Published: April 2, 2015

Global otolaryngology education

I recently spent two months teaching ENT residents at a medical center in Tanzania. The experience was very rewarding, and you can imagine how nice it was to operate nearly every day, with no night call! No coding. No precertification issues for surgery. No struggles with getting insurance companies to approve a specific prescription or test.

By Gayle E. Woodson, MD, AAO-HNS/F President

Gayle E. Woodson, MD, AAO-HNS/F PresidentGayle E. Woodson, MD, AAO-HNS/F President

I recently spent two months teaching ENT residents at a medical center in Tanzania. The experience was very rewarding, and you can imagine how nice it was to operate nearly every day, with no night call! No coding. No precertification issues for surgery. No struggles with getting insurance companies to approve a specific prescription or test.

globeBut healthcare in Africa has its own special challenges! Can you imagine that I am actually waxing nostalgic over the EHR system I left in the U.S.? That same system into which I was dragged, kicking and screaming? There, as in most developing countries, the charts are handwritten on paper charts. It is SO difficult to keep track of a patient’s health history. Other problems: Patient needs a CT scan, but the nearest scanner is two hours away, and most families struggle to cover the cost, or cannot afford such testing at all. Sometimes a needed medication is not available, no matter how much money the patient can afford to pay. Patients frequently present with very late stage disease. And the saddest challenge is that time and resources are not adequate to treat all the patients with severe problems.

In short, I have a more acute appreciation of healthcare in our country. This is despite all those bureaucratic issues that cause us to depend so heavily on the advocacy work of your Academy.

But I have also become aware of the increasingly global availability of healthcare information. In the past we used to donate old textbooks and other outdated materials to developing countries. Now, physicians and students have nearly instantaneous access to a vast array of up-to-date information over the Internet. At this center, I have witnessed the positive effects of applying newer protocols and guidelines in the management of patients, particularly in the area of perinatal mortality. And in this ENT department, 20 medical students rotate through the clinic each month. Each morning, two students give a presentation on an assigned topic. And they do an amazing job of presenting up-to-date information from resources ranging from Wikipedia to PubMed. What they learn about airway management and tumor surveillance is important and potentially life-saving for their future patients. Cell phones and other wireless devices are so prolific in Africa! Even in remote areas with no electricity or running water, people have wireless modems and their devices are recharged by pedal-powered generators.

Currently Sonya Malekzadeh, MD, is leading a Task Force, in collaboration with ABOto, Association of Academic Departments of Otolaryngology (AADO),  Otolaryngology Program Directors Organization (OPDO), Society of University Otolaryngologists-Head and Neck Surgeons (SUO),  and specialty societies, to explore the feasibility of a standardized otolaryngology curriculum. You can be certain that if this effort succeeds, a valuable product will be accessed by residents and students throughout the world.

These rapid changes in global information exchange should give us pause to consider the role our Academy plays in otolaryngology care throughout the world. And the Ebola crisis has heightened our awareness that we are not isolated. We are increasingly interconnected, even to seemingly remote areas. Many of our Members generously donate time and effort to humanitarian outreach programs. We must also attend to the specific priorities of scholarly activities. International colleagues attend our meetings in greater numbers each year, enriching our conferences with fresh perspectives and taking new knowledge to their home countries. I am confident that our International Task Force will identify ways to strengthen the valuable role that our Academy plays in the care of otolaryngology patients worldwide.



