Dr. Mark Asplund taught surgical staff in Malawi during his three months in 2016 as an International Medical Educator with PFP. In particular, he developed a close relationship with Dr. Raymond Nyirenda, a surgical resident at Queen Elizabeth Central Hospital in Blantyre.
Dr. Asplund became a mentor to the young surgeon, and independent of PFP, later brought Raymond over to the U.S. to complete an observorship in Wisconsin.
See One, Do One, Teach One
It's important as a surgeon to have mentors, because it's hard to learn the subtle ins-and-outs of surgery by yourself. 'See one, do one, teach one' is a surgical way to learn.
I was fortunate enough to have mentors at just about every level. The first would be my father who was a doctor in the north woods of Wisconsin. My biggest takeaway from my mentors? 'Know your anatomy, have a plan, stop the bleeding, and don't mess with the pancreas!'
All the registrars and staff in Malawi work hard and try to do the right thing. Raymond in particular has a lot of attributes that made him particularly easy to teach. His enthusiasm is big, he has a willingness to learn, and is curious. Raymond's parents are teachers and you can see that in him. Ninety percent of learning is showing up every day, and he did. Plus he's just really smart.
Problem Solving From Both Directions
Raymond and I had such a good relationship because, though I was helping him figure out how to solve problems, he became my problem solver too. He knew the ins and outs of Queen Elizabeth Hospital. For instance, there was nobody in the region who could do vascular access for dialysis, so they asked me to do it. But to get the anesthetic you need was an obstacle, and he got it all arranged. I don't know how Raymond did it.
By the time our three months were up we were both like MacGyver, figuring out solutions to everything together. That's how I approach teaching or doing my practice—you don't take no for an answer; there must be a way to figure it out. And there are a lot of problems to figure out in Malawi.
You have to be invested in the patients, since many of them wouldn't survive just because they didn't have the right equipment. Rather than accept a bad outcome, especially with Raymond, you'd sit down and say "how can we fix this?"
I thought it would be valuable for Raymond to do an observorship in the U.S. During their lectures in Malawi, they're told "here is how you treat this problem" but they can't treat them that way because they don't have the drugs needed, or they don't have the equipment. He reads about it in books and then has to take the test and answer one way—but when he goes to work, he doesn't have a laparoscope for instance, and he has to adapt.
So I wanted him to come to the U.S. and see how these procedures work. I thought it was important for him to see these things he reads about, but they don't have.
"You're Not There to Say 'Do it This Way.'"
Did I learn anything from Raymond? Of course. I learned to be more patient in how to navigate the system. Also, Raymond read everything, so I made sure I went back and read too. Especially about some of the unique diseases in Malawi, like malaria and schistosomiasis and most of the cancers we saw that were very advanced.
Also how to take care of people who were HIV positive. Raymond would remind me that many of the patients were HIV positive, so I would act accordingly. Those are off-the-cuff examples of what I learned from him, but you learn every day from someone like him, I think.
Physicians for Peace’s motto is "teach one, heal many" — and after being there with Raymond in Malawi, it's really expanded to "teach many, and you'll heal many more." That’s what we're seeing with Raymond. We helped teach him and now he's teaching; he's there constantly. I was only there for three months, but his presence will be felt much longer.
Mentorship is a two-way street. You're not just there to say "do it this way;" it's more of a give-and-take. You're there to say, "how do we solve this problem?" I would like to go back to observe Raymond and see how he figured out some of those problems because, believe me, we didn’t solve all of them! But together, we did solve a few here and there.
Tap here to read Raymond's account of their mentee-mentor relationship!
Seven years later, Raymond and Dr. Mark reunited on a Zoom call. Watch it here: