Montana doctor works to restore lives, hope in Africa
By David Murray - December 24, 2014
It's fair to say a majority of Americans probably can't locate Sierra Leone on a world map.
Many may not even be sure upon which continent the country lies.
However, this small African nation and its people have become the driving passion of at least one native Montanan.
Dr. Scott Brown, 53, is an anesthesiologist who grew up in Havre and earned his pre-med degree at Carroll College. For the past 15 years, Brown has traveled the world, helping to deliver desperately needed health care services to medically underserved communities in Africa and Latin America.
But it was his love for the people and culture of Sierra Leone that led Brown to develop a U.S.-based charitable organization dedicated to building a self-sustaining medical community in the West African nation.
The group Brown co-founded in 2012 with American plastic surgeon, Kathrine Waldorf, is called Surg+Restore. Its ultimate goal is to establish a self-sustaining community of plastic and reconstructive surgeons in Sierra Leone. Surg+Restore sends trained North American volunteers to provide intensive training sessions and workshops. They work one-on-one with doctors, nurses, therapists and lab technicians.
"Our goal is not just to go there and do a bunch of surgeries," Brown said. "There are a lot of surgical foundations in the United States that do that. Our goal is to teach, and our hope is to tie our plastic surgery program to the medical school there so we can train more doctors in Sierra Leone in plastic surgery and anesthesia."
Sierra Leone is a nation of roughly 6 million people located near the equator on Africa's Atlantic coast. Slightly larger than West Virginia, Sierra Leone was once a center of learning on the African continent. However, decades of political instability have torn the country apart.
During an 11-year-long civil war (1991-2002) thousands of Sierra Leone's children were forced to fight in a war largely funded by the trade in blood diamonds. Atrocities were committed on both sides.
The country's already deficient infrastructure was decimated. An exodus of trained professionals deprived Sierra Leone of the expertise needed to rebuild. Today, the United Nations ranks Sierra Leone as having the world's 11th highest infant mortality rate. Two-thirds of the country's rural population lacks access to clean drinking water. Sierra Leone is frequently ranked among the world's 20 poorest countries.
"There are about 23 or 24 surgeons in the whole country," Brown said. "There's no plastic surgeon. There's one anesthesiologist."
Brown's dedication to the people of Sierra Leone began in 2007. During a trip to Ghana that year, Brown met Dr. Martyn Webster, president of the Scottish organization ReSurge/Africa. Webster invited Brown to accompany him on a mission to Sierra Leone the following year.
Though he already had extensive experience with the lack of medical services in developing countries, what Brown experienced in Sierra Leone shocked him.
Brown recalled that during his prior trips to other African nations, the hospitals there had at least the rudimentary drugs and equipment required to perform surgeries. Sierra Leone had none of it.
"When I was in Tanzania we had an anesthesia machine, we had halothane (a commonly used general anesthetic) and they had monitors that worked," he said. "In Sierra Leone, they didn't even have oxygen. There were no muscle relaxants, so I couldn't put tubes in people's throats. I didn't even have any morphine."
During one of the first surgeries he attended, Brown was forced to drip the powerful anesthetic propofol (the drug that killed Michael Jackson) into a squeeze bag attached to a laryngeal mask and just guess at how deeply a patient would be anesthetized. Despite his years of experience, Brown found he continually had to administer far more propofol than he would have expected.
"I was just blasting these people with propofol, and they were still moving," Brown said. "I was having to do four times the dose that I'd do in the United States." When he returned to Sierra Leone in 2009, Brown discovered the reason the propofol had seemed so ineffective was because it was being stored in a tin shed subjected to the equatorial heat.
"In Sierra Leone, it's between 90 and 120 degrees every day," he said. "The propofol I was using on this first trip was decomposed." Say "plastic surgery" in the United States and many people will immediately think of face lifts and tummy tucks. In Sierra Leone, plastic surgery — or more accurately "reconstructive surgery" — is about restoring a person's basic quality of life.
"Reconstructive surgery outside almost any developed country means burn care," Brown said. "It means operating on cleft lips and palates, machete injuries, crush injuries and skin grafts."
Children with cleft lips and palates throughout much of Africa suffer not only from their disability, but from commonly held superstitious beliefs about people with congenital deformities.
"Generally, they won't let those kids in school because they think they're a disruption," Brown said. "They're made fun of — if not beaten. Sometimes they take a kid who's born with a cleft lip or palate out into the bush and let the wild animals eat them. There's a lot of belief in witchcraft there. It's very, very prevalent, and they generally think these kids are witches."
This belief in witchcraft means doctors and nurses must be cautious when applying a new medical procedure or offering constructive advice. Brown said that even when confronted with blatantly harmful or bigoted practices, westerners must maintain a level of cultural sensitivity to the standing beliefs of the community.
"Especially in a superstitious culture like that, you have to be very, very careful to go into these villages and tell people 'what you're doing is wrong,'" he noted. "You run the risk that either they will not believe you, or they may even form a mob and may run you out of town or harm you."
"What we don't want is for anything to go wrong," Brown added. "Big, big surgeries we don't do, because as soon as something goes wrong, then the hospital gets a stigma. They may think that we are witches or that there are witches working there."
Wound care is also problematic. The people of Sierra Leone often work physically demanding and dangerous jobs and injuries are common. Medical care frequently requires several days journey over bad roads, and the moist jungle climate often plays havoc with the healing process.
"The rainy season there averages 29 inches of rain per month," Brown said. "These wounds never dry, and they get these huge ulcers. I never would have imagined that healthy 20-year-olds would come in with these big, gaping leg ulcers."
Despite the many challenges, over the past six years the doctors and nurses volunteering in Sierra Leone have made gradual progress.
"We've built a wing to the Holy Spirit Hospital in Makeni, and between Surg+Restore and ReSurge/Africa we've been able to provide training for two future surgeons and two anesthesiologists to serve there," Brown said.
But much of that progress came to a screeching halt with the outbreak of the Ebola hemorrhagic fever in May.
In July, one of Surg+Restore's nurses, Gabrielle Taurwillle, died of the disease. Brown and the other doctors of Surg+Restore were forced to leave Sierra Leone and have canceled all return trips to the country until the epidemic is fully contained.
To date, more than 6,000 Africans in West Africa have died from Ebola. The impact of the epidemic extends to all medical services in the region.
"Ebola, right now in sub-Saharan Africa, runs about a 60 to 80 percent mortality rate," Brown said. "Ten doctors in Sierra Leone have died from Ebola, and there aren't a lot of doctors to go around. In the Ebola unit in Freetown, I think there are only four nurses left. The rest of them have either died, or they were afraid and they ran away."
Still, Brown remains optimistic. Working from his office in Portland, Ore., Brown is now raising money and awareness about the plight of Sierra Leone and Surg+Restore's efforts to train doctors there. He said he hopes to return to West Africa to continue his work sometime next year.
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