More from April 2015 - Vol. 34 No. 03

Dr. Curotta, nurse, and a happy patient at Baucau, East Timor.
Australian otolaryngology outreachExpanded from the print edition
By John Curotta, FRACS, Director of the Department ENT Surgery, Head of the Discipline ENT Surgery, Sydney University, Australia, and Immediate Past President of ASOHNS Australian otolaryngologists provide clinic and surgical ENT services mainly to South Pacific island nations, to Papua New Guinea, and to Timor Leste. Our humanitarian missions are tasked to those with the least ability to access care and to training, mentoring, and supporting those who will continue their care when we leave. The islands in the South Pacific, while beautiful, are small, remote, and very dispersed—Tonga, Vanuatu, Cook Islands, Solomon Islands (Guadalcanal), Samoa, Tuvalu, and Kiribati are visited. Kiribati is halfway from Australia to Hawaii, and has only 100,000 people on 33 islands totalling 350 square miles land (about six times the size of the District of Columbia) dotted over 1.35 million sq. miles of ocean. So there is little movement within the country and major difficulties for teams to get there, then get around. Timor Leste (East Timor), with a population of 1.1 million, is one of the newest nations. It shares a border with Indonesia, population 250 million. Four out of five Timorese live on less than US $2 per day. At Independence 12 years ago there was one doctor and the remains of a couple of hospitals and 90 percent of the population was unable to read or write. This is already down to 50 percent and the Guido Valdares National Hospital is running well with a strong educational ethos. Our ENT team consists of a surgeon, anaesthesiologist, audiologist, and a nurse or sometimes a surgical resident. The standard tour is one week, with four to five trips to Timor each year. Microscopes have been prepositioned but all other special equipment and medications are taken in. The first day or two is clinical assessment, including audiology, and usually 50 to 150 patients are seen and about 20 offered surgery. Four to five mastoidectomies and eight to 12 myringoplasties are done. Reinforcing instruction and training of ear care nurses, supplying medications, and reminding these people in remote places that they are not forgotten probably give more benefit than our few surgeries can accomplish.
Whether physicians like it or not, politics play a significant role in healthcare. It is tempting to ignore this fact, but to do so is a disservice to our patients and our profession. Accepting and embracing the situation allows us the opportunity to ensure that the impact of legislative policies on our patients is understood and that the voice of the physician is heard. Go, team, go Though physicians are thought to be independent, in fact we work in teams on a daily basis. Whether we are in the operating room or the office, we work with the anesthesiologists, nurses, techs, medical assistants, and administrative staff to achieve the ultimate goal of high quality, efficient patient care. We could not achieve our goals if we were not working together in a concerted effort. When it comes to advocacy, however, physicians struggle with pulling together, especially when compared to groups such as the trial attorneys or various nonphysician providers. Also, politics is a numbers game, and success is often quantified by who can garner the most signatures, who can raise the most money, or who has the greatest number of supporters. To increase the impact of our specialty’s message, we need clout in the form of numbers. To do this, we need to increase Academy member involvement in our legislative and political programs. Members of Congress are increasingly savvy at deciphering the number of otolaryngologists (constituents) represented by a particular initiative. So, every person who gets involved in AAO-HNS’ respective legislative or political programs ultimately helps us to achieve our goals. This “head count” is very important! Look for ways to participate in legislative and political advocacy, and show Members of Congress that all otolaryngologists are interested in protecting high-quality patient care. No ‘i’ in team Life teaches us that one-to-one interactions make the greatest impressions. By reaching out to a Member of Congress, we have the opportunity to make our message personal. There is also the opportunity to educate. Physicians have the best perspective of the impact governmental policy has on the delivery of healthcare. Our patients may feel the effects, but in most cases, they are not aware of the policies that lead to those outcomes. And though they vote on the policies, most Members of Congress are not intimately aware of the impact those policies have on patients and the practice of medicine. As physicians, we are the bridge between our patients and our legislators, and we owe it to our patients to advocate for their care. Fortunately, through the In-district Grassroots Outreach (I-GO) program, the Academy has staff dedicated to assisting otolaryngologists with arranging individualized interactions. These events can be tailored to each member’s comfort level and range from one-to-one meetings, practice visits, fundraising events, or larger town hall events. There is no “I” in team, but there is an “I” in I-GO! So, the answer to the question whether advocacy is an individual or team sport is … YES. By combining efforts on an individual basis that make our message personal with a collective voice to make sure we are heard, we can achieve our advocacy and patient care goals. *Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the American Academy of Otolaryngology-Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections. All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law requires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.