Mayo Clinic staff share their medical expertise around the world
Have medical expertise, will travel
The Mayo Clinic Global Health Program is empowering staff to share their clinical and research expertise with medically underserved areas in Asia, Africa and Latin America
As someone who grew up in the country of Georgia, Anna Mrelashvili, M.D. (PD ’12, PDN ’15), knew that pediatric care was severely lacking in certain parts of the country, which also had relatively high rates of neonatal mortality. So in 2012, Dr. Mrelashvili led a group of Mayo Clinic professionals to train Georgian colleagues in neonatal and critical care medicine. Mayo Clinic medical teams continued to visit three or four times a year, providing vital education on topics like newborn resuscitation, brain injury and infection prevention, and management of newborn heart disease.
Yves Ouellette, M.D., Ph.D. (PD ’02), Division of Pediatric Critical Care Medicine at Mayo Clinic in Minnesota, struck out on his own to establish relationships with physicians in children’s hospitals in Central and North Vietnam. He’s visited Vietnam about 40 times, teaching and mentoring local physicians, participating in patient rounds and collaborating on research.
In 2000, James Bower, M.D. (N ’95, MD ’96), chair of the Division of Movement Disorders at Mayo Clinic in Minnesota, learned that Ethiopia had just two neurologists in the entire country. He and other Mayo Clinic neurologists started taking annual trips to train physicians and worked with Ethiopian neurologist Guta Zenebe, M.D., to start the country’s first neurology program. Today, there are over 70 neurologists in Ethiopia.
Along with measurable health impacts, these trips resulted in a deep sense of professional satisfaction.
Watching the partnership between Georgian physicians and Mayo Clinic was “just the most fulfilling thing to see,” says Dr. Mrelashvili.
“Every time I travel to Vietnam I learn more about medicine and I am a better physician for it. It is rewarding to see others grow and get better at what they do,” says Dr. Ouellette.
“The week or two that I spent in Ethiopia every year were always my favorite weeks of the year,” says Dr. Bower. “I walk away with an incredibly refreshing perspective on why I went into medicine.”
These Mayo Clinic staff and alumni aren’t alone in their dedication to and appreciation for global health activities. For decades, Mayo Clinic consultants and allied health staff have traveled to underserved areas around the world to offer humanitarian support and medical expertise — on their own initiative.
But Mayo Clinic employees were unaware of colleagues doing similar work in similar locations, meaning these individual efforts could result in redundancies and feelings of isolation. Other Mayo Clinic employees were eager to take part in global health activities, but didn’t know where to start.
“People have been doing it pretty much independently,” says Dr. Bower. “Great work has been going on, but it’s all by individuals and no one was really talking to each other.”
That’s where the Mayo Clinic Global Health Program comes in.
Originally named Mayo Clinic Abroad when it was established in 2012, the program has since transitioned to Mayo Clinic International and been renamed the Mayo Clinic Global Health Program (MCGHP). Mayo Clinic International has enthusiastically supported the humanitarian work of MCGHP. They look at this work as an essential component of Mayo Clinic International’s desire to spread the knowledge of Mayo Clinic’s Model of Care across the world.
Dr. Bower is the medical director and chair of the Executive Committee for MCGHP, which has historically provided — and continues to provide — support for those engaged in independent global health activities. But it has recently shifted its focus to creating formal Mayo Clinic relationships at three medically underserved sites around the world: One in Asia, one in Africa and a future site in Latin America. Kumasi, Ghana, has been chosen as the African site, and the Asian project is underway in Da Nang, Vietnam.
At all three international sites, MCGHP will promote and develop programs that are sustainable, safe, and mutually beneficial for the host community and Mayo Clinic personnel. Rather than focusing on direct medical care, Mayo Clinic staff will provide medical education and research mentorship so that host communities become self-sufficient in delivering high-quality care.
“Our goal is to teach, not to practice,” says Dr. Bower. “The best thing we can offer is not to go in and practice for a week and then leave. It is to teach our colleagues how to improve their care for the local population.”
Learn more about how MCGHP supports independent work around the globe.
MCGHP offers practical support to employees who venture out on independent trips, such as a twice-yearly competitive scholarship for allied health employees. An annual Small Grants Program provides funds to support academic global health, such as sponsoring a speaker to visit one of Mayo Clinic’s campuses. Among many other efforts, these funds have helped allow Mayo Clinic staff to:
- Train local community members of Loja, Ecuador, to provide volunteer bereavement support.
- Fund simulation equipment used at annual emergency medicine conferences in Bolivia to teach skills such as airway intubation, cricothyroidotomy, ultrasound-guided central and peripheral line placement, and managing maternal obstetric emergencies.
