referral hospital for the entire Lake Victoria region in Tanzania, and her team handled large caseloads of gynecological and fistula surgeries. Bugando had a 900-bed capacity, but she still operated with resource constraints. “Because I was still in the public sector, not much was different,” says McCarty. “There were more resources in terms of lab tests, diagnostics, and imaging than we had in Sengerema, but we were still using 1990s cooler packs to keep oxytocin and other medications cool.” In her last year with the program, she moved to Hubert Kairuki Memorial University Hospital in Dar es Salaam, Tanzania’s largest city of approximately 5 million. Although they had over 1,000 Tanzanian medical students, McCarty’s OB/GYN department consisted of only three part-time and three full-time faculty, including herself and the dean of the medical school. “That meant large pre-clinical class sizes of 200 and a serious shortage of clinical supervision,” she notes. Despite these challenges and a large caseload of rare procedures and complications like cesarean hysterectomies, McCarty affirms that teaching was one of the most rewarding aspects of her time in Tanzania. “It’s incredibly motivating to be involved with students who are so inquisitive and eager to learn.”
Cura Personalis in Conflict Zones Flying from Miami to Boston to begin his freshman year of high school, Aaron Epstein (MA’12, M’18) was on a plane headed towards New York City as the events of September 11, 2001, unfolded. This led him to pursue national security, studying international policy and economics in college, and working in the defense industry for a few years before completing Georgetown’s security studies master’s program. But he wanted to be more than “just a small cog in the machine.” Working in Lebanon, he saw victims of bombings and shootings. “You would put a tourniquet on someone and that would be a direct, tangible way of helping people. A simple medical intervention seemed more effective at changing hearts and minds than policy work.” So he completed his prerequisites and applied to the School of Medicine. In his first year of medical school, Epstein founded the Global Surgical and Medical Support Group (GSMSG) to provide high-quality medical personnel for humanitarian relief near front-line conflict areas. GSMSG teams offer the full spectrum of care, says Epstein, plus training for local medical professionals to respond to the brain drain often seen in conflict zones. Epstein cites the Jesuit value of cura personalis as a guiding principle for the group. “Georgetown emphasizes that you need to consider the whole patient and their environment,” he says. “So we think about social and cultural factors.” For example, part of the group’s work involves training local women in health care to
Epstein (right) founded the conflict-zone medical relief and training group in his first year of medical school at Georgetown.
increase women’s access to care, particularly in areas where cultural norms limit contact between men and women. GSMSG, which is almost entirely self-funded, has conducted 11 major trips and trained 900 health care providers, including 750 EMT-level medics and 150 physicians and surgeons. The group includes 800 military veterans—former army physician assistants, nurses, or other medical personnel. Although some humanitarian organizations have restrictions around volunteers who are former military members, GSMSG takes the opposite approach. “If you’re going to provide care in a war zone, it makes sense to bring the person who was deployed there for eight years and is comfortable with that operating environment,” Epstein says. And the group is efficient: “For every $50,000 we get in donations, we can do $3 million worth of surgery and training,” Epstein notes, citing minimal overhead. “Our people are volunteering, they have full-time jobs, and every dime goes directly towards the medical effort. Our ultimate aim is self-programmed obsolescence through training locals to become self-sufficient.” Epstein continues to run GSMSG during his surgery residency at the University of Buffalo. The group’s next trip will be to Iraqi Kurdistan, planned for November 2018, and will focus on building up local nurses and staff whose critical work is undervalued, says Epstein. “In the Middle East, many view doctors and surgeons with prestige but equate nursing and therapy with janitorial work,” he says. “We’ve seen the lack of nurses and staff be a huge driver of mortality and morbidity in conflict regions. All the surgery in the world does no good without post-operative or nursing care. The doctors may be good navigators, but if you don’t have people in the engine room, the ship isn’t moving.”
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