Residency and fellowship rotations extend training to Africa
By Omar Sofradzija
Fabian Sierra-Morales, MD, still remembers his welcome to Zambia moment.
It occurred when he started rounds at a hospital in Lusaka — the capital city of the landlocked country in southern Africa — this February as an elective part of a fellowship in neuroimmunology at Rush University Medical Center. Accustomed to private patient rooms in the United States, he found several dozen patients — many very ill — sharing a single, large hall.
“Wow, I’m not in America anymore,” Sierra-Morales recalls thinking at the time.
Sierra-Morales was just the first of an expected annual stream of doctors from Rush who will be bringing much-needed medical care to Zambia and bringing back lessons learned to Chicago as part of a new elective rotation run by Igor Koralnik, MD.
Koralnik, who joined Rush in 2016 as chairperson of the Department of Neurological Sciences at Rush Medical College and chief of the Section of Neuroinfectious Diseases, brought the Zambia elective from his previous post at Harvard Medical College. There, he created a global neurology research program in Zambia.
“Extending the clinical experience beyond the United States can help a lot in Africa,” Sierra-Morales says. “You can learn, and you can give to the community there.”
‘There’s an immense unmet need for neurologists’
Koralnik is working to better Zambia’s health system by building a self-sustaining program for teaching neurological medicine there. As part of that effort, starting in the 2017-18 school year, two Rush neurology residents will complete a one-month elective rotation there each year, bringing their skills to Africa.
“It is an incredible opportunity that I am really excited about. I think we’re very fortunate to have Dr. Koralnik at Rush because of his ability to provide opportunities like this,” says Jacob Manske, MD, who is one of the first two Rush physicians selected for the program. “We become better doctors by exposing ourselves to different environments.”
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.
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.
“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 said. “There’s a different medical system. It’s resource-limited, so you have to rely more on your clinical skills” than high-tech equipment.
Typical week includes ‘heartbreak ... and gratification’
An open letter written by program leaders said 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.”
“It will be immersive,” Koralnik says, adding that residents will see first-hand many medical conditions they’ve only studied here, including tetanus and cerebral malaria.
That’s what Sierra-Morales found. “I saw a lot of meningitis, tuberculosis,” he said. “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.”
Others at Rush are eager to follow in Sierra-Morales’s footsteps.
‘I hope to come back to Rush a stronger neurologist’
“I am so excited and honored to be part of the first group of residents from Rush” in the Zambia program, says Teresa Lee, MD, 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.
For more information about Rush’s global work, please contact the Office of Global Health at firstname.lastname@example.org.