- Assist in establishing a colorectal training pathway for surgeons at St. Paul’s Hospital in Ethiopia.
- Purchase educational resources to virtually teach and mentor medical students in Nigeria on the topic of chronic kidney disease.
DEEP ROOTS IN VIETNAM
MCGHP’s work in Vietnam builds on a long history of Mayo Clinic involvement in the area via Tri Dinh, M.D. (OBG ’11), chair of the Department of Medical and Surgical Gynecology at Mayo Clinic in Florida.
Dr. Dinh’s history in Da Nang extends all the way back to his birth. His father, Tung Van Dinh, M.D., a prominent obstetrician-gynecologist known as Dr. Tung, was the director of Da Nang General Hospital. But after the fall of Saigon to the North Vietnamese military in 1975, the family emigrated to Galveston, Texas. Dr. Dinh was just 8 years old at the time.
Dr. Tung continued to practice medicine in the U.S. after he was retrained and board certified in obstetrics-gynecology and pathology at the University of Texas Medical Branch (UTMB) at Galveston.
Despite the distance, Dr. Tung kept in touch with his Vietnamese trainees over the years. So when diplomatic relations between the U.S. and Vietnam were restored in 1995, Dr. Tung encouraged his UTMB colleagues to visit Vietnam and share their medical expertise with local physicians.
Dr. Dinh, by then a practicing physician at UTMB, was interested. He was curious about the country of his birth, which he hadn’t seen in 25 years. But he didn’t want to return as a tourist.
“I always thought that if I ever went to Vietnam, I would also do something good and make a difference,” he says. “I wanted to use my knowledge to help colleagues in Vietnam who probably did not have the same access to higher education.”
Tri Dinh, M.D., and Nguyen Thi Phuong Dung, M.D., a gynecologic oncologist at Da Nang Oncology Hospital. In July of 2017, Dr. Dinh and colleagues started a fellowship in gynecologic oncology in Da Nang, Vietnam, as part of the Global Curriculum of the International Gynecologic Cancer Society. Dr. Dung is a recent graduate of the fellowship.
Tri Dinh, M.D., in the courtyard at Da Nang General Hospital
So with his father’s encouragement and facilitated by his father’s connections, Dr. Dinh set out on a volunteer medical trip to Da Nang in 1999 with two UTMB physicians.
That trip turned out to be the start of a long, productive partnership with the city’s hospitals. Dr. Dinh has regularly returned with a team of physicians and other healthcare professionals, giving lectures, conducting research with Vietnamese colleagues and teaching local physicians how to better care for their patients. Medical teams also operate on select cases alongside Vietnamese colleagues, providing hands-on training and demonstrating new surgical techniques.
Eventually, Dr. Dinh formalized this work by incorporating as the nonprofit Project TVD in his father’s honor. Dr. Dinh is president of the nonprofit, which organizes trips for volunteer physicians and allied health providers to deliver direct patient care and medical education.
“We’re only there for a week. We want to teach some skills and pass along knowledge that will be lifelong,” says Dr. Dinh.
One example: Vietnam had no widespread systematic cervical cancer screening. As Dr. Dinh and colleagues approached this problem in the 2000s, they knew pap smears — with their need for laboratory work up and the possibility of multiple follow-up visits and tests before treatment — were too labor-intensive and costly to be a realistic solution.
Instead, Dr. Dinh and a few colleagues spent 4 days performing and teaching Vietnamese professionals to perform the less precise but simpler visual inspection with acetic acid (VIA) triage test. VIA produces results in about a minute, and concerning findings may be treated in the same visit. They worked with the local government health system to establish this method as a cervical screening system for the Da Nang metropolitan area.
While the work of Project TVD was powerful, it was also limited.
“We’ve been this little nonprofit. We go there, we do a little teaching, we do a couple of surgeries. Sometimes we do something big, but we’re just worker bees and we’ve been trying to figure out how to sort of take the next step,” says Dr. Dinh. “Mayo Clinic Global Health is a step.”
In September 2023, MCGHP signed a memorandum of understanding to collaborate with Da Nang hospitals. It was signed during a trip to Da Nang that included over 20 Mayo Clinic physicians from Minnesota, Florida and Arizona, encompassing 18 different departments and divisions.
CHANGES AND CHALLENGES
Today, Da Nang is the largest city in Central Vietnam, with a population of over one million. The hospital Dr. Dinh’s father worked for in the 1960s — Da Nang General Hospital — has expanded with the additions of Da Nang Oncology Hospital and Da Nang Hospital for Women and Children. (MCGHP signed a memorandum with all three hospitals.)
