International Health Studies Grant 2014-15 in Action: Barriers to Surgical Access in Ethiopia

A Clinical and Research Experience

In October 2014, Nichole Starr – at the time, a 4th year medical student studying at the Boston University School of Medicine, received a grant from the Foundation’s International Health Studies Grant Program. Below is a synopsis of her international experience from Aug 25, 2014 to October 19, 2014.

Nicole Starr Ethiopia
The two months I spent volunteering at the Dessie Referral Hospital in the South Wollo Zone of Ethiopia presented me with many unique learning experiences. Dessie is a tertiary care center serving a catchment area of approximately 2 million people. While abroad, I also visited 21 primary healthcare sites which serve the same catchment area. I spent much of my time assisting midlevel and physician providers at town health centers and district hospitals, in clinical duties and research activities.

Global health priorities have evolved over the past several decades with greater public awareness of disparities in health outcomes between resource-rich and resource-poor nations. Recent estimates indicate that 11% of the global burden of disease could be treated with surgical intervention (Debas). It became clear to me during this trip that there is a shortage, at the district hospital level, to provide adequate surgical services in low and middle-income countries (LMICs) with equipment and trained personnel. I noticed how Ethiopia is particularly affected by these shortages. Other factors such as cultural, financial, and structural barriers impede the ability of patients to access the surgical services they need as well. 

Additionally I participated in the Lancet Commission for Global Surgery (a project aiming to characterize interfering obstacles to providing safe surgical care worldwide) by conducting provider interviews. My preceptor and I also participated in GlobalSurg, a worldwide study investigating the risk factors for morbidity and mortality in abdominal surgery worldwide. 

Aside from research initiatives, I was able to participate in clinical practice in Dessie Referral Hospital. Under the guidance of my preceptor, I assisted in both major and minor OR cases, attended referral clinic, made rounds on the wards for pre and postoperative patients, and attended teaching conferences with other students and faculty. 

Overall, this project was a blend of clinical and research experiences that enhanced my understanding of surgical care in LMICs as well as contribute to the medical community’s knowledge of barriers to accessing surgical care. As a future practitioner of academic global surgery, I valued the understanding I developed about the clinical context in which I will be working. I plan to contribute to the body of knowledge about global surgery, and create lasting partnerships.

- Nichole Starr, MPH, MD

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