Starting in the 2017-18 school year, two Rush neurology residents will complete a one-month rotation in Zambia, Africa, each yearas part of a new elective rotation run by Dr. Igor Koralnik, chairperson of the Department of Neurological Sciences at Rush Medical College and chief of the Section of Neuroinfectious Diseases at Rush University Medical Center.
Before 2010, there was only one neurologist in all of Zambia, a nation the size of Texas. By contrast, Illinois has about 660 neurologists, according to Koralnik. “There’s an immense unmet need for neurologists” in Zambia, he says.
Koralnik, who joined Rush in 2016, brought the Zambia elective from his previous post at Harvard Medical College. There, he created a global neurology research program in Zambia.
“It is an incredible opportunity that I am really excited about,” says Dr. Jacob Manske, who is one of the first two Rush physicians selected for the program. “We become better doctors by exposing ourselves to different environments.”
Time in Zambia sharpens clinical skills
Koralnik and his team study central nervous system infections and new onset seizures in patients infected with HIV while In Zambia, a nation where HIV is widespread. His team also staffs a neurology outpatient clinic and teaches neurology to the clinic’s house staff. They have written the curriculum for the first neurology residency training program in Zambia.
Through these efforts, Koralnik hopes to build a self-sustaining program for teaching neurological medicine in Zambia that will better the country’s health system. “Certainly, it’s only the first step, but it makes a huge difference for the people who can get this care,” he says.
Residents will experience “totally different clinical settings,” Koralnik says. “There’s a different medical system. It’s resource-limited, so you have to rely more on your clinical skills” than high-tech equipment.
Residents treat disease previously only seen in books
A typical week may include “heartbreak such as helping a family cope with aphasia (loss of language skills) in the breadwinner who has suffered a stroke. There is the gratification of successfully treating someone with epilepsy who was initially felt to be ‘possessed by spirits’ and is subsequently able to return to work, according to the program director in Zambia.
Koralnik says that residents will see first-hand many medical conditions they’ve only studied here, including tetanus and cerebral malaria.
That’s what Dr. Fabian Sierra-Morales found when he spent this February in Zambia on an elective part of a fellowship in neuroimmunology. “I saw a lot of meningitis, tuberculosis,” he says. “It’s good that you have that experience. You get to see a lot of patients with a lot of diseases ... you have the opportunity to help them and you have the opportunity to change the ways that they can survive.”
‘I hope to come back to Rush a stronger neurologist’
Others at Rush are eager to follow in Sierra-Morales’s footsteps.
“I am so excited and honored to be part of the first group of residents from Rush” in the Zambia program, says Dr. Teresa Lee, who will join Manske in the first residency group. “This is an incredible opportunity that not many residency programs offer, and I am sure this will be one of the highlights of my residency.
“I hope to come back to Rush a stronger neurologist and to share my experiences there with the other residents and the department,” Lee says.
Adds Manske, “A large part of properly taking care (of patients) depends on your ability to connect with and understand them. Exposing yourself to different cultures is needed to develop these skills to better care for patients” in Chicago and anywhere.
Research done as part of the program is supported by grants from the National Institutes of Health, but donations are needed to help sustain the teaching program over the long term, Koralnik says.
An overview by Koralnik on the development of the Zambia program was part of Rush’s 2017 Global Health Week, where Rush’s worldwide programs — and the benefits such work brings to the greater world and back to Rush — were highlighted for the Rush community.
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