This rapid development is not limited to Da Nang. According to the World Bank Group, though Vietnam was one of the poorest nations in the world in the 1980s, it has since grown to become a lower middle-income country. Vietnam has made concurrent advances in healthcare and public health, but the U.S. Department of Commerce notes that current challenges include outdated and overcrowded hospitals, obsolete medical equipment, and overstretched and underpaid medical staff.
David Turay, M.D., Ph.D. (S ’20), Division of Trauma, Critical Care and General Surgery at Mayo Clinic in Minnesota, was one participant on the September 2023 trip to Da Nang. He saw medical teams deliver “amazing” care despite dated CT scanners, a patchwork of few ambulances and limited capacity.
“The hospital always seemed at maximum capacity. It wasn’t uncommon to see patients admitted in beds along hallways,” he says. “The ICU had a 40-bed capacity with 100% occupancy throughout the week I was there. Imagine the daunting responsibility of the one critical care physician and about six nursing staff on call per day trying to care for that volume of critically injured patients.”
Among other challenges, these conditions can make it difficult for physicians to keep up to date on medical advances.
“One need our Vietnamese colleagues expressed consistently was for more access to cutting-edge knowledge on management of trauma and other conditions. These healthcare professionals were so busy caring for patients that they didn’t have time or ready access to such information,” says Dr. Turay.
According to Dr. Dinh, another barrier to continuing medical education is cost — a $900 conference registration fee would be about equivalent to the monthly salary of a Vietnamese mid-level physician, he says.
“Here in the United States, if we want to do continuing medical education, it’s pretty easy. There’s a million courses. Mayo gives us time off. Mayo gives us a stipend to do it. We just go,” says Dr. Dinh. “For a physician in Vietnam, it’s not that easy.”
So when physicians travel to Vietnam to pass on their expertise, it is deeply appreciated — something Dr. Bower witnessed firsthand after giving neurosurgery lectures in Da Nang.
“They had a busy afternoon, so they had to stop what they were doing to have this opportunity for me to give these lectures,” says Dr. Bower. “But the enthusiasm is just hard to describe, the appreciation that we flew halfway across the world in order to teach.”
ANSWERING THE CALL
Today, many different Mayo Clinic departments and physicians have recognized the thirst for knowledge among their Vietnamese colleagues and are actively involved in providing education and partnering in research at the Da Nang sites, with visits staggered throughout the year.
For example, a cardiac electrophysiology team led by Christopher McLeod, M.B., Ch.B., Ph.D. (I ’07, CV ’10, CVEP ’11), Department of Cardiovascular Medicine at Mayo Clinic in Florida, has been traveling to Da Nang for several years to develop, teach and mentor a group of young, local cardiologists — focusing on arrhythmia ablation as well as pacemaker and defibrillator implantation. In addition, cardiac electrophysiologists and cardiac critical care cardiologists from Da Nang have completed observerships at Mayo Clinic in Florida.
As another example, Autumn Brogan, M.D. (EM ’13), Department of Emergency Medicine at Mayo Clinic in Rochester and Mayo Clinic Health System in Mankato, Minnesota, and director of Global Emergency Medicine in Rochester, worked with Da Nang General to organize the first emergency medicine conference in Da Nang. A team of physicians and allied health providers participated in lectures and hosted a procedural workshop in emergency skills. The team is also collaborating on research projects including ultrasound-guided IV placement, nursing educational tools and best practices in sepsis.
All these endeavors are meant to empower their Vietnamese colleagues.
“We want to train them and show them what’s possible at Mayo Clinic, but we don’t think that they should replicate Mayo Clinic or MD Anderson or Memorial Sloan in Vietnam,” says Dr. Dinh. “We want to arm them with the knowledge to build a Vietnamese model or find the Da Nang answer to their problems.”
LOOKING FORWARD
As MCGHP continues to develop its work in Vietnam and establish programs in Africa and Latin America, Dr. Bower hopes that more Mayo Clinic staff become interested in participating in global health efforts.
“We’re trying to give people an opportunity to show up,” says Dr. Bower. “I do see growing enthusiasm.”
The needs will be different in Kumasi, Ghana, where MCGHP will create its second site, with an expected first trip in the fall of 2025. Resources are more limited there than in Vietnam, but Dr. Dinh notes that in all locations, Mayo Clinic health professionals and their host country colleagues are bound by a common mission.
“The reason for going into medicine is pretty much the same throughout the world. The way we do things may be different, but at the heart of it, we’re all very similar,” says Dr. Dinh. “Vietnamese physicians want the best for their patients, just like we do.
Questions? Reach out to MCGlobalHealth@mayo.edu
This story appears in the latest issue of Mayo Clinic Alumni magazine. You can read or download a PDF of the issue here.
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