In Namibia, perceptions about people living with disabilities keep that demographic unseen by the majority of the population Those perceptions also affect the way that the healthcare system offers treatment and rehabilitation to patients who suffer from injuries or illnesses that leave them disabled
But four physiatrists representing CMANA hope to change that
Mariam Zachary is a sports medicine physician at Mount Sinai in the Department of Rehab and Human Performance Zachary has been traveling on medical missions trips with CMANA to Namibia for several years Laurenie Louissaint, current sports medicine fellow and program director for the fellowship, trained at Mount Sinai with Zachary during her residency and joined the missions trip to Namibia in 2023 “Laurenie knew from the minute she met me as a medical student that she would be coming on these trips with me,” Zachary said
(Front row, left to right): Dr. Laurenie Louissant, Dr. Niña Tamayo, Dr. Jina Libby, and Dr. Youssef Saad meet with the deans of the school of medicine, physical therapy, and radiology in Namibia
The doctors were tasked with relieving pain by doing peripheral joint injections. Their popularity grew among the community as the week went on. Day one brought 180 people in for services. The next day and all the days following, 300 people were waiting to be seen when the doctors arrived
“Some of our colleagues who are primary care providers and also trained in sports medicine helped us do peripheral joint injections,” Zachary said. “But I guess it goes without saying that we weren't able to see 300 people every day ”
It was the inability to meet the overwhelming need of the Namibian people that sparked a conversation between Zachary and Louissant.
“It caused us to take a step back and let go of our hero complex and say, ‘What are we doing here if we’re walking away and there are still 100 people in pain?’ So, we spent the last two days with two house officers—or medical officers, they call them who are the residents in Namibia teaching them to do peripheral joint injections.
“And we decided that the real impact we could make would be training pain specialists in their country and they could do what we’re doing year-round, every year. So we came home with the mission to build an educational program,” Zachary said.
Zachary and Louissant soon connected with their colleague, Dr Niña Tamayo, a physiatrist who is involved with the International Rehab Forum (IRF) and global health initiatives.
“We started talking with her about our mission and our dream, and she just took it and ran. We had several meetings with Dr. Hague, who is the director of the IRF He gave us a ton of wisdom as to how he brought physiatry to different countries in Africa and around the world, the different programs that they've initiated, and what the need would be from both sides from our counterparts in Namibia and from us. So, Niña was tasked with going and doing a needs assessment,” Zachary said
Zachary was not able to attend the 2024 trip to Namibia, but Tamayo joined Louissant. A fourth doctor, Dr. Jina Libby, also traveled on this year’s trip. Libby, also passionate about global health and a missions
trip veteran, is a sports medicine fellow at NYU Langone Medical Center This initiative was coordinated under the guidance of Dr Youssef Saad, CMANA liaison in Namibia and head of surgical services in University of Namibia.
So while Tamayo was tasked with understanding the needs of Namibian physicians who treat patients with spinal cord injuries, Louissant and Libby worked together on the clinical side to see patients and provide interventional spine procedures
“Last year, we did more peripheral joint injections. And then this year, did mostly interventional spine, which is part of our training as interventional spine and sports medicine fellows. So, we ended up doing that Monday through Friday, and we also educated others as we worked whether it was interfaith nursing staff, the radiology technologist who was helping us with our procedures, or even getting to speak with the dean of the medical school,” Louissant said.
Even though Tamayo’s assignment was to find the champions of rehab medicine in Namibia, she realized she needed to take one step back First, she sought to understand how rehab medicine is practiced currently in the country
Tamayo found that a spinal cord injury unit did exist at the state hospital and an acute patient rehab unit exists at the private hospital. She learned everything she could about the doctors, therapists, settings, and protocols While many great things are happening in Namibian hospitals in these areas, huge disparities do exist between the public and private sectors, with many gaps in their offerings.
“They don't have any guidelines for rehab, except if you were in a motor vehicle accident and you have a spinal cord injury and you’re a state patient meaning you don’t have any insurance, you go to a unit in Central Hospital But if you have any other diagnosis—even a brain injury caused by a motor vehicle accident you don’t get rehab. At all.”
Tamayo struggled with this reality because in the States all needy patients receive rehab promptly But in Namibia, patients stay in the hospital until they are stabilized which could be for months on end and then are discharged home or receive end-of-life care.
But when Tamayo visited the private hospital, she was shocked at how different it was from the public setting. “It was like walking into a spa Their model is more similar to ours, and they already have it pretty well established They just need the education ”
Tamayo calls the contrast between the public and private hospitals “eyeopening” and a huge challenge in creating change in Namibia
“Where it was really lacking was the connection between private and public You can stay in the private hospital for as long as you have money, but the moment you run out of money, you will end up in the state hospital. And then if you don't meet their spinal cord injury criteria, you don't get rehab anyway,” Tamayo said.
