Dr. Mary Arthur recently returned from a mission trip to Ghana sponsored by Internal Healthcare Volunteers (IHCV). In this Member Spotlight, she shares her commitment to medical education and clinical care programs worldwide, including her work on ASA's Committee on Global Health.
How did you first become interested in global health and come to work with IHCV in particular?
I have devoted most of my career to education in anesthesiology, and I figured it was time to transition the experience I had gained educating young anesthesiologists to anesthesia education worldwide. I have been volunteering my time teaching residents in other countries, including Ghana. My anesthesia journey began in Ghana, where I was born and raised. So when I was approached by the International Healthcare Volunteers (IHCV) to join their medical mission to Ghana, I signed on. I was particularly interested in IHCV since it focused on education and supporting local residency programs in Ghana.
Please share a bit of your experience in Ghana – the goals of the mission and its health impacts on local communities?
IHCV was established in 2001, providing direct patient care and continuing medical education to local healthcare providers in Ghana and Jamaica. IHCV has provided care to over fifteen thousand patients and performed over one thousand two hundred major surgeries in Ghana. Our multi-disciplinary team of surgeons, pediatricians, radiologists, internal medicine physicians, residents, medical students, one student nurse anesthetist, and myself, one lone anesthesiologist, embarked on our journey to Ghana on August 4, 2023. We provided care at the Cape Coast Teaching Hospital (Teaching) and surgeries at the Cape Coast Metropolitan Hospital (Metro), built in 1938 on the Atlantic coast. Metro, unfortunately, has seen no major renovations since it was built. My first task on arrival was to make a trip to the operating room (OR), take inventory of what I had available, and figure out how to make it work. The anesthesia machine had not been used in a very long time; we had no end-tidal CO2, and I was unsure if the CO2 absorber was functional. However, we made it work with the bare minimum.
A little global health trivia: Before patients are scheduled for surgery at Metro, family members must donate two units of blood.
Our surgical cases included hysterectomies, myomectomies for giant uterine fibroids, and thyroidectomies for equally large thyroids. Our first patient was a complex case. She arrived with a starting hemoglobin of 7 g/dl and a fibroid, which weighed over 33 lbs. and had kept her indoors for three years. She was one of a set of triplets. Her sisters did not have the money to send her to have the procedure done at the teaching hospital. While the patient wanted a hysterectomy, her sisters insisted on a myomectomy. The social effects of having to be seen with a huge abdomen clouded her judgment and decision-making. After a lengthy discussion with the patient and family, we agreed on a myomectomy, which required multiple whole-blood transfusions.
All the thyroid cases ended up being challenging airways. Luckily, my anesthesia tech from my home institution (Medical College of Georgia) gave me a McGrath video laryngoscope to carry with me since I would have no backup, and I am so glad I listened.
In addition to the surgeries, our group played a pivotal role in managing medical and pediatric cases while we were there. Some patients were seeing a doctor for the very first time in their lives. At Teaching, we joined the local teams on rounds and ran clinics. I participated in ICU rounds, gave lectures, and presented the local anesthesia team with a central line task trainer. At the same time, our radiologist organized an ultrasound workshop for the anesthesia providers. Our radiologist was the go-to person to interpret all scans and X-rays, teaching the physicians and the radiology techs. We encountered a patient in a thyroid storm who presented for thyroid surgery. After managing her symptoms, we provided medications to last her for a year. Hopefully, if she remains compliant, she will be on our schedule for next year.
You also serve on ASA's Committee on Global Health. What would you like ASA members to know about the Committee and its work?
I am in awe of the wonderful work being done worldwide by Committee members. Listening to their commitment and dedication makes you want to do more. The most relevant aspect of the Committee's work is enhancing anesthetic care worldwide by developing education and clinical care programs. The Committee has supported educational training programs in Tanzania, Ghana, Zambia, and Rwanda through its overseas training programs. The Rwanda and Guyana programs are still active.
The Global Scholars Program supports the professional development of young leaders in the specialty from low- and lower-middle-income countries and invites them to participate in the ASA annual meetings. The Committee also supports a scholarship program for U.S. anesthesiology residents to spend a month in a resource-poor setting where they have the opportunity to experience the challenges of delivering safe anesthesia in a low-resource, underserved area in a developing country as well as participate in the training and education of local anesthesia providers.
What's your advice for physicians who are interested in participating in medical missions (at home or abroad)? How do you suggest they go about getting involved?
I would say that participating in medical missions makes you a better anesthesiologist. It allows you to impart knowledge and learn from the local physicians. It also allows you to innovate and think on your feet. On several occasions, I have had to devise a solution for navigating something in the OR when we did not have a particular piece of equipment. I credit that ability to the things I've picked up on my missions. For those interested in participating in medical missions, a good starting point is going to the ASA charitable foundation's website. The site details the work of the Committee. You also get to explore what educational programs and medical missions are out there and see a list of all volunteer positions abroad, volunteer to work with organizations, and donate supplies to help underserved communities.
What have you learned from your on-the-ground work in global health that you think those who haven't been abroad in that capacity may be unaware of or misunderstand?
I want to reiterate what Dr. Hannenberg wrote about the Global Scholar's program in the 2016 issue of the ASA Monitor. Anesthesia providers in low-resource settings do not have the professional network of peers we take for granted. We can discuss a case with a colleague, email a former teacher, and connect through specialty societies and online discussion platforms. None of this is readily available to our peers in vast regions of the world, leading to professional isolation regarding access to knowledge and education. Every human being deserves safe anesthesia care. As leaders in the field of anesthesiology, we should make it our mission to bring the standard of anesthesia care to the point that every person in the world can leave home for a procedure and know that 95% of the time, they will return home safely to their loved ones. Unfortunately, that is not the case in many parts of the world.
Is there anything else you'd like to talk about that we haven't yet touched on?
I want to say that I feel very honored to be serving on the ASA's Committee on Global Health, where I get to interact with and learn from very accomplished global health leaders. I am also very grateful to the IHCV for the opportunity to contribute to anesthesia education in Ghana. It allowed me to work with dedicated health professionals who volunteered their time, expertise, and knowledge for the less fortunate in society. We had fun times, made new friends, and finished dancing the night away at our going away reception at a rooftop party thrown in our honor. The most memorable moment was when the regional minister hosted us at her official residence, thanked us for the care we gave her constituents, and implored us to return. Those two weeks providing anesthesia for patients who had been waiting years to get the care they needed and seeing the joy on the faces of the patients, physicians, and nurses tell the whole story. It was worth it. I stayed behind, vacationed with my family for a week, and returned well-rested and ready for interview season.
Mary Arthur, MD, FASA, is a professor and cardiothoracic anesthesiologist at the Medical College of Georgia (MCG), where she serves as the residency program director and vice chair for education. She earned her medical degree from the University of Ghana before immigrating to the United States to train at the University of Massachusetts Medical School. Dr. Arthur is a tireless advocate for diversity in the workplace and a strong proponent of global education, volunteering her time to teach residents and physicians in various countries. She is a member of the ASA's Committee on Global Health.
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