In October, Denis Mukwege, M.D., Ph.D., received the 2018 Nobel Peace Prize for his efforts to stem the tide of sexual violence inflicted on women by armed fighters in the Democratic Republic of Congo.
Across the globe in Minnesota, a small group of Mayo Clinic staff rejoiced. They have seen first-hand the revolutionary work performed by Dr. Mukwege at his hospital in the Congo, delivering physical healing and much more to a constant stream of rape victims.
In 2010 and 2014, a Mayo team, led by Deborah Rhodes, M.D., worked alongside Dr. Mukwege at Panzi Hospital in the city of Bukavu. The team included Lois Mc Guire, Emanuel Trabuco, M.D., Sean Dowdy, M.D., Douglas Creedon, M.D., Ph.D., Eric Dozois, M.D., and Philip Fischer, M.D. The trips were born after a series of encounters Dr. Rhodes had with individuals who told her about the horrific conditions facing girls and women in the Congo.
"It's such an improbable story," Dr. Rhodes says of the relationship.
It began when one of Dr. Rhodes' patients returned from a visit to the Congo and told her about the brutal injuries incurred by women, girls, sometimes even babies. Dr. Rhodes was haunted by the stories. "I just could not get it out of my mind," she says.
She felt compelled to do something. The chance to take action came when a friend arranged for her to meet with a U.N. global ambassador for women and children affected by war. The ambassador told Dr. Rhodes that it would be great if she could gather a team of providers to go to the Congo and raise awareness of the situation there.
"No one knows about this, and no one is doing anything," the ambassador said.
That was all Dr. Rhodes needed to hear. It didn't take long for her to recruit others. After a personal, month-long fundraising campaign to raise money for the travel, the team embarked on its first journey in November 2010.
During their two trips, team members saw casualties of a war where sexual violence was used as a weapon by rogue militias and guerilla fighters. At Panzi Hospital, the Mayo Clinic team assisted in surgeries to treat injuries sustained as a result of this extreme sexual violence. Team members bore witness to the region's poverty and the overwhelming need of the hospital to treat its traumatized patients.
The team noted that, in addition to physical healing, Dr. Mukwege provided his patients something equally precious and rare in the war-ravaged region. He gave them hope.
"To understand Dr. Mukwege's contributions, you have to understand the environment in which he prevails," Dr. Rhodes says. "There are many great surgeons in the world, of which he is certainly one. But there are very few surgeons who made the sacrifice he's made to provide services that would be completely unavailable if not for him."
The environment is so poor that there is no access to most medical services. Without Dr. Mukwege, the extent of the trauma done to the women of the Congo is such that many of them would die.
"He is the only surgeon within thousands of miles who has the ability to offer treatment," Dr. Rhodes says. "There is nowhere else to go. Patients sometimes walk five, 10, 15 days to get to the hospital."
And Dr. Mukwege and his team are making sure the journey is worth it. With simple, clean cement rooms that have openings to the outside to allow for a breeze, the hospital is a safe haven where patients lie in comfortable cots with soft blankets. They are treated kindly and cared for in ways not available to them elsewhere.
"He has built this oasis through sheer determination," Dr. Rhodes says. "It really is the difference between life and death for these women."
The time spent working with Dr. Mukwege and his staff at Panzi Hospital was eye-opening for both the American and African teams, says Lois Mc Guire, a Mayo Clinic nurse practitioner.
"Dr. Mukwege had never worked with a nurse practitioner before, so he was curious about what the role was and what I could and couldn't do," she says. "We discussed the different cases. He was aware of all the treatments we would offer in the U.S. But due to the fact that he often didn't have the right medications available to him, his treatment options were limited."
Physicians at Panzi Hospital were taught to use equipment and supplies provided to them by the Mayo team. Roger Dearth, Mayo Clinic's director of Financial Reporting and Consolidations, worked on his own time to help collect, package and ship the items. Among the supplies sent was equipment to conduct cystoscopies and breast biopsies.
With the cystoscopy equipment — a thin tube with a light and camera that's inserted through the urethra into the bladder to help guide surgeons— physicians at Panzi Hospital were able to more easily perform reconstructive surgery on their patients.
The breast biopsy machine was a game changer in the way breast cancer patients were treated.
"If you went to the hospital with a suspicious breast lump, you would get a mastectomy even if the lump was benign, because they didn't have any way to biopsy," Dr. Rhodes says. "One of our first patients to use the equipment was scheduled for a mastectomy, but she got to keep her breast."
Mayo Clinic surgeons also taught their colleagues at Panzi Hospital new techniques in pelvic reconstructive surgery.
But the Mayo team learned just as much, if not more, than Dr. Mukwege's team. "Dr. Mukwege and his surgeons there are really worldwide experts curing the type of trauma they see," Dr. Trabuco says.
During their time at Panzi Hospital, the Mayo team saw a wide range of need — from simple to seemingly insurmountable. Ordinary items like sanitary pads and adult diapers are a high-value commodity for Dr. Mukwege's patients.
"Dr. Mukwege was pretty successful at fixing the fistulas. But some of the women are still incredibly incontinent," Dr. Trabuco says. "Without any supplies, there are implications for their entire social lives."