The other impediment Tamayo observed was that they didn’t have the capacity to extend rehabilitation services to other diagnoses.
After meeting with the Namibian doctors, Tamayo was pleased that three of them were interested in going through the certification
that IRF offers to become the rehab medicine physicians of their country
The next step, however, is to sponsor an educational summit to introduce the concept of rehab medicine to the Namibian people.
“I realized we needed to show officers, nurses, medics, and others within the healthcare field in Namibia that there are people currently in their country using assistive devices or who have disabilities Part of my interview process was to ask everybody what their perceptions were of people with disabilities. And they are not seen; that's the general gist of what I got. So whenever there's a person in a wheelchair who's like rolling around in the grocery store, everybody's like, ‘Whoa, that's possible? That's insane! Like, how are you getting out? Or how can you drive?’ They have all of these questions that they don’t understand,” Tamayo said.
Right now, the educational summit is tentatively set for September and will have live and virtual portions. Tamayo is busy working with her Namibian counterparts and other rehab specialists from the U S and Europe to plan the agenda and book speakers and panelists The next steps will focus on determining exactly what type of education the Namibians need.
Tamayo is insistent, however, that for these efforts to succeed and produce lasting change, it begins and ends with the Namibian people.
“You know, we can go in there and tell them what to do, but if the desire to actually build a program isn't there from their standpoint, it’s not going to happen.”
The team had a chance to enjoy the beautiful country of Namibia
“I think all of our dreams is to build something there where they're not going to need us, and they can successfully run it,” Tamayo said
CMANA missions trips are always about offering education to the patients we treat, and our goal is to leave behind something that serves the people long after we’re gone. We aim for the new educational program to provide sustainability in a way that we’ve not yet done
An Interview with Mina Sawires, Missions Committee Co-Director
When Mina Sawires is not practicing dentistry in Dallas, Texas, he’s working part-time as codirector of CMANA’s Missions Committee. His job is primarily logistical, helping to make sure missions trips launch and execute successfully. Another responsibility, though, requires longterm and big-picture thinking. Sawires is tasked with finding new areas where CMANA missionaries are needed.
We recently sat down with Mina Sawires to learn more about the latest CMANA initiatives and possible new service opportunities in the future.
Question: What’s the first step in starting a new initiative in a new country?
Sawires: We send a small exploratory group to a new country. On an exploratory trip, we are there to see what the infrastructure is like. We ask if the country and the local host can sustain and host a group of doctors coming from abroad. We ask what are their needs, and if we can help fill them or if it’s not a place for us to serve.
Question: Tell us about some of the recent new initiatives.
Sawires: One of the initiatives we started last year was in collaboration with the CMDA (Christian Medical and Dental Association).
We sent an exploratory team to North Macedonia for a medical education initiative. It was in collaboration with the Macedonian Medical School and the CMDA. So, we sent a small team—a physician, a resident, and two medical students—to give lectures and workshops at the Macedonia medical school and also learn from them about how they do things.
In this situation, my role was to meet with the CMDA leadership and the Macedonia medical leadership to figure out who we could send from our team to make an impact and give great feedback.
We sent a solid team, and they had a great time and great collaboration. They came back with so much positive feedback and things that we can do differently going forward. So, when we send the next team, we can be more prepared.
Macedonia is a location where we will be serving in the future.
CMANA’s team leads medical students at Macedonia Medical School in a suturing workshop.
Sawires: Also, here in the U.S., we had an initiative that was started with the internal medicine residency program at the UCLA Medical Center.
We've had a lot of meetings with the directors of the residency programs. They reached out to CMANA to see if we could take some of their residents on our mission trips. So we talked about the logistics and what that looks like.
So now at the UCLA Medical Center in the internal medicine residency program, they have CMANA’s mission trip schedule, and residents are able to go on our trips.
It’s good for us to collaborate with an academic program. It's also great for them to collaborate with our very diverse group of doctors who come from various backgrounds and experiences to see how things are done on the ground.
Question: Are there any long-term projects CMANA’s working on right now?
Sawires: Yes. I'm working on another international sustainable initiative. CMANA is building a dental hospital for patients with disabilities in Cairo, Egypt.
Because that is an area where there's a huge gap in dental care.
This was started [last year] and is in the beginning stages.
Question: Why are these new initiatives important for CMANA?
Sawires: Because part of our focus now is on training and collaboration.
We realize now that you go to a country for a week and do medical missions and it’s great.
