Go Doc Go: Doctors Doing Good | Medical | Hudson Valley | Hudson Valley; Chronogram
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Go Doc Go: Doctors Doing Good 

click to enlarge ANNIE INTERNICOLA
  • Annie Internicola

In the mountain-ringed terrain of Gondar, Ethiopia—a once-royal city known for its medieval castle ruins—malaria is not a problem. But a lot of other things can go wrong when you're practicing medicine in the far reaches of northeast Africa. The power might go out while a patient is having cryosurgery. Rats might eat the electrical wires on the LEEP machine that cost $10,000. A CO2 tank that's the size of a warhead, borrowed from a local brewery, could just decide to stop working one day, bringing the surgical schedule to a halt. For Maggie Carpenter, MD—a New Paltz–based family-practice physician with a side career in international medicine—those are just a few of the snafus that she has encountered while launching the first cervical cancer screening and treatment program at University of Gondar Hospital.

But none of that will stop Go Doc Go, a homespun, nongovernmental medical nonprofit that Carpenter created out of her calling to make a difference for women's health in parts of the world that need it most. Since high school, Carpenter has felt the urge to volunteer and find ways to improve people's lives. So when a colleague in Seattle asked if she'd like to go to Ethiopia to broker a contract that would bring US medical residents there, she didn't hesitate—and even paid her own way for a visit in 2011. Once there, Carpenter found there was more to be done beyond her original mission. "On a tour of the hospital," she recalls, "a doctor took me to the pathology department, and I said, 'Oh, this is where you do Pap smears.' He said, 'We don't do Pap smears.' I said, 'Really? What do you do for cervical cancer?' He said, 'We don't do anything.'"

That got Carpenter's wheels turning: When she got back from Ethiopia, she started researching what was being done in other low socioeconomic countries that don't have the resources or facilities for more extensive pathology. "I found that the World Health Organization [WHO] had already come out with a method called VIA, which is "visual inspection by acetic acid"—a see-and-treat method where you put basic store-bought vinegar on the cervix [abnormal tissue appears white when exposed to vinegar], and you just treat the patient right there. It's as good as the Pap, or better." An action plan in place, Carpenter just needed to find a way to get back to Ethiopia with some medical supplies and expensive machinery in tow. So she launched Go Doc Go as a grassroots nonprofit 501c3, and got to work fundraising. The first efforts were slow—it took three and a half years to gather the money for travel, machinery, and supplies through her network of family, alumni, friends, and friends of friends. Finally, Go Doc Go gained momentum, and in October 2014 Carpenter was ready to help the medieval city of Gondar step more firmly into 21st-century cancer care and prevention.

Trials & Tribulations of a Globetrotting MD

Many medical facilities around the world could benefit from the work of do-good doctors—and thankfully, we have some powerhouse international organizations to make that happen. But joining a large, worldwide establishment like Doctors Without Borders is a big commitment: Physicians have to quit their job and devote six months of their lives or more to a project. Carpenter also considered the "volunteer vacation" route, but paying $10,000 of her own money for a week or two practicing medicine in another country wasn't that appealing, and wouldn't necessarily make a long-term difference. In creating her own organization, Carpenter could focus on generating sustainable women's health programs—and still keep her day job at home.

While other international aid groups have built birthing centers and fistula repair clinics, "Cervical cancer has been kind of left out," says Carpenter. "They have a lot of HPV [human papillomavirus] there," she says of Ethiopia, which is similar to the US in the prevalence of the sexually transmitted virus that's responsible for virtually all cervical cancer cases. And while cervical cancer is one of the most treatable forms of cancer in Western countries (here, the problem is overscreening), it claims about 53,000 women's lives each year in sub-Saharan Africa, according to WHO. (A vaccine for HPV, now recommended in the US for preteen girls and boys, would be cost-prohibitive in a country like Ethiopia—and it might not be all that effective anyway, since it doesn't cover all types of HPV.)

Part of what makes Go Doc Go sustainable is that Carpenter isn't doing all of the work herself. Ingrid Frengle-Burke, a High Falls-based family nurse practitioner and Go Doc Go's assistant director, traveled to Ethiopia with Carpenter on the project's maiden trip in October 2014. Once they arrived, they met another American doctor, Kristin Austin, from Seattle, who had recently come to Gondar and was wondering how to spend her year; the cervical cancer project was something she could sink her teeth into. On that first trip, Carpenter and Frengle-Burke trained 17 medical providers in how to use the VIA method and how to treat abnormal tissue with one of two procedures: cryosurgery (or cryo), which involves using liquid nitrogen to freeze the cervix and kill the virus, or LEEP (loop electrosurgical excision procedure), which uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. For severe cases, a hysterectomy would be necessary. Once the program was up and running, it wasn't long before word spread and Ethiopian women were traveling to Gondar, sometimes from distances of 200 to 400 miles, for treatment. Fingers crossed there would be no power outages, wire-eating rats, or malfunctioning CO2 tanks to turn them away.

