When Park Ridge native Dr. Mark Bisanzo, 32, first visited Nyakibale during his final year of residency at Massachusetts General Hospital three years ago, he was looking for a way to use the skills he learned in medical school to give back and help people in need. What he got in return was much more.

The five-week trip altered his perspective on medicine and caused him to rethink his career path, focusing his energies on improving the lives of people like those he met at Nyakibale.

Bisanzo traveled to Uganda through Mission Doctors Association (MDA), an organization founded in Los Angeles in the late 1950s by a catholic bishop dedicated to providing quality medical care in poor areas.

He was assigned to Nyakibale, where he met Bill Walsh, an American surgeon based at Nyakibale who hoped to establish an emergency department at the hospital. Walsh was a skilled surgeon, but without an emergency department, many patients suffering from serious injuries had to wait hours to be treated, sitting alongside people there for routine check-ups. By the time Walsh was able to operate, these patients would often be critically ill.

The hospital serves a population of over 180,000 people, with roughly half under the age of 20. Since the paving of the road leading to the hospital, it is receiving more severe trauma cases, and larger numbers of patients from distant areas. A hospital mortality report stated eight of the 10 leading causes of death would be treatable with quality emergency care and resuscitation.

After realizing the profound impact an emergency department would have, Bisanzo began to look for a job that would allow him to return to periodically to help Walsh establish one at Nyakibale.

He found that job at the University of Connecticut Medical Center, where he works 10 months out of the year, taking trips to every fall and spring. “I get paid a little less,” Bisanzo said, “but I wouldn’t have wanted to work for somebody who didn’t see this was a good thing to do.”

In order to cover his extensive vacation time, Bisanzo works long shifts, often going without a day off in the weeks leading up to a trip and after he returns. However, he explained, “I do it because I want to spend as much time as I can there.”

In 2006, with the help of a few emergency physicians, he formed Global Emergency Care Collaborative (GECC), a non-profit organization designed to recruit doctors to work internationally and improve the care of patients in developing countries.

In its first endeavor, the GECC is partnering with MDA to build a fully functional emergency department at Nyakibale Hospital. The department is currently under construction, and Bisanzo hopes it will be completed by his next trip there in May. 

According to Bisanzo, emergency medicine is not as of yet an established discipline in Uganda. “Most hospitals either have poorly functioning ERs or none at all,” Bisanzo said.

Early on, the GECC will “provide clinical care and work with local doctors, eventually taking less of a clinical role and more of a teaching role. Once they are set up we will stay involved, providing assistance and support.”

Emergency medicine nurses working with GECC will train local nursing students to work in the emergency department and eventually the GECC plans to create a fellowship in emergency medicine for local doctors, the first of its kind in Uganda.

Nyakibale Hospital is divided into six wards, each one a sparse room containing anywhere from 10 to 30 beds lit by a few over-head lights. One of the problems doctors there must contend with is the inconsistent power supply. The electricity goes in and out and surgeons are sometimes forced to operate by flashlight.

The patients are mainly poor farmers and can only afford to pay nominal fees. A major surgery, such as removing part of a colon, costs approximately $40, small change compared to what Americans are used to paying for healthcare, but way too much for many of the patients at Nyakibale. 

To help keep the costs down, doctors working with the GECC bring surplus supplies from the United States, and have received other supplies donated by hospitals and medical supply companies. So far, the GECC with MDA has raised a total of $65,000 for the construction of the emergency department and the purchase of a new ultrasound machine and two large operating lights, but will need to raise much more for the supplies and staff salaries necessary.

The hospital’s limited resources can be challenging, Bisanzo said. “There are times when I’m taking care of a patient and I have sense of what’s wrong, but I can’t do the tests to prove it so I have to go on instinct.”

Sometimes in order to receive the level of care they require, patients must be transported to a larger hospital. But a transfer can be difficult because of the condition of the roads and the danger of traveling at night. Patients are responsible for fuel costs for the ambulance, something out of the price range for many.

“Most patients can not afford to stay far away from the village because over time it gets expensive,” Bisanzo said. “Hospitals do not provide food, so the family is responsible for bringing their meals and often their only means of transportation is the bus.”

Despite their relative lack of material possessions, Bisanzo said one of the things that first struck him was how happy the people there are. “The culture is a very warm culture, and the people are very appreciative of care. Sometimes they have to wait all day to see a doctor, and the first thing they say is thank you. It’s a very rewarding experience just to help them get better.”

Bisanzo remarked on his patients’ remarkable tolerance of pain. “There was a guy who sat at home for two days with a broken femur because he didn’t have the money for a ride to the hospital. There is a completely different set of expectations there.”

“There is a real acceptance they have of death. If a younger patient is involved in a car accident and dies, the family is sad, but there is an acceptance that some people are going to die young. It’s very refreshing to see.”

Although his commitment to Nyakibale has involved a lot of hard work, Bisanzo does not see it as a sacrifice. “It would be hard for me to do my job [at UConn] and enjoy it if I didn’t have this,” he says. “Every time I go, it rejuvenates me and puts things in perspective.”

Megan Burrow's e-mail address is burrow@northjersey.com.