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.
