UTHSC Extends Reach to Advance Health Equity Locally and Globally

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When surgeon Denis Foretia was growing up in Cameroon, he loved playing soccer. Every time he played, though, his knees would swell so badly it became difficult to walk.

“My mom took me to see one of the few doctors in the town of Buea, where I grew up,” he says. “It was there that I first met Dr. Sundjo Motaze, a brilliant and very well-dressed surgeon. I was very impressed by how he was able to treat me, but also frankly surprised at the very long lines of patients who waited for hours under the tropical sun for a consultation. This was my personal introduction to the world of medicine, and it piqued my curiosity enormously.”

Dr. Denis Foretia

Now an assistant professor of surgery at the University of Tennessee Health Science Center, Dr. Foretia holds an undergraduate degree from the University of Maryland Baltimore County, a medical degree from Vanderbilt University, and Master of Public Health and Master in Business Administration degrees from Johns Hopkins University. Still, he has not forgotten his childhood introduction to the realities of medicine in Cameroon, and he has made it his mission to improve treatment, research, and health outcomes in Africa.

“Growing up in Cameroon, a place where the hospitals do not really have much at all, and then training at a place like Vanderbilt and working at Hopkins, the discrepancy is huge regarding resources and what you can do and how the lack of resources affects the outcome and how it changes people’s lives,” Dr. Foretia says.

Dr. Foretia has joined other UTHSC faculty members with a similar desire to extend the university’s expertise and impact overseas and, at the same time, to bring back experience and knowledge to improve care at home.

From their passion, the UTHSC Center for Multicultural and Global Health (CMGH) was born. Its mission is to cultivate and leverage relationships with institutions locally, nationally, and globally to expand student, resident, and faculty access to multicultural health care delivery, address global health challenges, and train the next generation of global health leaders.

Dr. Foretia, second from left, operates at Soddo Christian Hospital in Ethiopia in 2016.

Dr. Foretia; Nia Zalamea, MD, an assistant professor of surgery; and Austin Dalgo, MD, an assistant professor of pediatrics and the director of the Center for Bioethics and Health Equity at Le Bonheur Children’s Hospital, are the architects and the foot soldiers, along with others, behind the center. All three are experienced at overseas health care work. Each has a deep dedication to improving delivery abroad and bringing lessons learned back home.

“The mission of the center is to advance equitable and sustainable health across Tennessee and the world through knowledge, partnership, and discovery,” says Dr. Dalgo, who has spent time during his medical career in Peru, Kenya, and Zambia. “I believe our center is poised to serve as a hub within the university that connects partners and our center to the real needs of the world.”

Dr. Dalgo believes embracing health care beyond the confines of the university and its immediate partners is the ticket to advancing health equity in Memphis and elsewhere.

“As I often say to my learners, most U.S.-trained health care providers understand the problems and diseases that face the 1 billion or so people living in high-income countries, but in our center, we are seeking to teach about and work alongside the other 6.5 billion,” he says. “I believe that our center will provide a forum for students and faculty to seek health equality through knowledge and experience, both locally and globally.”

Getting Started
On a past surgical mission in the Philippines: from left, Dr. Jeremiah Deneve; Dr. Jennifer Gordon, chief resident; and Dr. Martin Fleming.

The Center for Multicultural and Global Health was born from experience gained through another outreach organization at UTHSC, the Global Surgery Institute (GSI). Founded in 2018 in the College of Medicine, the GSI was designed to anchor and support surgical mission work that was already being done across specialties.

A survey done during the organizational phase of the Global Surgery Institute showed that approximately 20 surgical faculty members were providing 58 weeks of mission work each year around the globe on their own time, Dr. Zalamea says. The physicians, including Dr. Zalamea, were donating their surgical skills to help people in China, Vietnam, Honduras, Nicaragua, India and the Philippines, among many destinations. They included ophthalmologists, plastic surgeons, pediatric surgeons, pediatric cardiac surgeons, general surgeons, surgical oncologists and more.

That survey also showed 60 percent of incoming residents were interested in doing international work as part of their training, and 65 percent to 70 percent of medical students had already been involved in international work prior to residency.

“That’s a pretty moving statistic,” she says. “Not only do they want it, but they’ve already engaged in it.”

Dr. Nia Zalamea, left, with a coworker and a patient in the Philippines.

That didn’t surprise Dr. Zalamea, who is well acquainted with surgical work overseas. Prior to the pandemic, she had done medical mission work annually in the Philippines since 1999 with her father, a nurse anesthetist, and mother, a nurse, both of whom were born in that country and came to Memphis in the 1970s. The family founded the Memphis Mission of Mercy, a nonprofit to provide health care to their home country.

