On Pursuit of a Sustainable International Service Project in Otology:

Is “Teach A Man How To Fish” Paradigm Sufficient?

Ashkan Monfared, MDAssociate Prof of Surgery and Neurosurgery,

George Washington University

Global ENT Outreach

Richard Wagner, MDGlobal ENT Outreach

Objectives► Intro:

� Our Organization

► Evolution of GEO and its challenges� Challenges with patients� Challenges with instruments and hospitals� Challenges with the physicians� Challenges with local government

►Analysis of the problem:� Common denominator to all the challenges

►Observations:� New model: self sustaining, community based,

regenerating machinery

No Financial Disclosure

Global ENT Outreach

► Non-profit NGO

► Served in 23 countries

► Cared for over 3000 patients

► Involved with residency/fellowship programs in 6 countries

► Established temporal bone labs in Peru, Paraguay, and Cambodia. Planning two more in 2016.

Mission

� Otology, Hearing

� Goals: ►Provide care

►Educate

►Create self-sustaining program

►Create self-regenerating program

Evolution of GEO Approach

Stage I: Providing care, operate

► Challenges with patients:� Access, money, culture

► Challenges with instruments and hospitals:� Equipment expense,

customs

� Politics of the hospital

► Local Physicians Challenges

Stage II: Educate

►Challenges with the physicians

� Education

►Years of Practice

►Major investment of time

� Willingness to provide care

� Willingness to educate others

►Our attempt at residency programs

� Ethiopia

� El Salvador

Stage III: Analysis

►Root Cause of the challenges

� Patients: access, affordability, culture

� Materials: availability, expense, customs

� MD’s: skills, providing care, dissemination of knowledge, ego

� Common denominator? Money, politics, etc.

►Our method of learning:

� Trail and Error

� Consulting and reflecting on outcome

� Change in approach

Stage IV: Solution

► Long term solution:� Change view of

“development project”

► Short term solution: � Identify need

� Establishing priorities

� Community based ownership

� Self sustaining

� Self regenerating

Capacity Building

Cycle

ExecutionNGO activities

Local ENT participationCommunity assistance

Local Government

PlanningResource Allocation

Establish ResponsibilitiesProgram structure

BudgetEquipment

AnalysisNeeds AssessmentImpact assessment

Key issuesGoals

MonitoringAudiology skillsSurgical cases #

Progress and quality

RefinementsImpact analysisTesting skillsLog reviews

ObservationsPerformance reports

Capacity Building Model

Temporal Bone Labs

Long term solution:

►World is but one country and mankind its citizens

►Development project not a handout

►Change needs to be slow and organic

► Focus on human factor� Visiting surgeon

� Local physicians and allies

� Patients

� Community/politicians/etc

Human beings are limbs of one body,In creation of one soul and essence.

Should one limb be afflicted with the torments of fate,The other limbs would not remain in silence.

If thou hast no sympathy for others’ despair,The human name thou no longer share.

-Saadi Shirazi, 13th century Persian poet