The Human Touch in Humanitarian Medical Work

MD Anderson Cancer Center
Date: 04/18/2011


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Lisa Garvin: Welcome to Cancer Newsline, a weekly podcast series from The University of Texas M.D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention providing the latest information on reducing your family's cancer risk. I'm your host, Lisa Garvin. Today, our guest is Mark Zafero. He is a fellow at the Head and Neck Surgery Department here at M.D. Anderson and he has been quite involved in some humanitarian medical work across the world, so that's what we'll be talking about today. Welcome, Mark and thank you for being with us.

Mark Zafero: Thank you for having me.

Lisa Garvin: Let's talk about--how did you get into humanitarian medical work?

Mark Zafero: I started doing medical humanitarian work--my first experience was when I was in college. I guess it's always been something that has been with me to reach out and help others. That's probably why I am in--the majority of the reason why I'm in medicine. And so when I was in high school I started thinking about that and just felt like I had this--this calling to do that and so I went to college and I started in pre-med and then also at the same time I started trying to get involved in some humanitarian activities and I--in college, I went to Mexico and Belize on--on medical trips with doctors who I identified during college who did this kind of work. And then I just continued to do it throughout medical school and residency.

Lisa Garvin: Now, you're an otolaryngologist which is of course--that's ear, nose and throat?

Mark Zafero: Correct. The official name of the specialty is otolaryngology head and neck surgery.

Lisa Garvin: Now, tell me about your--what was your first mission? I've--there were three missions I'm aware of in--to Tanzania, Honduras and Nigeria, which one would you like to talk about first?

Mark Zafero: I'd be happy to talk about any of them.

Lisa Garvin: Let's talk about Tanzania. Apparently, there is quite a prevalence of a certain disease called chronic suppurative otitis media. What is that?

Mark Zafero: Chronic suppurative otitis media is an ear condition that often develops in childhood. It can--it can also develop in later adulthood. It's usually associated with chronic ear infections where the ears drain and eventually because of the ear infections the children or adolescence, young adults, end up with chronic ear disease in the form of tympanic membrane perforations. They end up with problems hearing because of that and also chronically draining ears.

Lisa Garvin: I can imagine that being deaf in a third world country is no picnic. So actually, this surgery really helps them live the best quality of life that they can.

Mark Zafero: It can. I think you can do a lot of good work in otology that is ear surgery in the third world. I think you're somewhat limited by your resources depending on what environment you're in. You can do--you could do some good as far as helping with hearing and--and helping to eliminate the chronic ear drainage.

Lisa Garvin: And it sounds like--you were saying earlier that there are very few otolaryngologists in Tanzania.

Mark Zafero: There are--I think there are eight in the country of Tanzania. I think that Tanzania has 40 million people. With the island that we were or where we were is the island of Zanzibar, it's off the East Coast of Tanzania and there are about 1.1 million people on that island and there's one otolaryngologist.

Lisa Garvin: Describe your experience. You were there I guess with the Global ENT Outreach Group.

Mark Zafero: It was a combination between Global ENT Outreach and ENT UK which is a--a humanitarian organization that's based out of England and we are there for a week and we did about 40 ear surgeries. We probably saw about a hundred patients during that time and we did about 40 ear surgeries. We were able to organize the surgeries into a five-day course that we put on for 2 Tanzanian otolaryngologists, the one otolaryngologist who lives on the island of Zanzibar and another otolaryngologist who flew over from Dar es Salaam which is the capital of Tanzania and he participated in the course. Then we had some video capability where we hooked the microscopes up to a television and were able to train these two otolaryngologists in performing some pretty simple ear surgeries that they had not done before and they--they watched for the first day but even by the second day or so they we're able to begin to start participating in--and by the last day, they were really able to show that they were able to do these surgeries and we were doing more of the watching so that was--it was a good feeling.

Lisa Garvin: Was this the one where you actually the bulb burnt out in your microscope and there was not a replacement?

Mark Zafero: We did. We did. We had some technical difficulties. We--we had two microscopes and the bulb burned out on one of them. We didn't have an extra light bulb for that microscope so we had to use only one microscope for a day or day and a half and they were able to send the bulb over from the main land from Dar es Salaam. But in the meantime, we used a--had an old ophthalmologic microscope that was left by some Chinese ophthalmologist in the hospital and we--we were able to use it for ear surgery although it wasn't--wasn't ideal we were able to--to get it done for the day or so where we weren't able to use that second microscope.

Lisa Garvin: In America, doctors are used to having everything at their disposal and equipment and supplies, so it really is all about making do with that you have, correct?

Mark Zafero: It is. It is. We had several other instances where things like this have happened and issues that occur and the power going out and, you know, having to being into surgery, we had headlight or without running water sometimes it's--you have to be prepared for all that.

Lisa Garvin: Let's talk about Nigeria. From--from what I read about your work, this seemed to be one of the more challenging assignments that you had. What brought you to Nigeria?

