hospital postoperative care and counseling programs,” Morgan said.
Since local doctors have learned to perform the needed fistula surgery, the problem is not educating doctors so much as not having enough doctors to educate.
“The whole staff is a really good unit, but the problem is a lack of manpower. People may say, ‘go over to Eritrea and teach them how to perform the surgery,’ but there are not that many people to teach,” Morgan said.
Morgan thinks for the near future many sub-Saharan African countries will need doctors to come over and assist because properly trained medical staff are needed.
Though his work in Eritrea is hard and he is often exhausted when he returns home, Morgan said that the doctors in Eritrea have it far worse than he does.
“One of the doctors that I work with is an OB-GYN and covers a half million people. He basically works seven days a week, 24 hours a day and never has a day off,” Morgan said. “It is hard to feel sorry for yourself when you see the doctors there working that hard.”
Left to right: Mark A. Morgan, MD; Sofia Mahari, MD, American family practitioner of Eritrean origin; Scott Locke, MD, American obstetrician.gynecologist from Standford Eritrean Women’s Project; Melanie Santos, MD, obstetrician/gynecologist resident from Stanford; Habte Melecot, Eritrean obstetrician/gynecologist and trauma surgeon.
Source: MA Morgan
Even though a great deal of his time is spent in surgery, Morgan has had the opportunity to examine the Eritrean culture.
“It is a varied culture and they have at least eight different ethnic groups and different spoken languages, including Tigrinya and Arabic,” Morgan said.
Morgan seemed refreshed by the country’s low crime despite its economic troubles and constant tensions of war with neighboring Ethiopia. Violent crime, Morgan said, is almost unheard of in the country.
When Morgan accidently left $500 in the pocket of his pants and sent them to be cleaned, his money was returned within an hour of dropping off the pants.
“Five hundred dollars would be anywhere from between a year to two years salary for most of the people in Eritrea. They are honest even though they are in a bad situation politically and economically,” Morgan said.
Another time Morgan left an old pair of shoes in Eritrea that he only used when operating and was not going to use again. When he returned a year later to the town where he left them, the townspeople, thinking he forgot them, had the shoes there waiting for him.
“In America if you leave something in a major hotel and try to get it back it’s hard to do. In Eritrea, the people thought I left them. They kept them and made sure I got them when I came back. It is a small thing, but it is telling and says something about the people,” he said.
Morgan hopes to continue helping where his skills are needed for as long as he possibly can.
“If I finish up in Eritrea, I will probably go somewhere else to help. I am 52 years old now so I will be at it probably another 10 or 15 years,” Morgan said.
Morgan believes there is a lot that Western doctors can do to aid developing nations, but they have to find the specific need that a less developed country may have and try to fill it.
“This is where a person’s sense of satisfaction will come from, if they do a good job and provide people the help that they need,” Morgan said. – by Paul Burress