“The anatomy and physiology of patients don’t change across the world,” Phillip Brennan reflected on his time at Kibogora Hospital in Rwanda. “The main differences were the buildings and tools used to practice surgery.”

Published Mar 28th, 2019

By Lindsay Hughes
lahughes@health.southalabama.edu

“The anatomy and physiology of patients don’t change across the world,” Phillip Brennan reflected on his time at Kibogora Hospital in Rwanda. “The main differences were the buildings and tools used to practice surgery.”

Brennan, a fourth-year student at the University of South Alabama College of Medicine, recently returned from his first medical mission trip with the Christian Medical Ministry of South Alabama (CMMSA). “From operating on the smallest to the biggest cases, in poorly lit rooms with dull instruments to the most well-lit procedure rooms, to serving in virtually any role in the operating room,” he said, “I felt comfortable in the positions I was given responsibility and autonomy.”

No matter the setting or the patient, the goal of care is always the same, Brennan noted. “In Rwanda,” he said, “it is particularly striking that although they have a fraction of resources available to practice surgery compared to the U.S., the goal of care does not change – and that is to ensure the very best outcome for the patient.”

Brennan joined fellow medical students, resident physicians, attending physicians and other support personnel on the annual trip, started in 2011 by CMMSA and Dr. Carl Albertson, an orthopaedic surgeon from Fairhope, Ala., and his wife, Francie Albertson. The Albertsons now spend half of the year in Rwanda at Kibogora Hospital.

“Each year there are patient losses we know would be preventable in the States, and that is difficult,” said Dr. Keith Peevy, professor of neonatalogy at the USA College of Medicine and a neonatologist with USA Health. “But we also know that there would be more without the training and equipment and the ongoing, year-round collaboration we share with them; so we accept what we cannot change, but continue to look for ways to improve their delivery of care.”

Kibogora Hospital is a referral hospital for complex obstetrics patients from 12 health centers in the region. During the last seven years, through the addition of monitoring, I.V. pumps, CPAP and improved oxygen delivery, the mortality rate in the NICU has fallen in what is a high-risk delivery population.

Dr. Hannah Bahakel, a pediatric resident with USA Health who earned her medical degree from USA in 2017, rounded in the NICU alongside Dr. Peevy, local doctors and nurses. She was struck by the effects of nutrition on prenatal and antenatal development, as she saw several cases of protein calorie malnutrition not typically seen with proper maternal and prenatal care.

“I was amazed by how strong the Rwandan people are,” she said. “The mothers would walk to the hospital every day to see their babies, sometimes from hours away.”

Her husband, Dr. Cole Bahakel, a radiology resident with USA Health who earned his medical degree from USA in 2016, performed and interpreted radiographs and ultrasounds. He, too, saw patients who traveled far for care. “There were patients that would travel for days on foot with broken bones and festering wounds to be treated,” he said. “It was an incredible feeling to realize that although I didn’t know everything and I’m not yet an expert in my field, I was able to help some people that might have otherwise had a more difficult or prolonged illness.”

Dr. Anna Crutchfield participated in the Rwanda mission in 2016 as a USA medical student and knew she wanted to go back at some point. She is now in her third year of residency training in family medicine at the University of South Carolina/Palmetto Health in Columbia, S.C. This year Dr. Crutchfield was able to return to Kibogora Hospital – this time as an alumna and mentor to medical students she remembered as first-years when she was a senior. “It was great to see how they have progressed,” she said.

Dr. Crutchfield said she encourages every physician to go on at least one mission trip. She plans to return to Rwanda once again in two years, after completing her fellowship training. “It helps to give you a different perspective on the medical field and life in general. The experiences I had in Rwanda I will take with me forever,” she said.

David Mulkey, a fourth-year student at the USA College of Medicine, said being able to pray with patients and the relationships he built in Rwanda are what he will remember most from the trip. One of the most impactful experiences of the trip for him was sewing up the grandson of a surgeon who worked at Kibogora Hospital.

Mulkey will do his residency training in family medicine at the University of Tennessee at Chattanooga. However, his well-rounded medical education at USA gave him a solid background to work in a variety of specialties in Rwanda, including pediatrics, internal medicine, obstetrics and gynecology, and surgery. “USA prepared me exceedingly well with excellent pre-clinical instruction and amazing hands-on experience during my clinical years,” he said.

Dr. Peevy said the mission is a “two-way street” in which everyone learns from one another. The education shared among the mission participants and the local staff runs deeper than medical information; it is also a cultural exchange. “You cannot teach about other cultures from a distance,” he said. “Students, physicians, and other professionals, medical and non-medical, gain an understanding of life there that cannot be achieved without that experience.”

Several participants pointed to a special experience called “spiritual rounds,” in which some of the missionaries, with the help of local college students as translators, would walk around the wards and pray with patients who wanted to participate. “There were times when the entire ward would break out in song, which was an experience unlike anything you’d see in the States,” Dr. Cole Bahakel said.

Dr. Peevy said, “We are always astounded at the beauty of the country, the friendliness of the people, the gratitude that they display, and acceptance we receive as outsiders appearing for three weeks.”

He said each year he returns with a greater awareness of how he finds real peace as a Christian. “The trip is an opportunity to do some soul searching regarding priorities in life,” Dr. Peevy said. “Seeing people who have little in material means but deep faith in God challenges the believers on the trip to look inside themselves at what is important to them and why.”

Visit www.cmmsa.org to learn more about the Christian Medical Ministry of South Alabama.

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