EXTENDING HELP IN TANZANIA

Dartmouth Health team makes an impact

In August 2024, Dartmouth Hitchcock Medical Center plastic surgeon John Nigriny, MD, DMD and his colleague Aaron Grand, MD, a plastic surgeon specializing in Hand Surgery and affiliated with the University of Pittsburgh Medical Center, were invited to lead a medical team to Dar es Salaam, Tanzania. The project was sponsored by ReSurge International, a nonprofit international humanitarian aid organization committed to providing reconstructive surgical care in developing countries worldwide. Nigriny practices Plastic and Reconstructive surgery and specializes in complex reconstruction, and he has made similar trips with ReSurge in the past dating back to 2003. For this project there was capacity to include more surgeons and a request for hand therapy, and without hesitation he invited Dartmouth Hitchcock Medical Center orthopaedic surgeon Lance Warhold, MD, FAAOS, a hand surgery specialist, and Alison Sanborn, MS, OTR/L, CHT, an occupational therapist, on what would be their first international medical trip.

“My time with the ReSurge team helped me see that there is so much good we can and should be doing,” Sanborn says. “We have the chance to share the culture and impact of Dartmouth Health abroad, and this is a net positive for all involved. The ReSurge model of providing education with the expectation that it will be paid forward to future clinicians is an important concept.”

Patients were seen at Muhimbili National Hospital in Dar es Salaam. Access to surgical specialists is severely limited in Tanzania, and patients in need were encouraged to attend the surgical clinic by their local doctors as well as through national TV and radio spots. Nigriny and Warhold saw patients that may have traveled days to meet with them, some coming on foot, by train, by bicycle and car for the chance to be assessed by the surgical and therapy teams.

Dozens of patients were screened in the hand section alone, and many more were evaluated for head and neck or maxillofacial reconstruction needs both in the clinic and hospital wards. The team of American surgeons provided direct supervision and education to 46 residents, fellows and attending surgeons, as well as operating room nurses, scrub technicians and anesthesiologists. Sanborn provided education to 10 physical and occupational therapists, two occupational therapy students, rehabilitation support staff, as well as doctors and nurses.

As representatives of Dartmouth Health, Nigriny, Warhold and Sanborn performed surgery and therapy, but they also provided essential expertise and mentorship, helping local healthcare professionals gain valuable insights and skills into plastic surgery, hand surgery, and physical and occupational therapy. They were praised by ReSurge for making a significant impact in both patient care and the education of Tanzanian clinicians.

Sanborn served in the capacity of educating physical and occupational therapists and training therapists in new orthosis fabrication techniques, as well as developing a program to address the many burn patients the hospital treats. Sanborn and Warhold also modeled for their Tanzanian peers how hand surgery and therapy are inextricably linked.

As a result of these efforts, ReSurge has extended an offer to continue working with Dartmouth Health on future trips and educational endeavors. Both the Orthopaedic and Plastic Surgery departments in Dar es Salaam have expressed strong interest in establishing a formal, ongoing virtual education program.

ReSurge International has invited Warhold back to Muhimbili National Hospital this spring to provide continuing care for some of the patients he treated in August. "I personally gained more from my experience than I could give in return," he says. "I still have more to offer."