Dedication like this from her professors inspired medical students like Janyn Quiz, who grew up in the Philippines, to join the GSI.

“I’m really grateful for my country, and I want to give back to them as much as I can,” says Quiz, who graduated in May.

“It has been shown that, when folks go and train even two weeks abroad, especially at the residency level, it really fundamentally alters the way they deal with costs in a hospital,” Dr. Foretia says. Having seen and performed surgeries in places with a fraction of what is available in the U.S., physicians are inclined to be more conscious of costs, waste and impediments to care, he says.

Dr. Denis Foretia, third from right, and UTHSC physicians Drs. Austin Dalgo and Ken Busby, met with leaders of the Levy Mwanawasa University Teaching Hospital in Lusaka, Zambia, in August 2019.

Dr. Foretia traveled to Africa many times in recent years, until the global pandemic put that on hold. The most recent trips to Zambia helped. Drs. Foretia and Dalgo establish a partnership with Levy Mwanawasa Medical University in Lusaka, Zambia, that allows the institutions to collaborate in clinical care delivery; in teaching medical, nursing, pharmacy and other health care students; and in research. UTHSC has secured equipment to replace some outdated machinery in the hospital in Zambia, and while the affiliation agreement, initially set to last three years, does not involve a financial commitment, it is resulting in cooperation among students and faculty of both institutions.

A new effort, the Herbert Shainberg Scholars Program, will provide medical students with the opportunity to study at Ben-Gurion University of the Negev in Israel for four weeks. In exchange, Ben-Gurion University will send students to UTHSC for four weeks. This exchange will enable  UTHSC and Ben-Gurion students to study and learn about the multicultural context of health care in Israel and Memphis. Ben-Gurion University Medical School for International Health has extensive programming and opportunities, including work with the Bedouin community there, to facilitate learning the various cultural, ethnic, and religious aspects of providing care.

Outgrowing Its Roots

So many UTHSC faculty members and students are now interested in or involved in health outreach in the U.S. and abroad that it became clear the effort was bigger than the GSI.

Dr. Ken Busby taught neonatal resuscitation to medical students in Zambia.

“Most of the work that is being done is not necessarily restricted to surgery or surgical subspecialties. It is all-encompassing, including global health in general in addition to surgical care, but it also includes the real need that we have across UTHSC to really better understand multicultural care delivery,” Dr. Foretia says.

As the new Center for Multicultural and Global Health moves forward, a steering committee of university leaders across UTHSC campuses is being formed, along with an advisory board of community leaders. New curricula are being added to better engage students and expose them to the multicultural aspects of health and delivery of care, as well as the global nature of health care.

Even COVID restrictions on travel have not stalled the mission.

“We have gone completely digital,” Dr. Foretia says. “And part of this digital transformation, which we believe is going to stay, is that we have increased our communication with our international partners. Our medical students and medical students in Zambia, for example, meet on a monthly basis to exchange ideas through a journal club.”

Plans for the Israel program are developing in order to be ready as travel as restrictions ease. International speakers have been brought in to exchange information virtually about COVID-19 response around the globe. The research collaboration with the medical university in Zambia is developing. And work in the Philippines continues long distance.

“The Philippines group has been super-active, though from a distance,” Dr. Zalamea says.

Since February 2020, the mission has distributed more than 80,000 N-95 masks to the Philippines, South Korea, and Italy. In Memphis, it also distributed more than 50,000 N-95 masks to Regional One Health, Baptist Memorial Health Care, Methodist Le Bonheur Health Care, local nursing homes and testing centers, as well as to schools in Bartlett, Millington, Frayser, Arlington, and Lakeland.

“The message we are trying to send is that, at UTHSC, we are really looking to leverage our expertise in providing care locally and internationally to inform how we better train medical students and residents coming out of our program,” Dr. Foretia says.

The center provides a home to faculty, residents, and students who want to address health equity locally and globally.

“The word ‘global’ can be a misnomer for both Global Surgery and Global Health,” Dr. Zalamea says. “At the end of the day, students and colleagues need to be able to find the folks doing work in Malawi, just as they need to be able to find the folks doing work in the Klondike Smokey City community in Memphis. The needs may be very different, or very similar, but at the end of the day, the more opportunities we give ourselves (as a UTHSC community) to do the work we are passionate about with regards to understanding the needs of the underserved and acting to address those needs, the better our community will become.”

Note: This story is published in the Spring issue of Our Tennessee magazine.