Limited resources, limitless learning
Zambia challenges residents with unusual pathologies, fewer diagnostic tools
As an undergraduate at West Virginia University (WVU), neurologist Kelly Baldwin, MD, said her career plan didn’t necessarily include medicine. “I didn’t always know I wanted to be a doctor. I thought I was going to be a teacher,” she said. “Then, when I was accepted to both a post-baccalaureate program and medical school, I found I was more excited about being a doctor, so that’s what I did.”
Although she chose to attend WVU’s medical school, Dr. Baldwin’s desire to teach never really faded. Instead, certain experiences Dr. Baldwin had at WVU influenced how, where and why she teaches. “As a medical student, I spent two summers in Zambia as part of a global health team,” she said. It was an experience she found deeply fulfilling, both intellectually and emotionally. As a physician, Dr. Baldwin was challenged by the range of unusual pathologies in her Zambian patients and the incredible care gap that exists in the developing world. As a human being, the gratitude of the patients touched and overwhelmed her. This compelling introduction to global health convinced her that clinical time spent at a location like the University Teaching Hospital in Lukasa, Zambia, could offer a depth of experience doctors simply cannot get in the U.S. So, when she became Geisinger’s neurology residency program director, Dr. Baldwin devoted herself to becoming a clinician educator and to building a global health curriculum and annual rotation for her trainees.
“When I was researching possible locations for the global health experience, Zambia stood out as the best option. Zambia is a country that accepts all people and is known regionally for their cultural acceptance of foreign physicians. The learning and working environment is incredibly rich, allowing for our trainees to see disease pathologies that do not exist in Danville,” she said. “The University Teaching Hospital (UTH) is huge: 1,600 beds. And the pathology is different. The neurologists at UTH treat infectious diseases like malaria, HIV, tuberculosis and opportunistic infections of the central nervous system every day. They also see very advanced presentations of conditions like neuropathy — 10 years and no treatment.”
With the help of Omar Siddiqi, MD, and Deanna Saylor, MD, neurologists who live and work at the University Teaching Hospital in Zambia, Dr. Baldwin launched the first resident rotation in March of 2019. “Our team was composed of myself, Cynthia Correll, MD (epilepsy), Christopher Cummings, MD (stroke), three internal medicine residents, one neurology resident and one advanced provider.”
One of the most exciting things about this rotation, Dr. Baldwin noted, is the ability to collaborate with the Zambian neurology residents. She said that although she is technically one of the attendings for the Zambian trainees at the hospital, in the end it is they who teach her and her residents. “The medical system in Zambia is different. I am precepting full-fledged doctors who’ve been in residency for five years. They’re brilliant and they teach me and my learners all things internal medicine, and most importantly how to practice neurology in a resource-limited setting,” she said.
Dr. Baldwin’s dream is to ultimately send a team of residents and attendings every six months to Lukasa. For the time being, she contents herself with one visit every fall. “I want to build a really robust international neurology rotation for our residents at Geisinger, and I want to do it in Lukasa because it is more impactful to stick with one location. I think it’s important for residents to learn in resource-limited settings, to see people of different cultures and values, and most importantly to give themselves to a humanitarian cause greater than themselves. It makes them better doctors — and better humans,” she said.