A Win for Women's Health

Fast forward to October 2015, when Carpenter and Frengle-Burke returned to Ethiopia to check on the program, bring supplies, and meet with Ethiopia's Ministry of Health to discuss future projects. In the year that had passed, the Gondar hospital had screened over 1,000 women, treated over 400 with either cryo or LEEP, and performed 30–40 hysterectomies. (Normally, the cancer rate would have been 25–30 percent, says Carpenter, but many women had already been screened and referred by small local clinics.) The program was a success, but challenges still arose—such as the problem of keeping stocked with supplies, since shipping to Ethiopia is so difficult. (When Carpenter and Frengle-Burke arrived, supplies had run out and the program had a waiting list.) And transportation issues meant that follow-up with patients was basically nonexistent.

Whether at home or abroad, making a difference with medicine for underserved populations has its obstacles. In the US, the hurdles come mainly from bureaucracy, says Carpenter; in Ethiopia, it's infrastructure—basic, everyday things that we in the West take for granted, like electricity and cars. Both she and Frengle-Burke work with high-need populations at their day jobs at home: Carpenter has launched a house-call service for elderly and hospice patients on Medicaid, spending her days driving around Ulster County visiting housebound and disabled people, while Frengle-Burke works at the Greater Hudson Valley Family Health Center, a community health and urgent care clinic in Newburgh. "It's a lot easier to make changes [in Africa]," says Frengle-Burke. "They have so many needs there, and we can make much more of an impact doing what we do." Collaborating with doctors in Gondar, she was struck by their work ethic. "The physicians there don't have the same lifestyle or salaries as they do here, though they have the same hours," she says. "It's impressive to see them working so hard. They're not living large."

The differences in lifestyle appeared even more stark through the eyes of their children: On Go Doc Go's first trip to Gondar in 2014, Carpenter brought her 14-year-old son, Julian, and Frengle-Burke took her 12-year-old daughter, Amelia. The two kids had the chance to spend a day at a local school and even teach an English lesson; they also visited a few families' homes. "One of my favorite things was watching [Amelia] see how people could live with so few material belongings, yet also be incredibly happy. The [Ethiopian] children were running around and smiling," says Frengle-Burke. Of course, not everything was rosy: Amelia also visited a fistula repair clinic, where teen and preteen girls like herself were being treated for the complications of delivering babies before they were fully grown, leading to obstructions and injuries that left them incontinent, and often ostracized from their families and communities that had rejected them. "It was intense to have my daughter see that, but also pretty amazing for her to learn about relevant and substantial problems that kids don't often think about when they're 12 or 13." (After the trip, says their mothers, both Julian and Amelia have an intense desire to see the world—and the more exotic the destination, the better.)

Code Blue for American Medicine

For Carpenter, working in Africa underscores not just the advancements but also the shortcomings of our country's healthcare system—its bloated, wasteful spending; its tendency to overscreen and overtreat patients; and its insistence on keeping sick people alive through any means necessary, even when quality of life has gone out the window. "There is no way that our current system can handle our model of overtreatment," she says. "What I have a hard time with is not just the money being spent, but the agony that people go through in their later years here, in the false belief or hope that they need just one more treatment or one more medication. What are we doing to our elderly? We're pumping them up with more and more medications. It's frightening." In her palliative care house-call practice, called Nightingale Medical, Carpenter helps housebound patients edit down their list of unnecessary pharmaceuticals, keeping only those that will improve their daily life. She's seen about 150 patients in less than two years, logging hundreds of miles in her Volkswagen Jetta—and likely saving Medicaid thousands of dollars by reducing hospital visits and fall risks for her elderly and hospice patients. "I'm hoping to get a coalition of people together in Ulster and Dutchess County to get funding so I can expand [the program]," says Carpenter. "My goal is to reproduce it as a model that can be used in lots of different places."

Go Doc Go, meanwhile, has gained supporters and is off and running. The Gondar program is saving the lives of women every day, and a similar program is in the works for two sites in Senegal and possibly a site in Cameroon as well. Money is still needed, of course, and Carpenter's goal is to build the organization's base so it can send volunteers out to field projects every six months or so. And while it's not easy work, it feels great to be able to do it, says Frengle-Burke, who plans to return to Ethiopia this summer. Adds Carpenter, "In modern medicine, it isn't so obvious how much good one is sometimes doing. This kind of work is so needed and so rewarding."

RESOURCES

Go Doc Go Godocgo.org

Nightingale Medical Nightingalemedical.org

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