But Panzi Hospital's most pressing need was different. And it opened the door for Dr. Rhodes and her Mayo Clinic team to establish a long-term connection to the Congo.
"One of the last days, I was sitting in Dr. Mukwege's office, and he came in and he said to me: 'Many people come here, and they bring their wrapped sandwiches and bottled water. They shed a tear and make a promise, and we never see them again. Something tells me, you're going to be different,'" Dr. Rhodes says. "And here I am, hiding my wrapped sandwich and water, and I said, 'I will try my hardest to be different. But you have to tell me what you need and what I can actually do.'"
Panzi Hospital has no running water. Electricity is available a few hours daily, but it's not dependable. There was no official medical record. So what Dr. Mukwege said next astonished Dr. Rhodes.
He said what they needed most was research.
"We cannot publish the outcomes of our work to support grant applications and justify funding that will sustain the hospital," Dr. Mukwege told Dr. Rhodes.
Dr. Rhodes kept her promise by raising enough money in less than a year to bring one of Panzi Hospital's physicians to Mayo Clinic to pursue a master's degree in clinical research. That physician was Alain Mukwege, M.D., Dr. Mukwege's son.
"He was one of the only surgeons who spoke English well enough and didn't have family obligations that prevented him from leaving the country for two years," Dr. Rhodes says. "He really was the best candidate."
In 2013, Dr. Alain Mukwege received a master's degree in clinical research from Mayo Clinic School of Graduate Medical Education. He had planned to return to Panzi Hospital and begin the important work of recording and publishing results of his father's work. However, just before he was to return to the Democratic Republic of Congo, an assassination attempt was made on his father and family. The senior Dr. Mukwege was moved to Panzi Hospital, which is protected by the United Nations. For his own protection, Dr. Alain Mukwege would remain in the U.S. and conduct his research from afar.
The Mayo Clinic staff members who've seen Dr. Mukwege work remain committed to making the plight of the women in the Congo known, and to making people aware of the advances Dr. Mukwege has made in the field of fistula repair.
"I was very reluctant, as we all were, to speak about our experience when we got back," Dr. Rhodes says. "It's almost like you're taking somebody else's violation, and you're using it without their permission. I felt these women's stories were not my stories to tell."
Ultimately, Dr. Rhodes decided to talk about the team's experience to continue spreading awareness of the situation in the Congo. "If you don't speak up, then you miss the opportunity for things to happen," she says.
After a presentation given by Drs. Rhodes and Dr. Dowdy, Marina Walther-Antonio, Ph.D., a Mayo Clinic gynecological researcher, introduced herself. "Her reaction was my reaction years before. She said: 'I can't stomach this. I can't look the other way. What can I do?'" Dr. Rhodes says.
Dr. Rhodes told Dr. Walther-Antonio that because of rape, many of Dr. Mukwege's patients had acquired HPV and developed cervical cancer. But there was no way for them to be tested for the virus, so they didn't know if they were at risk and needed cancer screening.
"The researchers spent two years developing a test, which is currently in a test phase," Dr. Walther-Antonio says. "It is intended to function like a pregnancy kit, where you pee on a vial, and it tells you whether you have a high-risk HPV strain or not. Materials are targeted [so they are] less than two dollars to make, don't require clinical expertise or laboratory handling and are color based to make it widely interpretable because most of these patients can't read."
Hand-in-hand with raising awareness about the plight of patients at Panzi Hospital is elevating the level of care they're offered.
"We are five phone digits away from doctors who are renowned in thyroid disease, in cancer, and all I have to do is call them up," Mc Guire says. "I think that when you have resources like that, it's your obligation to think outside of your own world and clinic, and think how we can best utilize the incredible staff and resources to help somebody else."
Since Mayo Clinic's beginnings, healing underserved communities has been an integral part of its mission.
"I believe we have an ethical obligation to share our knowledge — and our expertise and our resources — with our brothers and sisters across the world," Dr. Rhodes says. "If we don't do that, if we only feather our own nest, then we have not served the Mayo brothers' mission."
Dr. Rhodes says she hopes the next trip will allow them to distribute the newly developed HPV test to women in rural areas. The team also hopes to provide medical residents at Panzi Hospital an iPad-based education program. The hospital has many medical students and residents who train there. It also has a medical school next to it, but the students don't have computers. They are cut off from anything beyond outdated textbooks. Dr. Rhodes and her team hope to get education materials on iPads to give to students.
By supporting Dr. Mukwege's work in the Congo, Mayo Clinic is building on the foundation laid by the Mayo family.
"We're living out the heritage of Drs. Will and Charlie, which was not just inviting other patients in, but seeing other physicians out in the world," Dr. Fischer says. "Global health issues are integral to Mayo's mission. Mayo is really a resource for the world."
Tags: Dr. Deborah Rhodes, Dr. Douglas Creedon, Dr. Emanuel Trabuco, Dr. Eric Dozois, Dr. Marina Walther-Antonio, Dr. Philip Fischer, Dr. Sean Dowdy, Education, International, Lois Mc Guire, Mayo Clinic School of Graduate Medical Education, Roger Dearth