By Craig Boerner
World-renowned urologic surgeon Joseph Smith Jr., MD, remembers doing global humanitarian work in the eastern Congo many years ago with world-renowned gynecologist and human rights activist Denis Mukwege, MD, PhD, who was awarded The Nobel Peace Prize in 2018.
They were taking care of rape victims who have fistulas that cannot be repaired. It was a complicated procedure, getting into complex methods for urinary diversion to the abdomen. Mukwege is the world’s leading specialist in the treatment of wartime sexual violence and a global campaigner against the use of rape as a weapon of war.
The lighting was terribly insufficient, but Smith had a really good headlight to get them through. Some places he had visited during his career had to rely upon generators that may or may not work, so having a good headlight available was essential.
“My friend Dr. Mukwege in Congo, I sometimes tease him because I remember when I went there, he didn’t have a headlight, and I don’t know how he could see what he saw,” said Smith, director of Global Surgery in the Department of Urology at Vanderbilt University Medical Center (VUMC).
Smith’s recent decision to step back from clinical practice after a long and celebrated career has allowed him to focus entirely on global surgery efforts departmentally with faculty, fellows and residents to provide opportunities he believes are a key part of infusing humanitarian intent into their training.
“There are really two ways to go about these trips,” Smith said. “One is that you go to a place of need and provide as much medical care as you can to as many people as possible in the length of time that you’re there, usually anywhere from a week to the longest being three to four weeks,” he said. “You go and you do as much surgery as you can, and you help intensely a limited number of people, but you don’t leave any kind of a legacy with that.
“So much more important is to have an enduring legacy where we actually train the local physicians. I want to always work in situations where we either rely upon the local resources or provide resources that we will be able to leave on the ground with them,” he said.
He has been to Haiti, Liberia, Ethiopia, Burundi, and other parts of Africa that border conflict regions to provide care for women who had very complex vesicovaginal fistulas, often from rape trauma or other horrible indignities of war. He also sees a great need for prostate cancer care and pediatric urology services.
“As my thoughts have matured on the subject, my focus now is to only go to places where we can teach a cadre of local physicians who will be staying in that area and using those skills. Our goal is to teach the local doctors, but even beyond that, we’re working to establish a residency program to teach the local people to teach their own people and establish training programs.”
Smith has been overseas six times in the last six months in a supervisory capacity to help set up and oversee programs. He is currently working to help develop a residency program in urologic surgery in Africa, likely in Kenya, but the details are still under discussion.
“There is a functioning hospital there that does excellent training in a number of different specialties, and Vanderbilt faculty help with that. We want to establish a urology program there,” Smith said.
“Vanderbilt faculty will participate as we go over periodically and do teaching missions, but this will be the perfect example of what we’re intending — to help train the trainers as well as to work directly with the residents, who can then spread out to other areas of Africa.”
Smith remembers saying goodbye to his friend Mukwege at the conclusion of that aforementioned trip to Congo. He glanced down and saw his headlamp safely in the bottom desk drawer, waiting for the next surgeon to visit.