Mark Zafero: I went to Nigeria with a general surgeon who was practicing general surgeon in Temple, Texas at that time. His name is Brian Camazine and I'd actually read an article about him in a magazine and was intrigued by the work he was doing in--in Nigeria. He has been going there over 20 years. He goes on a yearly basis and he stays for a month and he has actually founded his own organization called Earthwide Surgical Foundation and he brings his own medical supplies there to a very rural village in Nigeria it's called Ikot Ekpene. It's a very rural environment and they do have a hospital there but it's very basic. It was--it was definitely a great experience. It was challenging in a lot of ways. We stayed there for about two and a half weeks on that trip and I think we did about 120 surgeries.

Lisa Garvin: And what--what kinds of surgeries were you doing there in Nigeria?

Mark Zafero: Since Dr. Camazine is a general surgeon, we did a lot of general surgery and, you know, bowel, abdomen type of surgery. We also did some obstetrics. We did some C-sections and then we did some head and neck surgery as well probably about a quarter of the cases we did were head and neck surgeries most commonly thyroidectomies. There's a large population of patients there who have very large thyroid goiters which is related to the lack of iodine in their diet and these are--unlike any goiters that you would see in the United States. They are very large and they're--they are cosmetically unappealing and it carries certain stigma there in Africa as well as they can create some functional problems with swallowing and such. They're not--they're not hardly ever--or cancerous so it's a benign tumor or benign goiterous gland would probably be a better term for it. But they do can present significant cosmetic and functional issues for them. So we did a fair amount of those. We also operated on some tumors of the parotid gland and the mandible most likely these were benign as well but they were significantly disfiguring tumors.

Lisa Garvin: Let's talk about your relationship with the patients that you treat there. Obviously, it's quite different than--than treating somebody in a typical hospital or academic setting. What sort of satisfaction did you--did you derive from the relationship with these patients?

Mark Zafero: I think you can have the same sorts of experiences in the United States as you do in the third world it's just much more difficult. The reason is it's because the environment is so different. You don't--you don't have as much as far the technology and--and also quite honestly you're not quite as stressed and busy with the amount of work and red tape and paper work that you're able to just focus on the--the patient. You're able to sit down with them get to know them better and their family and their story. Also you rely a lot more on your physical examination because you don't have as much imaging and pathology and all the technology that we have here. It does bring you back to your physical exam skills, you do rely on physical exam skills or diagnosis and also, you know, the--I think the human touch is much more of a part of your exam and also just a part of your demeanor in the third world and even if you can't always cure a patient from whatever physical ailment they have. Just by being present with them, I think can do a lot of healing that way.

Lisa Garvin: And they were very thankful I'm sure.

Mark Zafero: Patients in the third world are always very grateful and--and often in the United States as well. But I think that the amount of difficulty that they have to go through to see a doctor, they're--they just express that gratefulness so much and it is very rewarding to--to hear that even if it's for selfish reason sometimes, you hear--you're--you're constantly aware of how--how appreciative they are and grateful they are for their care. They will literally, you know, walk for days to--to see a doctor even sometimes longer than that. They'll--they'll travel for weeks. They will sleep on the hospital floor with their family for days waiting for their surgery. Some of these environments, for instance in Nigeria, the hospital does not have any facilities for laundry or for food or anything these sorts so the family is responsible for all that. They have to pay a fee to the--certainly the doctors don't charge a fee but they have to pay. Sometimes they have to pay a fee to the hospital to use the--even basic facilities that we are using and then they have to have their own food that they bring with them or that they cook there and they also have to wash their own, you know, clothes and sheets and all that, you know, hospital gowns, bed sheets they, you know, they're outside in the--in the well, you know, washing their own clothes and sheets and such and so you do sense how much difficulty they have and how much work they go through in--in--in getting to see the doctor and also caring for their--themselves and their loved ones.

Lisa Garvin: Let's talk about cancer. It's probably very difficult to treat cancer in a humanitarian setting.

Mark Zafero: It--it can be very difficult because usually with the cancer operation, the surgery is more extensive so you have to be in an environment that is supportive for that and you have to be sure that these patients have the appropriate counseling and care and followup. You also have to be sure that you're operating on the correct patients. It's not beneficial to do an operation on a patient who for instance has incurable cancer or is gonna be--is going to be functionally devastated from their--from their operations. So you have to be very careful about which patients you operate on and with the lack of support in terms of ancillary services that we may have in the United States in that environment.

Lisa Garvin: Do you feel like these experiences have made you a better doctor and surgeon?

Mark Zafero: I definitely do feel that way. I--I think every time I participate in one of those humanitarian trips, I come back a better doctor and I think a lot of times I think I come back and then I get numb again to the--all the kind of frustrations and stress that we experience on a daily basis as physicians and so it's always hopeful to go back again to--and to be reminded of why we're--why we're doing what we're doing.

Lisa Garvin: Great. Thank you very much. If you have questions about anything you've heard today on Cancer Newsline, contact Ask MD Anderson at 1877-MDA-6789 or online at www.mdanderson.org/ask. Thank you listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.