Kris Giacobbe noticed the toddler first. His name was Amboul. He was hard to miss in the halls of a busy Moroccan hospital, especially for a photographer like Giacobbe. His upturned face and inquisitive expressions were made for the camera. He had that spark of life. He was three years old and on an adventure. Amboul’s grandmother, sitting beside him, had no such glow. She knew what Amboul could not. He needed surgery, again.

In his short life, he’d been through a series of mistakes and botched procedures, and his kidneys were failing. During medical training at the hospital, Kris, her husband, Dean Giacobbe, MD, an anesthesiologist, and other Physicians for Peace medical educators saw many patients move ahead of Amboul. Amboul’s case was serious, but not serious enough, yet. The hospital couldn’t accommodate everyone. When Physicians for Peace left the hospital, after more than a week of training programs outside the scope of Amboul’s specific case, the boy and his grandmother were still seated in the hall, waiting, no closer to the promise of a healthy, normal life than they had been when they arrived after a seven-hour bus ride.

The memory is a knife in Giacobbe’s heart. Amboul isn’t the only child the world is failing. Two billion people in the world lack access to basic surgical care, according to the World Health Organization (WHO). The organization calls surgery the “most neglected” aspect of primary care – a critical piece of the global health puzzle that nonprofits and government agencies ignore or address superficially, with surgeons “dropping in” to perform one-time clinical procedures that local teams could manage year-round, with appropriate levels of education and support.

 

Learning Through Training

For more than two decades Physicians for Peace has been working alongside local surgical teams, providing much-needed training programs and educational tracks that ultimately lead to the best result of all: healthier patients. “The surgeons I’ve worked with are like sponges,” said Anthony Caldamone, MD, a pediatric urologist and longtime Physicians for Peace international medical educator. “It’s unbelievable. You do a six- or eight-hour operation and the whole (local) team is there watching you, the whole time. Every case becomes a teaching case.” Since 1989, the Physicians for Peace Specialized Surgery program has evolved dramatically – and it continues to be adapted to better suit the needs of partner sites in the developing world. Here are some recent highlights.

 

A Broad Scope of Specialties

In the early 2000s, Anthony Caldamone, MD, was shocked to meet Egyptian teens with bladder exstrophy. In the U.S., the condition – where the bladder sticks out of the abdominal wall – is rare and treated within weeks of birth. The early intervention prevents a lifetime of physical and emotional suffering. But the unlucky teens Caldamone met were struggling with the disorder and had been for years, sinking into cycles of poverty, sickness and isolation. “Because of the condition, the teenagers were incontinent, wet all of the time,” Caldamone said. “This kept them out of school. It kept them from getting married. It was absolutely unfair. I saw children who had gone through multiple failed surgeries. You hardly ever see that in the U.S. because we have so many trained pediatric urologists.”

Egypt had a base of adult urologists and surgeons, including healthcare professionals at Physicians for Peace partner hospitals, but at that time the country had no foundation for pediatric urology, a specialty that requires considerable reconstructive skill. Today, the Children’s Hospital at Cairo University, a Physicians for Peace training site during Caldamone’s outreach, maintains an active pediatric urology unit.

In Ecuador, Physicians for Peace also works to refine and enhance surgical teams’ knowledge of specialized skills. Since 2009, Physicians for Peace, led by Jon Partington, MD, has provided local teams with hands-on training in neurosurgical and reconstructive surgeries at Luis Vernaza Hospital in Guayaquil, which provides care for half the adult population of Ecuador. Like Caldamone, Partington said in-country teams have the necessary talent and drive – but they lack proper resources and opportunities for education and training. “The hospital has excellent physicians and good diagnostics, though they lack much in the way of equipment and one-time use items in the OR that we take for granted in U.S. hospitals,” Partington said.

 

Meaningful Partnerships for Lasting Change

Regardless of the country, Physicians for Peace works to build lasting partnerships with in-country professionals, so that the exchange of information and ideas can continue long after any single workshop or conference has ended. To build skills, that continuity is crucial, Anthony Caldamone, MD said. “Each (training program) has to build on the one before it,” he explained. “In the long run, that model has a much better effect in terms of long-term gains for both the medical teams and the patients.” Focusing on the educational needs, rather than on direct clinical care, strengthens professional ties between in-country teams and Physicians for Peace medical educators. Whereas other models of aid can inadvertently encourage people to wait for foreign medical assistance, the Physicians for Peace approach empowers local hospitals and clinics to serve patients year-round with confidence. The strong peer-to-peer connections have been especially important to Caldamone, who stays in frequent contact with his colleagues abroad. “A part of me is still there,” he said. “Teaching in these countries taught me about that part of the world. Before, it was just another place that was struggling. Now, it’s a place where I have friends, colleagues.”