But you still leave, and you leave a big gap. So, we wanted to create new initiatives to fill in those gaps.
CMANA’s team gives presentations to medical students at the Macedonia Medical School.
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Benjamin Franklin could have been talking about CMANA when he famously said, “An ounce of prevention is worth a pound of cure ” Investing in the long-term welfare of the people we serve is a primary aim of our organization We know that helping these people should go beyond treating their acute symptoms for one week. Helping them make sustainable changes now can have a positive impact on their health and livelihoods that will ripple through the next generations.
“My perspective on the CMANA trips is always about long-term sustainability. How do we educate and further elevate local people in the work that they're doing to take care of their communities?” Maryann Salib, a Philadelphia-based physician, said
With a specialty in general preventative medicine and public health, Salib works for a Christian clinic at home Her background and training equipped her to lead a team to Bolivia last year to deliver health education
“How do we turn this one-week trip into something that lasts beyond us? For those that we are serving, we don’t want to just go and put a bandage on a wound. We want to actually try to create support systems and education that can last beyond our one week.”
A primary way to achieve this is through partnering with the locals we serve In Bolivia, Salib and her team worked alongside local medical students and dentists for some of the medical campaigns While patients were waiting to be seen, the Bolivian medical students taught the patients using some posters they had prepared about various health topics.
“The American clinicians were able to do the treatment and diagnosis, and then the students were able to do some education. So I thought that worked well.
“Another thing we tried to do was start to develop some system of documentation [for patient care] so that the next team could see our notes and give follow-up care for patients with more continuity, rather than starting from scratch. We wanted the next team which happened to be coming in a month to see what we did and be able to build on it. This is especially important for chronic diseases like hypertension,” Salib said.
Helping affect change in any community, though, begins with its members. CMANA is committed to bringing education and training to the areas we serve, which is done best with the cooperation of the people who live there
This type of intervention lifts up communities, is culturally sensitive, and ultimately, is most effective for lasting positive results
So I think it really has to be the local people at the center of the work that we do.
“Something I've learned in my work here in Philadelphia is the importance of partnerships and partnering with those who know the community best and are closest to people So I really appreciate us being able to come alongside those who know the community much better than we do.”
A Bolivian dentist worked alongside our dentist, which was a positive arrangement. In what could be a potentially sensitive situation, our CMANA
teams want to provide further education and training if possible but not displace those who are already there Having a local dentist serve with our CMANA team was a mutually beneficial relationship
“I feel like health education can reduce the need for future treatment, but obviously, that's education that needs to be done over time in a culturally appropriate manner And so, that requires a lot of preparation and partnership with locals who know the culture best ”
Salib’s hope for the future involves more of the same: serving people through education so they are equipped to serve their communities. “Health education could look like us bringing tools that maybe they don't have access to, but letting them be the leaders they are We’d work alongside them, of course, maybe providing training that they then could offer to their communities So I think it really has to be the local people at the center of the work that we do ”
Bolivia: July 20-27 Registration is open.
Bolivia: August 24-31 Registration is open.
Specialties needed: primary care, internal medicine, pediatrics, dentistry, pharmacy, optometry, physical therapy
Botswana: First week of October TBD Exploratory First Mission!
Specialties needed: orthopedics, urogynecology, gynecology oncology, ophthalmology, anesthesia
Egypt: November Details and registration TBD
To ensure you are getting notifications for future trips, please email us at missions@cmanamerica.org
As the co-director of the Missions Committee, I often tell people my job is that of a talent scout I’m a networker and connector
Through my work, God puts me in touch with people who are great at what they do, and I give them the opportunities to do that in which they excel.
Establishing these new relationships between healthcare providers and the people who need their help is at the heart of all of our medical missions trips
I’m excited that this issue of our newsletter goes behind the scenes to give you more details about these connections being established and nurtured between CMANA and the people we serve
Another important piece of our work is educating ourselves about existing needs and gaps in healthcare To that end, we are always looking to expand our outreach into new countries Read excerpts from my interview on that topic on page 6
I know we all agree that it’s never good enough to simply deliver medical care to a group of people and then leave. It’s important to CMANA that when we arrive in a community, we not only deliver medical care, but we also commit to educating doctors
You’ll hear about efforts to provide resources and curriculum for doctors in Namibia You’ll also learn more about CMANA’s partnership with a medical school, which helps better educate American doctors and prepare them for medical missions.
Finally, I want to encourage you to join us for a medical missions trip! We have a unique opportunity to serve across the globe. While we bring healing to others, we essentially bring healing to ourselves.
Email us at missions@cmanamerica org for more information
—MINASAWIRES, CMANA Missions Committee Co-director